This document discusses a survey of bariatric surgeons that showed those performing mini-gastric bypass (MGB) surgery answered questions about gastric cancer risk, surgery outcomes, and costs correctly more often than surgeons not performing MGB. However, many surgeons overall demonstrated lack of knowledge about these topics. The document suggests cognitive biases may be impacting surgeon decision making and recommends recognizing fallibility in human judgment to make more rational decisions.
The Economics of Patience: The endogenous determination of time preferenceRussell James
This presentation reviews an economic model by Nobel Prize winning economist Gary Becker and Casey Mulligan incorporating the idea of imagination in time preference.
“I Had No Idea”: The Silencing of Food Insecurity and the Role of Undergradua...Iowa Campus Compact
Primarily focused on undergraduate
education, this session seeks to elicit new
ways to help our students understand and redress public silence and quiescence
around the issue of food insecurity.
Garry Leonard Running IV
Department of Geography
and Anthropology
UW-Eau Claire
Ruth Cronje
English and Honors
UW-Eau Claire
Mike Huggins
Eau Claire Clear Vision
UW-Eau Claire Honors
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
The Economics of Patience: The endogenous determination of time preferenceRussell James
This presentation reviews an economic model by Nobel Prize winning economist Gary Becker and Casey Mulligan incorporating the idea of imagination in time preference.
“I Had No Idea”: The Silencing of Food Insecurity and the Role of Undergradua...Iowa Campus Compact
Primarily focused on undergraduate
education, this session seeks to elicit new
ways to help our students understand and redress public silence and quiescence
around the issue of food insecurity.
Garry Leonard Running IV
Department of Geography
and Anthropology
UW-Eau Claire
Ruth Cronje
English and Honors
UW-Eau Claire
Mike Huggins
Eau Claire Clear Vision
UW-Eau Claire Honors
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
Sorry, Your Mum Is Not a Valid Test ParticipantMichael Rawling
Presented at Agile On The Beach, 2017.
Speaking to the right users and getting more than feature requests
If you want understand how a Lions hunts, don’t go to the Zoo, go to the jungle savannah.
Kevin roberts, CEO Saatchi & Saatchi
User Research is one of the cornerstones of UX but the sheer volume of techniques that are around, combined with jargon and ‘silo’d teams often means the shared, fundamental goals of many approaches - such as UCD, Design Thinking and Agile/XP to name but a few - of bringing together the understanding of the people who use a system with those who actually create it constantly fall short.
Mike Rawling, a ux veteran of projects of sizes and shapes, combines tried and tested experience with the latest practical techniques, hot from the ux trenches: including how to do user interviews right, observation and testing your ideas with users in a memorable and pragmatic way that fits right into the world of digital design and development - without compromising either UX or your XP, Agile or Lean principles.
Attendees will come away from this session with an introduction to using the right types of user research in your Agile/Lean/XP process so they continue to serve as a useful reference for your team and stakeholders throughout the life of your product.
BE THE NATURALIST! OR: SORRY, YOUR MUM IS NOT A VALID TEST PARTICIPANTMichael Rawling
SPEAKING TO THE RIGHT USERS AND GETTING MORE THAN FEATURE REQUESTS
"If you want understand how a Lions hunts, don’t go to the Zoo, go to the Savannah."
User Research is one of the cornerstones of UX but the sheer volume of techniques around, combined with jargon and ‘silo’d teams often means the fundamental goal of many approaches like UX and XP always seems beyond reach:
- To bring together (understanding of) the people who use a system with those who actually create it.
Mike Rawling, a ux veteran of products and projects of all sizes and shapes, takes attendees on a safari through the world of user research techniques, combining tried and tested formal UX experiences with the latest practical techniques, hot from the ux trenches you can use as a team. These include methods for user interviews, agile ethnography, user observation and practically testing your ideas with users in a measured way that fits right into the world of digital design and development: without compromising either UX or your XP, Agile, Lean or other development principles.
Those new to UX, new to user research or struggling with getting good feedback will come away from this session with an introduction to using the right types of user research in your Agile/Lean/XP process so they serve as an invaluable source of intelligence for you, your team and stakeholders, whilst most UX practitioners will come away with techniques that can help them solve the conundrum of ensuring rigorous user research in a rapidly changing landscape of disrupted devices, platforms and markets.
