Dissertations / Theses on the topic 'Triage (Medicine) Decision making'
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Forde, Colin Ainsworth. "Emergency Medicine Triage as the Intersection of Storytelling, Decision-Making, and Dramaturgy." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5354.
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This dissertation presents a comprehensive qualitative study of the decision-making aspects of emergency department (ED) triage at a large urban Trauma I hospital in the Southeast. Specifically, this study addresses the following research questions: (1) What do triage nurses perceive as the primary role of the triage process? (2) How do triage nurses interpret patient performances? These questions are explored through illuminating the intricacies of triage decision-making by the use of semi-structured interviews and observations.
The findings of this study indicate: (1) a better understanding of the triage decision- making process yielding more practical insights related to the informal, emergent, and often improvisational ways patients are received, categorized, and treated was needed, and (2) providing a clearer understanding of the processes involved in sorting patients may provide much-needed insight regarding clinical concerns and/or issues regarding patient categorization, adverse clinical events, and excessive patient wait times. These findings are of particular importance due to the widespread overuse of EDs for nonemergent care. Essentially, EDs are designed for patients to visit due to an alteration in their physical and/or mental state. Once a patient enters the ED, a medical professional is tasked with the responsibility of interpreting the physical and/or mental state of the patient, which is generally achieved by interpreting the patient story - the precipitating event that brought them into the ED. What this study contributes to the literature is a deeper understanding of the communicative processes that ED triage nurses leverage to make sense of patient stories.
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Lundberg, Camilla, and Karin Winge. "Prehospital bedömning : En forskningsöversikt." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-18828.
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Patienter utsätts för onödiga transporter och efterföljande väntetid på akutmottagningen, vilket i sin tur leder till ett onödigt vårdlidande. Det är inte längre en självklar åtgärd för ambulanssjukvården att transportera alla patienter till akutmottagningen för fortsatt vård. Detta innebär att kravet har ökat på ambulanssjukvården och den prehospitala bedömningen. Mot bakgrund av dessa förutsättningar som idag gäller för ambulanssjukvård, är frågan om forskningen kan vägleda till hur den prehospitala bedömningen ska kunna underlättas.Syftet med studien är att beskriva prehospital bedömning i ambulanssjukvård och genom en forskningsöversikt har kvalitativ och kvantitativ forskning analyserats.I resultatet framkommer det att prehospital bedömning består av två huvudinnehåll, dels en vårdvetenskaplig där den prehospitala bedömningen ses som en kontinuerlig process och dels en medicinsk där den prehospitala bedömningen inriktas på att utifrån fastställda kriterier ringa in patientens vårdbehov. I den vårdvetenskapliga forskningen framkommer att vårdrelationen är en central del i den prehospitala bedömningen liksom att vinna patientens förtroende. I den medicinska forskningen framkommer att prehospital bedömning och triagering med hjälp av protokoll kan vara ett sätt att minska patientens vårdlidande. Protokoll kan ge en vägledning till alternativa vårdnivåer men måste kombineras med ett vårdvetenskapligt patientperspektiv och ett öppet förhållningssätt för att möta patienters individuella nyanser. Genom att möjliggöra patientstyrning till alternativa vårdnivåer, kan akutmottagningar avlastas och leda till att fler patienter kan vårdas hemma, dock i ringa omfattning.Program: Fristående kurs
Uppsatsnivå: C
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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making." Doctoral thesis, Örebro University, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.
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Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.
In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.
The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.
The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.
In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.
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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making /." Örebro : Hälsovetenskapliga institutionen, Örebro universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.
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Spence, James Michael. "A Comparison of Major Factors that Affect Hospital Formulary Decision-Making by Three Groups of Prescribers." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1157518/.
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The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.
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Gollan, Srisuda Siera. "A Mixed Methods Examination of Pre-Hospital Trauma Triage Decision Making." Thesis, Augusta University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10634622.
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The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012).
The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS).
A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.
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Juhlin, Marie, and Ingela Liljeqvist. "Triage prehospitalt : Faktorer som har betydelse för sjuksköterskans bedömning." Thesis, Högskolan Kristianstad, Sektionen för Hälsa och Samhälle, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-8378.
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Bakgrund: Grundläggande för välfungerande sjukvård är möjligheten att efter bedömning av patienten vårdbehov kunna prioritera och hänvisa till lämplig vårdnivå på ett snabbt och säkert sätt. Det är viktigt att det sker på gemensamma grunder oavsett hur den initiala kontakten sker. När patienten anländer till sjukhus via ambulans, är han/hon redan bedömd via triage av en specialistutbildad sjuksköterska. Syfte: Syftet med studien är att belysa vilka faktorer som är av betydelse för sjuksköterskans triagebedömning prehospitalt. Metod: Uppsatsen genomfördes som en kvalitativ litteraturstudie. Resultat: Resultatet av litteratursökningen presenterar vilka faktorer som påverkar sjuksköterskan i beslutprocessen vid triagering. Triageutbildning, yrkeserfarenhet, personliga resurser och den psykosociala arbetsmiljön redovisas av de valda artiklarna. Diskussion: Triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön har betydelse vid triagebedömning. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet. Konklusion: Många faktorer är av betydelse för sjuksköterskans triagebedömning, både triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön. Ett gemensamt kvalitetsdokument är också en förutsättning för ett bra triagearbete. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet.Background: The foundation of a well functioning healthcare service is correct patient assessment and onward referral to the appropriate level of care. It is important that this transfer is conducted safely and effectively and that care considerations are the same no matter how the initial contact is made. Optimally the patient is evaluated by a triage trained specialist nurse before arrival at the hospital. Aim: The aim of this study is to highlight factors which are relevant to the nurse´s triage assessment pre-hospital. Method: Literature study. Results: This literature study discusses a number of factors which are important to the nurse in the process of triage evaluation e.g. triage training, work experience, and the psycho-social workplace environment. Discussion: Special training in triage procedures, the nurse's work experience and the psycho-social workplace environment have an affect on the triage evaluation process. The discussion emphasises the need for quality control and suggests the need for more studies in regard to pre-hospital medical care. Conclusion: Many factors are relevant to the nurse's triage assessment, both triage training, work experience and psychosocial work environment. A common quality documents is also a prerequisite for a good triage work. The discussion highlights the need for quality assurance and that more studies be performed in the prehospital operations.
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Kiatpongsan, Sorapop. "Decision Making for Medical Innovations." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11386.
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Fry, Margaret. "Triage Nursing Practice in Australian Emergency Departments 2002-2004: An Ethnography." University of Sydney, 2004. http://hdl.handle.net/2123/701.
