bluuebunny/crossref_metadata_2025 huggingface dataset:
Teacher Absenteeism: What Administrators Can Do
Authors: Pitkoff Evan
Published: March 2007

Teacher absenteeism has increased dramatically in recent years, especially in large, urban districts. This writer, who studied trends in one East Coast city, draws on his findings to formulate recommendations for improvement.
Technology Education: Meeting The Needs of a Complex Society
Authors: Savage Ernest
Published: March 2007

It is essential that today's students be prepared for life in an increasingly technological world. Here's a model for framing a technology education program, as well as an overview of some successful existing programs.
Teacher Induction Using a Shared Lesson Design Model
Authors: Garten Ted R. , Hudson James A. , Gossen Harvey A.
Published: March 2007

What is the relationship between university instruction and performance in the classroom by the new teacher? Can beginning teachers be prepared to be effective instructional designers and implementers? A study at Central Missouri State University offers affirmative answers to these questions, along with recommendations for how principals and university faculty can collaborate to make this happen.
A Time for Review : Implementing Site-Based Management: Overcoming the Obstacles
Authors: Mentell Edward J.
Published: March 2007

Site-based management can be an effective way to empower teachers and communities to improve their schools. However, carefully consid ered strategies are necessary if exist ing obstacles to implementation are to be overcome.
Teaching Life Concerns to Kids Who Don't Care
Authors: Hansen J. Merrell
Published: March 2007

If we are to combat the negative impact of such crises as the AIDS epidemic, violence, and adolescent sexual behav ior, schools must broaden their curricula. Students must be provided with charac ter and values education in addition to instruction in academic and intellectual skills.
School-Based Adolescent Health Care in the '90s
Authors: Nicholson Bruce
Published: March 2007

Here's one school that has established an array of health care programs to meet the needs of its students. Such programs could readily be put in place in other locales.
Making Democracy Work in Our Schools: From Theory to Reality
Authors: Slater Robert
Published: March 2007

Of the various qualities youngsters must have to promote and sustain democracy in America, by far the most important is the capacity to reason. We can give them this capacity if we change the way we do business in the classroom.
Mentoring Programs for Aspiring Principals: Getting a Solid Start
Authors: Walker Allan , Stott Kenneth
Published: March 2007

Districts considering implementing prin cipalship mentoring programs can in crease their programs' chances of success by considering a number of im portant issues before they begin. The suggestions provided here are based on the experiences gained through a men toring program in Singapore that has been operating for almost 10 years.
Recognizing How Adults Learn: Implications for Principals
Authors: Richardson M.D. , Prickett R.L.
Published: March 2007

Educators have historically supported the position that learning is a lifelong procedure, but few have acknowledged that learning is accomplished in different ways at various stages of life. Research indicates that a child seven years of age has a different learning pattern than a high school senior, or an adult. Until re cently, however, the same principles of learning, or pedagogy, were applied to all learning situations regardless of the learner's maturity.
Technology for the Information Age: Moving Out of the Complacency Paralysis
Authors: Williams Warren W. , Smith Jo Ann
Published: March 2007

As they seek solutions to confront the myriad problems facing them, adminis trators are frustrated by their inability to forge those lasting behavioral changes necessary to attack intransigent prob lems. The most persistent obstacle is that teachers are still most comfortable with what they do best, educating students in whole-group fashion within the confines of the self-contained class room.
National Journalism Certification: Providing Qualified Teachers And Advisers
Authors: Hathaway Tantillo Susan
Published: March 2007

More than half-a-million students across the country take journalism courses and over 700,000 are a part of publications staffs. Because of their critical role in communication both inside and outside school walls, these students deserve the best teachers they can get. A certification program can help to ensure this hap
The Need for a School Suicide Prevention Policy
Authors: Coy Doris Rhea
Published: March 2007

Intense social and academic pres sures on young adults can lead to sui cide attempts. To help prevent tragedy, school leaders should have suicide prevention polices and programs in place.
The School Counselor's Role in Educational Reform
Authors: Perry Nancy S.
Published: March 2007

How can principals work with school counselors to provide sound education and still satisfy the needs of the busi ness community? A comprehensive systematic counseling program that encourages all students to reach their potential will result in better learners and more highly skilled workers.
What Can We Expect To See in The Next Generation of Block Scheduling?
Authors: Shortt Thomas L. , Thayer Yvonne
Published: March 2007

In the school that uses a block sched ule, time is a resource that permits greater student learning, laboratory work, and student-directed interactive activities.
Can We Find the Traditional American School in the Idea of Choice?
Authors: Hlebowitsh Peter S.
Published: March 2007

The largest and most profound purpose of public schooling continues to be education for social understanding and democratic participation. Over time, might we awaken the powers of the localty-zoned school to serve the comprehensive educational needs of all youth?
Saying Yes to Vouchers: Perception, Choice, and the Educational Response
Authors: Walthers Kevin
Published: March 2007