From the event "Specimen Science: Ethics and Policy Implications," held at Harvard Law School on November 16, 2015.
This event was a collaboration between The Center for Child Health and Policy at Case Western Reserve University and University Hospitals Rainbow Babies & Children’s Hospital; the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School; the Multi-Regional Clinical Trials Center of Harvard and Brigham and Women's Hospital; and Harvard Catalyst | The Harvard Clinical and Translational Science Center. It was supported by funding from the National Human Genome Research Institute and the Oswald DeN. Cammann Fund at Harvard University.
For more information, visit our website at http://petrieflom.law.harvard.edu/events/details/specimen-science-ethics-and-policy
By the end of this presentation you should be able to:
Describe the justification of qualitative Sampling Techniques
Understand different types of Sampling Techniques
From the event "Specimen Science: Ethics and Policy Implications," held at Harvard Law School on November 16, 2015.
This event is a collaboration between The Center for Child Health and Policy at Case Western Reserve University and University Hospitals Rainbow Babies & Children’s Hospital; the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School; the Multi-Regional Clinical Trials Center of Harvard and Brigham and Women's Hospital; and Harvard Catalyst | The Harvard Clinical and Translational Science Center. It is supported by funding from the National Human Genome Research Institute and the Oswald DeN. Cammann Fund at Harvard University.
For more information, visit our website at http://petrieflom.law.harvard.edu/events/details/specimen-science-ethics-and-policy
Disruption of the 'usual' - rethinking behavior change and communication in n...craig lefebvre
Effective communication is an essential component in the mix of strategies used to effect behavior change in regard to healthy eating. But are nutrition educators using all the behavior change tools? Are we really communicating effectively? Is our communication passionate enough and inspired enough to be heard? How do we increase the likelihood of improving healthy nutrition behaviors? With so many voices and choices out there in so many mediums (i.e. social media, grocery and food packaging advertising, television commercials, radio, etc) we have constant competition. This topic is sure to get nutrition educators thinking about how they currently communicate and to consider new avenues and strategies for their programs.
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
More Related Content
Similar to Cognitive Biases in Bariatric Surgery: The Strange Case of the MGB
Sorry, Your Mum Is Not a Valid Test ParticipantMichael Rawling
Presented at Agile On The Beach, 2017.
Speaking to the right users and getting more than feature requests
If you want understand how a Lions hunts, don’t go to the Zoo, go to the jungle savannah.
Kevin roberts, CEO Saatchi & Saatchi
User Research is one of the cornerstones of UX but the sheer volume of techniques that are around, combined with jargon and ‘silo’d teams often means the shared, fundamental goals of many approaches - such as UCD, Design Thinking and Agile/XP to name but a few - of bringing together the understanding of the people who use a system with those who actually create it constantly fall short.
Mike Rawling, a ux veteran of projects of sizes and shapes, combines tried and tested experience with the latest practical techniques, hot from the ux trenches: including how to do user interviews right, observation and testing your ideas with users in a memorable and pragmatic way that fits right into the world of digital design and development - without compromising either UX or your XP, Agile or Lean principles.
Attendees will come away from this session with an introduction to using the right types of user research in your Agile/Lean/XP process so they continue to serve as a useful reference for your team and stakeholders throughout the life of your product.
BE THE NATURALIST! OR: SORRY, YOUR MUM IS NOT A VALID TEST PARTICIPANTMichael Rawling
SPEAKING TO THE RIGHT USERS AND GETTING MORE THAN FEATURE REQUESTS
"If you want understand how a Lions hunts, don’t go to the Zoo, go to the Savannah."
User Research is one of the cornerstones of UX but the sheer volume of techniques around, combined with jargon and ‘silo’d teams often means the fundamental goal of many approaches like UX and XP always seems beyond reach:
- To bring together (understanding of) the people who use a system with those who actually create it.
