The document discusses critical thinking and decision making in clinical contexts. It introduces dual process theory and how clinicians rely more on intuitive System 1 thinking which can lead to cognitive biases. Some biases discussed include availability bias, anchoring bias, confirmation bias, and search satisficing bias where clinicians fixate on initial diagnoses and do not fully consider alternatives. The document emphasizes the importance of balancing intuitive and analytical thinking to make well-informed decisions.
While making judgments and decisions about the world around us, we like to think that we are Objective,Logical, and
Capable of taking in and evaluating all the information that is available to us.
The reality is that our judgments and decisions are often
riddled with errors and influenced by a wide variety of biases.
The human brain is both remarkable and powerful, but certainly subject to limitations.
One type of fundamental limitation on human thinking is known as a cognitive bias.
A brief and general account of selected potential cognitive biases in drug discovery and development, along with some suggestions on how to avoid them.
I've discussed the various ways our brain makes illogical judgments and then makes errors in thinking. I've also discussed the difference between logical thought and how the brain thinks automatically. There is some content on logic as seen in animals too.
Here is a special post I've made about the Survivorship bias
https://cognitiontoday.com/what-you-need-to-know-about-success-stories-survivorship-bias/
Here is one on overcoming thinking biases
https://cognitiontoday.com/8-powerful-ways-to-overcome-thinking-errors-and-cognitive-biases/
Here is one on a few more cognitive biases
https://cognitiontoday.com/4-cognitive-biases-you-should-be-aware/
The human brain is capable of 1016 processes per second, which makes it far more powerful than any computer currently in existence. But that doesn't mean our brains don't have major limitations.
The lowly calculator can do math thousands of times better than we can, and our memories are often less than useless —plus,
we're subject to cognitive biases, those annoying glitches in our thinking that cause us to make questionable decisions and reach erroneous conclusions.
Here are a dozen of the most common and pernicious cognitive biases that you need to know about.
While making judgments and decisions about the world around us, we like to think that we are Objective,Logical, and
Capable of taking in and evaluating all the information that is available to us.
The reality is that our judgments and decisions are often
riddled with errors and influenced by a wide variety of biases.
The human brain is both remarkable and powerful, but certainly subject to limitations.
One type of fundamental limitation on human thinking is known as a cognitive bias.
A brief and general account of selected potential cognitive biases in drug discovery and development, along with some suggestions on how to avoid them.
I've discussed the various ways our brain makes illogical judgments and then makes errors in thinking. I've also discussed the difference between logical thought and how the brain thinks automatically. There is some content on logic as seen in animals too.
Here is a special post I've made about the Survivorship bias
https://cognitiontoday.com/what-you-need-to-know-about-success-stories-survivorship-bias/
Here is one on overcoming thinking biases
https://cognitiontoday.com/8-powerful-ways-to-overcome-thinking-errors-and-cognitive-biases/
Here is one on a few more cognitive biases
https://cognitiontoday.com/4-cognitive-biases-you-should-be-aware/
The human brain is capable of 1016 processes per second, which makes it far more powerful than any computer currently in existence. But that doesn't mean our brains don't have major limitations.
The lowly calculator can do math thousands of times better than we can, and our memories are often less than useless —plus,
we're subject to cognitive biases, those annoying glitches in our thinking that cause us to make questionable decisions and reach erroneous conclusions.
Here are a dozen of the most common and pernicious cognitive biases that you need to know about.
People make many decisions. In decision-making scenarios people use rules of thumb (heuristics) to assist in decision-making. Often the heuristics lead to decisions contrary to the desired outcomes. This presentation outlines a set of cognitive biases common in decision making and how to prevent the biases or mitigate the consequences.
You're not so smart - Cognitive BiasesOdair Faléco
We think we are smart, but understanding Cognitive Biases shows how limited is our perception of reality and information around us.
On this presentation I expalin and bring some real examples of the most commom biases used in the market, web and UX.
There are many kinds of cognitive biases that influence individuals differently, but their common characteristic is that they lead to judgment and decision-making that deviates from rational objectivity.
