364 research outputs found
Regulation, Renegotiation, and Reform: Improving Transnational Public-Private Partnerships in the Wake of the Gulf Oil Spill
Regulation, Renegotiation, and Reform: Improving Transnational Public-Private Partnerships in the Wake of the Gulf Oil Spill
The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK
This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests
Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany
Background
The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany.
Methods
Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions.
Results
Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice.
Conclusion
Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process
Adding a numerical description to civil standard of proof jury instructions : probabilistic evidence still defies correct liability assignment
49 leaves, 21 variously numbered leaves : colored illustrations ; 29 cmIncludes abstract and appendices.Includes bibliographical references (leaves 43-48).Responses from 67 law students were obtained using an online study
that presented a mock civil jury trial. Each participant was asked to determine liability. The study explores whether more correct assignment of liability occurs when the verbal “more probable than not” standard of proof is also quantified as a 51% probability, and when probabilistic evidence establishes a 70%, 51% or 50.01% likelihood of liability
Women and men with coronary heart disease in three countries : are they treated differently?
Non-medical determinants of medical decision making were investigated in an international research project in the US, in the UK and in Germany. The key question in this paper is whether and to what extent doctors' diagnostic and therapeutic decisions in coronary heart disease (CHD) are influenced by the patients' gender.
A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patient-actors of different sex, age, race and socio-economic status. The videotapes were presented to a randomly selected sample of 128 primary care physicians in each country. Using an interview with standardized and open-ended questions, physicians were asked how they would diagnose and treat such a patient after they had seen the video.
Results show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, a CHD was mentioned more often as a possible diagnosis for men than for women, and physicians were less certain about their diagnosis with female patients. Moreover, results indicate that gender differences in management decisions (therapy and lifestyle advice) are less pronounced and less consistent than in diagnostic decisions. Magnitude of gender effect on doctors' decisions varies between countries with smaller influences in the US.
Although patients with identical symptoms were presented, primary care doctors’ behavior differed by patients' gender in all three countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men
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A New Surrogate Variable for Erectile Dysfunction Status in the Massachusetts Male Aging Study
Erectile dysfunction (ED) is the subject of a vast clinical literature, but little information has been gathered from random samples of the general public. The Massachusetts Male Aging Study (MMAS) addressed this important aspect of men\u27s health. The MMAS was conducted in two waves, with baseline data collection in 1987–1989 and follow-up in 1995–1997. Subsequent to the baseline MMAS survey, a consensus developed that subjective measures are optimal for defining ED. Unfortunately, the baseline questionnaire did not ask subjects directly about their erectile functioning. Thus, we previously assigned the MMAS subjects a degree of impotence at baseline using a series of related questions, employing a discriminant formula constructed from a separate sample of urology clinic patients. At follow-up the men classified themselves directly in addition to answering the original series of related questions. In the present article, we report the results of a new discriminant function, based on the MMAS men at follow-up. We also compare the two methods and discuss our reasons for preferring the internally calibrated method
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Wavelet Decomposition of Forced Turbulence: Applicability of the Iterative Donoho-Johnstone Threshold
We examine the decomposition of forced Taylor-Green and Arn’old-Beltrami- Childress (ABC) flows into coherent and incoherent components using an orthonormal wavelet decomposition. We ask whether wavelet coefficient thresh- olding based on the Donoho-Johnstone criterion can extract a coherent vortex signal while leaving behind Gaussian random noise. We find that no threshold yields a strictly Gaussian incoherent component, and that the most Gaussian incoherent flow is found for data compression lower than that achieved with the fully iterated Donoho-Johnstone threshold. Moreover, even at such low compression, the incoherent component shows clear signs of large-scale spatial correlations that are signatures of the forcings used to drive the flows
Spatial aspects of the reproductive and feeding biology of the striped robber, Brycinus lateralis (Pisces: Characidae), in the Okavango Delta, Botswana
The Okavango Delta is a vast inland wetland system situated in northern Botswana. High rainfall is received in early summer in the southern Angolan highlands and throughout the Delta with the flood waters reaching the upper riverine floodplain between March and May where it percolates through to the lower drainage rivers between July and September. Aspects of the reproductive and feeding biology of two allopatric populations of the striped robber, Brycinus lateralis, a small characin species inhabiting the northern riverine floodplain and southern drainage rivers, were investigated. Both populations were similar in the biological aspects studied, with the flood cycle having little influence on the timing of reproduction, sexual maturity and dietary composition. Female fish from both populations matured sexually at 57mmSL, breeding over a protracted period during the warm, summer months. In both populations, the sex ratio was female-dominated at 4.8:1 (riverine floodplain) and 2.2:1 (drainage rivers). The striped robber is an opportunistic micro-carnivore with immature fish feeding predominantly on Daphnia spp. and adults being largely insectivorous
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