Shared Decision-Making in Pancreatic Surgery.

Objective: The objective of this study is to determine the factors influencing pancreatic surgery patients' perceptions of the shared decision-making process (SDM). Background: Decision-making in pancreatic surgery is complicated by the risk of morbidity and mortality and risk of early recurrence of disease. Improvement in SDM has the potential to improve the receipt of goal- and value-concordant care. Methods: This cross-sectional survey included patients who underwent pancreatic surgery. The following components were studied in relation to SDM: modified satisfaction with decision scale (SWD), modified decisional regret scale (DRS), quality of physician and patient interaction, and the impact of quality of life (FACT-Hep). Correlations were computed using Pearson's correlation score and a regression model. Results: The survey completion rate was 72.2% (of 40/55) and the majority (72.5%) of patients underwent pancreaticoduodenectomy. There were significant positive relationships between the SDM measure and (DRS, SWD; r = 0.70, P < 0.001) and responses to questions regarding how well the patient's actual recovery matched their expectations before treatment (r = 0.62, P < 0.001). The quality of the physician-patient relationship correlated with how well recovery matched expectations (r = 0.53, P = 0.002). SDM measure scores were significant predictors of the decision evaluation measure (R2(adj) = 0.48, P < 0.001), FACT-Hep (R2(adj) = 0.15, P < 0.001), and recovery expectations measure (R2(adj) = 0.37, P < 0.001). Conclusions: Improved SDM in pancreatic surgery is associated with more realistic recovery expectations, decreased decisional regret, and improved quality of life.

Coding Ethical Decision-Making in Research.

This paper presents methods and challenges attendant on the use of protocol analysis to develop a model of heuristic processing applied to research ethics. Participants are exposed to ethically complex scenarios and asked to verbalize their thoughts as they formulate a requested decision. The model identifies functional parts of the decision-making task: interpretation, retrieval, judgment and editing and seeks to reliably code participant verbalizations to those tasks as well as to a set of cognitive tools generally useful in such work. Important difficulties in the reliability and external validity of measurement are evaluated and a small set of illustrative data is used in support of that discussion. Results indicate that both intuitive emotional but also more deliberative cognition is present which is consistent with work in related literatures in expertise and in neuropsychology. Finally, the theoretical and practical potential of the approach is elaborated, particularly through links to a framing in Aristotelian ethics.

Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving operational changes in a labor and delivery ward.

Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional crew resource management training programs, "in situ simulation" occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them.

Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward.

Since the publication of To Err is Human, health care professionals have looked to high-reliability industries such as commercial aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management (CRM) training. In the health care domain, CRM training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional CRM training programs, in situ simulation occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this paper, we present the results from one such simulation: a patient who experienced a difficult labor and delivery resulting in an emergency caesarean section and a hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. The following article presents not only the latent threats but also the steps that the hospital has taken to remedy them. Results from clinical simulations in operational health care settings can help identify and resolve latent environmental threats to patient safety.

Alcohol's effects on women's risk detection in a date-rape vignette.

UNLABELLED: Researchers have established that alcohol is a risk factor for date rape for both victims and perpetrators. OBJECTIVE: The authors tried to experimentally address the link between alcohol consumption and women's risk detection abilities in a risky sexual vignette. PARTICIPANTS: The authors recruited 42 women from undergraduate classrooms at a large midwestern university and randomly assigned them to drink an alcoholic (.04 blood alcohol content) or a placebo beverage. METHODS: Participants completed self-report inventories and listened to a date-rape audiotaped vignette, which began with consensual sexual behavior and culminated in date rape, and the authors asked them to determine if and when the man should refrain from making further sexual advances. RESULTS: Student's t tests and Pearson r correlations showed that women who consumed alcohol and exhibited high levels of rape myth acceptance showed a significant decrease in risk recognition (p = .000 and .001, respectively). CONCLUSION: These findings highlight the significance of even small amounts of alcohol on behavior and cognition in women who are self-reported experienced drinkers.

Acceptability of treatments for trichotillomania. Effects of age and severity.

Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.