Creating a common trajectory: Shared decision making and distributed cognition in medical consultations

The growing literature on shared decision making and patient centered care emphasizes the patient’s role in clinical care, but research on clinical reasoning almost exclusively addresses physician cognition. In this article, we suggest clinical cognition is distributed between physicians and patients and assess how distributed clinical cognition functions during interactions between medical professionals and patients with Multiple Sclerosis (MS). A combination of cognitive task analysis and discourse analysis reveals the distribution of clinical reasoning between 24 patients and 3 medical professionals engaged in MS management. Findings suggest that cognition was distributed between patients and physicians in all major tasks except for the interpretation of MRI results. Otherwise, patients and physicians collaborated through discourse to develop a common trajectory to guide clinical reasoning. The patients’ role in clinical cognition expands the concept of patient-centered care and suggests the need to optimize physician-patient distributed cognition rather than physician cognition in isolation

Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training

Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

The Commonwealth Fund's Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths— there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, highquality health system

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these "underinsured" people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

The Arclight vs. traditional ophthalmoscope:a cross-over trial

BACKGROUND/OBJECTIVES: To compare skill acquisition of the new, cost-effective Arclight ophthalmoscope, with the traditional ophthalmoscope (TO), in medical students with no prior experience of ophthalmoscopy. SUBJECTS/METHODS: University of Dundee medical students took part in a cross-over trial. Students were divided into two groups and were alternately taught each device using a video tutorial. In period one, Group A was taught the TO first; Group B was taught the Arclight. They were then assessed using simulated objective, structured, clinical, examinations, examining four model heads with lettered fundal photographs of varying sizes of font. Groups crossed over following a 2-week washout period and were taught the second device and reassessed. A questionnaire was distributed to ascertain students’ opinions and preferences. RESULTS: Forty medical students participated. Overall, 92.5% of students performed better with the Arclight, irrespective of cross-over trial period. The mean difference in score in period one of the cross-over trial was 16.77 (95% CI: 11.63–21.93), with students performing better with the Arclight (p < 0.0001). The mean difference in score in period two was 8.02 (95% CI: 4.52–11.52), with students performing better with the Arclight (p < 0.0001). In addition, performance with the TO improved by 52.9% following initial exposure to the Arclight. The Arclight was the preferred device by 82.5% of students, and 82.5% of students would choose this device for future practice. CONCLUSION: Students performed better with and preferred the Arclight ophthalmoscope. The Arclight could be considered as a suitable alternative to the TO used for training medical students

Sex differences in mathematics and reading achievement are inversely related: within- and across-nation assessment of 10 years of PISA data

We analyzed one decade of data collected by the Programme for International Student Assessment (PISA), including the mathematics and reading performance of nearly 1.5 million 15 year olds in 75 countries. Across nations, boys scored higher than girls in mathematics, but lower than girls in reading. The sex difference in reading was three times as large as in mathematics. There was considerable variation in the extent of the sex differences between nations. There are countries without a sex difference in mathematics performance, and in some countries girls scored higher than boys. Boys scored lower in reading in all nations in all four PISA assessments (2000, 2003, 2006, 2009). Contrary to several previous studies, we found no evidence that the sex differences were related to nations’ gender equality indicators. Further, paradoxically, sex differences in mathematics were consistently and strongly inversely correlated with sex differences in reading: Countries with a smaller sex difference in mathematics had a larger sex difference in reading and vice versa. We demonstrate that this was not merely a between-nation, but also a within-nation effect. This effect is related to relative changes in these sex differences across the performance continuum: We did not find a sex difference in mathematics among the lowest performing students, but this is where the sex difference in reading was largest. In contrast, the sex difference in mathematics was largest among the higher performing students, and this is where the sex difference in reading was smallest. The implication is that if policy makers decide that changes in these sex differences are desired, different approaches will be needed to achieve this for reading and mathematics. Interventions that focus on high-achieving girls in mathematics and on low achieving boys in reading are likely to yield the strongest educational benefits