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This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.
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Srinivasaiah, Narasimhaiah. "Decision making in surgery and cancer care." Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:4798.
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Decision making in surgery and cancer care is an interesting, challenging, and yet little explored area of surgical sciences research. This research addresses that paucity. In performing this research, health outcomes research (HOR) literature was comprehensively reviewed. Health outcome measures including quality of life and health-related quality of Life were described, in addition to their measurements. Subsequently health outcome measures in relation to oncoplastic and aesthetic breast surgery were described, and health outcome measures in a number of benign breast and colorectal pathologies were studied. Decision making in surgery and cancer care was explored using a mixed methodology of quantitative and qualitative studies. To derive a more comprehensive view, different specialties were explored: breast, colorectal, and head and neck surgery. To address socio-cultural factors the qualitative focus group discussions were undertaken in England, Wales, and India. Quantitative studies included literature reviews, prospective studies, retrospective studies, and questionnaire surveys. Qualitative studies were based on focus group discussions. The results showed that raw quantitative data is only one of the factors influencing the decision making process. A number of other factors play an important role in the decision making process. These include: health outcome measures (quality of life, health-related quality of life), clinician factors (knowledge, skill, expertise, judgment), patient factors (socio-economic, education, cultural), nursing factors, translational research, and resource infrastructure. Important themes and outcomes emerged from the qualitative studies. The focus group discussions showed that decision making in surgery and cancer care varies not only between the developing and the developed world, but also within different regions in the western world. In England, a small minority of patients was driving the decision making process, compared with Wales, where joint decision making is the norm. However, in India decision making is predominantly led by the clinicians and the patient�s family members. As modern health care moves towards a patient centered care approach, evidence based patient choice and patient decision making clearly has a greater role to play, and the cultural and practical issues demonstrated in this thesis must be considered.
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Ventres, William Brainerd 1958. "Resuscitative decision making: Ethnographic perspectives." Thesis, The University of Arizona, 1991. http://hdl.handle.net/10150/291834.
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The topic of resuscitative decision making for hospitalized patients has generated numerous discussions among clinicians and ethicists. Traditionally, their attention has focused on normative standards, describing how decisions should be made, rather than on how they are made in practice. This study uses qualitative techniques, including key informant and participant interviews, participant observation, and microanalysis of in-hospital discussions, to assess what influence the doctor-patient relationship and other sociocultural and contextual determinants have on actual decision making and communication regarding resuscitation. The results suggest that many factors influence these processes. These include issues of competency and ambiguity, prototypical images of life and death, and the use of a structured form for documentation purposes. In light of these findings, the discussion suggests ways in which physicians can improve resuscitative communication with patients and families.
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McMichael, Alan James. "Medical judgement and decision making in stratified medicine." Thesis, Queen's University Belfast, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727757.
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Background: Stratified medicine aims to use a patient's genotype and other individual characteristics to predict their treatment outcomes. Several treatments have been developed which may potentially offer patients an increased response to treatment. For instance 5% of patients with cystic fibrosis can be prescribed Ivacaftor based on a specific genetic mutation. However, it is unclear about how a patient's genotype may influence particular aspects of medical decision-making, despite the relevance that this may have in routine clinical practice. Methods: Medical decision-making was investigated using a series of discrete-choice experiments (DCEs) in which participants were asked to consider and choose one of the presented scenarios. Regarding profession decision-making, in particular, the PhD research investigated extent to which a patient's genotype influenced the treatment judgements and recommendations of psychiatrists (n=68). Patient decision-making was investigated by using DCEs to assess how people with cystic fibrosis (n=80) 'traded-off the risks and benefits that were associated with each treatment option. In the final study of the thesis, I investigated whether or not members of the public (n=2804) would be willing to incur an increase in tax to help fund stratified medicine treatments. Results: The main findings of these studies suggest that clinicians may be unduly influenced by a patient's genotype when judging a patient's response to treatment and in their treatment recommendations. Cystic fibrosis patients may not be willing to tolerate some of the increased risks associated with their treatment options. Thus clinicians should discuss the risks and benefits associated with treatments with their patients. The PhD research highlighted that members of the public may not be willing to pay an increase in taxation unless the majority of people were eligible for the stratified medicine treatment, a result that poses a challenge for stratified medicine because only few people are eligible for potentially more effective treatments. Conclusions: Clinicians need to be cautious about being unduly influenced by a patient's genotype and should discuss the risks and benefits associated with different treatment options. Further research is needed to understand how a patient's genotype may influence the decisions that are made at the clinician, patient and policy level.
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Borén, Christofer, and Albin Granell. "Automated Triage in Digital Primary Care : Assessing the Potential of Using Multi-Criteria Decision-Making Models." Thesis, KTH, Industriell ekonomi och organisation (Inst.), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-278185.
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The increasing global deficit of healthcare resources makes efficiency improvements in the healthcare industry a complete necessity to assure safe and available healthcare for everyone. Digitalization is expected to play a fundamental role in this transition and digital primary healthcare providers have in recent years developed into a substantial part of the Swedishprimary care sector. Several of those have built solutions for automated triage, where the role of a triage officer in traditional primary care is replaced by an automated process, in which an triage algorithm directly refers the patient to the appropriate level of care. Despite the rise of digital healthcare providers and automated primary care triage systems in particular, research on the implications of automating the triage process in primary healthcare is scarce. This study aims to assess the potential of using MCDM models for automated triage in digital primary care, by conducting a single case study at one of the leading digital healthcare providers. The study is separated into two phases. In phase one, interviews are conducted to qualitatively determine what set of factors to include in an automated MCDM triage model.In phase two, the resulting model is simulated to evaluate the performance compared to the traditional triage model in which all patient journeys start with an initial nurse meeting. The study shows that an automated MCDM triage model can improve cost efficiency in terms of clinician salary costs and productivity in terms of fewer consultations per patient, compared to the traditional triage model. However, the traditional triage model is shown to be more efficient in terms of only utilizing doctor resources for patients in absolute need of doctor care.Det ökande underskottet av sjukvårdsresurser gör effektivitetsförbättringar i sjukvårdsbranschen nödvändigt för att säkerställa säker och tillgänglig sjukvård för alla. Digitalisering förväntas fylla en fundamental roll i denna transformation och digitala vårdgivare i primärvården har under de senaste åren växt till en betydande del av den svenska primärvårdssektorn. Flertalet av dessa har byggt lösningar för automatiserat triage, där triagefunktionärens roll ersätts av en automatiserad process där en triagealgoritm direkt hänvisar patienten till den lämpliga vårdnivån. Trots tillväxten av digitala vårdgivare i primärvården och deras automatiserade triagesystem i primärvården är forskning kring effekterna av att automatisera triageprocessen i primärvården begränsad. Denna studie strävar efter att utvärdera potentialen i att använda MCDM-modeller för automatiserat triage i den digitala primärvården genom en casestudie på en av de ledande digitala vårdgivarna i primärvården. Studien är uppdelad i två delar. I del ett genomförs intervjuer för att kvalitativt fastställa vilka faktorer som bör inkluderas i en automatiserad MCDM-modell för triage. I del två simuleras den resulterande MCDM-modellen för att utvärdera dess resultat jämfört med den traditionella triagemodellen i vilken alla patienter har ett inledande möte med en sjuksköterska. Studien visar att en automatiserad MCDM-modell för triage kan förbättra kostnadseffektiviteten i termer av lönekostnader och produktivitet i termer av färre konsultationer per patient, jämfört med den traditionella triagemodellen. Däremot visar den traditionella triagemodellen högre effektivitet i termer av att enbart utnyttja läkarresurser för patienter i absolut behov av läkarvård.
