Decision-making Instrument Research Articles

Learning by doing: To explore the influence of Simulation on Clinical Decision-Making Approaches on Final Year Medical Students at the University of Duisburg-Essen, Germany.

This article was migrated. The article was marked as recommended. Background: Final year medical students at the University Duisburg-Essen, Germany, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. A competency based medical curriculum determines that clinical judgement is an essential tool in effective patient care, patient safety and limiting clinical error. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices show specific factors, which are typical in inexperienced clinicians. Simulation provides opportunities in a competency-based medical education curriculum. There is limited evidence showing that simulation can provide an effective environment for teaching and learning clinical decision-making skills. This project explores how final year medical students at the University of Duisburg-Essen approach the clinical decision-making process as well as how simulation influences this process. Methods: Ethics approval was obtained from the local ethics committee. After completing a 10-week simulation course,thirty-five students completed a clinical decision-making instrument to categorise their clinical decision-making approaches. The Novice Decision Making Model and the Cognitive Continuum Model were combined with learning theories in Simulation (Social Cognitive Theory) and used to explore and interpret data collected through questionnaires, interviews and observation. Results: The majority (60%) of students employed a predominantly analytic approach, some students showed intuitive tendencies in clinical situations. During interviews students displayed typical novice approaches to decision-making and expressed positive comments relating to simulation. Conclusions: Simulation presents an opportunity for teaching and learning clinical decision-making. Results show the need for further inquiry into learning clinical decision-making through simulation. This research provides initial evidence that simulation can be incorporated into curricular teaching of clinical decision-making.

Swarm Intelligence Optimization: An Exploration and Application of Machine Learning Technology

Abstract In the agriculture development and growth, the efficient machinery and equipment plays an important role. Various research studies are involved in the implementation of the research and patents to aid the smart agriculture and authors and reviewers that machine leaning technologies are providing the best support for this growth. To explore machine learning technology and machine learning algorithms, the most of the applications are studied based on the swarm intelligence optimization. An optimized V3CFOA-RF model is built through V3CFOA. The algorithm is tested in the data set collected concerning rice pests, later analyzed and compared in detail with other existing algorithms. The research result shows that the model and algorithm proposed are not only more accurate in recognition and prediction, but also solve the time lagging problem to a degree. The model and algorithm helped realize a higher accuracy in crop pest prediction, which ensures a more stable and higher output of rice. Thus they can be employed as an important decision-making instrument in the agricultural production sector.

Designing animated pictorial instructions: A methodology proposed for the Open University of the Unified Health System in Brazil (UNA-SUS/UFMA)

Animated pictorial instructions are effective resources for learning medical content (e.g., surgical procedures). Considering this, the Open University of the Unified Health System of the Federal University of Maranhão (UNA-SUS/UFMA) in Brazil employs animation in their distance learning courses. From 2009 to the present the UNA-SUS/UFMA has offered 48 e-courses to health professionals, reaching around 470,000 enrolments. The development of animated instructions at UNA-SUS/UFMA considers medical and pedagogical knowledge only, lacking information design expertise to reach communication effectiveness. Thus, a design methodology was proposed based on: (a) the results of an analytical study of 100 medical animations; (b) the outcomes of a context analysis of the UNA-SUS/UFMA design process through interviews with the heads of the educational production departments; and (c) the results of an online questionnaire with 1,735 health professionals. The methodology consists of three phases: (1) Structuring: identification and arrangement of different contents (introductory content, inventory information, steps, warnings), resulting in an animation script; (2) Representation: definition of the animation graphic appearance and technological resources (e.g., pictorial style, camera framing, interaction cues), resulting in a visual storyboard or mock-up/prototype that can be tested with users (e.g., comprehension, usability tests); and (3) Finalization: programming and production of the animation. For each phase, instruments/protocols were developed to aid decision-making (form, guidelines and checklist). To evaluate the methodology, a focus group was conducted with the animation stakeholders/developers of the UNA-SUS/UFMA. The results were positive, but suggestions were made to improve the decision-making instruments, which were considered in the methodology final design.

