Consensus Statement on Perioperative Use of Neuromuscular Monitoring.

A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management. The panel believes that whenever a neuromuscular blocker is administered, neuromuscular function must be monitored by observing the evoked muscular response to peripheral nerve stimulation.

Risk as feelings in the effect of patient outcomes on physicians' future treatment decisions: a randomized trial and manipulation validation.

The present study tested predictions derived from the Risk as Feelings hypothesis about the effects of prior patients' negative treatment outcomes on physicians' subsequent treatment decisions. Two experiments at The University of Chicago, U.S.

The prevalence, correlates, and impact of logically inconsistent preferences in utility assessments for joint health states in prostate cancer.

Background: Variations in health state utilities can impact cost-effectiveness analyses. One potential source of error is when joint health state (JS) utilities are rated higher than the embedded single state (SS) utilities. Knowing when and in whom this occurs can improve cost-effectiveness analyses.

Effects of alternative styles of risk information on EMF risk perception.

Risk scenarios characterized by exposures to new technologies with unknown health effects, together with limited appreciation of benefits pose a challenge to risk communication. The present report illustrates this situation through a study of the perceived risk from mobile phones and mobile masts in residential areas. Good information should objectively convey the current state of knowledge.

A time tradeoff method for eliciting partner's quality of life due to patient's health states in prostate cancer.

Background: Cost-effectiveness analyses may better reflect the full costs and benefits of medical interventions if they incorporate the effects of patients' health on their family members.

Objective: To develop and apply a time tradeoff (TTO) technique to measure the impact of potential prostate cancer-related health states of the patients on the quality of life (QOL) of their partners.

Methods: We developed modified TTO questions and applied them in a pilot study in which we asked the partner of the patient to tradeoff his or her own life in order to reduce the burden that he himself or she herself expects to experience if the patient developed one of the prostate cancer-related health states.

Thinking about diagnostic thinking: a 30-year perspective.

This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.

Radiation from mobile phone systems: Is it perceived as a threat to people's health?

The aim of this study was to explore the prevalence, nature and determinants of concerns about mobile phone radiation. We used data from a 2006 telephone survey of 1004 people aged 15+ years in Denmark. Twenty-eight percent of the respondents were concerned about exposure to mobile phone radiation; radiation from masts was of concern to about 15%.

A linear index for predicting joint health-states utilities from single health-states utilities.

Direct elicitation of utilities for joint health (JS) states may pose substantial interview burden, while traditional models to predict these utilities from utilities of component single states (SS) are inconsistent with the data. Using individual-level data on utilities for health states associated with prostate cancer, we report the performance of a new model that encompasses three traditional models - additive, multiplicative, and minimum - previously used for predicting utilities for joint health states. Describing utilities in terms of utility losses l(.

Predicting utility ratings for joint health States from single health States in prostate cancer: empirical testing of 3 alternative theories.

Background: Cost-effectiveness analyses measure quality of life by associating utilities with specific health states. Utilities are often defined by single health states, such as incontinence or impotence in the case of prostate cancer treatments. Health conditions often occur simultaneously, yielding joint health states (e.

Patient-physician fit: an exploratory study of a multidimensional instrument.

Background: Patients face difficulty selecting physicians because they have little knowledge of how physicians' behaviors fit with their own preferences.

Objective: To develop scales of patient and physician behavior preferences and determine whether patient-physician fit is associated with patient satisfaction.

Design: Two cross-sectional surveys of patients and providers.

Patients' values and clinical substituted judgments: the case of localized prostate cancer.

The authors examined agreement between patients' utilities and importance rankings and clinicians' judgments of these assessments using a multiattribute model representing 6 aspects of health states potentially associated with localized prostate cancer. Patients were interviewed individually shortly after diagnosis and at a follow-up visit to obtain time-tradeoff utilities for 4 health states, including current health, and importance ranks of the 6 attributes. Their clinicians independently provided views of what utilities and importance ranks would be in the patient's best interest.

Do physicians know when their diagnoses are correct? Implications for decision support and error reduction.

Objective: This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence.

Design: Prospective, counterbalanced experimental design.

Setting: Laboratory study conducted under controlled conditions at three academic medical centers.

Inter-rater agreement in judging errors in diagnostic reasoning.

Context And Objective: Inter-rater agreement is essential in rating clinical performance of doctors and other health professionals. The purpose of this study was to establish inter-rater agreement in categorising errors in the diagnostic process made by clinicians using computerised decision support systems.

Methods: Eight possible error categories were developed for coding errors in diagnostic hypotheses and plans for next steps in the work-up.

Agreement between prostate cancer patients and their clinicians about utilities and attribute importance.

Purpose: To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests.

Method: Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment.

Pilot study of a utilities-based treatment decision intervention for prostate cancer patients.

This pilot study evaluates a shared decision-making approach to individual decision making in localized prostate cancer care. The approach is based on a decision analytic model that incorporates patient utilities, ie, patient preferences among possible health states that might occur with prostate cancer treatments. Data on comorbidities, histologic grade of the biopsy, and age were obtained for 13 patients with newly diagnosed localized prostate cancer who received care in a Veterans Administration medical center.

Critical thinking and clinical decision making in critical care nursing: a pilot study.

Objective: This pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity.

Design: The study was nonexperimental and correlational.

Presenting risks and benefits to patients.

Objective: To investigate whether patients are influenced by the order in which they learn the risks and benefits of a treatment and whether this effect is attenuated by a treatment's associated risk and/or benefit.

Design: Subjects were randomized to review 1 of 6 medical treatment information brochures.

Setting: Waiting rooms of primary care physicians at an academic health center.

Physicians' judgments of survival after medical management and mortality risk reduction due to revascularization procedures for patients with coronary artery disease.

Study Objective: s: To assess the accuracy of physicians' judgments of survival probability for medically managed patients with coronary artery disease (CAD), and of the absolute risk reduction of mortality due to coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for such patients; and relationships among these judgments and the physicians' propensity to perform revascularization.

Design: Two surveys (for three-vessel or two-vessel CAD) for patients presenting with stable CAD, currently managed medically, and without other life-limiting problems.

Setting: Multiple educational conferences, 1996-1997.