In the past four decades, behavioral economists and cognitive psychologists have discovered many cognitive biases human brains fall prey to when thinking and deciding. Cognitive biases are tendencies to think in certain ways that can lead to systematic deviations from a standard of rationality or good judgment. These biases arise from errors of memory, social attribution, and miscalculations such as statistical errors or a false sense of probability. Some social psychologists believe our cognitive biases help us process information more efficiently, especially in dangerous situations. Still, they lead us to make grave mistakes. We may be prone to such errors in judgment, but at least we can be aware of them.
Bayesian reasoning offers a way to improve on the native human reasoning style. Reasoning naively, we tend not to seek alternative explanations, and sometimes underrate the influence of prior probabilities in Bayes' theorem.
Credits: Wikipedia, LessWrong.org
As thinking human beings and team leaders or architects we can benefit from knowing more about how we think, deliberate and decide. Most teams rely on trust, transparency, collaboration, and collective decision-making. “Thinking, Fast and Slow,” by Daniel Kahneman explains two systems that drive how we think. System 1 thinking is fast, intuitive, and emotional; System 2 is slow, deliberate, and logical.
In this presentation you learn how fast and slow thinking affects your reactions, behaviors, and decision-making. You’ll explore how several common development practices (with an emphasis on some agile practices), can amplify and exploit your thinking abilities and where they might lead you astray.
Fast thinking works pretty well in a well-known context. You save time when you don’t have to deliberate over details and nuances in order to make informed decisions. But fast thinking can lead to extremely poor decisions. You might jump to conclusions, be wildly optimistic, or greatly under-assess risks and rewards. You need to exploit both fast and slow thinking and be acutely aware of when fast thinking is tripping you up.
Groupthink is a term first used in 1972 by social psychologist Irving L. Janis that refers to a psychological phenomenon in which people strive for consensus within a group. In many cases, people will set aside their own personal beliefs or adopt the opinion of the rest of the group.People who are opposed to the decisions or overriding opinion of the group as a whole frequently remain quiet, preferring to keep the peace rather than disrupt the uniformity of the crowd. Groupthink can have some benefits like When working with a large number of people, it often allows the group to make decisions, complete tasks, and finish projects quickly and efficiently.
However, this phenomenon also has costs as well. The suppression of individual opinions and creative thought can lead to poor decision-making and inefficient problem-solving.
Presented at CodeMash 2015. By Joseph Ours
Joseph's presentation is based on the book "Thinking Fast and Slow" where Nobel Prize winner Daniel Kahneman introduces two mental systems, one that is fast and the other slow. Together they shape our impressions of the world around us and help us make choices. System 1 is largely unconscious and makes snap judgments based upon memories of similar events and our emotions. System 2 is painfully slow, and is the process by which we consciously check the facts and think carefully and rationally. System 2 is easily distracted. System 1 is wrong quite often. Real-world examples that demonstrate how the two systems work are that pro golfers will more accurately putt for par than they do for birdie regardless of distance and people will buy more cans of soup when there is a sign on the display that says “limit 12 per customer."
This presentation was designed for a class on Management Support Systems. The emphasis is on dynamic decisions and group decision making, rather than research involving described scenarios.
Decision making and Critical thinking is a two essential parameters for a nurse leader and based on that decision has to be taken without creating unbiased opinions.
Important concepts around how we all make decisions. This presentation introduces the work of Nobel prize winner Daniel Kahneman on Cognitive Biases, and helps you understand why we make errors in judgement, and how to look for signs you're about make one.
Aims: to give clinicians tools they can use to improve their ability to reflect on a differential dx and aid in correct diagnosis
Objectives:
-- define a dual process cognitive model used when making a diagnosis
-- recognize common heuristics and their related cognitive errors and biases
-- apply a systematic, routine method for differential diagnosis generation.
People make many decisions. In decision-making scenarios people use rules of thumb (heuristics) to assist in decision-making. Often the heuristics lead to decisions contrary to the desired outcomes. This presentation outlines a set of cognitive biases common in decision making and how to prevent the biases or mitigate the consequences.
You're not so smart - Cognitive BiasesOdair Faléco
We think we are smart, but understanding Cognitive Biases shows how limited is our perception of reality and information around us.
On this presentation I expalin and bring some real examples of the most commom biases used in the market, web and UX.
There are many kinds of cognitive biases that influence individuals differently, but their common characteristic is that they lead to judgment and decision-making that deviates from rational objectivity.
