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Results for “Utility Theory”

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PubMed1998

Using multiple pharmacoeconomic methods to conduct a cost-effectiveness analysis of histamine H2-receptor antagonists.

A formulary decision at a health care institution was studied by using two pharmacoeconomic methods. A pharmacoeconomic study was undertaken to assess the impact of a 1995 formulary decision to designate cimetidine as the primary histamine H2-receptor antagonist (H2RA) and to restrict the use of famotidine. Consecutive patients receiving either i.v. cimetidine or famotidine for stress ulcer prophylaxis were reviewed during a two-month period in 1997, and information on demographics, dosage and duration of H2RA therapy, admission date, laboratory test values, and adverse drug reactions was collected. Data for 62 patients (43 cimetidine recipients and 19 famotidine recipients) were evaluated. Therapy was categorized as successful or failed, and the data were then evaluated by decision analysis to evaluate the cost-effectiveness of the agents and by multiattribute utility theory (MAUT) to incorporate a humanistic evaluation of the treatments, namely, the number of doses administered and the number of times dosages were changed. The decision tree revealed that the average cost of receiving cimetidine was $82.01 and the average cost of famotidine therapy was $92.45. The MAUT analysis showed that cimetidine was the preferred agent as long as cost was valued at greater than 60% of the decision-making process and efficacy remained equal between the two agents. Two pharmacoeconomic methods lent support to a formulary decision at a health care institution.

Cimetidine↗
PubMed1993

Enhancing staff nurses' interpersonal skills: theory to practice.

Nurses working with psychiatric-mental health patients require a repertoire of skills to assess patient behavior and needs, design creative interventions, and evaluate care. The work of interpersonal psychiatric nursing exists within the therapeutic relationship between nurse and patient. A coordinated series of classes and clinical supervision sessions that present an approach to psychiatric nursing care using three major themes of Peplau's model: learning acquisition, language competencies, and anxiety reduction are described. Clinical supervision was strongly encouraged for participants and one clinical supervisor decided to model supervisory sessions using elements of Peplau's theory. Utilizing selected aspects of Peplau's interventional techniques during clinical supervision and reflecting on the experience provided an opportunity to validate and integrate new knowledge and skills. Nurses who sought supervision thus had the advantage of experimental learning through participation in clinical supervision.

Clinical Competence↗
PubMed1981

Psychopathology and hemispheric dysfunction: a review.

In the past 15 years, investigators have attempted to relate psychiatric disorders to our developing knowledge about the asymmetrical organization of the cerebral hemispheres. This paper summarizes the varied, limited, and often conflicting results. The authors suggest that progress in this fascinating and potentially fruitful area will be improved by: a) more critical evaluation of the current literature with regard to its contradictions and to the techniques and theories utilized; b) systematic study of carefully diagnosed, large groups of patients; c) concurrent attempts to identify and carefully assess unusual patients; d) control of laterality measures for drug effects, institutionalization, and such cognitive and affective states as anxiety, depression, paranoia, and psychosis; and e) validation of the localizing value of neuropsychological tests in psychiatric patients by the study of previously diagnosed psychiatric patients with acquired focal brain disease.

Affective Disorders, Psychotic↗
PubMed2000

Multiattribute risk analysis in nuclear emergency management.

Radiation protection authorities have seen a potential for applying multiattribute risk analysis in nuclear emergency management and planning to deal with conflicting objectives, different parties involved, and uncertainties. This type of approach is expected to help in the following areas: to ensure that all relevant attributes are considered in decision making; to enhance communication between the concerned parties, including the public; and to provide a method for explicitly including risk analysis in the process. A multiattribute utility theory analysis was used to select a strategy for protecting the population after a simulated nuclear accident. The value-focused approach and the use of a neutral facilitator were identified as being useful.

Communication↗
PubMed1989

Comprehensive health seeking and coping paradigm.