Critical care nurses' critical thinking and decision making related to pain management

ObjectivesThe current study aimed to examine nurses’ critical thinking and decision-making skills related to pain management and their association with nurses’ characteristics. Research methodology/designThis descriptive correlational study used a convenience sample of 115 critical care nurses working in a university hospital in Jordan. Data were collected using a pain-related vignette and validated questionnaires. Main outcome measuresThe Critical Thinking Self-Assessment Scale and the Nursing Decision-Making Instrument were used to measure the nurses’ critical thinking and decision-making skills, respectively. As a secondary outcome measure, data regarding the sociodemographic/professional characteristics of the participants, including gender, marital status, experience, education and work environment, were collected. ResultThe participating nurses reported poor critical thinking and intuitive decision-making skills related to pain management. Nurses with more clinical experience and higher levels of education reported significantly better critical thinking and intuitive decision-making skills than less experienced and less educated nurses. Nurses with intuitive decision-making modes reported significantly better levels of critical thinking than nurses with analytical or flexible analytical-intuitive decision-making modes. ConclusionCritical care nurses were found to have ineffective critical thinking and intuitive decision-making skills related to pain management, which may lead to poor patient outcomes. Gaining more in-depth understanding of nurses’ critical thinking and decision-making skills and their associated factors is crucial for achieving effective pain management in critical care settings.

Effect of a multilevel implementation programme on shared decision-making in breast cancer care.

Women with newly diagnosed breast cancer face multiple treatment options. Involving them in a shared decision-making (SDM) process is essential. The aim of this study was to evaluate whether a multilevel implementation programme enhanced the level of SDM behaviour of clinicians observed in consultations. This before-after study was conducted in six Dutch hospitals. Patients with breast cancer who were facing a decision on surgery or neoadjuvant systemic treatment between April 2016 and September 2017 were included, and provided informed consent. Audio recordings of consultations made before and after implementation were analysed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to assess whether clinicians adopted new behaviour needed for applying SDM. Patients scored their perceived level of SDM, using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Hospital, duration of the consultation(s), age, and number of consultations per patient that might influence OPTION-5 scores were investigated using linear regression analysis. Consultations of 139 patients were audiotaped, including 80 before and 59 after implementation. Mean (s.d.) OPTION-5 scores, expressed on a 0-100 scale, increased from 38.3 (15.0) at baseline to 53.2 (14.8) 1year after implementation (mean difference (MD) 14.9, 95 per cent c.i. 9.9 to 19.9). SDM-Q-9 scores of 105 patients (75.5 per cent) (72 before and 33 after implementation) were high and showed no significant changes (91.3 versus 87.6; MD -3.7, -9.3 to 1.9). The implementation programme had an association with OPTION-5 scores (β = 14.2, P < 0.001), hospital (β = 2.2, P = 0.002), and consultation time (β = 0.2, P < 0.001). A multilevel implementation programme supporting SDM in breast cancer care increased the adoption of SDM behaviour of clinicians in consultations.

The Interaction between Ownership Concentration and Market Risk in European, American and Chinese Markets: the Effects of BREXIT

Today’s economy is facing various economic shocks, for instance BREXIT, that do not have any evidence from the past. Economic shocks directly affect market risks, the characteristics of which are observed by business company managers before making investment and operational decisions. Such decisions are directly affected by corporate ownership concentration and structure. The issue of ownership concentration in literature lacks approach when it is analysed in the interaction with market risk, caused by an economic shock. The contribution of this research to the discipline is the interaction between the indicators that reflect the impact of ownership concentration on corporate market risk by an economic shock (regression model was created). This model is proposed as a methodological tool to assess and analyse the scientific problem in question; it can also serve as a new and reliable instrument for business decision-makers and managers. An example of the data analysis representing European, American and Chinese markets as well as the United Kingdom as a country of origin of the economic shock under consideration is provided. The research proves that there exist statistically significant differences in the interaction between ownership concentration and corporate market risk in different markets. Also, it was found that BREXIT most significantly raised the risk in the UK market, as in the country of origin, in comparison to the risk observed in other markets. This paper contributes to the literature in corporate management decisions and systemic risk management; it also sheds light upon the economic-financial effects of the BREXIT process. Practical implication of this research is related to a focus on a detailed measurement instrument which allows to assess the systemic risk from a corporate management perspective.