Vouchers hold the promise of elevating teaching to professional status, raising levels of student achievement, and restoring the confidence of the taxpaying public, betieve this author and other voucher proponents.
Choice Within Schools Can Help Students, Schools, and Society
Authors: Matthews L. Joseph , Hansen J. Merrell
Published: March 2007

If we cannot give parents and students more choice within our schools, say these authors, it will only be a matter of time before they seek choice in other schools.
Missouri's A+ Schools Program: Providing Quality Education For All Students
Authors: Robison Robert A.
Published: March 2007

The A+ Schools Program is a legislated, statewide reform effort that offers a framework and incentives for providing quality education for all students—an education that has a career focus and is the academic foundation for lifelong learning.
The Manhattanville Neuroscience Outreach Program (MNOP): A Cooperative Education Model
Authors: Bettica Annemarie
Published: March 2007

This school-college cooperative education model is a cross-discipli nary approach that seeks to encourage and support community edu cation in the sciences. It is adaptable to any general science topic, depending on the strengths of the faculty and the students in the sponsoring institution.
Cooperative Learning and Traditional American Values: An Appreciation
Authors: Johnson David W. , Johnson Roger T.
Published: March 2007

Cooperation provides the power to make American democracy work. Cooperative (not competitive or individualistic) efforts make self-evi dent the truths that all humans are created equal and are endowed with the rights of life, liberty, and the pursuit of happiness. It is time to recognize the relationship between cooperative learning and commit ment to the values underlying American democracy.
Health, Physical Recreation, and Dance: Where Are They Going?
Authors: Davis Michael G.
Published: March 2007

Health, physical education, and dance curricuta must be based on qual ity standards and emphasize the importance of a healthy lifestyle and the value of being physically active.
Addressing the Literacy Crisis: Teaching Reading in the Content Areas
Authors: Barton Mary Lee
Published: March 2007

We are not helping students acquire the strategic reading skills they will need to cope with the ever-increasing demands of the market place. Administrators, teachers, and parents need to make literacy a top priority and reading skills must be incorporated into courses across the curriculum.
Meeting the Needs of Middle Level Students Through Service Learning
Authors: Hope Warren C.
Published: March 2007

Service learning integrates service into student instruction and learn ing. It promotes personal, social, and intellectual growth; develops a sense of civic responsibility; provides opportunities for leadership; and prepares students for the world of work. Employing service learning activities in middle level schools allows students to help others white involving them in activities that contribute to their learning.
What We Know About Block Scheduling and Its Effects on Math Instruction, Part II
Authors: Kramer Steven L.
Published: March 2007

Factors That May Have Contributed to Decreased Test Performance in British Columbia's Block Scheduled Schools
Promoting Inclusion Through Instructional Leadership: The Roles Of the Secondary School Principal
Authors: Parker Stephanie A. , Day Victoria P.
Published: March 2007

Learning is the core purpose, the quintessential mission of schools and schooling. Learning and its sundry issues also present problems and questions for school leaders: Who can learn? What can they learn? How should opportunities for learning be structured? To whom should such opportunities be directed? These questions are fundamental to the issue of inclusion in schools.
A Comparison of Six Wisconsin Mentoring Programs for Beginning Teachers
Authors: Ganser Tom , Koskela Ruth , Allen David M. , Eirich Genevieve T. , Nerad Robert M. , Rissmann-Joyce Stacie , Sobocinski Phil
Published: March 2007

Mentoring programs take many formats and serve several purposes. They are most commonly organized by local school districts, but may also sponsored by state departments of education, consortia of schools, educational service agencies, and teachers' professional organizations. Sometimes participation in a mentoring program is required for licensure or by local districts as a condition of employment.
John Dewey and News
Authors: McGlashan Zena Beth
Published: March 2007

The potential for the application of Dewey's pragmatism by contemporary media scholars is clear. We must not stay in the realm of philosophy alone but must offer proposals which contain not only his pragmatism, with its scientific method, but also the historical tradition of what is generally considered American pragmatism, concepts for change that might work.
Technology, Mass Communication, and Law
Authors: Hardt Hanno
Published: March 2007

... freedom of expression and freedom of the press mean... a guarantee for a social system that tolerates creative minds and encourages critical opinions by providing ways of involving the many and varying talents of individuals in the discussion about society and about the future of the social system.
Language as the "Strainer" of Scientific Thought
Authors: Skenes Robert E. , Carlyle Carolyn
Published: March 2007

"... words do not label things already there. Words are like the knife of the carver: they free the idea, the thing, from the general formlessness of the outside. As a man speaks, not only is his language in a state of birth, but also the very thing about which he is talking. Edmund Carpenter
Press Responsibility and New Journalism
Authors: Murphy James E.
Published: March 2007

