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Results for “decision aid”

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At least 163 records · Page 9Linked to original sources
PubMed2000

Need for validation of clinical decision aids: use of the AST/ALT ratio in predicting cirrhosis in chronic hepatitis C.

OBJECTIVE: A value of > or = 1 for the ratio of aspartate amino-transferase to alanine aminotransferase (the AST/ALT ratio or AAR) has been shown to have a positive predictive value of 100% for the diagnosis of cirrhosis in patients with chronic hepatitis C. If validated on separate cohorts, an AAR > or = 1 might obviate the need for liver biopsy in some patients with hepatitis C. METHODS: We attempted to validate the AAR by abstracting demographic and clinical data from a database of consecutive patients with hepatitis C who had a liver biopsy between 1993 and 1998. We used definitions, methods of data collection, and analyses comparable to those of the published study. A hepatopathologist blindly reviewed 49 liver biopsies for histological grade and stage. RESULTS: The current cohort of 177 patients and the previous cohort of 139 patients were comparable in mean age (42.3 vs 43.8 yr), percentage of men (63 vs 67), percentage with an AAR > or =1 (20 vs 17), and Child-Pugh distribution, but differed in substantial use of ethanol (11% vs 3.6%; p = 0.01) and in the prevalence of cirrhosis (23% vs 34%, p = 0.06). Respective sensitivities of the AAR were 56% and 53%. An AAR > or =1 had a positive predictive value of 64% (95% confidence interval 48-78%) for the current cohort. Thirteen of 36 patients (36%) with an AAR > or =1 were incorrectly identified as having cirrhosis. Of these 13 patients, 6 had a normal AST and ALT, 5 had a minimally elevated AST or ALT, and 1 had advanced fibrosis without cirrhosis. CONCLUSIONS: These results suggest that an AAR > or =1 may not be as useful for predicting cirrhosis in chronic hepatitis C as previously thought, and emphasizes the need for validation of clinical decision aids on independent patient cohorts.

Adult↗
PubMedDate not supplied

Capturing policy in hearing-aid decisions by audiologists.

Two studies are reported that together demonstrate that a rigorous protocol of cue elicitation employing behavioral observations of actual clinical behavior can be rewarded with powerful policy capturing in social judgment theory experiments. The decision policies of 16 clinical audiologists were derived in a study of the decision to recommend hearing-aid amplification. Using discriminant function analysis for each judge, the percentage correct classification rates for the hearing-aid recommendation criterion variable for all judges were high, with an average correct rate of 89.9%, despite widely divergent recommendation rates (21.4% to 87.1%) associated with individual decision behaviors.

Attitude to Health↗
PubMedDate not supplied

Computer-based clinical decision aids. A review of methods and assessment of systems.

During the last three decades a great deal of research has been devoted to the development of integrated clinical decision support systems. This report aims to give a basic understanding of what is required for such a system. By means of a large literature study a survey is given of the major components of computer-based clinical aid systems. The main approaches and several aspects of evaluation of such programs are described. The computer has several inherent capabilities which are suitable for medical problem solving and can help in the formalization of medical knowledge. The components of such systems include the computer database, the reasoning engine and the user interface. The different approaches on which the reasoning engine is built are based on manipulation of information and advocate the use of knowledge to construct a solution to a problem. The information in the mode vary from data-intensive to knowledge-intensive. Assessment of decision support systems is a very important phase in the development of such systems. Evaluation should be made on the accuracy of the program, the nature of the system, the use of the data and the acceptance by the target users. Whatever the model is, its effectiveness will depend on the data with which the program has to work. Acceptance by physicians depends among other things on ease of use of the user interface. Profound changes in the delivery of health care will be induced through the rapid growth of on-line computer communication together with the development of integrated clinical decision support systems and electronic medical records. Notwithstanding the rapid growth of computer technology, computer-aided decision making is in its infancy and real support in daily practice is not yet achieved.

Algorithms↗
PubMed2003

Helping patients make informed choices: a randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer.

BACKGROUND: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the "Decision Board" to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy. We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone. METHODS: Between October 1995 and March 2000, 176 women with lymph node-negative breast cancer who were candidates for adjuvant chemotherapy were randomly assigned to receive the Decision Board plus the medical consultation (83 patients) or the medical consultation alone (93 patients). One week after the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and chemotherapy. Satisfaction with decision making was assessed 1 week and 3, 6, and 12 months after randomization, and differences between groups were analyzed by a repeated measures analysis of variance. All statistical tests were two-sided. RESULTS: Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm (mean knowledge score = 80.2 [on a scale of 0-100], 95% confidence interval [CI] = 77.1 to 83.3, and 71.7, 95% CI = 69.0 to 74.4, respectively; P<.001). Over the entire study period, satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm (P =.032). There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy (77% and 70% for patients in the Decision Board arm and those in the control arm, respectively; P =.303). CONCLUSION: When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation.