While scholars in nursing are charged with the responsibility of advancing and structuring a body of knowledge for application in nursing practice, many of the currently utilized theories have been borrowed from other disciplines. Until such knowledge is redefined and synthesized according to the perspective of nursing, borrowed knowledge cannot be adequately understood. The purpose of this paper is to present a comprehensive client-orientated health seeking and coping paradigm. This paradigm is theorized to be a function of 12 factors which include: clients' situational and personal factors, resources, sociodemographic characteristics, cognitive appraisal, health goals, health seeking and coping behaviours, nursing goals and strategies, clients' perceived compliance, clients' perceived coping effectiveness, and immediate and long-term health outcome. The Lazarus Schema of Coping and Adaptation and the Schlotfeldt Health Seeking and Coping Paradigm were the parent conceptualizations from which the Comprehensive Health Seeking and Coping Paradigm (CHSCP) was derived. As a nursing-orientated multidimensional framework, the CHSCP will provide a useful framework for nurses interested in altering, enhancing or promoting the health seeking and coping of clients. By providing an intellectual focus for the initial and ongoing assessment of a multitude of variables which influence health seeking and coping, the specification of appropriate strategies can be developed and enhanced.

Adaptation, Psychological↗
PubMed1995

Nursing informatics: state of the science.

The phenomena of interest in nursing informatics are nursing data, nursing information and nursing knowledge. The current state of knowledge related to these phenomena suggests four implications for the development of systems to support nursing. First, research has provided evidence that knowledge and experience is related to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task-specific. Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to increase the level of knowledge of the nurse decision-maker. Second, structured patient assessment forms with linkages to knowledge bases of diagnoses have the potential to improve the quality of the patient assessment and the accuracy of the diagnosis or clinical inference. Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate. Model-based decision support applications such as decision analysis and multi-attribute utility theory can assist the clinicians and patients to analyse and compare the treatment alternatives in a systematic manner. Fourth, there is modest support for demonstrating the relationship between the process and outcomes of clinical decision making. Large databases built upon nursing data are needed to further examine this relationship.

Expert Systems↗
PubMed1994

Treatment limitation decisions under uncertainty: the value of subsequent euthanasia.

This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.

Computers↗
PubMed1985

A simplified optical model description of heavy ion fragmentation.

The fragmentation of 213 MeV/nucleon 40Ar ions by 12C targets is described within the context of a simple abrasion-ablation fragmentation model. The abrasion part of the theory utilizes a quantum-mechanical formalism based upon an optical model potential approximation to the exact nucleus-nucleus multiple-scattering series. The ablation stage of the fragmentation is treated as a compound nucleus evaporation. The decay probabilities for the various particle emission channels are computed using the EVAP-4 Monte Carlo computer program. Predictions for production cross sections for isotopes of sulfur, phosphorus, silicon, and aluminum are made and compared with experimental data. The model is also used to compare predicted and experimental element production cross sections for 1.88 GeV/nucleon 56Fe colliding with 12C and 208Pb targets.

Argon↗
PubMed2001

A collaborative pastoral care and counseling supervisory model.

Presents a collaborative pastoral care and counseling supervisory model based on constructivism and attachment theories. Addresses issues concerning cognition, learning theory, and anxiety. Identifies the stages in the supervisory process. Discusses ways in which cognitive, emotional, and social development are linked to attachment theory and places this in the context of supervision in pastoral counseling. Reflects on the theological relevance of attachment theory utilizing the biblical parable of the prodigal son.

Anxiety↗
PubMedDate not supplied

Risk taking among diabetic clients.

Diabetic clients must make daily decisions about their health care needs. Observational and anecdotal evidence suggests that vast differences exist between the kinds of choices diabetic clients make and the kinds of chances they are willing to take. The purpose of this investigation was to develop a diabetic risk-assessment tool. This instrument, which is based on subjective expected utility theory, measures risk-prone and risk-averse behavior. Initial findings from a pilot study of 18 women clients who are on insulin indicate that patterns of risk behavior exist in the areas of exercise, skin care, and diet.

