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Cognitive decision making

Jason W Beckstead
BACKGROUND: Brunswik's Lens Model and lens model equation (LME) have been applied extensively in medical decision making. Clinicians often face the dual challenge of formulating a judgment of patient risk for some adverse outcome and making a yes or no decision regarding a particular risk-reducing treatment option. OBJECTIVE: In this article, I examine the correlation between clinical risk judgments and treatment-related decisions, referring to this linkage as "cohesion"...
October 20, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Charlotte L Allan, Sophie Behrman, Nina Baruch, Klaus P Ebmeier
Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents...
October 20, 2016: Evidence-based Mental Health
Sanath Allampati, Kevin D Mullen
Hepatic Encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision making and prolonged reaction time to coma in its most severe form1. The very initial stages, recently termed covert Hepatic Encephalopathy (CHE), can only be diagnosed with the help of neuropsychiatric testing while the later and more severe forms, termed overt Hepatic Encephalopathy (OHE), can be diagnosed clinically. Severity of HE is graded based on West Haven Criteria and please refer to table 1 for more details2...
October 20, 2016: Minerva Gastroenterologica e Dietologica
Daphne E Whitmer, Valerie K Sims, Michael E Torres
OBJECTIVE: The goals of this study were to assess the risk identification aspect of mental models using standard elicitation methods and how university campus alerts were related to these mental models. BACKGROUND: People fail to follow protective action recommendations in emergency warnings. Past research has yet to examine cognitive processes that influence emergency decision-making. METHOD: Study 1 examined 2 years of emergency alerts distributed by a large southeastern university...
October 19, 2016: Human Factors
Rosemary Fama, Edith V Sullivan, Stephanie A Sassoon, Adolf Pfefferbaum, Natalie M Zahr
BACKGROUND: Executive functioning and episodic memory impairment occur in HIV infection (HIV) and chronic alcoholism (ALC). Comorbidity of these conditions (HIV + ALC) is prevalent and heightens risk of vulnerability to separate and compounded deficits. Age and disease-related variables can also serve as mediators of cognitive impairment and should be considered, given the extended longevity of HIV-infected individuals in this era of improved pharmacological therapy. METHODS: HIV, ALC, HIV + ALC, and normal controls (NC) were administered traditional and computerized tests of executive function and episodic memory...
October 19, 2016: Alcoholism, Clinical and Experimental Research
Daniel Hausmann, Cristina Zulian, Edouard Battegay, Lukas Zimmerli
BACKGROUND: Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient's condition. OBJECTIVE: The principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]). METHODS: The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings...
October 18, 2016: BMC Medical Informatics and Decision Making
Benjamin Margolin Rottman
Whether humans can accurately make decisions in line with Bayes' rule has been one of the most important yet contentious topics in cognitive psychology. Though a number of paradigms have been used for studying Bayesian updating, rarely have subjects been allowed to use their own preexisting beliefs about the prior and the likelihood. A study is reported in which physicians judged the posttest probability of a diagnosis for a patient vignette after receiving a test result, and the physicians' posttest judgments were compared to the normative posttest calculated from their own beliefs in the sensitivity and false positive rate of the test (likelihood ratio) and prior probability of the diagnosis...
October 17, 2016: Memory & Cognition
Manavi Tyagi, Theodora Fteropoulli, Catherine S Hurt, Shashivadan P Hirani, Lorna Rixon, Anna Davies, Nathalie Picaut, Fiona Kennedy, John Deanfield, Shay Cullen, Stanton P Newman
OBJECTIVE: We carried out a cross-sectional study to assess cognitive function in a sample of adult CHD patients, within the Functioning in Adult Congenital Heart Disease study London. The association between cognitive functioning and disease complexity was examined. METHODS: A total of 310 patients participated in this study. Patients were classified into four structural complexity groups - tetralogy of Fallot, transposition of the great arteries, single ventricle, and simple conditions...
October 18, 2016: Cardiology in the Young
Bhim Mani Adhikari, Martin Norgaard, Kristen M Quinn, Jenine Ampudia, Justin Squirek, Mukesh Dhamala
Musical improvisation offers an excellent experimental paradigm for the study of real-time human creativity. It involves moment-to-moment decision-making, monitoring of one's performance, and utilizing external feedback to spontaneously create new melodies or variations on a melody. Recent neuroimaging studies have begun to study the brain activity during musical improvisation, aiming to unlock the mystery of human creativity. What brain resources come together and how these are utilized during musical improvisation is not well understood...
October 18, 2016: Brain Connectivity
Jason K Hou, Christoph Gasche, Noam Z Drazin, Sarah Alandra Weaver, Orna G Ehrlich, Ridhima Oberai, Sophie Zapala, Corey A Siegel, Gil Melmed
BACKGROUND: Anemia is a common complication among patients with inflammatory bowel diseases (IBD) and is associated with high rates of IBD-related complications, resource utilization, and impaired quality of life. Despite practice guidelines for anemia in patients with IBD, gaps remain in the perceptions of anemia among health care providers. The aims of this study were to identify gaps in care and to develop a care pathway for anemia in patients with IBD. METHODS: The Crohn's & Colitis Foundation of America anemia care pathway was developed by a committee using principles of cognitive task analysis...