GRAVITY: the Calibration Unit

We present in this paper the design and characterisation of a new sub-system of the VLTI 2nd generation instrument GRAVITY: the Calibration Unit. The Calibration Unit provides all functions to test and calibrate the beam combiner instrument: it creates two artificial stars on four beams, and dispose of four delay lines with an internal metrology. It also includes artificial stars for the tip-tilt and pupil guiding systems, as well as four metrology pick-up diodes, for tests and calibration of the corresponding sub-systems. The calibration unit also hosts the reference targets to align GRAVITY to the VLTI, and the safety shutters to avoid the metrology light to propagate in the VLTI-lab. We present the results of the characterisation and validtion of these differrent sub-units.Comment: 12 pages, 11 figures. Proceeding of SPIE 9146 "Optical and Infrared Interferometry IV

The GRAVITY metrology system: modeling a metrology in optical fibers

GRAVITY is the second generation VLT Interferometer (VLTI) instrument for high-precision narrow-angle astrometry and phase-referenced interferometric imaging. The laser metrology system of GRAVITY is at the heart of its astrometric mode, which must measure the distance of 2 stars with a precision of 10 micro-arcseconds. This means the metrology has to measure the optical path difference between the two beam combiners of GRAVITY to a level of 5 nm. The metrology design presents some non-common paths that have consequently to be stable at a level of 1 nm. Otherwise they would impact the performance of GRAVITY. The various tests we made in the past on the prototype give us hints on the components responsible for this error, and on their respective contribution to the total error. It is however difficult to assess their exact origin from only OPD measurements, and therefore, to propose a solution to this problem. In this paper, we present the results of a semi-empirical modeling of the fibered metrology system, relying on theoretical basis, as well as on characterisations of key components. The modeling of the metrology system regarding various effects, e.g., temperature, waveguide heating or mechanical stress, will help us to understand how the metrology behave. The goals of this modeling are to 1) model the test set-ups and reproduce the measurements (as a validation of the modeling), 2) determine the origin of the non-common path errors, and 3) propose modifications to the current metrology design to reach the required 1nm stability.Comment: 20 pages, 19 figures. Proceeding of SPIE 9146 "Optical and Infrared Interferometry IV

Promotion of a neurosurgical academic journal on social media: a 1-year experience

BACKGROUND Social media (SoMe) use, in all of its forms, has seen massively increased throughout the past two decades, including academic publishing. Many journals have established a SoMe presence, yet the influence of promotion of scientific publications on their visibility and impact remains poorly studied. The European Journal of Neurosurgery «Acta Neurochirurgica» has established its SoMe presence in form of a Twitter account that regularly promotes its publications. We aim to analyze the impact of this initial SoMe campaign on various alternative metrics (altmetrics). METHODS A retrospective analysis of all articles published in the journal Acta Neurochirurgica between May 1st, 2018, and April 30th, 2020, was performed. These articles were divided into a historical control group - containing the articles published between May 1st, 2018, and April 30th, 2019, when the SoMe campaign was not yet established - and into an intervention group. Several altmetrics were analyzed, along with website visits and PDF downloads per month. RESULTS In total, 784 articles published during the study period, 128 (16.3%) were promoted via Twitter. During the promotion period, 29.7% of published articles were promoted. Overall, the published articles reached a mean of 31.3 ± 50.5 website visits and 17.5 ± 31.25 PDF downloads per month. Comparing the two study periods, no statistically significant differences in website visits (26.91 ± 32.87 vs. 34.90 ± 61.08, p = 0.189) and PDF downloads (17.52 ± 31.25 vs. 15.33 ± 16.07, p = 0.276) were detected. However, overall compared to non-promoted articles, promoted articles were visited (48.9 ± 95.0 vs. 29.0 ± 37.0, p = 0.005) and downloaded significantly more (25.7 ± 66.7 vs. 16.6 ± 18.0, p = 0.045) when compared to those who were not promoted during the promotion period. CONCLUSIONS We report a 1-year initial experience with promotion of a general neurosurgical journal on Twitter. Our data suggest a clear benefit of promotion on article site visits and article downloads, although no single responsible element could be determined in terms of altmetrics. The impact of SoMe promotion on other metrics, including traditional bibliometrics such as citations and journal impact factor, remains to be determined