Looking for summaries of the best current evidence for healthcare decision making? Cochrane Evidence may have a report on a topic of interest

Cochrane reviews are systematic reviews of primary research of human health care. They are systematic because they review ALL the available journal articles to answer a specific question.. Each systematic review can take up to 2 years and includes at least 2 people.
An example of a question would be
Can antibiotics help in alleviating the symptoms of a sore throat?
Cochrane Reviews do not answer every healthcare question, but they currently have several thousand reviews answering specific questions.

Cochrane Evidence has plain language summaries of the above reviews.
““Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to first read every study out there…” 
Sifting the evidence, The Guardian, 14 September 2016

How the brain makes decisions [news release]

How the brain makes decisions.
From the 25 May 2015 MedicalExpress news release

 

Some types of decision-making have proven to be very difficult to simulate, limiting progress in the development of computer models of the brain. EPFL scientists have developed a new model of complex decision-making, and have validated it against humans and cutting-edge computer models, uncovering fascinating information about what influences our decision-making and ability to learn from it.

…

Decision-making comes in two major into two types: Markovian and non-Markovian, named after the mathematician Andrey Markov (1856-1922). Simply put, in Markovian decision-making, the next decision step depends entirely on the current state of affairs. For example, when playing backgammon, the next move depends only on the current layout of the board, and not on how it got to be like that. This relatively straightforward process has been extensively modeled in computers and machines.

Non-Markovian decision-making is more complex. Here, the next step is affected by other factors, such as external constraints and previous decisions. For example, a person’s goal might be to travel on the train. But what will happens when he arrives at the door to the train depends on whether or not he has previously visited the ticket booth to buy a ticket. In other words, the next step depends on how he got there; without a ticket, he cannot proceed to the desired goal. In neuroscience, the “buy-ticket” step is referred to as a “switch-state”.

…

Decision dynamics

The results of the study drew three major conclusions. First, that human decision-making can perform just as well as current sophisticated computer models under non-Markovian conditions, such as the presence of a switch-state. This is a significant finding in our current efforts to model the human brain and develop artificial intelligence systems.

Secondly, that delayed feedback significantly impairs human decision-making and learning, even though it does not impact the performance of computer models, which have perfect memory. In the second experiment, it took human participants ten times more attempts to correctly recall and assign arrows to icons. Feedback is a crucial element of decision-making and learning. We set a goal, make a decision about how to achieve it, act accordingly, and then find out whether or not our goal was met. In some cases, e.g. learning to ride a bike, feedback on every decision we make for balancing, pedaling, braking etc. is instant: either we stay up and going, or we fall down. But in many other cases, such as playing backgammon, feedback is significantly delayed; it can take a while to find out if each move has led us to victory or not.

Finally, the researchers found that the spiking neurons model matches and describes human performance very well. The significance of this cannot be overstated, as non-Markovian decision-making has proven to be very challenging for computer models. “This is a proof-of-concept study,” says Michael Herzog. “But the study makes an important contribution toward understanding, and accurately modeling, the human brain – and even surpassing its abilities with artificial intelligence.”

…

[News release] How we make emotional decisions

From the 28 May 2015 MIT news item

Neuroscientists identify a brain circuit that controls decisions that induce high anxiety.

Some decisions arouse far more anxiety than others. Among the most anxiety-provoking are those that involve options with both positive and negative elements, such choosing to take a higher-paying job in a city far from family and friends, versus choosing to stay put with less pay.

MIT researchers have now identified a neural circuit that appears to underlie decision-making in this type of situation, which is known as approach-avoidance conflict. The findings could help researchers to discover new ways to treat psychiatric disorders that feature impaired decision-making, such as depression, schizophrenia, and borderline personality disorder.

…

The new study grew out of an effort to figure out the role of striosomes — clusters of cells distributed through the the striatum, a large brain region involved in coordinating movement and emotion and implicated in some human disorders. Graybiel discovered striosomes many years ago, but their function had remained mysterious, in part because they are so small and deep within the brain that it is difficult to image them with functional magnetic resonance imaging (fMRI).

…

 

[News release] Patients seek greater ownership of health-care decisions

From the 18 May 2015 EurkAlert

Study finds doctors must make great effort to provide patients more useful information to help them make medical choices

Patients faced with a choice of surgical options want to engage their physicians and take a more active role in decision-making, according to a study (abstract 567) released at Digestive Disease Week® (DDW) 2015. Further, those physicians must provide better support tools to help patients participate in the decision-making process. The study found that patients consult multiple sources (Internet, family, friends, doctors, etc.) and say that while doctors provide the most believable information, it was also the least helpful.