Adult↗
PubMed1999

Collaborative prototyping approaches for ICU decision aid design.

When computer-based aids do not support the human users' decision-making strategies or anticipate the organizational impacts of technological change, advances in information technology may degrade rather than enhance decision-making performance. Such failures suggest the design of human-computer cooperation for problem solving and decision-making must be driven by human cognitive and organizational process requirements rather than computer technology. Decision- and user-centered development techniques involve domain experts and end-users in the earliest phases of design to evolve an understanding of requirements through iterative prototyping. This paper presents a collaborative approach to cognitive systems engineering applied to developing a clinical aid to assist respiratory care in the surgical ICU.

Computer Systems↗
PubMed1994

[Scores as decision aids].

Scoring systems are nowadays said to be helpful in decision-making in preclinical and early clinical treatment of multiple trauma patients. To evaluate the importance of these scores in daily routine, we analysed the scores routinely used in our department at the Hannover Medical School. We present three scoring systems: the Polytrauma Score, the Pelvis Score, and the Hannover Fracture Scale. All of these have certain qualities relevant to the aspects of decision-making and prognostic value. The evaluation demonstrates that these scoring systems are genuinely helpful, especially for the inexperienced.

Adult↗
PubMed1982

A survey of decision aids for clinicians.

Inconsistency in applying medical knowledge is a major reason for varying standards of medical care. Five types of aid have been introduced into medicine to help decision-making: questionnaires, algorithms, database systems, diagnostic systems, and, finally, computer-based decision-support systems. Of these, the most effective act as reminder or prompt systems to assist doctors without threatening their clinical freedom.

Bayes Theorem↗
PubMed1985

[Presentation of a system for computer-aided decision in diabetes therapeutics].

This paper presents Sphinx, an expert system for computer-aided diagnosis in diabetes therapeutic. This interactive program makes logic deductions, comprehensible for users and it is not necessary for them to know artificial intelligence methodology. An improvement of the first results is possible and necessary, but the reliability of the advice already expressed by the system makes it useful as a future physician's implement.

Computers↗
PubMed1990

KADIS--a computer-aided decision support system for improving the management of type-I diabetes.

Despite the introduction of new therapeutic aids such as insulin pumps and injectors, blood glucose test tapes, particular insulin formulations, and the physiological basis-bolus principle of insulin dosage regimes, the metabolic care of most insulin-dependent patients is still insufficient. One potential tool of further improving the results in diabetes treatment consists in the application of computer-aided procedures to estimate individually optimal regimes. Employing a validated mathematical model of the glucose/insulin metabolic control system and individual sets of data from patients' self-monitoring, a software package was developed on a micro-computer which allowed both the retrospective analysis of data resulting from the therapeutic process, and the prospective simulation of the outcome of alterations in the regime in terms of glycaemia and insulinaemia. The two parts of the programme provide either for the patient or for the physician an interactive mode of working with the computer. The system is now being validated by means of a long-term follow-up study in type-I diabetic patients. It may be used mainly in diabetic outpatient centers and as a tool of educating, training, and motivating patients.

Computer Simulation↗
PubMed2002

Computer aided decision support on choosing the right technology for sewer rehabilitation.

The decision, whether and how to rehabilitate a damaged sewer is a complex one. Detailed information available from sewer inspection can be used for evaluating its condition and determining the urgency of rehabilitation. There are various rehabilitation techniques, from conventional open trenching to newer trenchless construction. Municipal waste water departments and companies must use their tight budgets in the most efficient and responsible way. Therefore, a decision support system for choosing the right/best sewer rehab technology is urgently needed. For a computer aided selection of the right technology for sewer rehabilitation a formalised weighing and ranking procedure should be used. That procedure should be based on a detailed description of the rehabilitation task. So the state of the existing sewer has to be identified, future technical requirements have to be formulated and specific local restraints taken into account. First, rehab technologies not capable of solving the problem under given constraints, are eliminated by "knock-out" criteria. Thus the number of potential solutions is reduced to those which are subsequently compared (computer aided) in pairs. There is no scoring hocus-pocus and criteria weighing in this decision system. The result is found just by comparing pairs of options on as many criteria as needed, and these criteria may be measured on different scales and need not be independent from each other.

Cities↗