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Holt, Jim, Ambreen Warsy, and Paula Wright. "Medical Decision Making: Guide to Improved CPT Coding." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6484.
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Background: The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit.
Methods: The authors–a professional coder, a residency faculty member, and a PGY-3 family medicine resident–reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels.
Results: Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies.
Conclusions: Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes.
Key Points:
* All previous studies of CPT coding have audited the written encounter note. * Medical decision making (MDM) is the most appropriate basis for selecting the CPT code for an office visit, as long as the history or the physical exam documentation also support that level. * Using MDM to retrospectively audit office visit notes showed that 50% of visits were undercoded. A small amount of additional documentation would allow the higher code. * Addressing all patient-mentioned problems during the visit, although clearly more time-consuming, would allow a higher CPT code to be used for 80% of the audited visits.
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Fourie, Jorique. "Social and economic decision-making in Urbach-Wiethe Disease." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32253.
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Background: Rodent and primate research have identified the basolateral amygdala as indispensable for social decision-making. This finding has not yet been translated to humans, and has even been partially contradicted by previous findings in patients with amygdala lesions that show generous economic investments in strangers. This thesis therefore aimed to determine whether selective basolateral amygdala damage in humans, caused by Urbach-Wiethe Disease, impairs instrumental non-social economic decision-making. Methods: Using an adapted reinforcement-learning task, the performance of basolateral amygdala damaged individuals (n=6) was compared with that of healthy controls (n=20) on social and economic decision-making during a probabilistic reinforcement task. The task required participants to make decisions for themselves and others based on learned probability of monetary reward or loss. A random effects Generalised Least Squares regression was conducted using Stata 15.1. to assess discrimination between Gain and Loss domains. A social-decision making task was also administered. Results: When making choices for themselves, Urbach-Wiethe Disease participants showed no difference in correct choices made between Gain and Loss domains. The Urbach-Wiethe disease participant's lack of discrimination between gains and losses for themselves was significantly different (p< 0.01) from that of controls, who made significantly more correct choices for themselves in the gain domain compared to the Loss domain. Social decision-making performance did not, however, differ significantly between Urbach-Wiethe Disease participants and controls. Conclusions: These findings regarding non-social decision-making support the important role of the basolateral amygdala as a salience detector, with lesions to this region resulting in reduced bias to the valence of potential economic outcomes, regardless of whether these pertain to costs or benefits. These findings are also consistent with prior work indicating that lesions to the basolateral amygdala can possibly produce loss-aversion due to a hypervigilance for fear and the lack of inhibition of the centromedial amygdala by the basolateral amygdala.
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Bowman, Scott. "Decision making and judgement in radiographic and sonographic practice : an investigation using decision analysis." Thesis, Open University, 2000. http://oro.open.ac.uk/54564/.
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This is a study into decision making and judgement in the context of radiography. The early part of the study investigated the nature and scope of decisions and judgements made in general radiography and sonography, while the later part focused on the decisions and judgements made by sonographers when breaking bad news to patients. The study is located in a broad interpretative framework, it used an adapted form of phenomenological methodology. A survey and an observational study were used to collect data. In-depth interviews were conducted which used decision analysis (a tool normally used as a decision aid) to elicit participants perceptions and experiences of decision making and judgement. Decision analysis was used in three different ways to collect data. The technique was found to be particularly useful in enabling participants to reflect on their intuitive processes and hence make them overt. The data collected during the observational phase of the study was used to formulate a classification of radiographic decision making and judgement. The study found that the predominant style of decision making and judgement in radiography is intuitive with some evidence of peer-aided decision making and judgement. There is little evidence that the participants use systems aided approaches. Participants found the process of decision analysis interesting but could not relate its use to their own professional practice other than as an educational or de-briefing tool. In sonography it was found that participants had an over-confidence in their diagnostic abilities which influenced their decision making. Sonographers were also found to produce information based on experience, when this information was absent from the decision making scenario provided. On the whole the participants in this study had given little thought to the process of decision making and judgement and the impact of factors such as base rates.
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Leccisi, Michael S. G. "Decision making in an intensive care environment in medicine." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=24089.
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Medical professions associated with time pressured environments, incorporate apprenticeship as part of training. While our understanding of decision making has moved towards examining these environments, how does this knowledge apply to instruction in these contexts?Specific reasoning strategies identified by Patel are useful in assessing medical instruction. Rasmussen's guidelines and Patel's protocol analytic methods are applied in this thesis to assess two time-pressured environments of a local hospital. In the medical and surgical intensive care unit, resident physician instruction and patient care co-occur withing the context of problem solving and decision making.
Differences between the two environments include a flattened hierarchy of communication, information exchange, and decision making content. Trainees approximated the proportion of directed reasoning strategies used by supervisors. Results are attributed to differences in knowledge-based solution strategy use, and medical domain structure. Implications for design of more guided apprenticeship programs is discussed.
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Taylor, Paul Martin. "Computer assisted decision making for image understanding in medicine." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287387.
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Wirtz, Veronika. "Medicine and choices : health policy and individual decision making." Thesis, University College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.404891.
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Tzafettas, Marilena. "Women's decision making process regarding prenatal diagnostic testing." Thesis, London Metropolitan University, 2017. http://repository.londonmet.ac.uk/1244/.