Adult↗
PubMed1984

Preferences for health outcomes. Comparison of assessment methods.

This study compared standard gamble (SG), time trade-off (TTO), and category scaling (CS) methods for assessing preferences among hypothetical outcomes of coronary artery bypass surgery. High correlations among assessment methods, as found in some previous studies, do not assure the absence of systematic differences in rating obtained by different methods. This study used analysis of variance to test for differences among the three assessment methods. Questionnaire responses were obtained from 67 of 109 physicians participating in a postgraduate course on clinical decision making, following a lecture and workshop on utility theory. SG and CS were used to rate multivariate combinations of angina (none, moderate, and severe) and survival (0, 5, and 10 years); and SG, TTO, and CS were used to rate univariate outcomes with angina (none, moderate, and severe) for the remainder of their life expectancy. SG ratings were higher than TTO ratings, which were higher than CS ratings (p less than 0.001 for all comparisons). Multivariate responses revealed a significant interaction between angina and survival dimensions using CS, but not using SG. We conclude that these methods are not interchangeable and that differences between SG and CS require a more complex explanation than differences in attitude toward risk.

Angina Pectoris↗
PubMedDate not supplied

Clinical reasoning and cognitive processes.

Expected utility theory, and the Bayesian probability theory on which it is based, form the normative basis of most work in medical decision analysis. Recent work in the psychology of judgments and decisions indicates that people do not conform to the axioms of this theory and that these deviations occur in clinical reasoning as well as in the psychology laboratory. At issue is what to do now. The authors argue that the important next steps lie at the interface between descriptive, prescriptive, and normative accounts, all of which affect each other. They point to examples in which the simplest application of supposedly normative theory seems inappropriate, and suggest ways in which the tension between normative and descriptive models may be resolved.

Cognition↗
PubMedDate not supplied

Toward an applied technology for quality measurement in health care.

Cost containment, financial incentives to conserve resources, the growth of for-profit hospitals, an aggressive malpractice environment, and demands from purchasers are among the forces today increasing the need for improved methods that measure quality in health care. At the same time, increasingly sophisticated databases and the existence of managed care systems yield new opportunities to observe and correct quality problems. Research on targets of measurement (structure, process, and outcome) and methods of measurement (implicit, explicit, and sentinel methods) has not yet produced managerially useful applied technology for quality measurement in real-world settings. Such an applied technology would have to be cheaper, faster, more flexible, better reported, and more multidimensional than the majority of current research on quality assurance. In developing a new applied technology for the measurement of health care quality, quantitative disciplines have much to offer, such as decision support systems, criteria based on rigorous decision analyses, utility theory, tools for functional status measurement, and advances in operations research.

Decision Support Techniques↗
PubMedDate not supplied

Healthy-years equivalents versus quality-adjusted life years: in pursuit of progress.

The authors respond to the contention that healthy-years equivalents (HYEs) do not fulfil claims they previously made. They refute the argument for the equivalence of the two-stage lottery and the time tradeoff and show that it fails to recognize the difference between choice problems under uncertainty versus certainty. They also dismiss the claim that HYEs assume risk neutrality with respect to healthy years of life, and show that HYEs are superior to the "general" (risk-averse) form of QALYs because HYEs employ fewer assumptions; in particular, they do not assume a specific form of the individual's utility function. The examples they used earlier are demonstrated to be conclusive, and the authors respond to arguments about the practical aspects of using HYEs vs QALYs. Finally, they take issue with the assumption that the roots of the QALY model are all attributable to utility theory.

Cost of Illness↗
PubMedDate not supplied

Valuing the future: temporal discounting of health and money.