….

 

[Press release] Flexible work schedules improve health, sleep | EurekAlert! Science News

Flexible work schedules improve health, sleep | EurekAlert! Science News.

From the 22 January 2015 press release

 

Giving employees more control over their work schedules may help curb sleep deficiency, according to health researchers.

“In the absence of sufficient sleep, we are not as attentive or alert, we process information more slowly, miss or misinterpret social and emotional cues and decision making is impaired,” said Orfeu M. Buxton, associate professor of biobehavioral health, Penn State. “For example, we may misjudge risks by undervaluing negative consequences and overvaluing potential rewards.”

About 30 percent of U.S. adults reported not regularly getting a sufficient amount of sleep, a 2012 Centers for Disease Control survey found. Sleep deficiency has been linked to increased risk of automobile crashes, chronic disease and early mortality. Improving adequate sleep within the population is a goal of Healthy People 2020, a federal initiative that sets national objectives and monitors progress concerning the health of the nation.

Buxton and colleagues looked to see if a workplace intervention, designed to increase family-supportive supervision and give employees more control over their work time, improved sleep quantity and quality. They report their results in an article published online today (Jan. 21) in the journal Sleep Health.

The researchers followed 474 employees as part of a Work, Family and Health Network study conducted at an information technology company, with about half of the employees serving as the control while the other half experienced the study intervention. Both employees and their supervisors participated.

The intervention was designed to reduce conflicts between work and personal life, and focused on two main cultural shifts: allowing employees to decide on when and where they worked and training supervisors to support their employees’ personal lives. Those who were assigned to the intervention were encouraged to be completely flexible about when and where they would work — at the office, from home or elsewhere — while still working the same number of hours as the control group. All of the participants wore a sleep-monitoring watch, a device that tracks movement to monitor periods of sleep.

 

…

[Press release] Boosting self-expression online may limit impulsive purchases

From the 10th December 2013 Penn State press release

By Matthew Swayne

December 10, 2013

UNIVERSITY PARK, Pa. — Long online transactions can take a toll on a person’s self-control, but adding more self-expression and personal identity to those processes can help restore control, according to Penn State researchers.

“Making a lot of choices leads to what researchers call ego-depletion and that can affect self-control,” said S. Shyam Sundar, Distinguished Professor of Communications and co-director of the Media Effects Research Laboratory. “When a person makes a lot of choices, the ability to exert self-control begins to diminish with every choice.”

Participants in an online study showed more self-control after they tailored a personal website that represented their own values and personality than a group that customized a site for other people, said Sundar. Creating the website required several decisions on what features to add and where to place the new features.

After people make too many choices, they tend to make more impulsive decisions, according to the researchers, who report their findings in the current issue of Computers in Human Behavior. For example, while making online purchases, customers may be more prone to buy upgraded, but unneeded features, toward the end of the sale.

Sundar, who worked with Hyunjin Kang, a doctoral student in mass communications, said that the study may help remind web users that they should exercise caution when they are making a lot of decisions duringecommerce sessions, surveys and other online transactions.

“People should become aware that if they are making a lot of choices — for example, during hotel or travel purchases — the activity can deplete their ability to control their actions,” said Sundar. “They may want to take a break and step away from the computer for a while to recharge that self-control.”

While some businesses may want users to be more impulsive during online purchases, Sundar said companies that want their customers to make reasoned decisions should incorporate self-affirming activities into the process.

“For instance, a customer who is environmentally conscious may be interested in personalizing their stay at a hotel with options that can help the environment and affirm their green identity,” Sundar said.

The researchers asked 54 university students to either tailor or browse a customizable website. One group was asked to customize a site to best reflect their personality and values. Researchers asked another group to create a site that represented someone of a different gender. The control group did not create a site, but browsed a similar, but generic website.

Participants who tailored their own site worked significantly longer on a puzzle than those who customized the website for others. The puzzle, which is an unsolvable anagram task, is a standard way to measure ego-depletion and decision fatigue, according to the researchers. The length of time that subjects try to solve the problem indicates the level of self-control remaining after the assigned activity.

“This shows that choosing behaviors in the customization process can make you feel depleted and you’ll persist less in an unsolvable task,” said Kang. “The cure, then, seems to be tasks that improve self-expression and help protect one’s identity.”