In the past four decades, behavioral economists and cognitive psychologists have discovered many cognitive biases human brains fall prey to when thinking and deciding. Cognitive biases are tendencies to think in certain ways that can lead to systematic deviations from a standard of rationality or good judgment. These biases arise from errors of memory, social attribution, and miscalculations such as statistical errors or a false sense of probability. Some social psychologists believe our cognitive biases help us process information more efficiently, especially in dangerous situations. Still, they lead us to make grave mistakes. We may be prone to such errors in judgment, but at least we can be aware of them.
Bayesian reasoning offers a way to improve on the native human reasoning style. Reasoning naively, we tend not to seek alternative explanations, and sometimes underrate the influence of prior probabilities in Bayes' theorem.
Credits: Wikipedia, LessWrong.org
As thinking human beings and team leaders or architects we can benefit from knowing more about how we think, deliberate and decide. Most teams rely on trust, transparency, collaboration, and collective decision-making. “Thinking, Fast and Slow,” by Daniel Kahneman explains two systems that drive how we think. System 1 thinking is fast, intuitive, and emotional; System 2 is slow, deliberate, and logical.
In this presentation you learn how fast and slow thinking affects your reactions, behaviors, and decision-making. You’ll explore how several common development practices (with an emphasis on some agile practices), can amplify and exploit your thinking abilities and where they might lead you astray.
Fast thinking works pretty well in a well-known context. You save time when you don’t have to deliberate over details and nuances in order to make informed decisions. But fast thinking can lead to extremely poor decisions. You might jump to conclusions, be wildly optimistic, or greatly under-assess risks and rewards. You need to exploit both fast and slow thinking and be acutely aware of when fast thinking is tripping you up.
Groupthink is a term first used in 1972 by social psychologist Irving L. Janis that refers to a psychological phenomenon in which people strive for consensus within a group. In many cases, people will set aside their own personal beliefs or adopt the opinion of the rest of the group.People who are opposed to the decisions or overriding opinion of the group as a whole frequently remain quiet, preferring to keep the peace rather than disrupt the uniformity of the crowd. Groupthink can have some benefits like When working with a large number of people, it often allows the group to make decisions, complete tasks, and finish projects quickly and efficiently.
However, this phenomenon also has costs as well. The suppression of individual opinions and creative thought can lead to poor decision-making and inefficient problem-solving.
Presented at CodeMash 2015. By Joseph Ours
Joseph's presentation is based on the book "Thinking Fast and Slow" where Nobel Prize winner Daniel Kahneman introduces two mental systems, one that is fast and the other slow. Together they shape our impressions of the world around us and help us make choices. System 1 is largely unconscious and makes snap judgments based upon memories of similar events and our emotions. System 2 is painfully slow, and is the process by which we consciously check the facts and think carefully and rationally. System 2 is easily distracted. System 1 is wrong quite often. Real-world examples that demonstrate how the two systems work are that pro golfers will more accurately putt for par than they do for birdie regardless of distance and people will buy more cans of soup when there is a sign on the display that says “limit 12 per customer."
This presentation was designed for a class on Management Support Systems. The emphasis is on dynamic decisions and group decision making, rather than research involving described scenarios.
Decision making and Critical thinking is a two essential parameters for a nurse leader and based on that decision has to be taken without creating unbiased opinions.
Important concepts around how we all make decisions. This presentation introduces the work of Nobel prize winner Daniel Kahneman on Cognitive Biases, and helps you understand why we make errors in judgement, and how to look for signs you're about make one.
Aims: to give clinicians tools they can use to improve their ability to reflect on a differential dx and aid in correct diagnosis
Objectives:
-- define a dual process cognitive model used when making a diagnosis
-- recognize common heuristics and their related cognitive errors and biases
-- apply a systematic, routine method for differential diagnosis generation.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Cultivating Intuition - Through Meticulous Self-trackingBen Ahrens
The following talk is a culmination of 5+ years of research, failed tracking trials, exhaustive experimentation, and mind-bending experiences - all of which have lead me to this point: Cultivating Intuition Through Meticulous Self-tracking
How to Think Straight- Cognitive Debiasing Pat CroskerrySMACC Conference
"How to think straight: Cognitive de-biasing by Pat Croskerry
The number of preventable deaths of hospitalized patients in the US each year is estimated at 40,000- 80,000. The figure for the ICU alone is estimated at 40,000 so the death rate must be in the higher end of the range. When settings outside the hospital are taken into account (ED, primary care), the overall number must be considerably higher.
