Discrepancies In Decisions Research Articles

Percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures: an umbrella review protocol of systematic reviews and meta-analyses

IntroductionSeveral systematic reviews and meta-analyses have confirmed that percutaneous vertebroplasty and percutaneous kyphoplasty showed safety and beneficial efficacy in patients with osteoporotic vertebral compression fractures. Whereas, there is wide variation...

Atmospheric dispersion modelling and dose projection under high uncertainty conditions

Understanding the overall magnitude of the deviations that may occur within the results of one or more codes allows avoiding discrepancies in decision making in the context of emergency preparedness and response. The uncertainty of the assessment input data plays a significant role in this. Currently, emergency centers around the world use a number of atmospheric dispersion modelling and dose projection tools that have the same functionality, are used for the same purpose, but may produce different results. This article reveals the problem of uncertainty in the results of atmospheric dispersion modelling and dose projection, which are laid down at the stage of input data for actual software products and decision support systems. The paper lists the main factors that can affect the uncertainty of the assessment results. On the example of the JRODOS system, possible options for describing the source for the spectrum of emergency events at NPPs are considered. Special attention is paid to assimilation of radiation monitoring results and response to hostilities.

A Comparative Analysis of Anticancer Drug Appraisals Including Managed Entry Agreements in South Korea and England.

This study aimed to compare appraisal decisions about anticancer drugs between the health technology assessment (HTA) agencies in Korea and England, and investigate whether the decisions and supporting evidence are comparable. This study identified 49 anticancer drugs listed by the Korean Ministry of Health and Welfare between January 2014 and December 2019. Of those, 46 anticancer drugs for 58 indications were included for analysis. Official appraisal documents from both countries for 58 drug-indication pairs were compared and assessed in terms of clinical and economic evidence. Evidence items and their groups for analysis were predefined. Three-quarters of cases were recommended with managed entry agreements (MEAs) in England and three-fifths in Korea. Finance-based MEA types were most common in both countries. Korean and English authorities made consistent decisions in 48 cases (83%) when classifying decisions as 'recommended' and 'not recommended', while the degree of agreement lowered to 16 cases (28%) when subdividing decisions according to MEA types. When the evidence base was identical, their decisions were more likely to be consistent. Regarding clinical evidence, while the majority of cases referred to the same pivotal studies, differences between the committees' recognized comparators and the appraisal date caused discrepancies in decisions. Economic evidence, including incremental cost-effectiveness ratio (ICER) estimates, was identical in only 12 cases (21%), which contributed to discrepancies. England relies on economic evaluation, with increasing use of data collection agreements, in contrast with Korea's new procedure exempting companies from providing economic evaluation. While there is possibility for international cooperation in the assessment of clinical evidence, transferability issues exist, particularly with regard to economic evidence.

Prevalence and risk factors for cage subsidence after lumbar interbody fusion: A protocol for systematic review and meta-analysis.

Introduction:Lumbar interbody fusion (LIF) is an effective treatment for lumbar degenerative diseases. Cage subsidence (CS) contitutes one of the most common postoperative complications. Many risk factors for CS after LIF have been reported in some studies. However, controversies still exist. The objective of this study will be to summarize data on the prevalence and risk factors of CS after LIF.Methods and analysis:Our study present a protocol that conducted a systematic review and meta-analysis of prevalence and risk factors for CS after LIF. Two reviewers retrieved the relevant articles using the 5 databases (PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science) from inception to May 31st, 2021. Primary outcome will be the prevalence of CS after LIF. Second outcomes include the risk factors associated with postoperative CS and clinical outcomes associated with postoperative CS. Three reviewers will screen citation titles and abstracts and evaluated full-text of each potentially relevant citation, and then extracted the data using a data extraction form. Any discrepancies in decisions between reviewers will be resolved through discussion. We assessed the methodological quality and risk of bias of the included studies based on the Newcastle–Ottawa Quality Assessment Scale (NOS). The aim of the extra analysis is to explore the explanations of the heterogeneity (age, gender, race, year of publication, type of study and surgical procedure). Publication bias will be assessed by Begg test, Egger test and funnel plots.Ethics and dissemination:No primary data will be collected and individual patient information and endangering participant rights, thus ethics approval is not required. Findings will be reported through publication and media.Protocol registration number:PROSPERO CRD42021257981 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).