Related articles

• Self-indulgence and the License to Sin (psychologytoday.com)
• The biological basis of highly impulsive and aggressive behaviors: new evidence (medicalnewstoday.com)
• You want fries with that? Don’t go there (sciencedaily.com)
• Ego depletion, pro-sociality & capitalism (stumblingandmumbling.typepad.com)
• New evidence on the biological basis of highly impulsive and aggressive behaviors (eurekalert.org)

[Reblog] Internet Use Associated with Better Decision Making in Older Adults

From the 25 November 2013 posting at HealthCetera – CHMP’s Blog
[Center for Health Media & Policy at Hunter College (CHMP): advancing public conversations about health & health policy]

Older adults face many important decisions about their health and financial well-being. Whether it’s making retirement savings last longer or authorizing a health proxy, the ability to make good choices has consequences for a senior’s quality of life, aging in place, and end of life care. According to a new study from Rush University, presented yesterday at the Gerontological Society of America Conference in New Orleans, Internet use is associated with better health and financial decision-making among older adults.

“The Internet has become the primary corridor for finding information and assisting in decision-making on finances and healthcare,” said Bryan James, Associate Professor, Department of Internal Medicine, Rush Alzheimer’s Disease Center in Chicago and lead author of the study. “The Internet is becoming what we call ‘proto-normative,’ meaning you have to have some ability or savvy to function online these days.”

Recent research from Pew’s Internet and American Life Project show that slightly more than half (53%) of all seniors are now online. However, James said there remains a significant portion of older adults who use the Internet infrequently, or not at all. This may have important implications for quality of life and independence, including the ability to age at home.

James pointed to the digital divide between older and younger people. In addition to the general anxiety expressed by older adults express about computers and the Internet,  there are also certain parts of the aging process that may may pose obstacles to Internet use, such as cognitive decline, as well as decline in hearing, vision, and motor skills.

……

Read the entire post here

Related Resources

Evaluating Health Information (from Health Resources for All, edited  by Janice Flahiff)

Anyone can publish information on the Internet. So it is up to the searcher to decide if the information found through search engines (as Google) is reliable or not. Search engines find Web sites but do not evaluate them for content. Sponsored links may or may not contain good information. A few universities and government agencies have published great guides on evaluating information. Here are a few The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.The tips include Remember, anyone can publish information on the internet! If something sounds too good to be true, it probably is. If the Web site is primarily about selling a product, the information may be worth checking from another source. Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency. Check to see how current the information is. Check for accuracy. Does the Web site refer to specific studies or organizations? The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials Topics include General Guidelines for Evaluating Medical Research Getting Information from the Web Talking with your Health Care Provider Additional Resources Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis) How to Evaluate Health Information on the Internet (US National Cancer Institute)9iiu9 Quackwatch (a private corporation operated by Stephen Barrett, MD)   …And a Rumor Control site of Note (in addition to Quackwatch)   National Council Against Health Fraud National Council Against Health Fraud is a nonprofit health agency focusing on health misinformation, fraud, and quackery as public health problems. Links to publications, position papers and more.

How Doctors Think About New Technologies

From the post by Leslie Kernisan at The Health Care Blog

…

My questions when considering a new technology

To begin with, here are the questions that I think about when considering a new technology:

Does it help me do something I’m already trying to do for clinical reasons? Examples include tracking the kind of practical data I describe here (sleep, pain, falls, etc), helping patient keep track of — and take — medications, helping caregivers monitor symptoms, coordinating with other providers…my list goes on and on, although I’ll admit that I prioritize management of medical conditions, with issues like social optimization being secondary. (Social optimization is crucial, it’s just not what physicians are best at, although I certainly weigh in on how an elder’s dementia or arthritis might affect their social options.)

What evidence is there that using it will improve the health and wellbeing of an older adult (or of a caregiver)? Granted, the vast majority of interesting new tech tools will not have been rigorously tested in of themselves. Still, there is often related and relevant published evidence that can be considered. For instance, studies have generally found that there’s no clear clinical benefit in having non-insulin dependent Type 2 diabetics regularly self-monitor blood glucose. (And it is certainly burdensome for older people with lots of medical problems.) Hence I would be a bit skeptical of a new technology whose purpose is to make it easier for older adults to track their blood sugar daily, unless it were targeted towards elders on insulin or otherwise at high risk for hypoglycemia.