The intention of the paper is to show the possible benefit of the New Journalism movement in offering a philosophy of journalism that seems to be more in tune with the journalistic social functions of education and interpretation which are becoming increasingly important.
Ferdinand Tönnies and Robert Park on Public Opinion: A Comparison and Analysis
Authors: Cartier Jacqueline
Published: March 2007

Even if he did not intend it to be so, Park's work serves as an extensive critique of many of Tönnies' central concepts, contributing substantially to continuing discussion concerning social dynamics and social goals.
Retail industry: how to find out
Authors: Grant Deborah
Published: March 2007

Retailing has become one of the fastest growing and most glamorous business sectors. Information sources about the industry have grown apace. This article evaluates the leading sources.
How to find US business information
Authors: Smith Gerry
Published: March 2007

Reviews the major sources of US business information — directories/company information, statistics, market research sources, magazines and newspapers, indexes and abstracts, databases, online vendors, libraries and information services, and research guides.
Online numeric databases : four years later
Authors: Foster Allan
Published: March 2007

Identifies seven major trends in business databases: concentration of players; convergence of database systems; growth of numeric databases; end-user access; alternative delivery modes; development of PC software and more gateways. Examines the changing role of information professionals, and outlines the major numeric/statistical business databases.
Ensuring the closure of your corporate information department: 10 tips for the uninitiated
Authors: Tudor James
Published: March 2007

Recommends 10 steps that can be taken by the corporate information professional to ensure the closure of the information centre in a stormy economic climate.
Does Clinical Error Contribute to Unnecessary Antibiotic Use?
Authors: McIsaac Warren J. , Butler Christopher C.
Published: March 2007

Patient expectations and physician attitudes are often cited as factors in the overuse of antibiotics. This study examined whether clinical error might also be important. In treating 517 patients with sore throat, family physicians estimated the probability that group A streptococcus infection was present. Two thirds of antibiotics prescribed were to culture-negative patients and therefore considered unnecessary. Physicians overestimated the probability that a group A streptococcal infection was present by an average 33.2% in these cases, compared with 6.9% otherwise (p < 0.001). The rate of unnecessary prescribing was 5.1% when the physician estimate differed from the true probability of a group A streptococcal infection by <10%, 16.0% for an error of 10-29%, 35.6% for an error of 30-49%, and 78.3% when the chance of the infection was overestimated by 50% or more. Clinical error in estimating the likelihood of group A streptococcal infection probably contributes to unnecessary antibiotic use in patients with sore throat. Key words: antibiotic use; clinical error; prescribing; sore throat. (Med Decis Making 2000;20:33-38)
Unstable Preferences:
Authors: Jansen Sylvia J.T. , Stiggelbout Anne M. , Wakker Peter P. , Nooij Marianne A. , Noordijk Evert M. , Kievit Job
Published: March 2007

Objective. Many studies suggest that impaired health states are valued more positively when experienced than when hypothetical. This study investigated to what extent this discrepancy occurs and examined four possible explanations: non-corresponding description of the hypothetical health state, new understanding due to experience with the health state, valuation shift due to a new status quo, and instability of preference. Patients and methods. Fifty-five breast cancer patients evaluated their actually experienced health state, a radiotherapy scenario, and a chemotherapy control scenario before, during, and after postoperative radiotherapy. Utilities were elicited by means of a visual analog scale (VAS), a chained time tradeoff (TTO), and a chained standard gamble (SG). Results. The discrepancy was found for all methods and was statistically significant for the TTO (predicted utilities: 0.89, actual utilities: 0.92, p ≤ 0.05). During radiotherapy, significant differences (p ≤ 0.01) were found between the utilities for the radiotherapy scenario and the actual health state by means of the VAS and the SG, suggesting non-corresponding description as an explanation. The utilities of the radiotherapy scenario and the chemotherapy control scenario remained stable over time, and thus new understanding, valuation shift, and instability could be ruled out as explanations. Conclusion. Utilities obtained through hypothetical scenarios may not be valid predictors of the value judgments of actually experienced health states. The discrepancy in this study seems to have been due to differences between the situations in question (non-corresponding descriptions). Key words: stability; utility assessment; standard gamble; time tradeoff; breast cancer; chemotherapy; radiotherapy. (Med Decis Making 2000;20:62-71)
Improved Statistical Classification Methods in Computerized Psychiatric Diagnosis
Authors: Vlachonikolis Ioannis G. , Karras Dimitris A. , Hatzakis Manolis J. , Paritsis Nicholas
Published: March 2007