While many factors contribute to diagnostic failure, a variety of sources suggest that physician’s thinking has a lot to do with it. Dual Process Theory describes how the brain makes decisions in one of two modes: through fast, unconscious, intuitive processes (System 1) or through slower, conscious, analytical processes (System 2). Mental short-cuts (heuristics) and biases are predominantly located in the intuitive mode where we spend most of our conscious time, and this is where the majority of decision failures occur. Thinking straight essentially means achieving a good balance between System 1 and System 2 decision making, and much of our cognitive effort needs to go into monitoring what our unconscious brains are doing in System 1. This is referred to by a variety of terms: metacognition, reflection, mindfulness, and others. They all involve cognitive de-coupling from System 1 and characterize the process of cognitive de-biasing. This is not easily accomplished in the ED or any environment where decision density is often high, throughput pressure exists, resources may be limited, and where decision makers may be fatigued and/or sleep deprived.
While medicine has acquired a variety of strategies over the years for de-biasing clinicians, added benefits can be obtained by developing specific mindware to tackle particular biases. Clinicians need to be aware of the operating characteristics of the dual process model of decision making, of the prevalence and nature of biases, and of how to apply and sustain de-biasing mindware in their decision making.
"
Guest lecture within the field of consumer behaviour prepared for the University of Antwerp (applied economics). I explore theories from (social) psychology to demonstrate our essential social nature. In the second part, these lessons are applied for a better new product development and communication.
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
Predatory publishing is a relatively recent phenomenon that seems to be exploiting some key features of the open access publishing model, sustained by collecting APCs that are far less than those found in legitimate open access journals. This CME aims to introduce to the participants on the phenomenon of predatory journals, why they continue to thrive, characteristics that are suggestive of a predatory journal, and how one can take step to minimize the risk of faling into predatory journal publication
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
This slide was first presented during the Malaysian 1st Emergency Medicine Annual Scientific Meeting, in conjunction with the Academy of Medicine Malaysia, Academy of Medicine Singapore and the Academy of Medicine Hong Kong Tripartite Meeting in Aug 2016.
Sensitivity, specificity and likelihood ratiosChew Keng Sheng
A short tutorial on sensitivity, specificity and likelihood ratios. In this presentation, I demonstrate why likelihood ratios are better parameters compared to sensitivity and specificity in real world setting.
ACLS 2015 Updates - The Malaysian PerspectiveChew Keng Sheng
This set of slide was presented during the Kelantan Resuscitation Update 22 Nov 2015 in accordance to the latest ACLS/ILCOR 2015 Guidelines. However, I have emphasized on certain important aspects relevant within the Malaysian context. Nonetheless, in general, there are no major changes for this year 2015
My talk in April 2015 in Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
New or Presumed New LBBB To Be Treated As a STEMI Equivalent? A Contra Argume...Chew Keng Sheng
My 6-page notes to go along with the "debate" of whether new or presumed new LBBB per se (without any other qualification) should be treated as STEMI equivalent
An introduction to the rationale and the two types (Write-in and Select-Menu) of Key Feature Questions. This presentation is based on an original article by Page and Bordage (1995).
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Question #1
• Jack is looking at Anne,
but Anne is looking at
George. Jack is married,
but George is not. Is a
married person looking
at an unmarried person?
A. Yes
B. No
C. Cannot be determined
3. Disjunctive Reasoning
• Would you have answered differently if
the options are only Yes or No?
• This thought process is called fully
disjunctive reasoning – reasoning that
considers all possibilities
• Most people can carry out fully disjunctive
reasoning when they are explicitly told
that it is necessary but most do not
automatically do so.
4. Discuss further
What if this is a clinical case?
Does it make a difference in your decision
making process if you have only option A
and option B as compared to if you are
given option C as well (which essentially is
a permission or excuse not to make a
definite choice on the basis of “inadequate
information given”)?