How does the data gathering compare to the gold standard? Many new tech tools gather data about a person. If we are to use this information for clinical purposes, then we clinicians need to know how this data gathering compares to the gold standard, or at least to a commonly used standard. For instance, if it’s a consumer wrist device to measure sleep, how does it compare in accuracy to observation in a sleep lab? Or to the actigraphy used in peer-reviewed sleep research? If it’s a sensor system to monitor gait, how does it compare to the gait evaluation of a physical therapist? If it’s the Scanadu Scout Tricorder, which measures pulse transit time as a proxy for systolic blood pressure, where is data validating that pulse transit time as measured by this device accurately reflects blood pressure? (BTW I can’t take such a tricorder seriously if it doesn’t provide a blood pressure estimate that I can have confidence in; blood pressure is essential in internal medicine.)

How exactly does it work? Especially when it comes to claims that the product will help with clinical care, or with healthcare, I want to know exactly how that might work. In particular, I want to know how the service loops in the clinician, or will facilitate the work the clinician and patient are collaborating on.

How easy is it to use? Tools and technologies need to be easy to use. Users of interest to me include older adults, caregivers, and the clinician that they’ll be interfacing with. BTW, all those med management apps that require users to laboriously enter in long drug names are NOT easy to use in my book.

How easy is it to try? Let’s assume a new technology is proposing a service to the patient (or to me) that offers plausible benefits, either because it’s a tech delivery of a clinically validated service, or because it passes my own internal common sense filters. How easy is it to actually set up and try? I’m certainly more inclined to explore a tool that doesn’t require a large financial investment, or training investment.

How cost-effective is using this technology? I’m interested both in cost-effectiveness for the patient & family, and also for the healthcare system. Sometimes we have simpler and cheaper ways to get the job done almost as well.

Can this technology provide multiple services to the patient? My patients are all medically complex, and have lots going on. Products that can provide multiple services (such as socializing with family off-site AND monitoring symptoms), or that can coordinate with another product — perhaps by allowing other services to import/export data — are a big plus.

Does this technology work well for someone who has lots of medical complexity? I always want to know if the product is robust enough to be usable by someone who has a dozen chronic conditions and at least 15 medications.

What I’d like to see on the websites

These days, a website is the generally the place to start when looking into a product or service.

It’s a great help to me when a product’s website addresses the questions I list above. Specifically, I find it very helpful when websites:

Have a section formatted for clinicians in particular. I’m afraid I don’t have much time for gauzy promises of fostering a happier old age. I just want to know how this will help me help my patients. Specific examples are very very helpful.

Have a “how it works” section with screenshots and concise text. Personally, I have limited tolerance for video (videos can’t be skimmed the way text and pictures can) and find it a little frustrating when most information is in videos. Note that it’s probably best to have separate “how it works” sections for clinicians and for patients/caregivers.

Provide a downloadable brochure for patients/families, and another for clinicians.Although it’s annoying when information is presented ONLY in a pdf brochure, I’ve discovered that I quite like having the option of a brochure. Brochures are much easier to read than websites, in that you don’t have mentally decide how to navigate them, or search through them in quite the way you do with websites. Also, brochures can be conveniently emailed to colleagues or patients, which is nice when you want to suggest that your patient try something new…..

 

Read the entire blog post here

 

Related articles

• 4 ways to make IT clinician-friendly (healthitplus.wordpress.com)
• Readers Write: Healthcare’s Crystal Ball – Predictions for 2013 (histalk2.com)
• Physicians’ websites are more “electronic brochures,” than online health resources (medcitynews.com)
• Capturing clinical innovation to improve patient care (siliconrepublic.com)
• Health, Technology and the Forgotten Stepchild of Innovation (forbes.com)

 

Key Trends in the Future of Medicine: E-Patients, Communication and Technology

English: Watson demoed by IBM employees. (Photo credit: Wikipedia)

 

From the 25 October 2012 post at Blogroll

 

…

Robots replacing doctors?

I’ve given hundreds of presentations and I teach at several universities about the use of social media in everyday medicine and I always highlight the importance of 1) doctor-patient relationship in person, and 2) good communication skills for doctors, but if I try to think ahead, I have to agree with Vinod Khosla that technology can replace 80% percent of the work of doctors.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis.

