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The disconnect between physician religious belief and experience and that of their patients is a growing problem in medicine. As physicians shy away from important discussions of their patients’ values, patients begin to drown in the growing medical complexity and feel less respected. Patient ability to drive their own care decisions is reduced when important topics like religious and spiritual beliefs are avoided. In light of the evidence of how religion and spirituality can influence health and medical decision making, physicians have a moral imperative to pursue an understanding of their patients’ belief system based on principle and pragmatism. There are easy tools available to help physicians streamline these patient interactions even when a physician is inexperienced in religious topics. For these reasons and more, it is of critical importance for physicians to no longer shy away from uncomfortable conversations but to pursue human flourishing through more deeply understanding their patients. While several objections may exist to this imperative, none are sufficient to outweigh the importance of this, and there are several tools in the toolbox that can make this process targeted, brief, and valuable. Ultimately, having a basic understanding of the religious views of patients enables physicians to more adequately assess barriers to health, understand key principles at play in medical decision making, and communicate effectively with patients and their families during stressful, life-altering times. Modern medical education allocates very few resources to training medical students to address patient beliefs, resulting in provider avoidance of religious conversations that are fundamental to patient health. / Urban Bioethics

Master of Science / Department of Psychology / Gary L. Brase / In 2006, the Center for Disease Control and Prevention recommended the revision of state HIV testing laws. With these recommendations, more low-risk individuals are tested regardless of their risk group. However, there is a greater chance of a false positive test result for low-risk individuals than for high-risk individuals. Additionally, previous research found that doctors and HIV counselors in Germany did not accurately communicate the relationship between risk factors and false positive tests (Gigerenzer, Hoffrage, & Ebert, 1998). This study aimed to (1) compare the findings of the 1998 German sample to HIV hotline counselors in the United States in 2011; and (2) to investigate the ability of students to calculate the conditional probability of HIV for a low-risk individual after receiving a positive test, based on idealized transcripts of conversations with HIV hotline counselors. The first study found that HIV hotline counselors use both verbal expressions of risk and percentages to communicate HIV testing statistics. Additionally, 2011 American counselors were more aware of the chance of false positives and false negatives than compared to the 1998 German sample. However, no 2011 American counselors were able to provide an accurate positive predictive value for a low-risk woman. The second study found low performance among students in the calculation of the positive predictive value. Performance was facilitated by a natural frequency format for high numerate individuals. There were different patterns of results for the General Numeracy Scale and the Subjective Numeracy Scale. This would suggest that these two scales might be measuring different constructs. These findings are consistent with the two theories supporting the Frequency Effect, namely the Frequentist Hypothesis and the Nested Sets Hypothesis. Additionally, this research suggests computation of the conditional risk of HIV is facilitated by a natural frequency format. Teaching techniques have been developed and demonstrate long lasting improvement in health related computations. If a few hours of training is all that it takes to communicate these life and death statistics in a manner that is consistent with reasoning, health practitioners and students should be required to have more education in communicating and computing probabilities.

Financial toxicity (FT) is the impact that out of pocket (OOP) costs of cancer care have on patients' well-being, leading to lower quality of life, less compliance with prescribed therapy, and poorer outcomes, including increased mortality. The purpose of this study was to understand the impact of FT on advanced cancer patients' lives and their health care decision-making. Fuzzy trace theory provided the framework for examining how patients use gist and verbatim when making health care decisions while experiencing FT. Gist refers to main ideas that are often infused with emotional overlays that people use to make risky decisions, while verbatim thinking involves the recall of precise facts and figures to make decisions. The research method was case study that included conducting 13 in-depth interviews, collecting artifacts, and scoring of FT using the Comprehensive Score for Financial Toxicity tool. Findings from two-cycle coding and cross-case analysis indicated that FT and OOP costs have significant impacts on patients' lives and how they make decisions about their cancer care. Participants considered cost as a risk in cancer treatment decisions and encoded this information using verbatim rather than gist, which they used for other dimension of risk in these decisions. Participants reported they would decline care if OOP costs were high and FT was present. When OOP costs were low, participants relied on gist decision-making and generally followed their physicians' recommendations. Findings may assist cancer experts who are investigating FT and its impact on cancer care as well as those who are developing support programs for patients who experience FT.

This thesis advances the understanding of the application of artificial neural networks ensemble to clinical data by addressing the following fundamental question: What is the potentiality of an ensemble of neural networks models as a filter and classifier in a complex clinical situation? A novel neural networks ensemble classification model called Rules and Information Driven by Consistency in Artificial Neural Networks Ensemble (RIDCANNE) is developed for the purpose of prediction of medical outcomes or events, such as kidney transplants. The proposed classification model is based on combination of initial data preparations, preliminary classification by ensembles of Neural Networks, and generation of new training data based on criteria of highly accuracy and model agreement. Furthermore, it can also generate decision tree classification models to provide classification of data and the prediction results. The case studies described in this thesis are from a kidney transplant database and two well-known collections of benchmark data known as the Pima Indian Diabetes and Wisconsin Cancer datasets. An implication of this study is that further attention needs to be given to both data collection and preparation stages. This study revealed that even neural network ensemble models that are known for their strong generalization ability might not be able to provide a high level of accuracy for complex, noisy and incomplete clinical data. However, by using a selective subset of data points, it is possible to improve the overall accuracy. In summary, the research conducted for this thesis advances the current clinical data preparation and classification techniques in which the task is to extract patterns that contain higher information content from a sea of noisy and incomplete clinical data, and build accurate and transparent classifiers. The RIDC-ANNE approach improves an analyst�s ability to better understand the data. Furthermore, it shows great promise for use in clinical decision making systems. It can provide us with a valuable data mining tool with great research and commercial potential.