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Objective: Expanding the original scope of the study, which was to explore the decision-making process of pregnant women in the uptake of invasive diagnostic tests - amniocentesis and Chorionic Villus Sampling (CVS) – and taking into account the latest emergence of a Noninvasive Prenatal Testing, NIPT, the primary goal of this study was to explore factors that influence women’s decision to have an invasive, a non-invasive or no further testing at all. Design and sample: The Prenatal Decision Making Questionnaire (PDMQ) developed for the purposes of this study. Following a pilot test and factor analysis, it was distributed to a population of pregnant women (N=421) prior to them receiving their combined screening results. The total sample was divided into three sub-groups according to their risk status (low-intermediate-high) for the analysis. Results. Logistic regression analysis using the R version 3.0.3 revealed that none of the PDMQ factors had a significant impact on women’s decision to have an invasive test (CVS), whereas the following three factors had a significant impact on the decision to have a non-invasive test (NIPT): negative attitude to doctors and an internal locus of control were associated with the uptake of NIPT, whereas a negative attitude to medicine was associated with rejection of NIPT When risk status was included in the model it was found that uptake of NIPT was predicted by the presence of some level of risk for T21 or T13/T18. On the contrary, uptake of CVS was only predicted by an increased risk for T21. Conclusion(s): Women’s decision making process in prenatal diagnosis is affected by several factors with personalised risk being one of the key determinants. The findings of this study can be used by healthcare professionals in providing the appropriate support and information and facilitating an informed decision during this stage of pregnancy.
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Evans, Jane 1954. "Surrogate decision-making : speaking on behalf of another." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33756.
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The adult, competent patient has the ability to be involved in decisions regarding care and treatment. The critically ill patient, who is incompetent or incapacitated will be unable to speak for herself and yet, decisions will need to continue to be made. Decisions should reflect the values and beliefs of the patient. In health care we have determined that one of the best methods of preserving the autonomy of the patient through the reflection of values and beliefs is by involving a surrogate decision-maker. This thesis examines the many facets and factors that define the complex role of surrogacy. The role is described by reviewing literature on the current legal standards of decision-making, by analysing the data describing patient-surrogate preferences and the relevancy of such factors as culture and religion as facilitators or inhibitors in the decision-making process. The thesis suggests that a shared decision-making approach could provide the key to a partnership between the health care professional and the surrogates to assist in the preservation of patient autonomy.
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Rakow, Timothy John. "Pre surgical judgement and decision making in paediatric cardiac surgery." Thesis, University College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271154.
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Melrose, Karen L. "Social comparison and health-related judgement and decision making." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/80144/.
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The six studies presented in this thesis investigated the extent to which people compare to others when making a range of health-related judgements and decisions and aimed to identify the cognitive mechanisms used in this comparison process. A key question was whether biases found in specific judgements and decisions, such as deciding to seek help when it is not needed or not seeking help when it is needed, could be explained by social comparison effects. It was found that participants compared to others using rank-based strategies when making judgements and decisions about mental and physical health symptoms and when judging their health in general (Study 1, 2 and 4). Social comparison effects were generally small to medium in size (average Cohen's f2 = 0.09, range = 0.01-0.39). Health-related help-seeking accuracy was associated with how participants believed their experience of symptoms compared to that of others. Participants were four times more likely to seek help when it was not needed if they believed that they experienced symptoms more frequently than others, and two to three times more likely not to seek help when it was needed if they believed that they experienced symptoms less frequently than others (Study 1). However, participants' beliefs about how their sleep compared to that of others had little influence on their sleep-related judgement and decision-making (Study 3). There was no evidence that participants' beliefs about how much support they received relative to others was associated with perceptions of this support (Study 5 and 6). The findings have implications for the development of both interventions that may improve accuracy in health help-seeking decisions and social norms-based interventions, the measurement of comparison effects, self-rated health and social support, social comparison theory, and models of symptom appraisal and health-related help-seeking.
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Xia, Hui. "Visual medical decision-making: Bipartite graphs vs. interactive tables." Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/9562.
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Most of the current medical diagnosis support systems are based on a textual design. In this thesis we present a model that uses a different design. It uses visualization to aid home diagnosis of common diseases in a user-friendly way. The model clearly displays the diagnostic results on the screen. A way of organizing the information into a picture of all symptoms, diseases, and the complex relationships between them (especially the combination of symptoms onto a single screen to give a global view) is presented. The purpose of designing this model is to bring complicated medical knowledge to the ordinary user. We believe that the simplified and economic display can demystify medicine, and empower the user to take better care of himself. By this convenient software tool people can discover quickly at home whether their symptom is serious or not, and then decide whether it is necessary to see the doctor; also people can compare the diagnosis the model makes with the doctors'. This model does not recommend treatment or therapy.
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Lu, Jingyan 1971. "Supporting medical decision making with collaborative tools." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=103266.
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This study examines the decision-making activities and communicative activities of two groups participating in a simulated medical emergency activity: the control group (CG) using a traditional whiteboard and the experimental group (EG) using a structured interactive whiteboard. The two groups differ in that the EG has a structured template to annotate and share their arguments with each other. Data analysis of the decision-making activities focused on planning, data collecting, managing, and interpreting patient data. Data analysis of the communicative activities focused on informative, argumentative, elicitative, responsive, and directive acts. In the early stage of decision-making the EG spent significantly more time interpreting the situation and less time managing the patient than the CG; in the later stage the EG spent significantly more time managing the patient but less time interpreting the situation. No significant results were found in communicative activities due to low cell frequencies of the utterances. Qualitative results indicated that shared visualizations can disambiguate and clarify verbal interactions and promote productive argumentation and negotiation activities. Shared cognition facilitates the construction of shared situation models and joint problem spaces which lead to better decision making and problem solving.
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Wolf, Lisa Adams. "Testing and refinement of an integrated, ethically-driven environmental model of clinical decision-making in emergency settings." Thesis, Boston College, 2011. http://hdl.handle.net/2345/2224.
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Thesis advisor: Dorothy A. JonesThesis advisor: Pamela J. Grace
The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. Background: Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. Methodology: The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. Findings: The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Lane, Eliesh O'Neil. "Decision-making in the human subjects review system." Diss., Available online, Georgia Institute of Technology, 2005, 2005. http://etd.gatech.edu/theses/available/etd-01132005-104405/unrestricted/lane%5Feliesh%5Fo%5F200505%5Fphd.pdf.
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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2005.Richard P. Barke, Committee Chair ; Roberta Berry, Committee Member ; Ann Bostrom, Committee Member ; Barry Bozeman, Committee Member ; Mary Frank Fox, Committee Member. Vita. Includes bibliographical references.