IBM’s Watson is just the perfect example here. They have been working closelywith oncologists at Memorial Sloan-Kettering Cancer Center in New York in order to see whether Watson could be used in the decision making processes of doctors regarding cancer treatments. Watson doesn’t answer medical questions, but based on the input data, it comes up with the most relevant and potential answers and the doctor has the final call. This is an important point as it can only facilitate the work of doctors, not replacing them…

..So what should we expect to see in the next decades? I think we will see amazing developments in many areas, except medicine in which small and slow steps will mark the way towards a more transparent healthcare system in which decision trees are available for everyone, online content and social media are both curated, patients are empowered, doctors are web-savvy, and collaborative barriers are gone forever. A new world in which medical students are trained to be able to deal with the rapidly evolving technologies and e-patients.

 

A great related graphic at http://envisioningtech.com/envisioning-the-future-of-health.pdf

(WordPress was not responding when an upload was attempted)

 

 

 

Related articles

• Vinod Khosla: Technology Will Replace 80 Percent of Docs (jflahiff.wordpress.com)
• Key Trends in the Future of Medicine: E-Patients, Communication and Technology (jflahiff.wordpress.com)
• IBM’s Watson Is Learning Its Way To Saving Lives (fastcompany.com)
• How Much is too Much and Who Decides? (finnpartners.com)
• “Third kind of computer” learns cancer medicine (computerworld.co.nz)
• Vinod Khosla Thinks I’m Narrow-Minded (thehealthcareblog.com)
• Topol says machines will be vital to healthcare transformation, new doc-patient partnership (medcitynews.com)

 

Elevated Indoor Carbon Dioxide Impairs Decision-Making Performance

 

 

 

 

Berkeley Lab researchers found that even moderately elevated levels of indoor carbon dioxide resulted in lower scores on six of nine scales of human decision-making performance. (Credit: Image courtesy of DOE/Lawrence Berkeley National Laboratory)

From the 17 September article at ScienceDaily

Overturning decades of conventional wisdom, researchers at the Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab) have found that moderately high indoor concentrations of carbon dioxide (CO₂) can significantly impair people’s decision-making performance. The results were unexpected and may have particular implications for schools and other spaces with high occupant density.

On nine scales of decision-making performance, test subjects showed significant reductions on six of the scales at CO₂ levels of 1,000 parts per million (ppm) and large reductions on seven of the scales at 2,500 ppm. The most dramatic declines in performance, in which subjects were rated as “dysfunctional,” were for taking initiative and thinking strategically. “Previous studies have looked at 10,000 ppm, 20,000 ppm; that’s the level at which scientists thought effects started,” said Berkeley Lab scientist Mark Mendell, also a co-author of the study. “That’s why these findings are so startling.”

While the results need to be replicated in a larger study, they point to possible economic consequences of pursuing energy efficient buildings without regard to occupants. “As there’s a drive for increasing energy efficiency, there’s a push for making buildings tighter and less expensive to run,” said Mendell. “There’s some risk that, in that process, adverse effects on occupants will be ignored. One way to make sure occupants get the attention they deserve is to point out adverse economic impacts of poor indoor air quality. If people can’t think or perform as well, that could obviously have adverse economic impacts.”

The primary source of indoor CO₂ is humans….

Read the entire news article here

Related articles

• Elevated indoor carbon dioxide impairs decision-making performance (phys.org)
• Elevated indoor carbon dioxide impairs decision-making performance (rdmag.com)
• Elevated indoor carbon dioxide impairs decision-making performance (sciencedaily.com)
• Claim: CO2 makes you stupid? Ask a submariner that question (wattsupwiththat.com)
• High CO2 Levels Indoors Impair Cognition (treehugger.com)

[Reblog] Use of patient decision aids may lead to “sharply lower hip/knee surgery rates & costs”

From the 4 September 2012 blog post at HealthNewsReview.org

4 COMMENTS

Photo credit: Cindy Funk via Flickr

A paper in Health Affairs (subscription required for access) shows what can be done with decision aids in clinical practice in what the authors describe as “the largest (observational study) to date of the implementation of patient decision aids in the context of quality improvement for elective surgery.”

A team from Group Health Cooperative in Seattle reports:

“Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12–21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients’ and physicians’ preferences, may reduce rates of elective surgery and lower costs.”

Group Health says it has distributed more decision aids than any other single health care organization in the world. More than 25,000 Group Health patients have received decision aids, and is now distributing at the rate of about 900 more each month.

