Evolution in medical decision making

The classical approach to medical decision making can be limited by the underlying theories. The evolutionary computation is a different concept, which can find many different solutions of the problem. In medicine, this is useful because of different expectations the decision system must face. We implemented a tool for genetic induction of vector decision trees, which are a good choice for a medical decision model because of their simplicity and transparency. The vector decision tree gives multiple classifications in one single pass. Evolutionary development of such trees achieved good results when the results were statistically compared to those of other classical methods. For medical interpretation however a cooperation with doctors is needed to verify the model build.     

Medical decision making in scarcity situations

The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians (oncologists, cardiologists, and nursing home physicians) and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld.     

Planning and decision making for ambulatory surgery

There has been rapid growth in the number of ambulatory surgical centers in the United States over the past few years. Yet little research has been done to assist community health planners and surgeons in decision making and planning for ambulatory surgery. In this paper, an analytical framework is developed to assist surgeons in deciding whether to perform a procedure on an ambulatory or an inpatient basis. The Hospital Discharge Survey data collected by the National Center for Health Statistics are also analyzed to investigate their applicability in this analytical framework as well as to aid planners in developing community-wide ambulatory surgery projections. In spite of the limitations on the available data, the models developed here suggest possible future avenues for planning ambulatory surgeries.     

Structured spreadsheet modeling in medical decision making and research

The construction, evaluation, implementation, and use of models representing various algorithms, strategies, methods, theories etc. based on the analysis of great amounts of data are necessary in both Medical Research and Decision Making (MR/DM). Performing such tasks manually is not only time consuming and tedious, but also very error-prone. The appearance of a computer with its ability to store and process information has opened an opportunity to facilitate enormously and improve activities. However, the effective use of computers is limited by difficulties accompanying noncomputerspecialists like doctors, nurses, and other medical staff in learning and using conventional programming languages, tools, and techniques. In this paper we present Structured Spreadsheet Modeling as a possible solution, and show that it is applicable in the MR/DM field on a concrete basis.     

特质性焦虑对风险明确及不明确情境下决策的不同影响

目的 探讨特质性焦虑对风险明确及不明确情境下决策的影响是否相同.方法 依据特质性焦虑的得分,185名被试被分成高特质性焦虑组(HTA)、中特质性焦虑组(MTA)、低特质性焦虑组(LTA),分别对3组被试进行爱荷华博弈测试、色子测试及威斯康辛卡片测试.结果 相对于MTA被试,HTA、LTA被试在风险不明确情境下的决策表现较差[MTA:(2.08±18.51)次;HTA:(5.62±20.35)次;LTA:(5.94±10.96)次],差异有显著性(F=3.86,P=0.023),特质性焦虑与风险不明确情境下决策表现的关系类似于倒“U”字型;MTA、HTA、LTA3组被试在风险明确情境下的决策表现差异不明显[MTA:(4.55±10.17)次;HTA:(4.00±9.75)次;LTA:(4.33±11.20)次],无统计学意义(F=0.03,P=0.968),同时在执行功能及反馈加工上也没有显著差异.结论　特质性焦虑影响风险不明确情境下的决策,而对风险明确情境下的决策没有影响.     

Communicating evidence for participatory decision making

Context  Informed patients are more likely to actively participate in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment; however, currently there are no evidence-based guidelines for discussing clinical evidence with patients in the process of making medical decisions. Objective  To identify ways to communicate evidence that improve patient understanding, involvement in decisions, and outcomes. Data Sources and Study Selection  Systematic review of MEDLINE for the period 1966-2003 and review of reference lists of retrieved articles to identify original research dealing with communication between clinicians and patients and directly addressing methods of presenting clinical evidence to patients. Data Extraction  Two investigators and a research assistant screened 367 abstracts and 2 investigators reviewed 51 full-text articles, yielding 8 potentially relevant articles. Data Synthesis  Methods for communicating clinical evidence to patients include nonquantitative general terms, numerical translation of clinical evidence, graphical representations, and decision aids. Focus-group data suggest presenting options and/or equipoise before asking patients about preferred decision-making roles or formats for presenting details. Relative risk reductions may be misleading; absolute risk is preferred. Order of information presented and time-frame of outcomes can bias patient understanding. Limited evidence supports use of human stick figure graphics or faces for single probabilities and vertical bar graphs for comparative information. Less-educated and older patients preferred proportions to percentages and did not appreciate confidence intervals. Studies of decision aids rarely addressed patient-physician communication directly. No studies addressed clinical outcomes of discussions of clinical evidence. Conclusions  There is a paucity of evidence to guide how physicians can most effectively share clinical evidence with patients facing decisions; however, basing our recommendations largely on related studies and expert opinion, we describe means of accomplishing 5 communication tasks to address in framing and communicating clinical evidence: understanding the patient's (and family members') experience and expectations; building partnership; providing evidence, including a balanced discussion of uncertainties; presenting recommendations informed by clinical judgment and patient preferences; and checking for understanding and agreement.      

New input to hospital decision making

To respond to the rapidly changing environment of the hospital industry and to the impact of a prospective reimbursement experiment the Genesee Hospital has established a new structure and process to combine clinical and administrative expertise in management and planning activities. Various analyses and recommendations are developed from a data base of merged clinical and financial information. The result has been both better-informed decision-makers and more comprehensive analyses on which to base decisions.     

糖尿病合并脑卒中的预后分析

目的探讨和研究糖尿病合并脑卒中的预后。方法将该院接收的84例脑卒中患者,分为观察组与对照组,其中合并糖尿病患者37例,为观察组,血糖正常的脑卒中患者47例,为对照组,然后对这两个组进行比较。结果通过该们对两个组的患者进行比较后得出,高血糖对脑卒中的预后危害较大。结论要及时纠正患者的空腹血糖,从而减轻减缓脑卒中对患者神经功能的损伤,并有效的改善患者的病情,以降低患者的死亡率。