Background. Mainstream psychiatric diagnosis involves mainly sequential, expert-system-derived, logical decision rules. Among the few statistical classification methods that have been sporadically evaluated are Bayes, k-nearest neighbor, and discriminant analysis classifiers. Methods. A statistical classification method based on artificial neural networks (ANN) with task-specific constrained architectures was applied to a sample of 796 clinical interviews, where the symptom evaluation and the diagnostic judgments were made using the Psychiatric State Examination (PSE) system. The proposed constrained ANN (CANN) method was compared with other statistical classification methods. Results. CANN was found to be superior to all other considered methods, having an overall "correct" classification rate of 80% when applied to test data. Similarly, the concordance coefficients of agreement with the PSE diagnostic categories were all very high. Among the other used methods, discriminant analysis had slightly inferior performance but better generalization capability. Conclusions. The proposed CANN method has a definite utility in psychiatric diagnosis and requires further evaluation, perhaps alongside other standard classification systems and/or with larger samples. Key words: computer-aided psychiatric diagnosis; artificial neural networks ; expert systems; classification methods. (Med Decis Making 2000;20:95-103)
Five Minutes with the Governor
Authors: Paltiel A. David
Published: March 2007

This paper aims to initiate a dialog among readers regarding the positioning and promotion of health-related decision analysis in the public sector. It is motivated by the author's personal observations that quantitative and economic evaluation methods continue to be viewed with skepticism by some public officials and that no consensus exists within our community as to what an appropriate message to such decision makers might be. A personal view of some key themes to be stressed in defining a vision for the field is presented. Key words: decision analysis; cost-effectiveness; policy. (Med Decis Making 2000;20:239-242)
Capturing Policy in Hearing-aid Decisions by Audiologists
Authors: Doyle Janet , Thomas Shane A.
Published: March 2007

Two studies are reported that together demonstrate that a rigorous protocol of cue elicitation employing behavioral observations of actual clinical behavior can be rewarded with powerful policy capturing in social judgment theory experiments. The decision policies of 16 clinical audiologists were derived in a study of the decision to recommend hearing-aid amplification. Using discriminant function analysis for each judge, the percentage correct classification rates for the hearing-aid recommendation criterion variable for all judges were high, with an average correct rate of 89.9%, despite widely divergent recommendation rates (21.4% to 87.1 %) associated with individual decision behaviors. Key words: judgment; clinical decision making; representative design; cue elicitation; audiologist policies; hearing aids. (Med Decis Making 1995;15:58-64)
Decision Analysis for lower-third-molar Surgery
Authors: Brickley Mark , Kay Elizabeth , Shepherd Jonathan P. , Armstrong Rosemary A.
Published: March 2007

The objective of the study was to identify those factors that should affect treatment planning for patients who have lower third molars, using decision-analytic techniques. Utility values based on data from 104 patients indicated that the respondents considered that postoperative complications (except mild pain and temporary paresthesia) reduced health to a greater degree than did complications following non-intervention. A decision analysis indicated that the maximum expected utility of prophylactic third-molar surgery (60.25) was lower than that for non-intervention (76.96). The decision was sensitive to changes in the probabilities of occurrence of recurrent pericoronitis (threshold = 0.52), resorption of an adjacent tooth (threshold = 0.29), loss of an adjacent tooth (threshold = 0.32), and cystic change (threshold = 0.34). These thresholds are much higher than the incidence of problems affecting the lower third molar shown by a concurrent clinical audit and literature review. This study therefore suggests that lower third molars should not be removed prophylactically. Key words: decision analysis; utility values; third molar surgery. (Med Decis Making 1995;15:143-151)
Communicating the Benefits of Chronic Preventive Therapy
Authors: Hux Janet E. , Naylor C. David
Published: March 2007

Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction-"34% reduction in heart attacks"-88% of the patients assented to therapy. All other formats elicited significantly more refusals (p < 0.0001): for absolute risk difference—"1.4% fewer patients had heart attacks"—42% assented; for in verted absolute risk—"treat 71 persons for 5 years to prevent one heart attack"—only 31% accepted treatment. When the data were extrapolated to disease-free survival—"average gain of 15 weeks"—40% consented. Similar responses were obtained for descriptions of an antihypertensive drug: 89% assented to therapy when given relative risk reduction but only 46% when given absolute risk reduction. The subjects were confident in both acceptance and refusal: 93% of the decisions were rated "somewhat certain" to "completely certain." The authors conclude that patients' views of medical therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most ap propriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit. Key words: patient compliance; framing effects; informed consent; physician-patient communication. (Med Decis Making 1995;15:152-157)
The Role of Reluctance to Give Up life in the Measurement of the Values of Health states
Authors: Fowler Floyd J. , Cleary Paul D. , Massagli Michael P. , Weissman Joel , Epstein Arnold
Published: March 2007