Mike Rawling, a ux veteran of products and projects of all sizes and shapes, takes attendees on a safari through the world of user research techniques, combining tried and tested formal UX experiences with the latest practical techniques, hot from the ux trenches you can use as a team. These include methods for user interviews, agile ethnography, user observation and practically testing your ideas with users in a measured way that fits right into the world of digital design and development: without compromising either UX or your XP, Agile, Lean or other development principles.
Those new to UX, new to user research or struggling with getting good feedback will come away from this session with an introduction to using the right types of user research in your Agile/Lean/XP process so they serve as an invaluable source of intelligence for you, your team and stakeholders, whilst most UX practitioners will come away with techniques that can help them solve the conundrum of ensuring rigorous user research in a rapidly changing landscape of disrupted devices, platforms and markets.
From the event "Specimen Science: Ethics and Policy Implications," held at Harvard Law School on November 16, 2015.
This event was a collaboration between The Center for Child Health and Policy at Case Western Reserve University and University Hospitals Rainbow Babies & Children’s Hospital; the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School; the Multi-Regional Clinical Trials Center of Harvard and Brigham and Women's Hospital; and Harvard Catalyst | The Harvard Clinical and Translational Science Center. It was supported by funding from the National Human Genome Research Institute and the Oswald DeN. Cammann Fund at Harvard University.
For more information, visit our website at http://petrieflom.law.harvard.edu/events/details/specimen-science-ethics-and-policy
By the end of this presentation you should be able to:
Describe the justification of qualitative Sampling Techniques
Understand different types of Sampling Techniques
From the event "Specimen Science: Ethics and Policy Implications," held at Harvard Law School on November 16, 2015.
This event is a collaboration between The Center for Child Health and Policy at Case Western Reserve University and University Hospitals Rainbow Babies & Children’s Hospital; the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School; the Multi-Regional Clinical Trials Center of Harvard and Brigham and Women's Hospital; and Harvard Catalyst | The Harvard Clinical and Translational Science Center. It is supported by funding from the National Human Genome Research Institute and the Oswald DeN. Cammann Fund at Harvard University.
For more information, visit our website at http://petrieflom.law.harvard.edu/events/details/specimen-science-ethics-and-policy
Disruption of the 'usual' - rethinking behavior change and communication in n...craig lefebvre
Effective communication is an essential component in the mix of strategies used to effect behavior change in regard to healthy eating. But are nutrition educators using all the behavior change tools? Are we really communicating effectively? Is our communication passionate enough and inspired enough to be heard? How do we increase the likelihood of improving healthy nutrition behaviors? With so many voices and choices out there in so many mediums (i.e. social media, grocery and food packaging advertising, television commercials, radio, etc) we have constant competition. This topic is sure to get nutrition educators thinking about how they currently communicate and to consider new avenues and strategies for their programs.
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
4. Surgeon's Knowledge Contributes to
Patient Outcomes
• Richardson et al., Annals of Surgery:10 September 2012
• Survey of Knowledge and analysis of
patient outcomes in Nova Scotia
• 377 patients (72%) were treated by
25 surgeons
• Surgeon survey score was associated
with More Adequate Lymph Node
Excision, Lower Risk of Colostomy,
Local Recurrence Rate and Higher
Case Volume
6. IFSO Varianational Committee Survey
• Results (Preliminary)
• Experience with 39,000 cases in the
prior year
• Lap Band is a "Poor" Surgery
• RNY & Sleeve Surgeons have "lots"
of leaks
• MGB Surgeons Answered More
Correct than Non-MGB Surgeons
7. MGB Surgeons Answered More Correct than
Non-MGB Surgeons!
But FIRST some other results...
13. Did you once use the band in your practice
and then stop?
• Did you once use the band in your
practice and then stop?
• Yes: 51% Had Been Band Surgeons
and
Now Have Abandoned the Band
14. Leaks: MGB Surgeons vs RNY Surgeons
• MGB Surgeons
52% No Leaks in Past Year
(1 surgeon with 2 Leaks, Both from
Sleeve, Awful experience by report)
• RNY/Sleeve Surgeons
36% No Leaks in Past Year
(15% had 4 Leaks Last year!)