5. “Humans are cognitive misers
because our basic tendency is to
default to the processing
mechanisms that require less
computational effort, even if they are
less accurate” – Keith Stanovich,
cognitive psychologist
6. Question #2
• Suppose you want to
buy a book and a
pencil. The book and
the pencil cost
RM1.20 in total. If the
book costs RM1.00
more than the pencil,
how much does the
pencil cost?
7. Discuss further
• Discuss on intelligence vs Rationality
• “We often assume intelligence and
rationality go together but we shouldn’t be
surprised when smart people do foolish
things” – Keith Stanovich
• Dysrationalia – is the inability to think and
behave rationally despite having
adequate intelligence
10. How do we make decisions?
• Decision making is one of the most
important we do, it is the engine that
drives our behavior.
• We make many decisions continuously in
the course of our waking hours. These
decisions vary in complexity
• Some are relatively simple, automatic
process, well-rehearsed. Some have
consequential implications – like choosing
our life-partners
11. “What we are, or how we live our lives
are largely determined by the
decisions we made”
“We first make our choices, then our
choices make us”
12. How do we make decisions?
• One of the major developments in
cognitive psychology over the last 20
years is the dual process theory (DPT) of
reasoning.
• The DPT of reasoning has emerged as
the dominant theory of reasoning
particularly through the works of people
like Epstein, Tversky and Kahneman,
Stanovich and West, and Evans.
13. Dual-process thinking
• According to the DPT of reasoning, there
are two modes of decision making, i.e.,
System 1 and System 2.
• System 1 is the fast, intuitive, reflexive,
automatic and frugal thinking and it is
where we spend most of our time making
most of our decisions. Driving a car for
someone who has been driving for a long
time is an example of System 1 thinking.
14. Dual-process thinking
• System 2, on the other hand is a
deliberate, analytical, purposeful or
effortful form of thinking that is usually
slower.
• Discuss: give further examples of some of
the decisions that you make in your daily
lives that are largely based on System 1
and those that are based on System 2
15. Dual-process thinking
System 1 (Intuitive) System 2 (Analytical)
Experiential-inductive Hypothetico-deductive
Heuristic Systematic
Pattern recognition Robust decision making
Unconscious thinking theory Deliberate, purposeful
thinking
Fast Slow
High capacity Limited
High emotional attachment Low emotional attachment
Low scientific rigor High scientific rigor
17. Case illustration #2
This child develops this rash after 5 days of antibiotics for fever
and cough. The resident takes a quick glance of this child and
diagnose him with Stevens-Johnson syndrome. He says that he
has seen a similar case before when he was a house officer and
he remember that case very well because the child died later on.
18. Was the resident right?
• The resident employed System 1 thinking
• Quick, intuitive, pattern recognition based
on what he has seen before
• High emotional association – his previous
patient died following a ‘similar case’
• But was he right?
• SJS often has extensive mucosal
involvement. SSSS usually does not.
• Nikolsky’s sign is usually present in SSSS
19. Heuristics
• Although System 1 is the fast, reflexive
thinking mode that we commonly used,
inherent to the intuitive nature of this
system, it often requires the use of
heuristics.
• Heuristics are mental shortcuts or “rules
of thumb” or “gut-feeling” used to assist
us to rapidly make decisions without
formal analysis.
20. Heuristics
• Two heuristics that are considered
essential for a clinician when faced with
an emergency situation are the “rule-out-
worst-case-scenario” and the sick/not sick
dichotomy
21. RECOGNIZED
Pattern
Patient Pattern Recognition Executive T Dysrationalia
Presentation Processor override override Calibration Diagnosis
Repetition
NOT
RECOGNIZED
23. Cognitive biases
• While heuristics are helpful cues for
System 1, at times, they are prone to
cognitive biases and errors.
• Cognitive biases or cognitive disposition
to respond are our predictable
tendencies to respond in a certain way to
the contextual clues at that time
• These biases are often unconsciously
committed, and may result in flawed
reasoning
24. Availability bias
• Availability bias – this refers to our
tendency to judge things as being more
likely, or frequently occurring, if they
readily come to mind.
• Therefore, a recent experience with a
particular disease, for example, thoracic
aortic dissection may inflate likelihood of
a clinician to diagnose the patient with
this disease every time when the clinician
sees a case of chest pain.