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Dhukaram, Anandhi Vivekanandan. "CISDA Development Process for decision aids to support self-care decision making." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6618/.
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The self-care management of chronic disease patients is complicated by various everyday decisions that range from routine ill-structured problems, e.g., “What to eat?” to uncertain symptoms-related decisions, e.g., “Why do I feel tired?” Such decisions can have significant consequences on a patient’s health, treatment, care, and associated medical costs. Due to the complexity involved in understanding and analysing everyday decision making, there is a lack of empirical research to guide the development of self-care decision aids. This thesis aims to address this problem by formulating and illustrating the Critical Illness Self-care Decision Aid (CISDA) process through a coherent, structured, integrated design and development process using a case study. Following a literature review, the problems in current approaches and the criteria needed for the development were derived from evidence-based frameworks such as chronic disease management, decision aids standards and complex interventions development process for future designs. Mixed methods were used including: focus groups, interviews, questionnaire, Cognitive Work Analysis and case scenarios for not only constructing an account of self-care needs and decisions but also to evaluate the development process and the decision support provided involving patients, doctors, caregivers, non-medical experts like psychologists and IT/Systems engineers. The CISDA process consists of: (i) needs assessment, (ii) theory formation, (iii) modelling, (iv) integration, (v) interface design and development, and (vi) evaluation for addressing the relevant intersection of human factors, systems engineering, and software engineering. This thesis should prove useful to not only systems engineers but also to a range of practitioners concerned about decision making, maintaining a user's cognitive perspective during specification and analysis of a complex system.
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Gil-Herrera, Eleazar. "Classification Models in Clinical Decision Making." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4895.
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In this dissertation, we present a collection of manuscripts describing the development of prognostic models designed to assist clinical decision making. This work is motivated by limitations of commonly used techniques to produce accessible prognostic models with easily interpretable and clinically credible results. Such limitations hinder prognostic model widespread utilization in medical practice.
Our methodology is based on Rough Set Theory (RST) as a mathematical tool for clinical data anal- ysis. We focus on developing rule-based prognostic models for end-of life care decision making in an effort to improve the hospice referral process. The development of the prognostic models is demonstrated using a retrospective data set of 9,103 terminally ill patients containing physiological characteristics, diagnostic information and neurological function values.
We develop four RST-based prognostic models and compare them with commonly used classification techniques including logistic regression, support vector machines, random forest and decision trees in terms of characteristics related to clinical credibility such as accessibility and accuracy. RST based models show comparable accuracy with other methodologies while providing accessible models with a structure that facilitates clinical interpretation. They offer both more insight into the model process and more opportunity for the model to incorporate personal information of those making and being affected by the decision.
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McKee, Deborah Rettig. "The effects of framing on younger and older adults' medical decision-making." Morgantown, W. Va. : [West Virginia University Libraries], 2001. http://etd.wvu.edu/templates/showETD.cfm?recnum=2082.
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Thesis (Ph. D.)--West Virginia University, 2001.Title from document title page. Document formatted into pages; contains viii, 71 p. Includes abstract. Includes bibliographical references (p. 43-47).
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Rainof, Mila. "Do caregivers accurately assess the decision-making ability of their cognitively-impaired relatives?" [New Haven, Conn. : Yale University], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-152209/.
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Adams, Rachel Lynette. "Politeness strategies in decision-making between GPs and patients." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4498/.
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Policy, training and research reflect the importance of patient involvement in decisions about their care. Adoption demands certain skills though, may result in conflict, or be too threatening for patients. Using an iterative process, politeness theory was used to analyse the linguistic management of these threats and challenges in videos of GP consultations. The collaborative nature of GPs’ positive politeness had persuasive effects, whilst their negative strategies gave rise to examples of ambiguity causing confusion. Patients’ negative politeness demonstrated discomfort when presenting potentially contentious decisions whilst their use of positive politeness acted as a means of promoting cooperation. GPs used positive politeness when supporting patients’ decisions, offering reassurance and redressing damage to face, conversely disagreement was conveyed by the absence of such strategies and lack of reparative work. Difficulties were identified in the way in which space for patient participation was created and managed, and the strategies used to convey information. The contrast in GP responses to patients’ decisions highlighted how subtle barriers to participation can be. These findings demonstrate the complexity of language and meaning and the need for a more sophisticated understanding of language use in communication skills and related training, as well as associated research.
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Erickson, Deborah S. "Factors Affecting Clinician Decision-Making in In Vitro Fertilization." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1691.
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This study focused on factors that influenced clinician embryo disposition decision-making in in vitro fertilization (IVF). Evidence-based medicine (EBM) should be built on the premise of shared decision-making. This paradigm is often skewed, resulting in clinician stress, a higher probability of errors, reduced productivity, or ineffective decisions. Guided by the theory of planned behavior and the self-perception theory, this study assessed the independent variables' religiosity, ethnicity, level of burnout, gender, age, years of experience, and clinical role in relationship to the dependent variable "decision-making" as measured by the Lyerly Frozen Embryo Survey, Maslach Burnout Inventory, and the Areas of Worklife Survey. IVF clinicians throughout the United States and Europe (n = 151) completed an online survey via a nonrandom, cross-sectional methodology. Study results indicated the factors were not significant. A vast majority of participants identified as: White, (84%), and female (75%), and that religion was very important (73%). The bulk of participants had a moderate level of burnout (85%), which showed that the multitude of participants were not experiencing overly high levels of emotional exhaustion, were not emotionally detached from their patients' needs, and felt a high degree of personal accomplishment. Recommendations included using a larger sample size, different variables, or developing a new survey as the decision making process may have been more multifaceted than anticipated. There are more areas to be studied around factors and decision making to fully understand these concepts. The positive social change implications include an increased awareness of factors that have the potential for impacting clinician decision-making as a reminder of the importance to be cognizant and sensitive of the needs of patients.
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Eva, Kevin Wayne. "The influence of differentially processing evidence on diagnostic decision-making /." *McMaster only, 2001.
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Russo, Teresa A. "Factors affecting the process of clinical decision-making in pediatric pain management by Emergency Department nurses." Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/1756.
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The purpose of this mixed methods study was to describe the cognitive processes/knowledge sources used by Emergency Department (ED) nurses in decision-making activities regarding triage and pediatric pain assessment and management. Deficiencies persist in ED pediatric pain assessment, and management methods or approaches that might help resolve these deficiencies have not been identified previously. Methodology triangulation with sequential use of qualitative- quantitative methods provided a rich description of knowledge sources and cognitive processes used by ED nurses relative to pediatric pain assessment decisions. Based on qualitative results, a set of vignettes was developed to assess ED nurses. Data analysis using ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influence triage acuity decisions.