Use of digital tools by PHC professionals as instrument for health decision-making

Abstract Background Investments have been made in precision public health strategies, as a way to better assess needs and evaluate the health services. Experiences point out that the computerization of health systems reduces costs and improves the quality of information. Primary Health Care (PHC) workers are key elements of this transformation, which can be enhanced with the use of digital health strategies. This paper aims to know the perception of the use of digital tools provided by the Ministry of Health by PHC workers in municipalities in the state of Ceará/Brazil. Methods Focus groups and field monitoring were carried out with different professional profiles. The inclusion criterion was the use of digital tools in their daily work. Questionnaires were built to conduct semi-structured interviews. The analyzes were made using content analysis method. Results Among the 21 participants (32-49 years old, mostly female),3 reported not having digital knowledge prior to the use of digital tools in their daily work. Mostly associated the use of digital tools with greater agility and ease in the work routine and greater accuracy of information. The challenges were mainly related to the use of the equipment(tablet),such as fear of breakage, theft and problems in the synchronization of the information system. There was a consensus that the data collected are useful, however they are underutilized for the work process in PHC. Conclusions The use of digital tools in the health work process is able to foster the critical view of professionals for analysis and decision making, pointing out strategies to face health issues in the territories. Pointed out as a facilitator in daily work, the use of digital tools does not exclude the use of paper sheets. Despite the greater supply of data, these are not used to their full potential, mainly due to insufficient time, given the numerous tasks for professionals. Key messages Carefully planned, developed and deployed digital interventions are powerful tools to improve health care system performance. The use of digital tools in the health work process is able to foster the critical view for analysis and decision making, pointing out strategies to face health issues in the territories.

THE ROLE AND SIGNIFICANCE OF THE SHORT-TERM RESULT AND PRAXEOLOGICAL ANALYSIS OF THE COMPANY’S OPERATIONAL ACTIVITY (ON THE EXAMPLE OF PRZEDSIĘBIORSTWO GOSPODARKI KOMUNALNEJ W ŚREMIE SPÓŁKA Z O. O.)

The essence of the research is the cognitive and decision-making values of the result analysis and praxeological operational activity of the enterprise in a short period of time. The aim of the research is to indicate the role and importance of the above-mentioned decision-making instruments in the context of the dynamics of economic activity and quick feedback from the market.&#x0D; The subject of the considerations presented in the article is to present the role and importance of a short-term analysis of the resulting operational and praxeological activity of an enterprise (on the example of Przedsiębiorstwo Gospodarki Komunalnej w Śremie Spółka z o. o.).&#x0D; The essence of the considerations is contained in the specific solutions presented in the article in the field of controlling and indications of possible corrective and remedial actions, etc., e.g. the financial situation of the examined enterprise. Based on the results of the research, it can be concluded that the short-term financial analysis plays an important role in assessing the functioning of this type of companies. It is also an important instrument for optimizing activities and processes within the package of instruments, including those in the field of management engineering.

Fuzzy-AHP Application in Analyzing the Factors Affecting Quality of Rural Labor

This paper aims to investigate the factors affecting the quality of rural labor in Vietnam, a case study in Thai Nguyen province. For this purpose, we establish an integrated framework of factors affecting the quality of rural labor. We use Fuzzy analytic hierarchy process (Fuzzy-AHP) to assess the weight of the criteria and sub-criteria of rural labor quality. This method introduced by Saaty (1987) is a useful tool to cope with the complexity of decision-making. The Fuzzy-AHP is one of the most common Multi-Criteria Decision-Making instruments for dealing with quantifiable and intangible criteria, which reflect the relative importance of the alternatives based on constructing a pairwise comparison matrix. The results show that the four most weighted factors are institutions, local government policies, technical qualifications, and mentality. In particular, the weight of the institution is the largest (0.2343), meaning that this factor is the most important one affecting the quality of rural labor in Thai Nguyen province. The weight of local government policy is close to that of institution, about 0.2259. The weights of technical qualification and mentality are 0.1238 and 0.1135, respectively. In addition, age and education levels do not significantly affect the rural labor quality of Thai Nguyen province.

Application of METAP methodology for clinical ethics consultation in end-of-life care in Bulgaria

Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process (METAP) methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants (86.0%) expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated.

