Predecisional information distortion in physicians’ diagnostic judgments: Strengthening a leading hypothesis or weakening its competitor?

© 2014.Decision makers have been found to bias their interpretation of incoming information to support an emerging judgment (predecisional information distortion). This is a robust finding in human judgment, and was recently also established and measured in physicians’ diagnostic judgments (Kostopoulou et al. 2012). The two studies reported here extend this work by addressing the constituent modes of distortion in physicians. Specifically, we studied whether and to what extent physicians distort information to strengthen their leading diagnosis and/or to weaken a competing diagnosis. We used the “stepwise evolution of preference” method with three clinical scenarios, and measured distortion on separate rating scales, one for each of the two competing diagnoses per scenario.In Study 1, distortion in an experimental group was measured against the responses of a separate control group. In Study 2, distortion in a new experimental group was measured against participants’ own, personal responses provided under control conditions, with the two response conditions separated by amonth. The two studies produced consistent results. On average, we found considerable distortion of information to weaken the trailing diagnosis but little distortion to strengthen the leading diagnosis. We also found individual differences in the tendency to engage in either mode of distortion. Given that two recent studies found both modes of distortion in lay preference (Blanchard, Carlson & Meloy, 2014; DeKay, Miller, Schley & Erford, 2014), we suggest that predecisional information distortion is affected by participant and task characteristics. Our findings contribute to the growing research on the different modes of predecisional distortion and their stability to methodological variation

How the UK public views the use of diagnostic decision aids by physicians: a vignette-based experiment

Objective: Physicians’ low adoption of diagnostic decision aids (DDAs) may be partially due to concerns about patient/public perceptions. We investigated how the UK public views DDA use and factors affecting perceptions. Materials and Methods: In this online experiment, 730 UK adults were asked to imagine attending a medical appointment where the doctor used a computerized DDA. The DDA recommended a test to rule out serious disease. We varied the test’s invasiveness, the doctor’s adherence to DDA advice, and the severity of the patient’s disease. Before disease severity was revealed, respondents indicated how worried they felt. Both before [t1] and after [t2] severity was revealed, we measured satisfaction with the consultation, likelihood of recommending the doctor, and suggested frequency of DDA use. Results: At both timepoints, satisfaction and likelihood of recommending the doctor increased when the doctor adhered to DDA advice (P ≤ .01), and when the DDA suggested an invasive versus noninvasive test (P ≤ .05). The effect of adherence to DDA advice was stronger when participants were worried (P ≤ .05), and the disease turned out to be serious (P ≤ .01). Most respondents felt that DDAs should be used by doctors “sparingly” (34%[t1]/29%[t2]), “frequently,” (43%[t1]/43%[t2]) or “always” (17%[t1]/21%[t2]). Discussion: People are more satisfied when doctors adhere to DDA advice, especially when worried, and when it helps to spot serious disease. Having to undergo an invasive test does not appear to dampen satisfaction. Conclusion: Positive attitudes regarding DDA use and satisfaction with doctors adhering to DDA advice could encourage greater use of DDAs in consultations

The Role of Physicians’ First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms

Background. First impressions are thought to exert a disproportionate influence on subsequent judgments; however, their role in medical diagnosis has not been systematically studied. We aimed to elicit and measure the association between first impressions and subsequent diagnoses in common presentations with subtle indications of cancer. Methods. Ninety UK family physicians conducted interactive simulated consultations online, while on the phone with a researcher. They saw 6 patient cases, 3 of which could be cancers. Each cancer case included 2 consultations, whereby each patient consulted again with nonimproving and some new symptoms. After reading an introduction (patient description and presenting problem), physicians could request more information, which the researcher displayed online. In 2 of the possible cancers, physicians thought aloud. Two raters coded independently the physicians’ first utterances (after reading the introduction but before requesting more information) as either acknowledging the possibility of cancer or not. We measured the association of these first impressions with the final diagnoses and management decisions. Results. The raters coded 297 verbalizations with high interrater agreement (Kappa = 0.89). When the possibility of cancer was initially verbalized, the odds of subsequently diagnosing it were on average 5 times higher (odds ratio 4.90 [95% CI 2.72 to 8.84], P &lt; 0.001), while the odds of appropriate referral doubled (OR 1.98 [1.10 to 3.57], P = 0.002). The number of cancer-related questions physicians asked mediated the relationship between first impressions and subsequent diagnosis, explaining 29% of the total effect. Conclusion. We measured a strong association between family physicians’ first diagnostic impressions and subsequent diagnoses and decisions. We suggest that interventions to influence and support the diagnostic process should target its early stage of hypothesis generation. </jats:p