15. MGB Surgeons Answered More Correct than Non-
MGB Surgeons
• Q #75: "There are many large scale
studies that show no increased risk of
gastric cancer after Billroth II:"
• i.e.: 30 yr f/u, over 500 pts
• "Risk of gastric cancer is * Not * increased
after partial gastrectomy."
• Bassily R, Dept Gastroent., Victoria, Australia.J Gastroent
Hepatology. 2000 15(7):762;
• 44% Non-MGB Surgeons did not know this
16. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• 76. I understand the difference
between "Association" and
"Causation"
• 12% Did know the difference
17. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• 77. In a study from the Netherlands of 58,279
patients 162 stomach cancers were detected.
• A higher risk for stomach cancer was found for
men with the lowest level of education
• (RR lowest/highest level = 2.0, p = 0.02)
• i.e. Lower education = higher risk of stomach
cancer
• Do you think less education "CAUSES" stomach
cancer?
• 15% answered: Less Education
"Causes" Gastric Cancer
18. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• 78. There are some studies showing a slight
increased risk of gastric cancer 20-30 years after
Billroth II.
• But these patients had the Billroth II
overwhelmingly for Ulcer Disease and
• Ulcer and Gastric Cancer have a common
etiology;
• H. Pylori.
• Only 3% Disagreed with this,
97% Agreed with this
19. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• 79. Unoperated Gastric Ulcer patients have
double the risk for Gastric Cancer:
• Am J Gastroenterology 2007 Jun;102(6):1185-91. Pub 2007 Apr
13. Long-term risk of gastric cancer by subsite in operated and
unoperated patients hospitalized for peptic ulcer. Bahmanyar S, et
al, Department of Medical Epidemiology and Biostatistics,
Karolinska Institute, Stockholm, Sweden
• 29% Did not know this
(Even though one of the relevant articles is
quoted and referenced for them!)
20. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• There are MANY more Examples...
• 82. The death rate stomach cancer in the United
States has dropped from 28 to 5 per 100,000
people
• (PS This is True)
• 25.4% Did Not Know this.
21. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• There are MANY more Examples...
• 85. I have recently reviewed the literature on
gastric cancer and am very knowledgeable about
the risk of gastric cancer
• 64.4% Said No, they are not very
knowledgeable about the risks of
Gastric Cancer!
22. MGB Decreases Costs/RNY Does Not
• MGB decreases Hospitalization and Costs (1)
• New study: RNY Fails to Decrease Costs(2)
• 1. Int J Surg. 2007 Feb;5(1):35-40. Pub 2006 Aug 10.
Hospitalization before and after mini-gastric bypass surgery.
Rutledge R.
• 2. Arch Surg. 2012 Jul 1;147(7):633-40. Health expenditures
among high-risk patients after gastric bypass and matched
controls. Maciejewski ML, Livingston EH, Smith VA, Kahwati LC,
Henderson WG, Arterburn DE.
24. MGB Surgeons Answered More Correct than
Non-MGB Surgeons
• These are probably all good honorable
men and women who care for their
patients and want to the best for them
• But this survey shows that in the area of
the Mini-Bypass/Billroth II/Bile Reflux and
Gastric cancer
• These surgeons are woefully ignorant of
basic medical information published in the
medical literature?
• Even when it is referenced and quoted
• Surprisingly so!
25. In Summary:
MGB Surgeons Answered More Correct
than Non-MGB Surgeons
What's Going On Here?
P.S. Maybe we just got some poor
Non-MGB surgeons to fill out the
survey
Email me: DrR@CLOS.net
Maybe you can help bring up their
score!
27. Human Decision Making Errors
Very Common Cognitive Bias
•Exaggerate Rare Events
•Downplay Common Events
•Underestimate risks taken Willingly, (car)
•Overestimate risks Beyond Control
(airplane)
28. Irrational Illogical Thinking (Page 1 of
10)
•
Decision-Making Errors Cognitive
Ambiguity effect – the tendency to avoid options for which missing information makes the
probability seem "unknown."[6]
• Contrast effect – the enhancement or diminishing of a weight or other
measurement when compared with a recently observed contrasting object.[18]
Biases
• Anchoring – the tendency to rely too heavily, or "anchor," on a past reference or on one • Curse of knowledge – when knowledge of a topic diminishes one's ability to
trait or piece of information when making decisions (also called "insufficient adjustment"). think about it from a less-informed perspective.