25. Anchoring
• Anchoring – this refers to our tendency to
fixate our perception on to the salient
features in the patient’s initial
presentation at an early point of the
diagnostic process so much so that we
fail to adjust our initial impression even in
light of later information.
26. Confirmation bias
• Confirmation bias – this refers to our
tendency to look for confirming evidence
to support the diagnosis we are
“anchoring” to, while downplaying, or
ignoring or not actively seeking evidences
that may point to the contrary.
27. Confirmation bias
• Confirmation bias often goes together
with anchoring. For example, if a clinician
has anchored or fixated the diagnosis of
myocardial infarction in his mind, he will
have the tendency to look for evidences
to support this diagnosis, say, ST
segment elevation on electrocardiography
even if the amount of elevation is very
minimal.
28. Confirmation bias
• In contrast, if the patient’s chest X-ray
demonstrates a widened mediastinum
width with unequal pulses on examination
and high blood pressure, the clinician
may have ignored such important cues
that may point to the life threatening
condition of thoracic aortic dissection.
29. Search satisficing
• This refers to our tendency to stop
looking or call off a search for a second
diagnoses when we have found the first
one.
• This bias can prove to be detrimental in
polytrauma cases.
30. Search satisficing
• A classic example of this bias is the
tendency of the physician to call off the
search for a second fracture once he
thinks he is “sufficiently satisfied” with
finding the first fracture of medial
malleolus, when in fact, the patient may
have sustained Maisonneuve fracture
with a second proximal fibula fracture.
31. Case illustration #3
This patient claimed to have
twisted his left ankle and
complained of severe ankle
pain. The medical officer in
the A&E ordered an X-ray
of that ankle. He saw some
abnormalities over the
medial malleolar region and
then referred the case to the
orthopedics.
Question: Do you agree with his plan of management? Give
your comments.
33. Normal mortise view
• The entire mortise joint space should be
of uniform width, ≤ 4 mm (light gray).
• The distal tibiofibular joint (dark gray)
should be only slightly wider than the
mortise joint space, ≤ 5.5 mm.
• The tibiofibular overlap should be > 1 mm
on the mortise view.
34.
35. An example of search satisficing
A Maisonneuve fracture should be
suspected whenever there is a
fracture to the medial aspect of the
ankle or widening of the distal
tibiofibular joint
Always remember the adage in X-
rays of #:
“One joint below, and one joint
above”
36. Triage cueing
• This is basically a form of anchoring
where once a triage tag has been labelled
on a patient, the tendency is to look at the
patient only from the perspective of the
discipline in which the patient is tagged
to.
37. Diagnostic momentum
• Once diagnostic labels are attached to
patients they tend to become stickier and
stickier. Through intermediaries,
(patients, paramedics, nurses,
physicians) what might have started as a
possibility gathers increasing momentum
until it becomes definite and all other
possibilities are excluded.
38. Sunk cost fallacy/bias
• The more a clinician invest in a particular
diagnosis, the less likely he is to release it
and consider alternatives. This form of
entrapment is common in financial
investment. In clinical setting, the time
mental energy, and for some, the ego
may be a precious investment to let go.
Confirmation bias maybe a manifestation
of such unwillingness to let go of a failing
diagnosis.
40. Ego bias
• This refers to our tendency of
overestimating the prognosis of one’s
own patients compared to that of a
population of similar patients under the
care of other physicians.
41. Blind spot bias
• This refers to the bias that many people
have where they believe that they are
less susceptible to errors compared to
others. This has some similarities with
ego bias.
42. Hindsight bias
• This bias typically occurs during morbidity
and mortality meetings where the
outcome of the case is already known.
• With hindsight bias, a case with a bad
outcome is judged negatively where the
sequence of decisions made leading up
to the outcome must be bad as well.
43. Hindsight bias
• However, it is not necessarily true that
just because the outcomes are bad, the
decisions are bad too, as people
generally do not deliberately make bad
decisions.
• The decisions taken at that time must
have made sense to them.
44. Hindsight bias
• Furthermore, the process of cognitive
autopsy during morbidity and mortality
meetings are devoid of the ambient
context (e.g. a busy working emergency
department) and the affective dispositions
(e.g. the stress, sleep-deprived or
depressed nature of the doctor) in which
the decision was made during that
particular time.