Questions that involve willingness to risk or give up life often are used to measure the values of health states. In the Boston Health Study, interviews with 291 patients who had AIDS included questions about health status and current desire for resuscitation, and a series of hypothetical questions about desire for life-extending efforts if the patients found themselves in undesirable states, such as being chronically nauseous or blind. An index, "reluctance to give up life" was made from five such questions. The desire for resuscitation was related to current health status, but the general reluctance to give up life was not. Desire to be resus citated was significantly related to current health status only when "reluctance to give up life" was "low." For people reluctant to say they will give up any life at all, questions that involve risking or trading life seem likely to be poor measures of the values of health states. Key words: utility; time tradeoff; standard gamble. (Med Decis Making 1995;15:195-200)
Bayesian Decision Making Based on Measurements Containing Errors
Authors: Philosophov Leonid V.
Published: March 2007

The paper presents a Bayesian approach to the construction of diagnostic and prognostic algorithms, based on the use of several diagnostic factors (tests) in combination. With this approach, the simultaneous use of dichotomous, discrete, categoric, and continuous factors is easy and the resulting algorithms are more efficient than those of other known methods. Moreover, each factor value that is available for use is assumed to represent an estimate (the result of an imperfect measurement) of some (unknown) true value. The proposed method of accounting for measurement errors is advantageous as regards efficiency for users of the algorithm (physicians) if the accuracy of the factor-measurement techniques at their disposal differs from that of the constructor of the algorithm (the scientist). The approach is illustrated by an example, and possible error models and methods of collecting statistical data are discussed. Key words: Bayes' formula; factors; factor measurements; errors of measurement; estimates; decisions; decision efficiency. (Med Decis Making 1990;15:264- 275)
Justifying Prenatal Screening and Genetic Amniocentesis Programs by Cost-Effectiveness Analyses
Authors: Ganiats Theodore G.
Published: March 2007

A strength of cost-effectiveness analysis is the presentation of all relevant clinical options, variables, and outcomes and the placement of values on the outcomes Despite success in many fields of health policy, cost-effectiveness analysts have failed to provide a complete evaluation of prenatal screening and genetic amniocentesis programs Specifically, all pub lished cost-effectiveness analyses of these programs at best only partially acknowledge the potential life of the aborted fetus. These incomplete evaluations not only violate some basic principles of cost-effectiveness analysis, they also produce conclusions that may be misleading. Ultimately, society must answer two basic questions regarding the use of cost- effectiveness to justify prenatal screening programs: Is cost-effecfiveness analysis an ap propriate tool for the evaluation of these programs? If so, then what are the outcomes of interest? This paper first shows that the current literature does not present a complete evaluation of these programs. The ramifications of this incomplete evaluation are presented from several perspectives. Finally, given the problems associated with the use of cost- effectiveness analysis, the article suggests that cost-effectiveness analysis is not yet an appropriate tool to justify prenatal screening or genetic amniocentesis programs Key words: amniocentesis; abortion; cost-effectiveness analysis; health policy. (Med Decis Making 1996;16:45-50)
Patient Satisfaction with Health Care Decisions
Authors: Holmes-Rovner Margaret , Kroll Jill , Schmitt Neal , Rovner David R. , Breer M. Lynn , Rothert Marilyn L. , Padonu Georgia , Talarczyk Geraldine
Published: March 2007

Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions The six-item scale has excellent reliability (Cronbach's alpha = 0.86). Discriminant validity, tested by performing principal- components analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with "decisional confidence," and least with "desire to participate in health care de cisions" and "satisfaction with provider " The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients' intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure Key words: patient satisfaction; medical decision making; decision support (Med Decis Making 1996;16:58-64)
An Empirical Note on Willingness to Pay and Starting-point Bias
Authors: Stålhammar Nils-Olov
Published: March 2007

One of the most serious sources of potential bias when using the contingent valuation (CV) method to assess willingness to pay (WTP) is implied-value cues, i.e., different types of starting-point bias. The possible existence of starting-point bias is serious, since it may be interpreted to mean that the responders' preferences are very unstable. While the empirical evidence from environmental economics on starting-point bias is mixed, an earlier study in health economics did not find any clear evidence of starting- point bias. However, in the study presented here, a clear presence of starting-point bias was found. In a Swedish survey of how and when patients take antisecretory drugs, the patients were asked about their willingness to pay for a medication that can be taken in relation to meals compared with one that must be taken at least one hour before meals and has the additional disadvantage that it interacts with contraceptive pills. Among the 105 respondents, 82 were willing to pay a sum in addition to the normal patient fee in order to obtain the drug that could be taken during meals. The 82 patients thereafter participated in a bidding game that could start at a low bid (SEK 20) or a high bid (SEK 1,000). On average, the patients were willing to pay an addi tional SEK 138 (1 SEK = 0.13 U.S. dollar, April 1995) to obtain the superior drug. However, the average WTP among the 42 patients who started at the low bid was 70 SEK, which should be compared to an average of 289 SEK among the 40 patients who initially were offered the high bid. Key words: contingent valuation; willingness to pay; starting-point bias. (Med Decis Making 1996;16:242-247)
Using a Trade-off Technique to Assess Patients' Treatment Preferences for Benign Prostatic Hyperplasia
Authors: Llewellyn-Thomas Hilary A. , Williams J. Ivan , Levy Linda , Naylor C.D.
Published: March 2007