A comparative analysis of methods for mapping groundwater pollution hazard: application to the Gallocanta Hydrogeologic Unit (Spain)

Anthropogenic activities are the main sources of groundwater pollution. In order to prevent groundwater degradation and to apply suitable mitigation measures, hazard maps are a useful instrument for decision makers. The ultimate goal of the research is to analyse the effectiveness of several groundwater hazard indexes at the Gallocanta Lagoon Basin. To do so, the Hazard Index, the Danger of Contamination Index and the Pollutant Origin and its Surcharge Hydraulically method were applied and compare, and the potentialities and weaknesses of the resulting maps have been analysed. Accurate hazard maps were obtained and, based on their methodological approach, significant differences were found in relation to the rating process, the inventory of the sources, and the treatment of quantity and likelihood. In the light of the results, the indexes tended to undervalue the hazard level of agricultural activities, which were the main sources of pollution of the study area. Therefore, due to the characteristic land uses of the study area, typical of the Mediterranean context, some proposals to improve the indexes have been suggested.

An Institutional Approach to Digitalization in Sustainability-Oriented Infrastructure Projects: The Limits of the Building Information Model

The transport sector accounts for a large share of global Co2 emissions. To mitigate the impact of climate change, several sustainability-oriented large-scale infrastructure projects such as electric road systems and expanding rail systems have recently been on the policy agenda. A parallel development that is expected to accelerate the transition of the transport sector is digitalization, which, although ongoing for many decades, has recently been augmented by concepts such as artificial intelligence (AI) and smart city technologies. The integration of these digitalization tools at the organizational level poses not only opportunities but also some challenges for the actors involved in infrastructure projects. An approach that is currently promoted in the infrastructure sector is the Building Information Model (BIM), which is a decision-making instrument that leverages various digitalization tools and applications. However, although the economic implications of BIM are widely discussed in the literature, the (inter-) organizational dynamics involving multiple actors in infrastructure projects are not fully grasped. Large infrastructure projects are sociotechnical endeavors embedded in complex institutional frames; hence the institutional norms, practices and logics in them are significant. Responding to this, this paper adopted an institutional analysis and put the BIM approach in the (inter-) organizational context in infrastructure delivery. Drawing on empirical data from three organizations in infrastructure delivery in Spain, this paper analyzed the tensions among actors during BIM adoption and implementation.

Scoring System for Identification of "Survival Advantage" after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion.

Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.

Resilience Decision-Making for Complex Systems

Abstract Complex systems—such as gas turbines, industrial plants, and infrastructure networks—are of paramount importance to modern societies. However, these systems are subject to various threats. Novel research does not only focus on monitoring and improving the robustness and reliability of systems but also focus on their recovery from adverse events. The concept of resilience encompasses these developments. Appropriate quantitative measures of resilience can support decision-makers seeking to improve or to design complex systems. In this paper, we develop comprehensive and widely adaptable instruments for resilience-based decision-making. Integrating an appropriate resilience metric together with a suitable systemic risk measure, we design numerically efficient tools aiding decision-makers in balancing different resilience-enhancing investments. The approach allows for a direct comparison between failure prevention arrangements and recovery improvement procedures, leading to optimal tradeoffs with respect to the resilience of a system. In addition, the method is capable of dealing with the monetary aspects involved in the decision-making process. Finally, a grid search algorithm for systemic risk measures significantly reduces the computational effort. In order to demonstrate its wide applicability, the suggested decision-making procedure is applied to a functional model of a multistage axial compressor, and to the U-Bahn and S-Bahn system of Germany's capital Berlin.

The probe for the weighted dual probabilistic linguistic correlation coefficient to invest an artificial intelligence project

As one of the burgeoning decision-making instruments, the integrity of dual probabilistic linguistic term sets (DPLTSs) is to express the decision information in terms of cognitive certainty and uncertainty. The superiority of correlation coefficient is to demonstrate the interrelationship of the variables. This paper aims to give full play to the advantages of the above two. Firstly, it defines the dual probabilistic linguistic correlation coefficient. Then, it is based on the proposed entropy for DPLTSs calculates the comprehensive weight vector. Moreover, combined with the proposed correlation coefficient, it further defines the weighted correlation coefficient as a measure for the application about artificial intelligence. Besides, it uses the dual probabilistic linguistic closeness coefficient as the reference to compare the pros and cons. Finally, a specific numeric simulation is utilized to demonstrate the feasibility of the two different measures.