It should also be noted that 5 years ago, Washington passed the first state legislation recognizing the use of patient decision aids and “shared decision making” as a higher standard of informed consent.

The study was funded by the Commonwealth Fund. The implementation of decision aids was funded in part by the Informed Medical Decisions Foundation, which has been the sole supporter of this website for its entire existence.  However, no one at that Foundation influences what I publish on this site.  First author Dr. David Arterburn has also reviewed stories for HealthNewsReview.org.

Related Resources

• Comparing Medical Treatments – guides for a number of diseases/conditions(US Agency for Healthcare Research and Quality)
• MedlinePlus – search by disease/condition
• eMedicine Health – search by disease/condition
• MayoClinic.gov -Diseases and Conditions

How Symptoms Are Presented Online Influence People’s Reactions To Possible Medical Conditions

From the 14 March 2012 article at Medical News Today

…Today, people are more likely to go online to punch in their symptoms.

Details of a new study examining how symptoms presented online influence people’s reactions to possible medical conditions will be presented in Psychological Science, a journal of the Association for Psychological Science. Researchers found that identifying symptoms in “streaks” – sequences of consecutive items on a list that are either general or specific – prompted people to perceive higher disease risk than symptoms that were not identified in an uninterrupted series. …

…A recent report by the Health Information National Trends Survey examined the use of Internet in seeking cancer-related information. More than 60 percent of individuals who are feeling ill go to the Internet to search for health information. Many decide to go to the doctor or not based on what they learn online,” Kwan said. “This is really an era of self-diagnosis. To our knowledge, our study is the first to examine the impact of online presentation formats on medical decision making.” ..

..”The length of the list matters,” Kwan said. “This is analogous to a dilution effect. If you don’t have that many symptoms, you may not experience concern about getting that disease if you’re looking at a long list.”

Medical implications of the study include insight into how symptoms may be presented online, depending on goals. For instance, if someone wants to increase awareness of an emerging medical issue that requires treatment, symptoms that are more likely to be checked off in sequence can be grouped together, Kwan said.

According to Votruba, “If there are concerns that the perceptions of disease risk are too high, possibly resulting in over utilization of health services, then symptom lists should alternate common and specific symptoms or create longer symptom lists.”

“Previous research shows that perception of risk of disease is a powerful predictor of health preventative behavior (such as going to the doctor),” Kwan said. “How information is presented online will make a substantive difference in behavior.”

Related articles

• New study examines how medical symptoms presented online makes a difference in health-care choices (eurekalert.org)

How algorithm driven medicine can affect patient care

How algorithm driven medicine can affect patient care

From the KevinMD article of  Mon Jan 30, 2012

 

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.

Let me explain. For most elective surgeries I give a single dose of antibiotics just before I cut. For elective colon surgery, the antibiotics are continued for 24 hours post-op. This is accepted standard of care. You don’t want to give antibiotics inappropriately or continue them indefinitely.

But what about a patient with gangrenous cholecystitis or acute appendicitis? What if, in my clinical judgment, I want to start the patient on antibiotics right away (i.e. several hours before anticipated incision time) and then continue them for greater than 24 hours post-op, depending on what the clinical status warrants? I should be able to do that right?

Well, you’d be surprised. You see, at two different, unaffiliated hospitals I cover, the surgeons have seen that decision-making capability removed from their power….

A family history of alcoholism may make adolescent brains respond differently

A family history of alcoholism may make adolescent brains respond differently

Excerpts from the press release

 

• Adolescents with a family history of alcoholism (FHP) are at risk for developing alcohol use disorders.
• A new study has compared the brain activity of FHP youth to peers with no family history of alcoholism.
• Two areas of the brain – the prefrontal cortex and cerebellum – responded differently during risky decision-making in high-risk youth compared to their lower-risk peers.

Researchers know that adolescents with a family history of alcoholism (FHP) are at risk for developing alcohol use disorders. Some studies have shown that, compared to their peers, FHP adolescents have deficits in behavioral inhibition. A study of the neural substrates of risk-taking in both FHP adolescents and their peers with a negative family history of alcoholism (FHN) has shown that FHP youth demonstrated atypical brain activity while completing the same task as the FHN youth.