September 30, 2016: Inflammatory Bowel Diseases
Douglas MacKay, Alexandra Robinson
Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is morally problematic...
November 2016: American Journal of Bioethics: AJOB
M Raj, S W Choi, J Platt
Informed consent (IC) struggles to meet the ethical principles it strives to embody in the context of hematopoietic cell transplantation (HCT). Patients often participate in multiple clinical trials making it difficult to effectively inform the participants and fulfill complex regulations. The recent Notice of Proposed Rule Making would make major changes to federal requirements, providing a timely opportunity to evaluate existing practice. Twenty health care professionals within a Midwest Academic Medical Center involved in obtaining IC in the HCT clinic or involved in patient care during or after the IC process were interviewed to understand: (1) how they approached the IC process; (2) how they described a 'successful' IC process; and (3) opportunities for innovation...
October 17, 2016: Bone Marrow Transplantation
Miranda C Staples, Chitra D Mandyam
Alcohol use disorder currently affects approximately 18 million Americans, with at least half of these individuals having significant cognitive impairments subsequent to their chronic alcohol use. This is most widely apparent as frontal cortex-dependent cognitive dysfunction, where executive function and decision-making are severely compromised, as well as hippocampus-dependent cognitive dysfunction, where contextual and temporal reasoning are negatively impacted. This review discusses the relevant clinical literature to support the theory that cognitive recovery in tasks dependent on the prefrontal cortex and hippocampus is temporally different across extended periods of abstinence from alcohol...
2016: Frontiers in Psychiatry
Robert F Kushner
Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling...
November 2016: Medical Clinics of North America
Conxa Perpiñá, Mara Segura, Sergio Sánchez-Reales
OBJECTIVE: The aim of the present study was to compare decision-making and cognitive flexibility in patients with disordered eating and weight, ranging from anorexia nervosa to obesity, and a healthy group. METHOD: Participants were 113 patients (86 with eating disorders and 27 with obesity), and a group of 39 healthy subjects; all completed the Iowa gambling task, the Wisconsin Card Sorting Test and several clinical self-report measures. RESULTS: Eating disordered and obese patients showed impaired performance on the decision-making task, and the obese group showed the worst performance on the set-shifting task...
October 15, 2016: Eating and Weight Disorders: EWD
Antti J Luikku, Anette Hall, Ossi Nerg, Anne M Koivisto, Mikko Hiltunen, Seppo Helisalmi, Sanna-Kaisa Herukka, Anna Sutela, Maria Kojoukhova, Jussi Mattila, Jyrki Lötjönen, Jaana Rummukainen, Irina Alafuzoff, Juha E Jääskeläinen, Anne M Remes, Hilkka Soininen, Ville Leinonen
OBJECTIVES: Optimal selection of idiopathic normal pressure hydrocephalus (iNPH) patients for shunt surgery is challenging. Disease State Index (DSI) is a statistical method that merges multimodal data to assist clinical decision-making. It has previously been shown to be useful in predicting progression in mild cognitive impairment and differentiating Alzheimer's disease (AD) and frontotemporal dementia. In this study, we use the DSI method to predict shunt surgery response for patients with iNPH...
October 14, 2016: Acta Neurochirurgica
Martin Knapp, Derek King, Renée Romeo, Jessica Adams, Ashley Baldwin, Clive Ballard, Sube Banerjee, Robert Barber, Peter Bentham, Richard G Brown, Alistair Burns, Tom Dening, David Findlay, Clive Holmes, Tony Johnson, Robert Jones, Cornelius Katona, James Lindesay, Ajay Macharouthu, Ian McKeith, Rupert McShane, John T O'Brien, Patrick P J Phillips, Bart Sheehan, Robert Howard
OBJECTIVE: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. METHODS: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial...
October 13, 2016: International Journal of Geriatric Psychiatry
Robin S Mickelson, Kim M Unertl, Richard J Holden
BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts...
October 12, 2016: JMIR Human Factors
Angelo Pirrone, Abigail Dickinson, Rosanna Gomez, Tom Stafford, Elizabeth Milne
Objective: Two-alternative forced-choice tasks are widely used to gain insight into specific areas of enhancement or impairment in individuals with autism spectrum disorder (ASD). Data arising from these tasks have been used to support myriad theories regarding the integrity, or otherwise, of particular brain areas or cognitive processes in ASD. The drift diffusion model (DDM) provides an account of the underlying processes which give rise to accuracy and reaction time (RT) distributions, and parameterizes these processes in terms which have direct psychological interpretation...
October 10, 2016: Neuropsychology
Oliver Mauthner, Veerle Claes, Jeremy Walston, Sandra Engberg, Isabelle Binet, Michael Dickenmann, Déla Golshayan, Karine Hadaya, Uyen Huynh-Do, Stefano Calciolari, Sabina De Geest
AIM: To present the rationale, design and methodology of the GERAS project, which examines whether assessment of frailty and mild cognitive impairment could enhance risk prediction for biomedical, psychosocial outcomes and foster efficient resource allocation in kidney transplantation. BACKGROUND: For the burgeoning cohort of older patients considered for kidney transplantation, evidence gaps regarding frailty and mild cognitive impairment limit clinical decision-making and medical management...
October 12, 2016: Journal of Advanced Nursing
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