45. Overconfidence bias
• It refers to our universal tendency to
believe that we know more than we do.
• Overconfidence reflects a tendency to act
upon incomplete information, intuitions, of
hunches.
46. Gambler’s fallacy
• The concept of this bias is borrowed from
the gambling situation where if a coin is
tossed ten times, and for every case of
the toss, head is shown.
• A person with gambler’s fallacy will say
that if the coin is tossed for the 11th time,
there must be a greater chance of being
tail.
47. Gambler’s fallacy
• However, the coin has no memory and
the coin actually has a 50-50 chance of
showing tail in each toss, which is
independent of the previous outcomes.
48. Gambler’s fallacy
• An example of this fallacy can happen
when a clinician see five cases of
shortness of breath in the course of a
working shift, and in each case, the
patient turns out to be having pneumonia.
49. Gambler’s fallacy
• When the 6th patient with shortness of
breath arrives in the emergency
department, a clinician with this fallacy
will probably think that for this 6th time,
the patient must be having a condition
other than pneumonia, such as asthmatic
attack.
50. Posterior probability error
• This is the opposite of gambler’s fallacy.
In this bias, if a clinician sees five patients
with shortness of breath in the course of a
working shift, which turn out to be
pneumonia in every cases; when the 6th
patient with shortness of breath arrives in
the emergency department, the tendency
is to believe that this patient must be
having pneumonia as well.
51. Summary of common cognitive biases (1)
Cognitive bias Thought process
Availability bias “I remember seeing a similar
patient with diagnosis X.
Therefore this patient must be
having diagnosis X”
Anchoring bias “From the very offset, it seems
that this patient is having
diagnosis X, so, he must be
having diagnosis X”
Confirmation bias “Since this patient has diagnosis
X, I must look for evidence to
support that this patient has
diagnosis X”
Search satisficing “I have found diagnosis X in this
patient and I am happy with it!”
52. Summary of common cognitive biases (2)
Cognitive bias Thought process
Triage cueing “The triage officer found that the
patient has diagnosis X. Let’s
treat the patient as having
diagnosis X”
Diagnostic momentum “The HO says the patient has
diagnosis X. The MO says the
patient has diagnosis X. The
specialist says the patient has
diagnosis X. And nobody is
challenging it”
Sunk cost fallacy “I have invested so much of my
time and energy in managing this
patient as having diagnosis X.
What else could it be?”
53. Summary of common cognitive biases (3)
Cognitive bias Thought process
Gambler’s fallacy “I have seen the last 5 patients
with diagnosis Y. This time, this
patient must be having diagnosis
X”.
Posterior probability error “I have seen the last 5 patients
with diagnosis Y. This time, this
patient must be having diagnosis
Y as well”.
Ego bias “Statistically speaking, my
patients often do better than
patients from the other team!”
Blind spot bias “This kind of mistakes often
happen to Dr. X’s patients. I
wouldn’t have made such
mistakes”
54. Cognitive biases categories
• Biases due to over-attachment to a
particular diagnosis
– Anchoring, confirmation bias
• Biases due to failure to consider other
diagnosis
– Search satisficing
• Biases due to inaccurate estimation of
prevalence
– Availability bias, gambler’s fallacy, posterior
probability error
55. Cognitive biases categories
• Biases due to the way the patient is
presented
– Triage cueing
• Biases due to inheriting someone else’s
thinking
– Diagnostic momentum
• Biases due to physician’s personality and
affect, decision style
– Ego bias, blind spot bias
56. Critical Thinking (1)
1. Knowing and understanding the System
1 & System 2 thinking
2. Recognizing the distracting stimuli,
biases and irrelevance affecting our
decisions
3. Identifying, analyzing and challenging
assumptions in arguments
4. Be aware of cognitive fallacies and poor
reasoning
57. Critical Thinking (2)
5. Recognizing deceptions – deliberate or
otherwise
6. Having the capacity for assessing the
credibility of information
7. Understand the need for monitoring and
control of our own thinking processes
8. Be aware of the critical impact of fatigue
and sleep deprivation on decision
making
58. Critical Thinking (3)
9. Understand the importance of monitoring
and control of our own affective states
that influence the quality of our decisions
10. Understand the context under which
decisions are made
11. Capacity to anticipate the consequences
of our decisions
59. Pre-dispositional factors
• Further compounding the difficulty in
clinical decision making is the undeniable
fact that the quality of our clinical
decisions is also influenced by ambient or
environmental conditions under which the
decision is made.