Five common themes emerged from the qualitative data; 1) Age of the child is important, 2) Behavior can tell a lot, 3) Really looking at the patient, 4) Things that help make decisions, and 5) Things that hinder decisions. Ordinal logistic regression analysis of the quantitative data identified predictor variables of infants compared to school-age children, Hispanic ethnicity, moderate number of years of ED experience (11 -20 years) and years of education that were associated with higher triage levels .The implications of this new knowledge include changes in ED triage nurse practice towards pain assessment, and increased awareness of the need for education in use of pain assessment tools. Additional implications include education related to pain management practices by ED physicians and pain medication protocols at triage.
This information may enhance triage and care of the pediatric patient experiencing pain, expand the knowledge base of emergency nursing, identify areas in which to implement changes, assist in improving care provided to children experiencing pain, and provide direction for future education, training, and research.
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Stamp, Michelle Amina. "Young men's sexual health decision making : a qualitative study." Thesis, Northumbria University, 2015. http://nrl.northumbria.ac.uk/27300/.
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The National Chlamydia screening programme in England screens only half the number of men compared with women, and the places men are being screened for chlamydia differ from that of women (NCSP, 2012). There is a wealth of data which shows that men are being screened in non-clinical settings, such as educational establishments, or that they are choosing to self-request screening via the internet as opposed to seeking alternative health service provision. However, we are unsure of the reasons for their choice. Furthermore, it is unclear what the impact of a positive or negative diagnosis for chlamydia has on subsequent sexual behaviour. By adopting a situational, qualitative methodology, this study aimed to understand the complex factors involved in men’s sexual health decision making following a request for a home testing kit for chlamydia. The focus for this study was young men aged 20 to 24 years who have a high rate of chlamydia infection, and who have been screened through the National Chlamydia screening programme in the North East of England. Data was collected through ten in-depth interviews, and seven follow up interviews after 12 months. Follow up interviews were primarily used to gauge any long term behaviour change. Patients’ sexual health records provided additional data which was used for triangulation. Data was analysed with the use of framework analysis. Findings from the research were presented to a focus group of professionals and the outcomes from that discussion have been implemented in sexual health provision locally. This research has also fed into a national working group which reviewed chlamydia testing guidelines for positive patients. Findings show that the decisions the young men made about sexual partners and sexual practice are based on a number of factors: pre-influencing factors, which were based on the men’s perceptions and beliefs about women, categorising them as “risky” with a sexually transmitted infection or “clean” with no infections, alcohol use and contraception vs STI prevention . Situational factors including sexual gratification and sexual arousal and post rationalisation factors such as peer pressure and masculinity. Factors influencing decisions to seek testing were triggered by unprotected sex with casual partners, strengthened by catalytic influences including media campaigns. The findings suggest a negative chlamydia test result gives respondents a clean bill of health allowing them to engage in further unprotected sex. A positive diagnosis resulted in the intention to change behaviour and modify sexual practice. After follow up interviews, intention did not lead to actual behaviour change and many became re-infected within 6 months. A conceptual model based on the study findings has been developed for use in professional practice. This model identifies the variables which influence the men’s decision making at different stages in the decision making process. This study has shown that the factors that influence young men’s sexual decision making and the impact of diagnosis on subsequent sexual behaviour have major implications for public health in terms of reinfection and further transmission.
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Gökalp, Elvan. "Modelling and solving healthcare decision making problems under uncertainty." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/102291/.
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The efficient management of healthcare services is a great challenge for healthcare managers because of ageing populations, rising healthcare costs, and complex operation and service delivery systems. The challenge is intensified due to the fact that healthcare systems involve various uncertainties. Operations Research (OR) can be used to model and solve several healthcare decision making problems at strategic, tactical and also operational levels. Among different stages of healthcare decision making, resoure allocation and capacity planning play an important role for the overall performance of the complex systems. This thesis aims to develop modelling and solution tools to support healthcare decision making process within dynamic and stochastic systems. In particular, we are concerned with stochastic optimization problems, namely i) capacity planning in a stem-cell donation network, ii) resource allocation in a healthcare outsourcing network and iii) real-time surgery planning. The patient waiting times and operational costs are considered as the main performance indicators in these healthcare settings. The uncertainties arising in patient arrivals and service durations are integrated into the decision making as the most significant factors affecting the overall performance of the underlying healthcare systems. We use stochastic programming, a collection of OR tools for decision-making under uncertainty, to obtain robust solutions against these uncertainties. Due to complexities of the underlying stochastic optimization models such as large real-life problem instances and non-convexity, these models cannot be solved efficiently by exact methods within reasonable computation time. Thus, we employ approximate solution approaches to obtain feasible decisions close to the optimum. The computational experiments are designed to illustrate the performance of the proposed approximate methods. Moreover, we analyze the numerical results to provide some managerial insights to aid the decision-making processes. The numerical results show the benefits of integrating the uncertainty into decision making process and the impact of various factors in the overall performance of the healthcare systems.
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Condiracci, Courtney N. "Return to Play Decision Making with Concussed Athletes: Sports Medicine Practitioners’ Responses." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1533053587483438.
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Boya, Manhal. "Visual information acquisition, decision-making, pacing and performance during time trial cycling." Thesis, University of Essex, 2018. http://repository.essex.ac.uk/21415/.
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Pacing research attempts to explain how effort varies during athletic events to produce the best performance without premature fatigue. Little is understood about the cognitive processes leading to pacing decisions and behaviour. The aim of this thesis was to measure cyclists’ visual behaviour, using eye-trackers, to determine information acquisition patterns during cycling time trials (TT). The first study found experts looked at primary information longer than novices during 10 mile TTs, with speed being the primary information source for experts, and distance was the primary information source for novices. A follow-up study confirmed that speed was the preferred source of information for experienced cyclists, and that pacing and performance decrements were observed when removing preferred information sources. In a third experiment, it was found that limiting the availability of preferred information to 15 sec every 10% and 20% of a 5 km TT, had no effect on performance compared to continuously available preferred information. In a final study an attempt was made to measure cyclists’ visual behaviour during a road time trial because the laboratory studies are limited by ignoring balance, navigation and collision avoidance demands on visual attention. It was found that cyclists were looking at the road for an average of above 50% of over all time. Cyclists spent approximately 20% of the overall time seeking performance information, in which 7/10 chose speed as the primary information. It is concluded that difference in information acquisition processes exist between novice and expert cyclists with experts affording more attention to speed and novice to distance. Furthermore, performance remains relatively unaffected by limiting the availability of preferred feedback information, which may be important so that during road-based TT’s, the capacity to attend to balance, navigation and collision-avoidance cues exist.