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“We know that a familial history of alcoholism is a significant risk factor for future alcohol abuse,” said Bonnie J. Nagel, assistant professor of psychiatry and behavioral neuroscience at Oregon Health & Science University as well as corresponding author for the study. “We were interested in determining whether adolescents at heightened risk for alcohol use made more risky decisions during a laboratory task compared to their lower-risk peers. Additionally, we wanted to examine whether differences in brain responses when making risky decisions were present in these two groups. We wanted to investigate pre-morbid neural risk factors during decision making in FHP youth, as opposed to differences in brain response due to heavy alcohol use itself.”

“This is the first study to examine the neural substrates of risk-taking in FHP adolescents who are substance naïve,” ..

Read the entire press release here

Related articles

• A family history of alcoholism may make adolescent brains respond differently (medicalxpress.com)
• A Family History Of Alcoholism May Make Adolescent Brains Respond Differently (medicalnewstoday.com)
• Brains of Teens with Alcoholic Parents Are Different (livescience.com)
• National News: Risk attitude link to alcohol abuse (coventrytelegraph.net)
• Family History of Alcoholism May Affect Teens’ Decision-Making (alcoholselfhelpnews.wordpress.com)
• Teen brains exposed to alcoholism differ – United Press International (upi.com)
• Why Problem Drinking During Adolescence Is Never a ‘Phase’ (addictionts.com)
• If alcoholism runs in my family, am I at greater risk? (theglobeandmail.com)
• Adolescents’ brains respond differently than adults’ when anticipating rewards (eurekalert.org)

People Don’t Just Think with Their Guts; Logic Plays a Role Too

From the 29 December 2011 American Psychological Association press release

For decades, science has suggested that when people make decisions, they tend to ignore logic and go with the gut. But Wim De Neys, a psychological scientist at the University of Toulouse in France, has a new suggestion: Maybe thinking about logic is also intuitive. He writes about this idea in the January issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science.

Psychologists have partly based their conclusions about reasoning and decision-making on questions like this one:

“Bill is 34. He is intelligent, punctual but unimaginative and somewhat lifeless. In school, he was strong in mathematics but weak in social studies and humanities.

Which one of the following statements is most likely?

(a) Bill plays in a rock band for a hobby.

(b) Bill is an accountant and plays in a rock band for a hobby.”

Most people will let their stereotypes about accountants rule and pick (b). But, in fact, we have no idea what Bill does for a living—he could be a politician, a concert pianist, or a drug dealer—so it’s more likely that only one random possibility, the rock band, is true, than that both (a) and (b) would happen to be true.

This line of research has suggested that people don’t use logic when making decisions about the world. But the truth is more complicated, De Neys says. When most people read a question like the one above, there’s a sense that something isn’t quite right. “That feeling you have, that there’s something fishy about the problem—we have a wide range of ways to measure that conflict,” De Neys says. For example, he has shown with brain imaging that when people are thinking about this kind of problem, a part of their brain that deals with conflict is active. “They stick to their gut feeling and don’t do the logical thing, but they do sense that what they are doing is wrong,” De Neys says.

De Neys thinks this sense, that something isn’t quite right with the decision you’re making, comes from an intuitive sense of logic. Other scientists have found that children start thinking logically very early. In one study, 8-month-old babies were surprised if someone pulled mostly red balls out of a box that contained mostly white balls, proof that babies have an innate sense of probability before they can even talk. It makes sense, De Neys says, that this intuitive sense of logic would stick around in adults.

This research deals with the basics of how we think, but De Neys says it may help explain more complex decision-making. If you want to teach people to make better decisions, he says, “It’s important to know which component of the process is faulty.” For example, if you want to understand why people are smoking, and you think it’s because they don’t understand the logic—that smoking kills—you might put a lot of energy into explaining how smoking is bad for them, when the actual problem is addiction. It’s a long way from a question about Bill’s career to understanding something like why someone decides to get married, for example; but research like this should help,” De Neys says.

 

Related articles

• People don’t just think with their guts; logic plays a role too (esciencenews.com)
• Rely on your gut feeling (news.bioscholar.com)
• People don’t just think with their guts; logic plays a role too (eurekalert.org)
• People don’t just think with their guts; logic plays a role too (medicalxpress.com)

Elderly Can Be As Fast As Young In Some Brain Tasks

“If you look at aging research, you find some studies that show older people are not impaired in accuracy, but other studies that show that older people do suffer when it comes to speed.  What this model does is look at both together to reconcile the results.”

From a December 2011  Ohio State University news release 

COLUMBUS, Ohio – Both children and the elderly have slower response times when they have to make quick decisions in some settings.