• For example, when faced with a potential
clinical emergency situation, physicians
are often expected to make diagnostic
decisions within a limited time frame.
60. Affective state of the decision maker
• Other factors such as the affective state
of the clinician, general fatigue,
interruptions, distractions, sleep
deprivation etc, can influence the quality
of our decisions too. For example, sleep
deprivation (in the course of a long
working shift, for example) can have a lot
of negative impact, not only to the quality
of the decision making, but to the general
health of the clinician as well.
61. Sleep deprivation
• Sleep deprivation and circadian
dysynchrony can impair performance and
reduce many aspects of human capability
including reduced attention vigilance,
impaired memory, impaired decision-
making, lagged reaction time, impaired
hand-eye coordination and disruptive
communications.
62. Sleep deprivation
• For example, it has been shown that after
17 hours of continuous wakefulness,
hand-eye coordination task would have
declined to such a level equivalent to that
of a blood alcohol level of 0.05%. And at
24 hour of sustained wakefulness, the
impairment in psychomotor function is
equivalent to a blood alcohol
concentration of 0.1%
63. Sleep deprivation
• Furthermore, a fatigued worker will also
have a tendency to slow down work his
work processes in order to maintain
accuracy (known as the “speed-accuracy
trade-off”)
64. De-biasing strategies
• One of the tremendous challenges in
cognitive biases is finding ways to de-bias
them. A de-biasing strategy commonly
used is called the cognitive forcing
strategies. These are deliberate,
systematic self-regulatory cognitive
mechanisms to provide a check and
balance to minimize biases.
65. Metacognition
• An example of cognitive forcing strategies
is metacognition. Metacognition is an
individual’s ability to stand apart from his
own thinking in order to be aware of his
own preferred learning approaches and
ultimately to manipulate his own cognitive
processes to his own advantages.
66. Metacognition
• In short, metacognition is “thinking about
thinking.” It allows one to ask questions
like: “How well did I do?” “What could I
have done it differently if I am given a
chance again?” etc.
67. De-biasing strategies
• But suppose one has the necessary
mindware, then the next question
Stanovich argues would be whether one
actually perceives a need to de-bias
them. But even if the person perceives
the need for de-biasing, the next question
would be whether the de-biasing effort
needed is a sustained effort.
68. De-biasing strategies
• If it is but the person does not have the
capacity for sustained de-biasing, then
the natural tendency is still to fall back
into System 1 of reasoning. This is
because when it comes to choosing the
cognitive strategies to apply for solving a
problem, we generally choose the fast,
computationally inexpensive strategy
(System 1).
69. Cognitive forcing strategies (1)
• One of the ways to minimize the risk of
committing cognitive biases is to forcibly
ask ourselves these few questions
whenever we have made our clinical
decisions (especially if our decision is to
discharge the patient):
1 What is/are the possible life/limb threats
in this patient? Why does the patient
come?
70. Cognitive forcing strategies (2)
2 What if I am wrong? What else could it
be?
3 Do I have evidences for/against this
decision/diagnosis that I've made?
4 What are the ambient/affective factors
that are influencing my decisions?
71. Cognitive forcing strategies (3)
5 In the unfortunate event that this case
landed as a medico-legal case 10 years
down the road, is what I've documented
defensible? (in other words, have I
documented what needs to be
documented, is my writing legible
enough, is the date and time written,
etc).
72. • Download a free article on ‘Making
decision better’ here:
• http://tinyurl.com/cbjvjof
73. Authority gradient
• Another issue that may hamper the
learning and practice of critical thinking is
the issue of authority gradient.
• Authority gradient is defined as the
gradient that may exist between two
individuals’ professional status,
experience, or expertise that contributes
to difficulty exchanging information or
communicating concern.
74. Authority gradient
• Authority gradient is especially prevalent
in our Asian culture - which maybe
heavily influenced by Asian philosophies
of respecting the seniors.
• Such noble value is of course vitally
important in maintaining societal harmony
but can be dangerous if taken to the
extreme and junior doctor adopts an
unhealthy pessimism attitude.