ABSRACT: Liver transplantation and allocation has been a controversial issue in the United States for decades. One of the main concerns in the allocation system is the trade-off between the two main objectives, efficiency and equity. Unfortunately, it is difficult to reach consensus on how to develop allocation policies that aim at balancing efficiency and equity, among transplantation policy makers, administrators, transplant surgeons and transplant candidates.Our research identifies and classifies the outcomes of liver allocation into two major categories, efficiency and equity, that are, often times, conflicting. Previous researchers did not consider how to balance outcomes in these two categories. Our research uses Analytic Hierarchy Process, a Multi-Criteria Decision Analysis methodology, to build a framework that quantifies the decision-making process and help decision makers to reach a valid consensus in terms of balancing these outcomes. Latest available patient registration and follow-up data are used in data analysis. Results from this analysis serve as inputs for the simulation model that is capable of evaluating alternative hypothetical policies.This research addresses the deficiencies of the current liver transplantation policy and is intended to refine the policy that will result in a more balanced allocation system with respect to efficiency and equity. Our proposed methodology can be applied to incorporate further changes in policy selection and refinement.

Submitted by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-18T18:29:46Z No. of bitstreams: 1 Publico-10.pdf: 2044084 bytes, checksum: eef64e9d622b35c3b0880540380f1814 (MD5) / Approved for entry into archive by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-18T18:31:35Z (GMT) No. of bitstreams: 1 Publico-10.pdf: 2044084 bytes, checksum: eef64e9d622b35c3b0880540380f1814 (MD5) / Made available in DSpace on 2016-08-18T18:31:35Z (GMT). No. of bitstreams: 1 Publico-10.pdf: 2044084 bytes, checksum: eef64e9d622b35c3b0880540380f1814 (MD5) Previous issue date: 2005 / Intel do Brasil / Altos índices de mortalidade infantil em comunidades carentes podem ser evitados através da identificação precoce dos fatores de risco e do acompanhamento direto e contínuo da assistência médica materno infantil. No entanto, essa assistência demonstra ser complexa, com precariedade na locomoção e troca de informação das equipes da saúde, comumente constituídas por profissionais de diversas especialidades. Ainda, verifica-se uma freqüente participa- ção de voluntários de organizações não governamentais envolvidos diretamente com essa assistência. O objetivo desse trabalho foi desenvolver um instrumento digital – aqui denominado Sistema BabyCare – para a coleta, armazenamento e apoio à decisão aos profissionais de saúde, e demais envolvidos, nos cuidados a pacientes na assistência primária infantil em comunidades carentes. Esse sistema baseia-se em tecnologias de dispositivos móveis para utilização local em unidades básicas de saúde em comunidades carentes, assistidos ou não pelo Programa Saúde da Família (PSF), e ambulatórios e hospitais. Foram realizadas avaliações sobre o uso do sistema na cidade de São Paulo, envolvendo 60 usuários com diferentes formações, incluindo voluntários da Pastoral da Criança. Os questionários aplicados resultam um alto índice de aceitação geral (98,3%); treinamento in loco considerado adequado (91,9%); percepção na melhoria na rotina e na redução de tempo da consulta (100,0%), e na redução no volume de documentos (96,7%). Por fim, o protótipo apresentou-se robusto e eficiente para uso em comunidade / High infant mortality rates in needy communities can be prevented through direct and continuous follow-up of maternal and child health care. However, this assistance has proven to be complex, with the precarious mobility and exchange of information of healthcare teams, usually consisting of professionals from different specialties. In addition, there is a frequent participation of volunteers from non-governmental organizations directly involved in this assistance. The purpose of this work was to develop a digital device – referred as BabyCare System – for the collection, storage and support to decision for healthcare professionals and other concerned people, in order to assist patients in primary child care in needy communities. This system is based on handheld device technologies to be used locally in basic healthcare units in needy communities, whether assisted or not by the Healthcare Family Program (Programa Saúde da Família – PSF), as well as in ambulatory facilities and hospitals. Evaluations have been conducted regarding the use of the system in the city of São Paulo, involving 60 users with different formations, including volunteers from the Pastoral da Criança, an ecumenical institution for children. The applied questionnaires result in a high level of general acceptance (98.3%); the on-site training was considered as appropriate (91.9%); a perception of routine improvement and decrease in the time of consultation (100.0%), and a decrease in the volume of paperwork (96.7%). Finally, the prototype has proven to be robust and effective for the use in needy communities with precarious computer and telecommunication infrastructure.