Emerging paradigms of cognition in medical decision-making

Patel, Vimla L.; Kaufman, David R.; Arocha, José F.

doi:10.1016/s1532-0464(02)00009-6

Cited by 267 publications

(222 citation statements)

References 57 publications

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“…Echoing the findings of Patel et al in the literature, 24 there appeared to be widespread recognition of the complexity of factors involved in making a 'good' decision.…”

Section: Comparison With Existing Literaturementioning

confidence: 95%

Hospital admissions from nursing homes: a qualitative study of GP decision making

McDermott¹,

Coppin²,

Little³

et al. 2012

Br J Gen Pract

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BackgroundDecisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions AimTo explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital. Design and settingA purposive sample of 21 GPs from two counties in the South of England. MethodData from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method. ResultsThis study suggests that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable. ConclusionDeveloping a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.

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“…Echoing the findings of Patel et al in the literature, 24 there appeared to be widespread recognition of the complexity of factors involved in making a 'good' decision.…”

Section: Comparison With Existing Literaturementioning

confidence: 95%

Hospital admissions from nursing homes: a qualitative study of GP decision making

McDermott¹,

Coppin²,

Little³

et al. 2012

Br J Gen Pract

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“…Vignettes examine complex decisions where in situ methods (e.g. think-aloud protocols) are less practical, and are used extensively in NDM research (Jacklin et al 2008;Patel, Kaufman, and Arocha 2002;Reyna and Lloyd 2006).…”

Section: Designmentioning

confidence: 99%

“…information, scenario detail) leading to this decision; ○ Influence of organisational factors (e.g. protocols, norms) underlying decision-making; (Bertsimas, Farias, and Trichakis 2012;Pauker and Kassirer 1975), framing effects upon decision-making (Croskerry 2002;Fackler et al 2009;Kahneman, Slovic, and Tversky 1982), experience and expertise (Flin, Youngson, and Yule 2007;Klein 1993;Patel, Kaufman, and Arocha 2002), and organisational and group norms for decision-making (Eisenberg 1979;Gore et al 2006). Finally, the themes and data from the qualitative analysis were summarised and synthesised into a single table, which aimed to provide an initial conceptual set (illustrated by examples) of factors influencing how clinicians make risk trade-offs in ICU.…”

Section: Interview Protocolmentioning

confidence: 99%

Impossible decision? An investigation of risk trade-offs in the intensive care unit

2017

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b centre for Perioperative medicine and critical care research, imperial college Healthcare nHs Trust, London, UK ABSTRACTIn the intensive care unit (ICU), clinicians must often make risk trade-offs on patient care. For example, on deciding whether to discharge a patient before they have fully recovered in order to create a bed for another, sicker, patient. When misjudged, these decisions can negatively influence patient outcomes: yet it can be difficult, if not impossible, for clinicians to evaluate with certainty the safest course of action. Using a vignette-based interview methodology, a naturalistic decision-making approach was utilised to study this phenomena. The decision preferences of ICU clinicians (n = 24) for two common risk trade-off scenarios were investigated. Qualitative analysis revealed the sample of clinicians to reach different, and sometimes oppositional, decision preferences. These practice variations emerged from differing analyses of risk, how decisions were 'framed' (e.g. philosophies on care), past experiences, and perceptions of group and organisational norms. Implications for patient safety and clinical decision-making are discussed.Practitioner Summary: Physicians managing ICUs have to make rapid decisions with incomplete information and suboptimal resources. A qualitative vignette-based interview study examined how such decisions are made. We found physicians used a heterogeneous mixture of risk assessments, factual knowledge and prior experience to make judgements, which leads to potential for inconsistent decision-making.

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“…In general, problem-solving studies are more operational in formalizing latent sources of error as well as describing the root causes of problems or events. Besides, experienced knowledge differs in important respects from intermediate knowledge and has a qualitatively distinct engagement with differential use of reasoning strategies in problem solving: for example, experts are involved in the process of situation assessment with a data-driven reasoning whereas the novices and intermediates are much more proactive in handling solution options and organizing further investigations with a hypothesis-driven reasoning (Patel, Kaufman, & Arocha, 2002).…”

Section: Introductionmentioning

confidence: 99%

Mining association rules for the quality improvement of the production process

Kamsu-Foguem

Rigal

Mauget

2013

Expert Systems with Applications

132

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To cite this version:Bernard Kamsu-Foguem, Fabien Rigal, Félix Mauget. Mining association rules for the quality improvement of the production process. Expert Systems with Applications, Elsevier, 2013, vol. 40, pp. 1034-1045 b s t r a c tAcademics and practitioners have a common interest in the continuing development of methods and computer applications that support or perform knowledge-intensive engineering tasks. Operations management dysfunctions and lost production time are problems of enormous magnitude that impact the performance and quality of industrial systems as well as their cost of production. Association rule mining is a data mining technique used to find out useful and invaluable information from huge databases. This work develops a better conceptual base for improving the application of association rule mining methods to extract knowledge on operations and information management. The emphasis of the paper is on the improvement of the operations processes. The application example details an industrial experiment in which association rule mining is used to analyze the manufacturing process of a fully integrated provider of drilling products. The study reports some new interesting results with data mining and knowledge discovery techniques applied to a drill production process. Experiment's results on real-life data sets show that the proposed approach is useful in finding effective knowledge associated to dysfunctions causes.

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Emerging paradigms of cognition in medical decision-making

Cited by 267 publications

References 57 publications

Hospital admissions from nursing homes: a qualitative study of GP decision making

Hospital admissions from nursing homes: a qualitative study of GP decision making

Impossible decision? An investigation of risk trade-offs in the intensive care unit

Mining association rules for the quality improvement of the production process

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