• Attentional Bias – the tendency of emotionally dominant stimuli in one's environment to • Decoy effect – preferences change when there is a third option that is
preferentially draw and hold attention and to neglect relevant data when making asymmetrically dominated
judgments of a correlation or association. • Denomination effect – the tendency to spend more money when it is
•
denominated in small amounts (e.g. coins) rather than large amounts (e.g.
Availability heuristic – estimating what is more likely by what is more available in memory,
bills).[19]
which is biased toward vivid, unusual, or emotionally charged examples.
• Distinction bias – the tendency to view two options as more dissimilar when
• Availability cascade – a self-reinforcing process in which a collective belief gains more evaluating them simultaneously than when evaluating them separately.[20]
and more plausibility through its increasing repetition in public discourse (or "repeat
• Duration neglect – the neglect of the duration of an episode in determining its
something long enough and it will become true").
value
• Backfire effect – when people react to disconfirming evidence by strengthening their • Empathy gap – the tendency to underestimate the influence or strength of
beliefs.[7] feelings, in either oneself or others.
• Bandwagon effect – the tendency to do (or believe) things because many other people do • Endowment effect – the fact that people often demand much more to give up
(or believe) the same. Related to groupthink and herd behavior. an object than they would be willing to pay to acquire it.[21]
• Barnum effect - the observation that individuals will give high accuracy ratings to • Essentialism – categorizing people and things according to their essential
descriptions of their personality that supposedly are tailored specifically for them, but are nature, in spite of variations.[22]
in fact vague and general enough to apply to a wide range of people. • Exaggerated expectation – based on the estimates, real-world evidence turns
• Base rate neglect or Base rate fallacy – the tendency to base judgments on specifics, out to be less extreme than our expectations (conditionally inverse of the
ignoring general statistical information.[8] conservatism bias).[5][23]
• Belief bias – an effect where someone's evaluation of the logical strength of an argument • Experimenter's or Expectation bias – the tendency for experimenters to
is biased by the believability of the conclusion.[9] believe, certify, and publish data that agree with their expectations for the
• Bias blind spot – the tendency to see oneself as less biased than other people, or to be
outcome of an experiment, and to disbelieve, discard, or downgrade the
corresponding weightings for data that appear to conflict with those
able to identify more cognitive biases in others than in oneself.[10] expectations.[24]
• Choice-supportive bias – the tendency to remember one's choices as better than they • False-consensus effect - the tendency of a person to overestimate how much
actually were.[11] other people agree with him or her.
• Clustering illusion – the tendency to under-expect runs, streaks or clusters in small • Functional fixedness - limits a person to using an object only in the way it is
samples of random data traditionally used
• Confirmation bias – the tendency to search for or interpret information in a way that • Focalism - the tendency to rely too heavily, or "anchor," on a past reference or
confirms one's preconceptions.[12] on one trait or piece of information when making decisions.
• Congruence bias – the tendency to test hypotheses exclusively through direct testing, in • Focusing effect – the tendency to place too much importance on one aspect of
contrast to tests of possible alternative hypotheses. an event; causes error in accurately predicting the utility of a future outcome.
• Conjunction fallacy – the tendency to assume that specific conditions are more probable [25]
than general ones.[13] • Forer effect - the observation that individuals will give high accuracy ratings to
• Conservatism or Regressive Bias – tendency to underestimate high values and high descriptions of their personality that supposedly are tailored specifically for
likelihoods/probabilities/frequencies and overestimate low ones. Based on the observed them, but are in fact vague and general enough to apply to a wide range of
evidence, estimates are not extreme enough[5][14][15] people. This effect can provide a partial explanation for the widespread
• Conservatism (Bayesian) – the tendency to belief update insufficiently but predictably as a acceptance of some beliefs and practices, such as astrology, fortune telling,
result of new evidence (estimates of conditional probabilities are conservative)[5][16][17] graphology, and some types of personality tests.