The probability-tradeoff technique may be used to assess treatment preferences in dichotomous choices. In this feasibility study, it was used to elicit benign prostatic hyperplasia (BPH) patients' attitudes towards three different treatments. Eighty-seven male outpatients used rating scales and the standard gamble to indicate the extents to which they were free of BPH symptoms. Paired descriptions of "watchful waiting" (WW), treatment with an alpha blocker (AB), and transurethral resection of the prostate (TURP) were presented, and the probability-tradeoff technique was used to obtain treatment-preference scores. The tradeoff task identified six internally consistent pref erence-order subgroups. The majority (n = 55; 63.2%) were in the two subgroups in which TURP was the least-preferred treatment. Compared with the other respondents, the members of these two subgroups reported significantly higher utilities for their BPH symptom status (89 vs 79; t = 2.87; p < 0.0005). Within each subgroup, preference scores for the middle- and top-ranked treatments were computed relative to the bottom- ranked treatment; for both WW and AB, significant across-subgroup differences were observed. In this preliminary study the probability-tradeoff technique was feasible, able to identify unique preference-order subgroups, and able to generate apparently mean ingful preference scores in a clinical situation involving three alternative treatments. Further development of tradeoff tasks as the value-clarification component of decision aids for individual patients seems warranted. Key words: patients' preferences; deci sion aids; benign prostatic hyperplasia; utilities; probabilities; risk aversion. (Med Decis Making 1996;16:262-272)
Routine Individual Feedback on Requests for Diagnostic Tests
Authors: Winkens Ron A.G. , Ament André J.H.A. , Pop Peter , Reniers Peter H.A. , Grol Richard P.T.M. , Knottnerus André J.
Published: March 2007

The authors assessed the economic consequences of routine individual feedback on test requests provided to 85 family physicians in a region with 187,000 inhabitants. In a retrospective study as part of a quasi-experiment, cost trends in a region where feedback was provided over a seven-year period were compared with cost trends elsewhere in The Netherlands without feedback. Data on variable costs were obtained for 400 individual tests that accounted for 90% of all requests. Differences in request trends thus were transformed to savings in costs of diagnostic testing, taking account of the extra costs of providing the feedback. Expenditures for diagnostic testing de clined after the start of the feedback, despite the costs of providing the feedback. The savings increased as the feedback continued. Compared with the trend elsewhere without feedback, over seven years a total net sum of 1.4 million U.S. dollars was saved. Routine individual feedback is therefore economically worthwhile. Key words: economic evaluation; feedback; diagnostic testing; quality assurance; cost contain ment. (Med Decis Making 1996;16:309-314)
Do Violations of the Axioms of Expected Utility Theory Threaten Decision Analysis?
Authors: Nease Robert F.
Published: March 2007

Research demonstrates that people violate the independence principle of expected utility theory, raising the question of whether expected utility theory is normative for medical decision making. The author provides three arguments that violations of the independence principle are less problematic than they might first appear. First, the independence principle follows from other more fundamental axioms whose appeal may be more readily apparent than that of the independence principle. Second, the axioms need not be descriptive to be normative, and they need not be attractive to all decision makers for expected utility theory to be useful for some. Finally, by providing a metaphor of decision analysis as a conversation between the actual decision maker and a model decision maker, the author argues that expected utility theory need not be purely normative for decision analysis to be useful. In short, violations of the in dependence principle do not necessarily represent direct violations of the axioms of expected utility theory; behavioral violations of the axioms of expected utility theory do not necessarily imply that decision analysis is not normative; and full normativeness is not necessary for decision analysis to generate valuable insights. Key words: ex pected utility theory; independence axiom; decision analysis; normativeness. (Med De cis Making 1996;16:399-403)
Inferences for Likelihood Ratios in the Absence of a "Gold Standard"
Authors: Joseph Lawrence , Gyorkos Theresa W.
Published: March 2007

