Clinical Decision Making and Informatics Links:
Decision Analysis Courses Online
CDM Clinical Decision Making Fellowship lectures at NEMC.
PubMed medline beta search engine
Infoseek search engine
The Construing Person: According to [George] Kelly, anxiety is experienced
whenever one is confronted with events that are outside the range of
convenience of one's personal constructs, that is, one has no basis for
anticipating them. In short anxiety is being "caught with one's constructs
Thesis Research ContributionI have developed a representation of patient values and a tailored elicitation procedure which forms the backbone of my thesis research.
Utility Assessment on an Individualized BasisThe core of my Ph.D. thesis is a method for the collection of patient values on an individualized basis suitable for use in decision analysis models. The most unique aspect is that the representation of values is in the words of the patient. The elicitation is systematic and reproducible. It is basically a reconstruction of utility assessment using some fundamental utility assessment building blocks with a little systematic psychological domain methodology for eliciting dimensions of importance to an individual. You can download a 10 page pre-thesis paper in postscript or Word for W95 format from my ftp site or press here. The full thesis is available from the same site or press here. The defense was September 4th, 1998. You may view the web version of a presentation given February 5th, 1997, to my Oral Exam Committee for successful Ph.D. candidate qualification by clicking here .
Why, you ask, do we need to elicit the values of an individual?
I recently completed a pilot study in collaboration with Mark Davis,
MD, of the Beth Israel Deaconess Emergency Department in which we wanted
to find out whether patients would prefer to avoid severe disability as
a consequence of stroke or any increased risk of death. Current trends
in the use of clot dissolving drugs like tissue Plasminogen Activating
factor present us with a decision regarding just such a tradeoff. Studies
suggest that these drugs decrease the rate of long term disability significantly
if administered within a few hours of the onset of signs of stroke, but
at the cost of slightly increasing the risk that you might die with in a
few days. Understanding the preference of an individual in this case could
greatly aid decision making in choice of treatment. To no one's surprise,
we found a diversity in the values expressed in our structured interveiws.
To our surprise, however, we found more answers that were difficult to make
sense of than we expected, despite the authors of these answers being very
convinced of their preferences. I presented a talk that reviewed our findings
and the surprising rate of what is sometimes referred to as "discordant"
responses to values elicitation. The talk concludes that we need to find
better ways to systematically discover the way these patients think with
a few strategies based on the analysis of the data. Moreover, it justifies
the pursuit of my thesis research. You can browse
an html version of the presentation
Click "grand ambitions" to see the original intentions that inspired the specific research I am doing. This piece was written as I started out. It is interesting to see how things (both content and presentation) have changed.
The 1998 Richard B Talbot SymposiumThis three symposium was held at the AVMA Convention in July, 1998, at the Baltimore Convention Center. As the Chair of the program committee, I would be highly biased to say it was a success. However, a lot of people had many good things to say before, during and after it happened. The program agenda remains so you can see what you missed. All the presentation titles are linked to online abstracts. For a brief historical perspective you will want to check out the Call for Posters .
Online course in Veterinary InformaticsThe web page for the online course in Veterinary Informatics I coordinated as part of the Veterinary Information Network may be seen at VIN Class. It was last offered in Fall of '95. Check the very bottom of that page for a link to Letterman's Top Ten signs you've gone to a bad veterinarian. Thanks to Ken Boschert for authoring another great web page.
Other interesting stuffFor a look at my hyper-linked CV (linked to all related areas I have found), (Press here) . Use this page to access home pages of areas, places, or institutions where I have been or participate(d) in.
Publications on the topic of my master's thesis were published in Simulation. They were entitled: Using Expert Systems for Simulation Modeling of Patient Scheduling (Sept, 2000) and The Application of Simulation to Veterinary Practice Management (March, 1996). You may browse the postscript file of the latter article for Simulation (~30 pages) entitled A Veterinary Practice Simulator Based on the Integration of Expert System and Process Modeling or the pair of (~10 page ea.) articles for the Journal of the American Veterinary Medical Association (March 15, 1996). (Press here for Part 1) (Press here for Part 2)
A group of veterinary informaticists have put together a series of seminars published in the quarterly publication, Seminars in Small Animal Medicine and Surgery. My contributions were entitled Clinician Computer and What is Computer Aided Diagnosis? . The first article is an overview of the veterinarian as a diagnostic decision maker. The second articles is self explanatory. Double-click the titles to see a postscript file of each 12 page article.
Any of these files may be found at my ftp site.
"An idea will become self-evident--once
you've forgotten learning it!"
what showed up
on our steps after the first Nor'Easter of Fall, 1997.
10521 Via del Sol, Orlando, FL, 32817
Interactive Technologies Group
2290 Lucien Way
Maitland, FL, 32751
last edited 12/10/2001