Discrepancies in decision making preferences between parents and surgeons in pediatric surgery

BackgroundLittle data exists regarding decision-making preferences for parents and surgeons in pediatric surgery. Here we investigate whether parents and surgeons have similar decision-making preferences as well as which factors influence those preferences. Specifically, we compare parents’ and surgeons’ assessments of the urgency and complexity of pediatric surgical scenarios and the impact of their assessments on decision-making preferences.MethodsA survey was emailed to parents of patients evaluated in a university-based pediatric surgery clinic and surgeons belonging to the American Pediatric Surgical Association. The survey asked respondents to rate 6 clinical vignettes for urgency, complexity, and desired level of surgeon guidance using the Controlled Preferences Scale (CPS).ResultsRegarding urgency, parents were more likely than surgeons to rate scenarios as emergent when cancer was involved (parents: 68.8% cancer vs. 29.5% non-cancer, p < .001; surgeons: 19.2% cancer vs. 25.4% non-cancer, p = .051). Parents and surgeons were more likely to rate a scenario as emergent when a baby was involved (parents: 45.2% baby vs. 36.2% child, p = .001; surgeons: 28.0% baby vs. 14.0% child, p < .001). Regarding decision-making preferences, parents and surgeons had similar CPS scores (2.56 vs. 2.72, respectively). Multivariable analysis showed parents preferred more surgeon guidance when scenarios involved a baby (OR 1.22; 95% CI 1.08–1.37; p < 0.01) or a cancer diagnosis (OR 1.29; 95% CI 1.11–1.49; p < 0.01), and that both parents and surgeons preferred more surgeon guidance when a scenario was considered emergent (parents: OR 1.81; 95% CI 1.37–2.38, p < 0.001; surgeons: OR 2.48 95% CI 1.76–3.49, p < 0.001).ConclusionsWhen a pediatric patient is a baby or has cancer, parents are more likely then surgeons to perceive the clinical situation to be emergent, and both parents and surgeons prefer more surgeon guidance in decision-making when a clinical scenario is considered emergent. More research is needed to understand how parents’ decision-making preferences depend on clinical context.

Self-promotion hypothesis: The impact of self-esteem on self–other discrepancies in decision making under risk

This study aimed at investigating the role of self-esteem in self–other decision making under risk. A sample of 117 participants selected from 626 undergraduate students as a function of their Rosenberg Self-Esteem Scale scores completed a modified version of the cups task, in which participants were required to choose between a risky and a sure option for themselves or others. We found that the participants with high self-esteem (HSE) made more risk-seeking decisions than those with low self-esteem (LSE), and participants made more risk-seeking decisions in loss situations than in gain situations. Furthermore, the LSE participants made more risk-averse decisions for themselves than for others in gain situations but made more risk-seeking decisions in loss situations. In contrast, HSE participants made more risk-seeking decisions for themselves than for others in gain situations but made more risk-averse decisions in loss situations. These findings revealed that self-esteem has a robust effect on self–other decision making. A self-promotion hypothesis was introduced to explain these findings.

What if you are not Bayesian? The consequences for decisions involving risk

Many studies have examined the extent to which individuals’ probability judgments depart from Bayes’ theorem when revising probability estimates in the light of new information. Generally, these studies have not considered the implications of such departures for decisions involving risk. We identify when such departures will occur in two common types of decisions. We then report on two experiments where people were asked to revise their own prior probabilities of a forthcoming economic recession in the light of new information. When the reliability of the new information was independent of the state of nature, people tended to overreact to it if their prior probability was low and underreact if it was high. When it was not independent, they tended to display conservatism. We identify the circumstances where discrepancies in decisions arising from a failure to use Bayes’ theorem were most likely to occur in the decision context we examined. We found that these discrepancies were relatively rare and, typically, were not serious.