Likelihood ratios are extensively used to evaluate the performances of diagnostic tests and to update prior odds of disease to posttest odds. Since few tests are truly 100% accurate, including many used as "gold standards," it is important to be able to esti mate likelihood ratios in cases where no such standard is available. In this paper, methods to calculate point and interval estimates for likelihood ratios are described. The results numerically coincide with those reviewed by Centor when a "gold standard" is assumed available, but typically provide wider interval estimates when such a stan dard is not available, reflecting the increased uncertainty inherent in such situations. Unlike previous techniques, the methods do not require normal approximations or log arithmic transformations, and hence provide accurate estimates even when parameter distributions are highly skewed. The methods are illustrated using the results of two different diagnostic tests for the presence of an intestinal parasitic infection. Key words: Bayesian analysis ; diagnostic tests; epidemiologic methods; likelihood ratios; Monte Carlo methods; statistical models. (Med Decis Making 1996;16:412-417)
The Validity of QALYs
Authors: Bleichrodt Han , Johannesson Magnus
Published: March 2007

Pliskin, Shepard, and Weinstein identified three preference conditions that ensure that quality-adjusted life years (QALYs) represent preferences over gambles over chronic health profiles. This paper presents an experimental test of the descriptive validity of two of these preference assumptions: utility independence and constant proportional tradeoff. Eighty students at the Stockholm School of Economics and 92 students at Erasmus University Rotterdam participated in the experiment. The results of the ex periment support the descriptive validity of constant proportional tradeoff: both within groups and between groups constant proportional tradeoff could not be rejected. The results are less supportive of the descriptive validity of utility independence. Within- groups utility independence was rejected. Between-groups utility independence could not be rejected, but this may have been due to a lack of statistical power. Analysis of the individual responses revealed that without adjustment for imprecision of preference, 39 respondents (22.8%) satisfied constant proportional tradeoff. Twenty-three respon dents (13.4%) satisfied utility independence without adjustment for imprecision of pref erence. However, because of the relative unfamiliarity of the respondents with both the health states to be evaluated and the methods of health-state-utility measurement, it is likely that the respondents' preferences were imprecise. Adjusted for imprecision of preference, the upper estimates of the proportions of respondents who satisfied constant proportional tradeoff and utility independence, respectively, were 90.1% (155 respondents) and 75.6% (130 respondents). Pliskin et al. further derived that if an individual's preferences satisfy both constant proportional tradeoff and utility indepen dence, then these preferences can be represented by a more general, risk-adjusted QALY model. Without adjustment for imprecision of preference, ten respondents (5.8%) satisfied both constant proportional tradeoff and utility independence. Adjusted for imprecision of preference, the upper estimate of the proportion of respondents who satisfied both constant proportional tradeoff and utility independence was 68.6% (118 respondents). The results of this study indicate that constant proportional tradeoff holds approximately. The evidence is much weaker for utility independence, however. This has important implications for the use of QALY-type measures in medical decision making. Key words: QALYs; health utility measurements; medical decision making; individual preferences. (Med Decis Making 1996;17:21-32)
Can Preference Scores for Discrete States Be Used to Derive Preference Scores for an Entire Path of Events?
Authors: Kuppermann Miriam , Shiboski Stephen , Feeny David , Elkin Eric P. , Washington A. Eugene
Published: March 2007

The authors conducted a study exploring whether preferences for sequences of events can be approximated by preferences for component discrete states. Visual-analog- scale (VAS) and standard-gamble (SG) scores for a subset of the possible sequences of events (path states) and component temporary and chronic outcomes (discrete states) that can follow prenatal diagnostic decisions were elicited from 121 pregnant women facing a choice between chorionic villus sampling and amniocentesis. For in dividuals, preference scores for path states could not be predicted easily from discrete- state scores. Mean path-state VAS scores, however, were predicted reasonably ac curately by multiple regression models (R2 = 0.85 and 0.82 for two different anchoring schemes), with most measured scores lying within the 95% confidence intervals of the derived scores. It is concluded that, for individual patient decision making, preferences for path states should be elicited. When mean preference values for a population are sought, however, it may be reasonable to derive regression weights from a subset of respondents and then to apply those weights to preferences for discrete states elicited from a larger group. Key words: utility measurement; patient preferences; multiple re gression ; standard gamble; visual analog scaling; prenatal diagnosis. (Med Decis Mak ing 1997;17:42-55))
Primer on Medical Decision Analysis: Part 5—Working with Markov Processes
Authors: Naimark David , Krahn Murray D. , Naglie Gary , Redelmeier Donald A. , Detsky Allan S.
Published: March 2007

Clinical decisions often have long-term implications. Analysts encounter difficulties when employing conventional decision-analytic methods to model these scenarios. This occurs because probability and utility variables often change with time and conventional decision trees do not easily capture this dynamic quality. A Markov analysis performed with current computer software programs provides a flexible and convenient means of modeling long-term scenarios. However, novices should be aware of several potential pitfalls when attempting to use these programs. When deciding how to model a given clinical problem, the analyst must weigh the simplicity and clarity of a conventional tree against the fidelity of a Markov analysis. In direct comparisons, both approaches gave the same qualitative answers. Key words: decision analysis; expected value; utility; sensitivity analysis; decision trees; probability. (Med Decis Making 1997; 17:152-159)
Failure of Three Decision Rules to Predict the Outcome of In-hospital Cardiopulmonary Resuscitation
Authors: Ebell Mark H. , Kruse James A. , Smith Mindy , Novak Jeanne , Drader-Wilcox Joelle
Published: March 2007