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McNeill, Yvonne L. "The study of living kidney donor decision-making and psychosocial outcomes." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/3498/.
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Background: Individuals with end-stage kidney disease need dialysis or a kidney transplant. Kidney transplantation from a living donor is the preferred treatment. Live kidney donor transplantation, however, is an invasive surgery performed on a healthy individual for the benefit of another person. Therefore, donors should be fully informed of the risks involved in donation. The medical outcomes for kidney donors are well known, however, the research investigating the psychosocial impact of donation is limited. Understanding the psychosocial outcome of living kidney donation would promote informed consent, allow donors to plan their postoperative recovery period, and guide the development of services that maintain the long-term health of donors. Aims: This study aimed to investigate the postoperative quality of life of live kidney donors, to investigate which variables predict postoperative psychosocial outcome, with particular interest in the variable of coping style and to gather information regarding how individuals decide to become living kidney donors and how satisfied they are with their pre- and postoperative care. Methods: Living kidney donors at Glasgow Western Infirmary, Manchester Royal Infirmary and St. James’ Hospital, Leeds were asked to complete a preoperative assessment consisting of the SF-36, HADS, COPE and The Donor Decision Control Scale. Four weeks postoperative, donors were asked to again complete these questionnaires, and in addition The Living Donor Survey. Results: -‐ 48 -‐ Complete data was available for thirteen donors. The results indicate that live kidney donation had a significant adverse affect on the physical wellbeing of the donors; the postoperative scores on the PCS and all of the corresponding domains were significantly lower and with a large effect size. Five (38%) of the donors experienced postoperative complications, three of whom were readmitted to hospital. With respect to psychological wellbeing, donors’ scores on the MCS did not differ significantly from their preoperative scores. With respect to anxiety, for the group as a whole, postoperative HADS anxiety scores were lower and the severity and prevalence of anxiety symptoms reduced. For depression there was only a marginal increase in HADS depression scores. Analysis of each individual’s outcomes indicated that there was a marked difference in the impact of donation. The results suggest that poor psychosocial outcome following donation was marginally associated with relying on mental disengagement as a coping strategy. Improved outcome in the postoperative period was associated with seeking social support Conclusions: The physical health of donors is adversely affected by live kidney donation. Four weeks postoperatively live kidney donors report their physical health as being worse than those with long-standing illness. The psychological wellbeing of the majority of donors appears to be largely unaffected by live kidney donation. However, a minority of donors report a poorer psychological wellbeing following donation. Individuals who use active coping strategies have higher postoperative MCS scores, reflecting better psychological wellbeing. However, this conclusion should be interpreted with caution due the small sample size and therefore the possibility of a type I error.
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Niles, B., V. Gifford, Jodi Polaha, I. Rivkin, and C. Koverola. "Innovative Competency Training in Ethical Decision Making for Providers Delivering Telebehavioral Health Services." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6612.
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Pugh, Dale M. "A phenomenological study of clinical decision making by flight nurse specialists in emergency situations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1249.
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Clinical decision making is an integral, multifaceted phenomenon fundamental to nursing practice. The domain of flight nursing practice is unique in terms of knowledge, structure, clinical presentations and environment. The uniqueness and diversity of patient scenarios and the advanced practice level of the flight nurse role blend to provide a potential rollercoaster flight mission. At the time this research was conducted nursing standards to guide clinical decision making were being developed. Medically orientated clinical guidelines were in place, but they were designed to highlight a specific, well defined clinical scenario or skill. It has been argued that guidelines for nursing practice do not always parallel the complex clinical situations in which advanced practitioners may find themselves (Malone, 1992b). Flight Nurse Specialists (FNSs) with greater than two years flight nursing experience employed by the Royal Flying Doctor Service (RFDS) - Western Operations were interviewed regarding their experiences of clinical decision making in emergency situations. Using a phenomenological methodology, indepth interviews were audiotaped and transcribed. The interviews were analysed using the method described by Colaizzi (1978). Data was described and interpreted, common themes were extrapolated and analysed. A Gestalt of Knowing was identified by the interconnection and interrelationships of the extrapolated themes. The three themes are: Ways of Knowing the Patient, Context of Knowing and Reflective Practice. Ways of Knowing the Patient is constructed with the sub-themes intuitive knowing, experiential knowing and objective knowing. The second theme, Context of Knowing, is made up of the sub-themes aviation environment, non or minimised involvement in triage, knowing co11eagues, solo practitioner, experiential level and practice guidelines. Self-critique and change in practice formed the theme Reflective Practice. Findings provide a significant contribution to the knowledge of clinical decision making in nursing and to the practice of flight nursing in the Western Australian context. Several recommendations arose from the findings in relation to further research, policy making, standards development and practice developments. Further research is needed into the themes and sub-themes. FNSs need to be allowed to undertake the role of triage for those flights that they will undertake as the solo health professional. The development of standards for flight nursing would benefit from the consideration of the findings of this study and other qualitative studies of clinical decision making. Reflective practice should be considered as a mechanism for not only evaluating practice but as a mechanism for identifying stressful events.
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Schumacher, Constance Louise. "Understanding Self-Management Decision Making in Heart Failure." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4099.
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Heart failure patients are responsible for managing fluctuations in symptoms between exacerbations by employing treatment adherence, active monitoring, and management strategies based on expert guidelines. Despite education, delayed help seeking persists among those in the need of acute medical intervention, as evidenced by high hospital admission and readmission rates. The purpose of this qualitative grounded theory study was to explore the decision making processes undertaken by heart failure, community-dwelling individuals as they experience symptom changes. Eighteen face-to-face interviews were conducted with participants who had heart failure and received self-management education from a home care agency in Southern Ontario, Canada. Data were analyzed using iterative steps of open, axial, selective coding, and qualitative software text queries. Three process themes were identified: perceiving symptoms, normalizing symptoms, and adapting to symptoms, with an overarching theme of control and absence of consultative behaviors. The central concept revealed in this study was normalizing symptoms in heart failure which included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and a loss of functional capacity. These findings can be used to inform system changes needed to strengthen consultative patient-health professional relationships required for effective self-management problem-solving. This study leads to positive social change by explaining how self-management is practiced from the patient's perspective, which can inform practice recommendations and future research.
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Harrison, Michael J. "The enhancement of intra-operative diagnostics and decision-making using computational methods." Thesis, University of Auckland, 2005. http://hdl.handle.net/2292/74.