But recent research suggests that much of that slower response is a conscious choice to emphasize accuracy over speed.

In fact, healthy older people can be trained to respond faster in some decision-making tasks without hurting their accuracy – meaning their cognitive skills in this area aren’t so different from younger adults.

Roger Ratcliff

“Many people think that it is just natural for older people’s brains to slow down as they age, but we’re finding that isn’t always true,” said Roger Ratcliff, professor of psychology at Ohio State University and co-author of the studies.

“At least in some situations, 70-year-olds may have response times similar to those of 25-year olds.”

Ratcliff and his colleagues have been studying cognitive processes and aging in their lab for about a decade.  In a new study published online this month in the journal Child Development, they extended their work to children.

Ratcliff said their results in children are what most scientists would have expected: very young children have slower response times and poorer accuracy compared to adults, and these improve as the children mature.

But the more interesting finding is that older adults don’t necessarily have slower brain processing than younger people, said Gail McKoon, professor of psychology at Ohio State and co-author of the studies.

“Older people don’t want to make any errors at all, and that causes them to slow down.  We found that it is difficult to get them out of the habit, but they can with practice,” McKoon said.

Researchers uncovered this surprising finding by using a model developed by Ratcliff that considers both the reaction time and the accuracy shown by participants in speeded tasks.  Most models only consider one of these variables.

“If you look at aging research, you find some studies that show older people are not impaired in accuracy, but other studies that show that older people do suffer when it comes to speed.  What this model does is look at both together to reconcile the results,” Ratcliff said.

Ratcliff, McKoon and their colleagues have used several of the same experiments in children, young adults and the elderly….

Read the entire press release

Related articles

• Elderly can be as fast as whippersnappers in some brain tasks (scienceblog.com)
• Elderly Can Be As Fast As Young In Some Brain Tasks (medicalnewstoday.com)
• Elderly Can Be As Fast As Young in Some Brain Tasks (neurosciencenews.com)
• 70 year olds can be as fast as 25 year olds in some brain tasks (tricitypsychology.com)
• Elderly can be as fast as young in some brain tasks, study shows (eurekalert.org)
• Aging Brains Match Youth in Some Mental Tasks (livescience.com)
• Elderly can be as fast as young in some brain tasks, study shows (sciencedaily.com)

How Happiness Impacts Choice

From the abstract at Full Text Reports

Consumers want to be happy, and marketers are increasingly trying to appeal to consumers’ pursuit of happiness. However, the results of six studies reveal that what happiness means varies, and consumers’ choices reflect those differences. In some cases happiness is defined as feeling excited, and in other cases happiness is defined as feeling calm. The type of happiness pursued is determined by one’s temporal focus, such that individuals tend to choose more exciting options when focused on the future, and more calming options when focused on the present moment. These results suggest that the definition of happiness, and consumers’ resulting choices, are dynamic and malleable.

 

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• What’s the meaning of happiness? (fiveminuteeconomist.wordpress.com)

Rat Study Sheds Light on How Alcohol Affects Young Brain

Rat Study Sheds Light on How Alcohol Affects Young Brain
Drinking at an early age may have long-lasting repercussions for decision-making, risk-taking

 

From the March 17 2011 Health Day news item by Robert Preidt

THURSDAY, March 17 (HealthDay News) — Based on the results of a new study conducted with rats, researchers say that kids who drink alcohol may have trouble with decision-making in adulthood.

Alcohol consumption during adolescence can change the perception of risk but does not affect how rewards are valued, the University of Washington researchers found.

The investigators studied decision-making in adult rats that had been given free access to alcohol when they were adolescents. The researchers measured changes in the neurotransmitter dopamine when the rats were offered rewards alone and also in response to cues predicting risky or certain outcomes.

“Dopamine is central to the way we process and evaluate rewards and is the primary target in the brain for virtually all abused drugs,” study author Jeremy J. Clark, an acting assistant professor of psychiatry and behavioral sciences, explained in a university news release.

In the rats, alcohol use during adolescence increased dopamine signaling to risky options but did not affect responses to rewards.

“Alcohol is corrupting the ability to make a good decision by altering the perception of risk. It doesn’t appear to be about the reward,” Clark said.

The study was published March 14 in the journal Proceedings of the National Academy of Sciences.***

***For suggestions on how to get this article for free or at low cost click here

 

 

 

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• No Tonic for Tension: Stress Drinking Linked to Early Alcohol Use (livescience.com)
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