在日常工作中强化急诊医学临床决策方法训练初探

急诊医学是临床决策应用最频繁的学科之一。为了提高我院急诊科医师的临床决策水平,全科医师在3人“研究小组”带领下,于2009年10月至2010年12月,通过研习有关文献掌握常用的临床决策方法;在分诊、接诊、抢救、晨会、主任查房、病例讨论会等日常工作环节,强化临床决策方法的训练和运用。比较4种主要决策方法在“训练前组”和“训练后组”抢救病例的应用比例,发现快捷的“模式识别法”和“运用规则法”的使用比例明显提高,严谨而费时的“假设一演绎法”的使用比例明显降低,“事件驱动法”和“失误率”无明显变化。提示：在日常工作中强化急诊医学临床决策方法的训练有助于提高急诊医师的临床决策水平。     

运用循证医学方法防范妇产科领域医疗纠纷的研究——12例妇产科医疗纠纷病例临床决策分析

探讨循证医学方法在妇产科医疗纠纷防范中的意义。选取12例医疗纠纷病例,对照研究其原决策与循证决策、专家意见。结论认为循证医学决策更加科学化,有利减少医疗纠纷。     

妇产科临床决策中的辩证思维

妇产科临床实践中处处可以体现辩证唯物主义哲学原理的作用,以辩证的思维去认识妇产科疾病,树立整体观念、认清病情发展的主要矛盾、建立个体化治疗的概念、认识疾病的本质、建立疾病预防的观念、密切关注病情的发展变化,有利于正确的,临床决策。     

老年患者的外科治疗决策及围手术期处理

泌尿外科老年患者多,老年患者必然手术并发症多,手术死亡率高。虽然现在泌尿外科近70％的手术已进入了微创时代,手术时间大幅缩减,但是老年患者的临床决策仍常常是个非常纠结的问题,手术要达到什么目的？何时要做适当的放弃？除了充分的围手术期准备,医生要敢于承担,家属要充分理解和合作。     

不同预测率的不确定决策的ERP研究

该研究采用事件相关电位技术,对不同预测率的不确定决策的加工机制进行了研究。实验条件为四种不同预测率的不确定决策任务,控制条件为确定决策任务,对两种条件下的数据进行比较,结果发现：1）反应时,随着不确定性程度的增强而逐渐增长;2）正确率,被试决策的平均正确率基本上符合数字本身的可预测率。脑电结果发现：在200～300ms的时间窗口内,不确定和确定决策任务下的预测率都诱发了一个晚期的负成分（N2）,五种任务之间（随着不确定程度的降低）存在着一个梯度的变化,其中50％和62．5％之间不存在着显著差异,其它预测率之间都存在着显著差异。这些结果表明被试在不确定决策任务中会对不同预测率进行归类表征,并会对不同的不确定程度有不同的知觉。     

The limited effects of power on satisfaction with joint consumption decisions

We conduct three experiments in which participants in dyads choose between two restaurants, each of which is preferred by only one participant, and one participant has the power to decide which restaurant both will patronize. We find that the power to make a joint decision increases satisfaction with the choice only when those involved have a competitive decision orientation, a weak or anonymous relationship, and the outcome they choose is subsequently available. Participants who have a cooperative orientation are satisfied whether or not they have power and whether or not the resulting choice is consistent with their initial preferences.     

Anticipatory and control processes in the interaction with secondary tasks while driving

The paper describes an experiment where anticipatory processes in the interaction with secondary tasks while driving could be explicitly identified and contrasted to control processes during the engagement in the secondary task. A special experimental set-up in a driving simulator environment was created that allows drivers to deliberately decide whether they want to be distracted or not depending on the driving situation and the expected development of that situation. As indicators for a situation-adaptive interaction with secondary tasks parameters from driving behaviour, secondary task performance and visual behaviour were analyzed. A study with 24 test drivers revealed that drivers are, in general, able to interact with a secondary task in a situation-aware manner. For example, drivers rejected more secondary tasks in already highly demanding situations or tried to delay the beginning of the task. During secondary task performance drivers observed the situational development with short control glances back to the road and adapted their speed. The analysis of driving errors revealed that rejecting a task in an already highly demanding driving situation is an effective strategy to maintain an adequate level of driving safety. However, some critical factors were identified that might hinder the driver from executing such strategies. Several recommendations for supporting the driver on this issue are given.     

The role of emotion expectancies in adolescents' moral decision making

This study investigated the impact of emotion expectancies on adolescents’ moral decision making in hypothetical situations. The sample consisted of 160 participants from three different grade levels (mean age = 15.79 years, SD = 2.96). Participants were confronted with a set of scenarios that described various emotional outcomes of (im)moral actions and needed to decide what they would do if they were in the protagonist’s shoes. Findings demonstrate that emotion expectancies differentially influenced adolescents’ hypothetical decision making in antisocial versus prosocial behavioral contexts. Whereas negatively charged self-evaluative emotions over failing to act morally (e.g., guilt) were the strongest predictor for moral choice in antisocial behavioral contexts, positively charged self-evaluative emotions over acting morally (e.g., pride) most strongly predicted moral choice in prosocial contexts. Older adolescents paid greater attention to outcome-oriented emotions that make the decision to act morally less attractive (e.g., regret). Overall, the study suggests that emotion expectancies influence moral decision making in unique and meaningful ways.     

Time keeping and working memory development in early adolescence: A 4-year follow-up

In this longitudinal study, we examined time keeping in relation to working memory (WM) development. School-aged children completed two tasks of WM updating and a time monitoring task in which they indicated the passing of time every 5 min while watching a film. Children completed these tasks first when they were 8 to 12 years old and then 4 years later when they were 12 to 16 years old. Time keeping in early adolescence showed a different pattern of outcome measures than 4 years earlier, with reduced clock checking and increased timing error. However, relative changes in WM development moderated these adverse effects. Adolescents with greater relative gains in WM development were better calibrated than participants with less developing WM functions. We discuss these findings in relation to individual and developmental differences in executive control functions and socioemotionally driven reward seeking.     

People avoid situations that enable them to deceive others

Information advantage enables people to benefit themselves by deceiving their counterparts. Using a modified ultimatum bargaining game with an exit option, we find that people are more likely to avoid settings enabling them to privately deceive their counterparts than settings which do not enable deception. This tendency is explained by people's reduced desire to become responsible for the other's outcomes when deception is possible. Results of three experiments show that people avoid entering a setting that enables deception by appearing fair while being unfair (Exp. 1–3). Experiment 2 showed that this tendency was reduced when interaction partners were displayed as competitive rather than cooperative. Experiment 3 showed a stronger tendency to avoid tempting situations that enable private deception than to approach situations in which one can privately benefit others. We conclude that when navigating through social space, people avoid situations enabling them to deceive others.