Normative discounted utility theory specifies that the values of all future outcomes (for example, those related to health and money) should be discounted at a constant rate. Two experiments demonstrated that, contrary to this prescription, decision makers use different discount rates for health-related decisions and money-related decisions. Temporal discountings for health and money were similar in that both demonstrated two biases previously found in monetary decisions: discount rates were inversely related to magnitude of outcome and length of delay. The relatively large discount rates used by the subjects suggest why it is often difficult to implement preventive health measures that improve future health.

Decision Making↗
PubMed1993

Psychological determinism and the evolving nursing paradigm.

The purpose of this article is to explore three behaviorist theories and their roles within the evolving paradigm of nursing. The authors suggest that the behaviorist theories of locus of control, self-efficacy, and the health belief model are derived from deterministic philosophical premises. These premises are in direct conflict with the premise of free will. As interpreted by the authors and many others, the emerging paradigm of nursing relies on the free will of the individual, the ability of the individual to choose for himself/herself what course of action to take, to avoid, or to pursue. The authors address the psychological deterministic philosophical premises within the three theories and utilize nursing theories to compare and contrast the views of free will and determinism. Finally, they suggest that the use of borrowed and applied theories should decline when nurse scientists are true to the philosophical assumptions of theories within nursing science.

Attitude to Health↗
PubMed2004

Treatment decision-making and the form of risk communication: results of a factorial survey.

BACKGROUND: Prospective users of preventive therapies often must evaluate complex information about therapeutic risks and benefits. The purpose of this study was to evaluate the effect of relative and absolute risk information on patient decision-making in scenarios typical of health information for patients. METHODS: Factorial experiments within a telephone survey of the Michigan adult, non-institutionalized, English-speaking population. Average interview lasted 23 minutes. Subjects and sample design: 952 randomly selected adults within a random-digit dial sample of Michigan households. Completion rate was 54.3%. RESULTS: When presented hypothetical information regarding additional risks of breast cancer from a medication to prevent a bone disease, respondents reduced their willingness to recommend a female friend take the medication compared to the baseline rate (66.8% = yes). The decrease was significantly greater with relative risk information. Additional benefit information regarding preventing heart disease from the medication increased willingness to recommend the medication to a female friend relative to the baseline scenario, but did not differ between absolute and relative risk formats. When information about both increased risk of breast cancer and reduced risk of heart disease were provided, typical respondents appeared to make rational decisions consistent with Expected Utility Theory, but the information presentation format affected choices. Those 11% - 33% making decisions contrary to the medical indications were more likely to be Hispanic, older, more educated, smokers, and to have children in the home. CONCLUSIONS: In scenarios typical of health risk information, relative risk information led respondents to make non-normative decisions that were "corrected" when the frame used absolute risk information. This population sample made generally rational decisions when presented with absolute risk information, even in the context of a telephone interview requiring remembering rates given. The lack of effect of gender and race suggests that a standard strategy of presenting absolute risk information may improve patient decision-making.

Adult↗
PubMed2004

"Research to practice": a practical program to enhance the use of evidence-based practice at the unit level.

PURPOSE/OBJECTIVES: To assist clinical nurses in translating research into clinical practice. DATA SOURCES: City of Hope Quality-of-Life (QOL) Model to guide presentations and discussion, research utilization theories, and evidence-based practice literature. DATA SYNTHESIS: Based on percentage of individual participant involvement, the four domains of QOL, and a knowledge survey. OUTCOMES: Attendance, discussion, QOL domain ranking, satisfaction, and pre- and postknowledge scores. Attendance averaged 13 individuals; average discussion participation was 54%. The psychological QOL domain was most important (58%), and discussion averaged a score of 3 (1 = slow to 5 = lively). A one-point increase (scale 1-5) measured a change in knowledge. CONCLUSIONS: The challenge for nursing assessment is to fully address patient issues in the psychological domain. IMPLICATIONS FOR NURSING: A practical program can be formulated to bring evidence-based practice to the clinical setting.

Adult↗