29. Example Cognitive Biases
• Anchoring – the tendency to rely
too heavily, or "anchor," on a past • Availability cascade – a self-
reference or on one trait or piece reinforcing process in which a
of information when making
collective belief gains more
decisions (also called "insufficient
adjustment").
and more plausibility through
•
its increasing repetition in
Attentional Bias – the tendency
of emotionally dominant stimuli in public discourse (or "repeat
one's environment to something long enough and it
preferentially draw and hold will become true").
attention and to neglect relevant • Backfire effect – when
data when making judgments of a people react to disconfirming
correlation or association.
evidence by strengthening
• Availability heuristic – their beliefs.[7]
estimating what is more likely by
what is more available in memory,
which is biased toward vivid,
unusual, or emotionally charged
examples.
30. Irrational Illogical Thinking
Decision-Making Errors: Cognitive
Bias
•Example Cognitive Biases
•Confirmation Bias (favor information that
confirms preconceptions)
•Herd Behavior (group think override
rational)
•“Reptilian Brain”Amygdala is part
"impulsive," primitive system that triggers
32. THE REPTILIAN BRAIN:
EMOTION & DECISION MAKING
•Primitive, Impulsive
•Irrational decision-
making
•System I: Instinct
•Amygdala: Interferes
with the Frontal lobe
•Rational Logical
Thinking:
•System II: Deliberative
•Frontal Lobe
33. IRRATIONAL ILLOGICAL
THINKING:
Cognitive Bias
•We think we are smarter
than we really are
•Examples to numerous to
mention
•One example:
•The Roll of the Dice and
the Judges
•Dice rolled before sentencing Criminals in Israel
•# on the Dice affected the sentence handed down!
•"Anchoring bias"
34. IRRATIONAL ILLOGICAL
THINKING:
Sample Cognitive Biases
•CONFIRMATION BIAS
Contrary Evidence =>
Maintains or strengthens
present beliefs
•Overconfidence
in present beliefs;
"Group Think"
•Poor Decision Making
•Especially Present in Organizations, Military,
Political & Social Groups
35. REPTILIAN BRAIN (System I)
POOR DECISIONS
FEAR LEADS TO JUDGMENT ERRORS
•Errors in Risk Assessment
•Death Airplane Crash
•Death Car Crash
•1 in 1,000 patient / 20
years risk of gastric cancer
•Bowel Obstruction from
internal hernia +16% in 5
years
37. REPTILIAN BRAIN
POOR DECISION MAKING
•
•1867
Lister published
antisepsis paper:
Dr. Gross; Gross Clinic 1875
38. HUMAN DECISION MAKING ERRORS:
EXPECTED, NOT RARE
•Realize Fallibility of
Human Decision Making
•Humility
•Socratic Questioning of
Assumptions
•Search for Logical &
Rational Decision Making
39. THE PROBLEM
•Obesity Epidemic
•History of Failure of Bariatric
Surgical Procedures
•Selecting the “Ideal / BEST”
Bariatric Surgical Procedure
40. The Mini-Gastric Bypass is an Excellent Operation
with Results Reported on Thousands of Patients
Over the Past 10-15 years
• Survey Shows:
• Short, Simple, Effective, Durable,
• 30 min Operation with 1 day Hospital Stay
• Lower Leak rate than Sleeve or RNY
• Better / Best Weight Loss
• Leaks easily identified and easily managed
• Easily Reversible, Revisable
• Marginal Ulcer / Gastritis (Bile & Acid Peptic)
= RNY Rate of marginal ulcer
• Gastric Cancer is Low, no more common in BII
than in people that eat Hot Dogs/Salami or other
processed meats
41. The Mini-Gastric Bypass is an Excellent Operation
with Results Reported on Thousands of Patients
Over the Past 10-15 years
• Survey Shows:
• Surgeons that Reject the MGB
are routinely and repeatedly found to
answer questions about gastric cancer, the
Billroth II, etc. incorrectly much more often
than MGB Surgeons
• 2/3 explicitly state they are not very
knowledgeable about Gastric Cancer
• These Errors May be the Result of
Unrecognized Cognitive Biases