An Ethical framework to access organisation's decision making processes

This study applies an ethical framework to test the decision-making process that took place during the Katrina disaster. Building on assumptions and concepts drawn from ethical theories, decision capacity, and the discourse analysis perspective, the validity and effectiveness of decisions issued by the local, regional, and federal governments were assessed. A number of official committees’ reports, which were published by the U.S. government in the wake of the Katrina disaster, were used as the primary sources of data for an instrument that was developed from Soliman’s ethical framework in 2010. The findings in this study indicate significant discrepancies in decision making for both the planning and response phases during the Katrina disaster. Four major ethical concepts; which are responsibility, accountability, transparency, and decision capacity were found to be violated, resulting in an exacerbation of suffering for the disaster survivors. This study recommends that concerning any disaster, officials and decision makers review and integrate ethical standards when developing programs and activities in order to protect citizens’ legal and personal human rights. Keywords: Katrina disaster, ethical framework, decision capacity

What Factors Moderate Self-Other Discrepancies in Decision Making? Results from a Vaccination Scenario.

When we make risky decisions for others, we tend to follow social norms about risks. This often results in making different decisions for others than we would make for ourselves in a similar situation (i.e., self-other discrepancies). In an experiment, we investigated self-other discrepancies in young adults' decisions to purchase a vaccine against a sexually-transmitted virus for themselves or for another person (i.e., the target of the decision). When the target's preferences were in line with social norms, surrogates showed large self-other discrepancies in line with these norms. When the target's preferences were contrary to social norms, surrogates did not show self-other discrepancies in line with these preferences; instead they still followed social norms, F(1, 140) = 21.45, p < .001, η p 2 = .13. Surrogates with lower numeracy, F(2, 128) = 3.44, p = .035, η p 2 = .05, and higher empathy, F(2, 128) = 3.72, p = .027, η p 2 = .06, showed self-other discrepancies more in line with the target's preferences, even when these were contrary to the norm. Surrogates whose own risk attitudes were contrary to social norms showed larger self-other discrepancies, F(1, 128) = 5.38, p = .022, η p 2 = .04. These results demonstrate that perceived social norms about risk can predict self-other discrepancies in risky decisions, even when the target's preferences are known and at odds with the social norm. Further, the surrogates' numeracy, empathy, and propensity to take risks influence the extent to which risky decisions for others resemble risky decisions for oneself.

The Impact of Depression on Self–Other Discrepancies in Decision Making

ABSTRACTAlthough there is a small but growing body of literature on how people make risky decisions for others and predict others' decisions, results seem to be contradictory. The authors contribute to the understanding of these mixed results by investigating how depression affects self–other discrepancies in decision making and the psychological processes that underlie these discrepancies. In an experiment, depressed and nondepressed individuals read a series of scenarios involving decisions about health, money, and interpersonal relationships. They then indicated which of two options they would choose for themselves or for another person, or predicted which option this person would choose for himself or herself. Finally, participants reported benefits and drawbacks of the decisions (i.e., cognitions) and feelings about risk. Depressed individuals were less prone to bias when they predicted others' decisions than nondepressed individuals. Feelings about risk played a key role in determining the direction and the magnitude of this bias. In contrast, both depressed and nondepressed individuals showed bias when they made decisions for others. This bias affected their decisions in opposing ways and was determined by cognitions. This bias is consistent with literature showing that depression is associated with an increased sensitivity to social risks. The authors provide a theoretical explanation of self–other discrepancies in decision making in depressed and nondepressed individuals and conclude that the results support the assumption that depression is associated with psychological processes whose role is to increase sensitivity to social threats rather than with a more general negative bias in cognitive functioning. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Analysis of Online and Offline Head and Neck Image-guided Radiation Therapy