Preoperative predictors of liver decompensation after mini-invasive liver resection

Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661-6.215; p < .0.0001) and presence of ascites (OR 3.320; 95% CI 1.468-7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0days). The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.

Small business networks in the field of organic farming: strategies and management tools

Abstract: Business cooperation networks are based on specific parameters: common goal, competitive earnings, interaction among partners and management. Networks of farmers focused on organic production are growing due to the increasing demand. The objective of this research is to propose a framework of organizational strategies and management and governance tools for networks of small businesses operating in the field of organic farming. The methodology adopts a qualitative approach and it is comprised by a conceptual and theoretical review as well as two case studies. The proposed framework shows organizational strategies and management tools- that are crucial for the networks to thrive. Management instruments include, strategic, integration, contractual and decision-making instruments. Global strategies correspond to strategies regarding competitiveness, strategies regarding the product/market and strategies regarding the use of means. The value chain activities comprise the functional strategies. Results revealed significant particularities and common aspects of the organizational strategies and management tools.

CARDIM DE CARVALHO’S CONTRIBUTION TO THE UNDERSTANDING OF DECISION MAKING IN CONTEMPORANEOUS FINANCIAL MARKETS

ABSTRACT According to the post-Keynesian approach, uncertainty is inherent to the loci in which investors decide the portfolio allocation of their wealth (or the wealth they manage) in a monetary economy. In financial assets’ markets, to deal with uncertainty, agents use instruments that evolved with time and encompass two elements of the decision-making process: (i) which premises will be considered to make a decision, the focus of Keynes’ General Theory; (ii) the sequel between the premises and the very decision, the focus of Keynes’ Treatise on Probability. The aim of this paper is twofold. The first one is to summarize the contribution of Fernando Cardim de Carvalho to the understanding of the decision-making under uncertainty. The second one is to analyse the decision-making instruments used in contempo-raneous financial assets’ markets in light of his contribution that is especially suitable for this goal due to his acquaintance with the Treatise.

Exploration and Application of Machine Learning Technology Based on Swarm Intelligence Optimization

Background: In the agriculture development and growth, the intelligent machinery and equipment plays an important role. Various researchers are involved for implementing the research and patents to aid the smart agriculture and author reviewer that machine leaning technologies are providing the best support for this growth. Method: To explore machine learning technology and machine learning algorithms, mostly based on swarm intelligence optimization, and their applications are studied. An optimized V3CFOA-RF model is built through V3CFOA. The algorithm is tested in the data set collected concerning rice pests, later analysed and compared in detail with other existing algorithms. Results: The research result shows that the model and algorithm proposed are not only more accurate in recognition and prediction, but also solve the time lagging problem to a degree. Conclusion: The model and algorithm helped realise a higher accuracy in crop pest prediction, which ensures a more stable and higher output of rice. Thus they can be employed as an important decision-making instrument in the agricultural production sector.

Oxygen treatment of ventilated critically ill children: Nursing assessment and cognitive processes in clinical decision-making

The aim of this study was to describe nurses’ opinions regarding assessments of oxygen requirements and which modes of cognition they used about oxygen treatment in ventilated children aged 0–3 years. The method was survey design with descriptive statistics. The sample included 90 nurses from intensive care units within all university hospitals in Norway. The questionnaire covered use of physiological, clinical, and technical observations in assessments, and the Nursing Decision-Making Instrument was used to map the mode of cognition. Respondents perceived they used many of the physiological criteria except for the haemoglobin–oxygen dissociation curve, pulse and blood pressure. Most respondents used clinical and technical criteria to assess oxygen needs, but more than half would exceed 10% oxygen at each regulation. They considered written guidelines to be necessary. A majority demonstrated a flexible use of analytical and intuitive modes of cognition in the decision-making processes. The results indicate that assessment of children’s need for oxygen may be based on insufficient information, and written guidelines should be developed.