Thoughtful Decision-making Research Articles

The ‘Unbefriended’ Challenge PA/LTC

The ‘Unbefriended’ Challenge PA/LTC

Complications in Brief: Quadriceps and Patellar Tendon Tears

Effective treatment of knee extensor mechanism disruptions requires prompt diagnosis and thoughtful decision-making with surgical and nonsurgical approaches. When surgery is chosen, excellent surgical technique can result in excellent outcomes. Complications and failures arise from missed or delayed diagnoses and from technical problems in the operating room. In particular, inappropriate surgical timing (especially late surgery), misplaced patellar drill holes, and failure to address concomitant injuries can result in complications seen when repairing a patellar or quadriceps tendon tear. We review the complications that can occur during treatment of these injuries (Table 1).

Does the Attitudinal Model of Supreme Court Decision Making Depend on Litigation Choices? Applying the Priest-Klein Selection Hypothesis to Litigation in the High Court

In political science the well-known “Attitudinal Model” of legal decision making dictates that judges’ sincere policy preferences drive legal outcomes. In contrast, the celebrated “Selection Hypothesis” from the law and economics literature suggests that litigants carefully consider factors affecting potential case success (including judicial ideology) and accordingly choose to settle cases in which legal outcomes can be readily predicted in the name of efficiency. Thus, judges end up adjudicating a non-random set of cases which, in the typical situation, should not lend themselves to ideological decision making. From this perspective, the influence of Supreme Court justices’ ideological preferences on outcomes should be obviated by the forward thinking decisions of mindful litigants. We are left with two dominant theories on jurisprudential outcomes that appear to be at odds with each other. We endeavor to address this situation by incorporating litigant selection effect considerations into a basic attitudinal account of Supreme Court justice decision making. Our primary thesis that the influence of judicial ideology on legal outcomes is conditioned on case sorting decisions by litigants that precede the justices’ case decisions on merits. We also extend our assessment of this thesis by evaluating our basic model on a subset of cases involving the Court’s most formidable litigator – the federal government.

Nurses’ decision‐making in cases of physical restraint: a synthesis of qualitative evidence

This article is a report of a review that aimed to synthesize the available qualitative evidence on nurses' decision-making in cases of physical restraint. The use of physical restraint in acute and residential healthcare facilities is a widespread practice in many countries. Decisions about the use of physical restraints are complex and ethically laden. The lack of evidence supporting the use of physical restraints, the negative consequences of restraint for patients, and the low availability of alternatives obviously complicate the decision-making. Research papers published between January 1990 and January 2010 were identified in Cinahl, Embase, Medline, PsycInfo and Web of Science. A systematic review was carried out to obtain a meta-synthesis of qualitative evidence. The process of meta-synthesis was supported by the Joanna Briggs Institute's guidelines. The decision-making of nurses dealing with the use of physical restraints is a complex trajectory primarily focused on safety. However, thoughtful decision-making requires nurses to carefully balance different options and associated ethical values. The decision-making process of nurses is influenced by both nurse- and context-related factors. This review provides a deeper understanding of nurses' decision-making process on the use of physical restraints. Context- and nurse-related factors can hinder nurses from making an ethical decision on the appropriate use of physical restraints. There is an urgent need to stimulate and educate nurses to arrive at an appropriate decision about the use of physical restraints.

Ad Hoc percutaneous coronary interventions in patients with stable coronary artery disease—A study of prevalence, safety, and variation in use from the American College of Cardiology National Cardiovascular Data Registry (ACC‐NCDR®)

To utilize the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) to monitor the performance and safety of ad hoc PCIs. The performance of ad hoc PCI remains controversial. Patients' preference, cost, and vascular access issues favor an ad hoc strategy. Adequate time for thoughtful decision-making, scheduling complexity, informed consent, and physician reimbursement favor PCI on a subsequent day. We analyzed results in 68,528 patients with stable angina entered in the ACC-NCDR from 2001-2003. Ad hoc PCI was evaluated in many clinical and nonclinical subgroups. A multivariable analysis was performed to determine whether ad hoc PCI had an independent relationship with complications or procedure success. Overall, 60.6% of patients underwent ad hoc PCI. There was no difference in ad hoc PCI mortality, renal failure, or vascular complications from staged PCI. A lower percentage of patients at high vs. low risk and with vs. without renal failure underwent ad hoc PCIs (58.6% vs.63.0% and 50.7% vs. 60.9% respectively). There was wide variation in the performance of ad hoc PCIs according to payer (70.2-60.3%), hospital PCI volume (67-50.2%), hospital owner (89.7-59.6%), and geographic area (75.5-47.4%). Ad hoc PCI per se was not independently related to PCI success or complications. PCI success was related to patient/lesion related factors and not to the performance of ad hoc PCIs per se. Although ad hoc PCI can be performed in more patients than at present, this strategy will never be possible in all patients at all times.

The Politics of Expertise in Congress and the News Media

Objective. Experts are increasingly active in U.S. policymaking, but what accounts for their varied visibility is unclear. The agenda‐setting and media studies literature suggest that experts are generally neutral, distant actors in policymaking whose products are made visible by Congress and the news media when helpful. This study examines how and when the intentional efforts of experts can also affect their relative visibility and whether a proliferation of expert organizations, as has occurred in American policymaking in recent decades, is correctly viewed as creating conditions for more rational, thoughtful decisionmaking, as some existing scholarship might suggest. Methods. I consider the conveyance of expertise among a sample of 66 public policy think tanks in congressional testimony and three national newspapers between 1991 and 1995. In a multivariate analysis, I evaluate what accounts for the quantity of congressional and media visibility. I then use a content analysis to examine differences in the nature of visibility received by think tanks. Results. Washington‐based think tanks and think tanks of no identifiable ideology have some advantage in gaining congressional and media visibility overall. Think tanks deemed credible receive more, and more substantive, visibility than those that are ideological and marketing‐oriented. Conclusions. Cumulatively, my findings suggest that more credible, staid, not identifiably ideological expert organizations are slightly favored by congressional staff members and journalists to provide guidance on issues and news stories. More ideological and marketing‐oriented sources of expertise, by contrast, are more relied upon to build support for ideas, either in staged congressional hearings or on the editorial pages of newspapers. Expert organizations can affect their relative visibility; the evidence is mixed on whether their proliferation makes policymaking and decisionmaking better informed or more rational or thoughtful.

Consensus projects: teaching science for citizenship

In the first part of this article it is argued that knowledge of social aspects of science are of importance and relevance for science education for citizenship. The focus is on the importance of debate, criticism and evaluation of knowledge claims, within the scientific community. Knowledge of the nature and the limits of science are necessary as tools to interpret and debate statements with a science dimension occurring in debates over socio-scientific issues. The second part of this article presents a teaching model for engaging students in thoughtful decision-making on controversial socio-scientific issues. The main features of the teaching model are the evaluation and criticism of knowledge and opinions and the establishing of a consensual conclusion that includes a recommended action. Using the consensus project model implies an introduction to important social aspects of science concerning evaluation and validation of knowledge claims.