The objective of this study was to evaluate three decision-support tools (the Pre-Arrest Morbidity or PAM score, the Prognosis After Resuscitation or PAR score, and the Acute Physiology and Chronic Health Evaluation or APACHE III score) for their abilities to predict the outcomes of in-hospital cardiopulmonary resuscitation (CPR). The medical records of all 656 adult inpatients undergoing CPR during a two-to-three-year period in three large hospitals were retrospectively reviewed, and demographic and clinical variables were abstracted. Of 656 patients undergoing resuscitation, 248 (37.8%) survived the resuscitation attempt long enough to be stabilized (immediate survival), but only 35 (5.3%) survived to discharge. Only 11 patients had PAM scores higher than 8, none of whom survived to discharge; 131 patients had PAR scores above 8, of whom six survived to discharge. The PAR score and the APACHE III score had the greatest areas under the receiver operating characteristic curves (when predicting the outcome of survival to discharge), although no individual area for either outcome was greater than 0.6. None of the decision-support tools studied was able to effectively discriminate between survivors and non-survivors for the outcomes of immediate survival and survival to discharge following in-hospital CPR. This is consistent with previous work utilizing the APACHE II score, which did not identify a threshold above which patients did not benefit from CPR. The findings for the PAR score and the PAM score stand in contrast to previous studies that found them to be potentially useful decision rules. Further work is needed to develop a decision-support tool that better discriminates between survivors and non-survivors of in-hospital CPR. Key words: resuscitation; prognosis; cardiopulmonary resuscitation; decision support; decision making. (Med Decis Making 1997;17:171-177)
The Effect of Data Sampling on the Performance Evaluation of Artificial Neural Networks in Medical Diagnosis
Authors: Tourassi Georgia D. , Floyd Carey E.
Published: March 2007

Purpose. To study the effect of data sampling on the predictive assessment of artificial neural networks (ANNs) for medical diagnostic tasks. Methods. Three statistical techniques were used to evaluate the diagnostic performances of ANNs: 1) cross validation, 2) round robin, and 3) bootstrap. These techniques are different sampling plans designed to reduce the small-sample estimation bias and variance contributions. The study was based on two networks, one developed for the diagnosis of pulmonary embolism (1,064 cases) and the other developed for the diagnosis of breast cancer (206 cases). Results. The three sampling techniques produced different performance estimates for both networks. The estimates varied substantially depending on the training sample size and the training-stopping criterion. Conclusion. The predictive assessment of ANNs in medical diagnosis can vary substantially based on the complexity of the problem, the data sampling technique, and the number of cases available. Key words: computer-aided diagnosis; artificial neural networks; sampling; cross validation; round robin; bootstrap; receiver operating characteristic analysis. (Med Decis Making 1997;17:186-192)
Is Experience a Good Teacher?
Authors: Wilson Ira B. , Green Michael L. , Goldman Lee , Tsevat Joel , Cook E. Francis , Phillips Russell S.
Published: March 2007

Background. Recent studies have shown that physicians do not accurately assess patients' health status or treatment preferences. Little is known, however, about how physicians' levels of training or experience relate to their abilities to assess these preferences. To better understand this phenomenon, the authors compared the abilities of medical interns and attending physicians to predict the choices of their adult patients for end-of-life care. Methods. 230 seriously-ill adult inpatients were surveyed about their desires for cardiopulmonary resuscitation, their current quality of life, and their attitudes toward six other common adverse outcomes. The medical intern and attending physician who cared for these patients were asked to estimate the patient's responses for all of the same items. Agreement was assessed using the kappa statistic. Results. Compared with interns, attending physicians had known patients longer, had talked with patients more frequently about prognosis, and felt they knew more about their patients' preferences (all p < .0001). Despite this, the attending physicians were no more accurate than the interns in assessing patients' preferences. Both interns and attending physicians had only a fair understanding of patients' preferences for cardiopulmonary resuscitation or their quality of life (kappa statistics 0.32 to 0.47), and even less understanding of their willingness to tolerate adverse outcomes (kappa statistics -0.03 to 0.37). Conclusions. For this cohort of seriously ill patients, neither medical interns nor their attending physicians were consistently accurate in assessing patients' preferences, and attending physicians were not more accurate than medical interns. Attending physicians should not assume that they can infer patients' preferences any better than the interns caring for these hospitalized patients. Key words: end-of-life care; patient-physician relationship; patient preferences; resident physicians. (Med Decis Making 1997;17:217-227