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The data presented and views expressed in this document are the result of multiple published and unpublished studies over the last 25 years. My over-arching goal in this research was to use modern computing power to create functionally useful diagnoses, in real time, from the monitoring systems used during routine anaesthesia and to present these diagnoses in an ergonomic manner. In addition it was intended to incorporate into the anaesthetic monitor, expert systems that help with the management of uncommon situations. The Australian and New Zealand College guidelines on monitoring during anaesthesia dictate those measurements that should be made during every anaesthetic; from these data evidence can be gathered, integrated, and presented to the clinician. Constraints in this field of research include the inability of the monitors to see, hear or understand the context of operating theatre activities, and computer processing time. Because many studies are involved the methods are detailed in the main text, and are not summarized here. Physiological 'envelopes' have been developed, in which the 'normal' variation in physiological variables, during anaesthesia, are enclosed. They have enabled the creation of intelligent alarm systems that can suggest diagnoses. A retrospective off-line study showed that it was possible to diagnose the onset of malignant hyperpyrexia, using fuzzy logic templates, about 10minutes earlier than the clinician. Some variables may be more important than others in making a diagnosis, and the strength of a diagnosis depends on the amount of supporting evidence, the amount of evidence not against the diagnosis and the amount of missing data. Decision-making (for example to transfuse or not transfuse blood) can also be mathematically modelled so that decision making is more consistent. Finally, investigation of the ways of displaying data indicates that the output can be very explicit. My overall conclusion is that real time decision support systems for the management of clinical dilemmas are possible. They can be instantly and easily accessible and can sit discretely in the background of anaesthetic monitors to be activated at will by the anaesthetist.
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McRobert, Cliona. "Primary care decision-making for shoulder pain : identifying treatment effect moderators using clinical expertise." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5162/.
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Background: Shoulder pain is a common, costly condition with variable prognosis. Commonly used treatments for shoulder pain in primary care include: (i) advice & analgesia, (ii) exercise and/or manual therapy, and (iii) corticosteroid injection. Current guidelines do not assist clinicians in optimal treatment selection for this condition. Prognostic factors help identify subgroups likely to have poor prognosis, however their potential to help clinicians decide between different treatments is unclear. Methods: A systematic review identified which patient attributes modify effects of these three treatments. Clinical consensus workshops were conducted with 21 UK-based clinicians who manage shoulder pain to identify patient attributes relevant to treatment decision making. The impact of these attributes on treatment choice was studied in a conjoint analysis study of decision-making for shoulder pain. Results: The review identified 20 potential treatment effect moderators, with low quality evidence. Clinical consensus workshops identified 12 salient patient attributes. The conjoint study received responses from 387 clinicians (31 countries, 64% UK). Results showed that 11 of the 12 attributes discriminated between treatment choices, following adjustment for responders’ country, profession, and experience. Recommending injection was most strongly associated with lack of improvement (OR 2.81, 95%CI 2.16; 3.65), previous positive response to injection (2.79, 2.07; 3.76), and patient preference (2.41, 1.82; 3.19). Recommending physiotherapy was most strongly influenced by patient preference (2.77,2.16; 3.55), presence of weakness/instability (2.05, 0.79; 1.23) and previous positive response to physiotherapy (2.22, 1.76; 2.80). Not recommending corticosteroid injection was associated with traumatic onset and unstable diabetes or cardiac issues, whereas not recommending physiotherapy was associated with sleep disturbance and high pain. Discussion: The relative importance of patient attributes that influence shoulder treatment selection was quantified. Logical clinical patterns emerged suggesting that specific patient attributes guide clinicians treatment selection. Future research is indicated to assess if identified attributes indeed modify treatment effects.
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Beach, Jocelyn M. "Survival following fenestrated endovascular aortic repair - implications for decision making." Case Western Reserve University School of Graduate Studies / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1465492151.
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Kushniruk, Andre W. "Complex decision making in intensive care : the role of medical expertise." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0026/NQ50203.pdf.
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Minati, Ludovico. "Multimodal analysis of the neural correlates of decision making in the context of financial risk." Thesis, University of Brighton, 2012. https://research.brighton.ac.uk/en/studentTheses/7a8e582a-4a20-4eed-8640-16b77584e697.
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Everyday life is pervaded by prospects presenting risks and potential rewards, and the ability to decide effectively is critical for survival. Existing literature implicates integrated action of multiple neocortical and subcortical areas, yet the mechanisms underlying risky decision-making remain debated. Here, the processing of elementary prospects, bearing variable potential losses, gains and associated outcome probabilities was investigated through multiple modalities. Autonomic monitoring indicated very limited involvement of peripheral arousal in economic parameter representation, qualifying the somatic marker hypothesis. Electroencephalography demonstrated marked dissociation between long- latency cortical potentials, tracking potential gains and value, and alpha-band arousal response to potential losses and amount magnitude. Univariate functional MRI revealed a differential cortical representation of potential losses and gains, action of the mesial prefrontal cortex as decisional comparator and involvement of the insula in encoding outcome uncertainty. Subsequent graph-based network analysis demonstrated that the medial and anterior lateral prefrontal cortices harbour key value-integrating hubs, characterized by large numbers of effective connections and high topological centrality. Predicated on the apparent lack of striatal involvement indicated by functional MRI, a behavioural experiment was conducted on patients with basal ganglia degeneration, confirming normal decisional performance. Exploring the role of the lateral prefrontal cortex in regulating risk propensity and representation of gains and losses, a direct-current neuromodulation experiment was performed: though no changes in decisional pattern were observed, enhancing right hemisphere activity boosted confidence, echoing the biases observed in pathological gamblers. These results highlight that value determination proceeds through a distributed neocortical representation of specific economic parameters, particularly losses, feeding into densely-interconnected integrative hubs in the mesial and anterior lateral prefrontal cortex. Future work will need to confirm the effect of real vs. virtual financial endowment, explore the generalization to prospects presenting different combinations of options and investigate relevant patient populations.
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Irwin, Christa Kalberer. "The use of systematic reviews for decision making in animal production medicine and policy." [Ames, Iowa : Iowa State University], 2010. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1476307.
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Baker, Jacqueline D. "Nurses' perceptions of clinical decision-making in relation to patients in pain." Connect to full text, 2001. http://hdl.handle.net/2123/489.
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Thesis (Ph. D.)--University of Sydney, 2001.Title from title screen (viewed Apr. 24, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Nursing, Faculty of Nursing. Includes tables and questionnaires. Includes bibliography. Also available in print form.