Spatio-temporal patterns of recent and future climate extremes in the eastern Mediterranean and Middle East region

Recent and future changes in temperature and precipitation climate extremes are estimated using the Hadley Centre PRECIS ("Providing REgional Climates for Impacts Studies") climate model for the eastern Mediterranean and Middle East region. The area of interest is considered vulnerable to extreme climate events as there is evidence for a temperature rise while precipitation tends to decline, suggesting likely effects on vital socioeconomic sectors in the region. Observations have been obtained for the recent period (1961–1990) and used to evaluate the model output. The spatial distribution of recent temporal trends in temperature indicates strong increasing in minimum temperature over the eastern Balkan Peninsula, Turkey and the Arabian Peninsula. The rate of warming reaches 0.4–0.5 °C decade⁻¹ in a large part of the domain, while warming is expected to be strongest in summer (0.6–0.7 °C decade⁻¹) in the eastern Balkans and western Turkey. The trends in annual and summer maximum temperature are estimated at approximately 0.5 and 0.6 °C decade⁻¹ respectively. Recent estimates do not indicate statistically significant trends in precipitation except for individual sub-regions. Results indicate a future warming trend for the study area over the last 30 years of the 21st century. Trends are estimated to be positive and statistically significant in nearly the entire region. The annual trend patterns for both minimum and maximum temperature show warming rates of approximately 0.4–0.6 °C decade⁻¹, with pronounced warming over the Middle Eastern countries. Summer temperatures reveal a gradual warming (0.5–0.9 °C decade⁻¹) over much of the region. The model projects drying trends by 5–30% in annual precipitation towards the end of the 21st century, with the number of wet days decreasing at the rate of 10–30 days year⁻¹, while heavy precipitation is likely to decrease in the high-elevation areas by 15 days year⁻¹

Synergistic Effect of Selenium Addition and Water Stress on Melilotus officinalis L. Mineral Content

The objective of this study was to examine the combined effects of selenium (Se) enrichment and water stress on the accumulation of available macro- and micronutrients in Melilotus officinalis L. aerial parts. Plants of M. officinalis were subjected to three levels of Se addition (0, 1 and 3 mg Se L-1 water) and to two water treatments: a) full irrigation and b) limited irrigation (water stress). The above ground biomass (stems and leaves) was analyzed for Se, potassium (K), sodium (Na), magnesium (Mg), iron (Fe), copper (Cu), calcium (Ca), manganese (Mn) and zinc (Zn). Se addition differentially affected the K, Mg and Ca content of M. officinalis aerial parts, while it led to the reduction of the micronutrients Cu, Fe and Mn. Water stress resulted in the increase of K, Na, Mg, Ca and Cu, and to the decrease of the Fe, Zn and Mn content. An interaction between selenium addition and water treatment was more notable for Ca and Mg, which decreased under water stress at low Se level and for Zn and Cu, which increased under water stress at high Se level. According to our findings, Se-induced increased accumulation of some inorganic ions in the aerial parts of this species under water stress conditions could serve as a means to alleviate the adverse impact of water deficit on important metabolic processes, enhancing M. officinalis tolerance to water stress

Online experiment comparing GPs’ antibiotic prescribing decisions to a clinical prediction rule

Background: The“STARWAVe” clinical prediction rule (CPR) uses seven factors to guide risk assessment and antibiotic prescribing in children with cough (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting). Aim: To assess the influence of STARWAVe factors on General Practitioners’ (GPs) unaided risk assessments and prescribing decisions. We also explored two methods of obtaining risk assessments and tested the impact of parental concern. Design and setting: Experiment comprising clinical vignettes administered to 188 UK GPs online. Method: GPs were randomly assigned to view 32 (of 64) vignettes depicting children with cough. Vignettes varied the STARWAVe factors systematically. Per vignette, GPs assessed risk of deterioration in one of two ways (sliding scale vs. risk category selection) and indicated whether they would prescribe antibiotics. Finally, they saw an additional vignette, suggesting that the parent was concerned. Using mixed-effects regressions, we measured the influence of STARWAVe factors, risk elicitation method, and parental concern on GPs' assessments and decisions. Results: Six STARWAVe risk factors correctly increased GPs’ risk assessments (bssliding-scale0.66, ORscategory-selection1.61, ps0.001) while one incorrectly reduced them (short duration: bsliding-scale=-0.31, ORcategory-selection=0.75, ps0.039). Conversely, one STARWAVe factor increased prescribing odds (fever: OR=5.22, p<0.001) while the rest either reduced them (short duration, age, recession: ORs0.70, ps<0.001) or had no significant impact (wheeze, asthma, vomiting: ps0.065). Parental concern increased risk assessments (bsliding-scale=1.29, ORcategory-selection=2.82, ps0.003) but not prescribing (p=0.378). Conclusion: GPs use some, but not all, STARWAVe factors when making unaided risk assessments and prescribing decisions. Such discrepancies must be considered when introducing CPRs to clinical practice