PurposeThe introduction of a daily image-guided radiation therapy (IGRT) program is an important step. It has implications for the radiation therapy team in terms of accuracy, workflow, and decision making. This study assesses how successful a radiation therapy department has been in using this technology and the accuracy of individual decision making when comparing online and offline image match data. MethodsTwenty intensity-modulated radiation therapy head and neck patients had their IGRT data assessed retrospectively. Online analysis was completed based on a 0-mm action threshold. Offline analysis was then conducted on the same data. Any discrepancies in decision making were then assessed. ResultsResults indicated that the treating radiation therapy team was able to image match consistently when benchmarked against their colleagues in the offline environment. Analysis of online versus offline corrections in each of the three orthogonal directions showed strong agreement. Further analysis revealed no statistically significant differences for systematic errors, whereas a statistically significant but small difference was present for random error. ConclusionIn this age of sophisticated equipment, daily IGRT is a valuable modality. However, the introduction of daily online IGRT inclusive of a 0-mm action threshold for head and neck IGRT requires careful consideration and evidence that such accuracy can be achieved. Ultimately, it is still the radiation therapist who must make the decision, which places great importance on the competency of the treating radiation therapy team.

Abstract W MP13: Missed Imaging Diagnosis Without CT Perfusion May Affect Clinical Decision for TPA and Thrombectomy in Acute Stroke

Purpose: In a previous study, we found higher detection rate of 2nd and 3rd order vascular thrombosis when CT Perfusion (CTP) was performed as compared to non-contrast CT (NCCT) and CT angiography (CTA) alone. Additionally, a significant number of patients with acute infarct were reported as negative without CTP. In this study, we sought to determine whether missed imaging diagnosis without CTP might affect clinical decision making. Methods: A total of 758 cases were included in our previous study, with CTP deficits reported in all 71 cases with final infarct volume of 2.8 ml or above. Conversely, 23 of 96 (24%) cases without CTP were reported as negative. In the group without CTP, 7 of 10 patients who had 2nd or 3rd order vascular thromboses with a final infarct &gt; 30cc were reported negative, whereas only 1 of 10 cases were missed in patients who had CTP but a negative NCCT. The treatment decisions at the time of stroke were reviewed for these patients. Results: In 10 cases with final infarct volume &gt; 30ml reported negative without CTP, zero received TPA or thrombectomy. Conversely, in the same category, 5 of 10 cases with positive CTP received TPA (p = 0.041). There was also a higher rate of TPA or thrombectomy treatment in patients with a positive imaging diagnosis, both with CTP (13 of 71, 18.3%) and without CTP (28 of 73, 38.4%), as compared to the group reported negative without CTP (3 of 23, 13%, p = 0.059). Fewer cases in the CTP group received treatment as compared to cases reported positive without CTP. A possible reason is that the cases with CTP were from an earlier phase of our acute stroke program, when treatment tended to be more conservative. Conclusions: Our study finds discrepancies in decision making for TPA and thrombectomy in stroke cases with positive versus negative imaging diagnosis. The cases reported negative were less likely to receive treatment, including those with relatively large final infarct size (&gt;30ml). We speculate that a negative imaging diagnosis may create doubt for clinical diagnosis in some cases. Adding CTP in the acute stroke imaging protocol will increase imaging diagnostic accuracy and exclude stroke mimics, therefore providing valuable information for treatment.

Doc, what would you do if you were me? On self–other discrepancies in medical decision making.

Doctors often make decisions for their patients and predict their patients' preferences and decisions to customize advice to their particular situation. We investigated how doctors make decisions about medical treatments for their patients and themselves and how they predict their patients' decisions. We also studied whether these decisions and predictions coincide with the decisions that the patients make for themselves. We document 3 important findings. First, doctors made more conservative decisions for their patients than for themselves (i.e., they more often selected a safer medical treatment). Second, doctors did so even if they accurately predicted that their patients would want a riskier treatment than the one they selected. Doctors, therefore, showed substantial self-other discrepancies in medical decision making and did not make decisions that accurately reflected their patients' preferences. Finally, patients were not aware of these discrepancies and thought that the decisions their doctors made for themselves would be similar to the decisions they made for their patients. We explain these results in light of 2 current theories of self-other discrepancies in judgment and decision making: the risk-as-feelings hypothesis and the cognitive hypothesis. Our results have important implications for research on expert decision making and for medical practice, and shed some light on the process underlying self-other discrepancies in decision making.