Spatial variability of precipitation regimes over Turkey

Turkish annual precipitation regimes are analysed to provide large-scale perspective and redefine precipitation regions. Monthly total precipitation data are employed for 107 stations (1963–2002). Precipitation regime shape (seasonality) and magnitude (size) are classified using a novel multivariate methodology. Six shape and five magnitude classes are identified, which exhibit clear spatial structure. A composite (shape and magnitude) regime classification reveals dominant controls on spatial variability of precipitation. Intra-annual timing and magnitude of precipitation is highly variable due to seasonal shifts in Polar and Subtropical zones and physiographic factors. Nonetheless, the classification methodology is shown to be a powerful tool that identifies physically-interpretable precipitation regions: (1) coastal regimes for Marmara, coastal Aegean, Mediterranean and Black Sea; (2) transitional regimes in continental Aegean and Southeast Anatolia; and (3) inland regimes across central and Eastern Anatolia. This research has practical implications for understanding water resources, which are under ever growing pressure in Turkey

Sedimentation processes and palaeographic evolution of Makrilia Pliocene deposits, SE Crete.

Η λεπτομερής ιζηματολογική ανάλυση των αποθέσεων της τομής Μακρυλιά, έδειξε την ύπαρξη τουλάχιστον 5 κύκλων ιζηματογένεσης με αυξανόμενο προς τα πάνω κοκκομετρικό μέγεθος που αναπτύχτηκαν σε ένα περιβάλλον υφαλοκρηπίδας. Η κύρια λιθολογία είναι αμμούχος πηλός και τα ιζήματα μεταφέρθηκαν ως ομογενές αιώρημα. Το ποσοστό του ανθρακικού ασβεστίου είναι χαμηλό και τείνει αυξανόμενο προς τα πιο αδρομερή κλάσματα. Οι μετρήσεις του οργανικού υλικού έδειξε την παρουσία αρκετών δειγμάτων με αυξημένο οργανικό υλικό προτείνοντας την ύπαρξη εν δυνάμει μητρικών πετρωμάτων για την γένεση υδρογονανθράκων. Η σχέση μεταξύ του ανθρακικού ασβεστίου και οργανικού υλικού είναι κύρια αρνητική προτείνοντας ανοξικές συνθήκες. Η βιοστρωματογραφική ανάλυση έδειξε Πλειοκαινική ηλικία των ιζημάτων που αποτέθηκαν σε εναλλασσόμενες οξικές – ανοξικές συνθήκες. Από τα παραπάνω αποτελέσματα και περνώντας υπόψη τα υπάρχοντα αποτελέσματα τωνιζημάτων που περιβάλλουν την περιοχή μελέτης φαίνεται πως οι μελετηθείσες αποθέσεις συγκεντρώθηκαν σε μια ρηχή με ήσυχα νερά ενδο-ορεινή λεκάνη στα περιθώρια της κύριας λεκάνης της Ιεράπετρας.Detailed sedimentological analysis in Makrylia cross-section deposits showed at least five coarsening-upward cycles that were developed in a shelf environment. The main lithology is sandy silt and the sediments were transported as homogenous suspension in a low energy environment that deposited in a shallow water basin. The content of calcium carbonate (CaCO3) is low and tends to increase to the coarsegrained clasts. Organic carbon (TOC) measurements showed the presence of many samples with high content in TOC suggesting potential hydrocarbon source rocks. There is mostly a negative correlation between CaCO3 and TOC introducing generally anoxic conditions. Biostratigraphic analysis showed that the studied deposits are of Pliocene age that were precipitated in alternating conditions of oxic- anoxic events. According to the above results and taking into account previous results from the surrounding sediments it seems that the studied deposits accumulated in a shallow, low energy, intra-mountain basin at the margins of the main Ierapetra basin