Biases and imperatives in handling medical technology

ObjectivesFor a long time key actors in health care have conceived of medical technology as a rational science-based means to obtain specific human goals, such as reducing suffering and increasing health. However, this appears paradoxical as medical technologies are handled in ways that appear non-rational by the standards of the field itself, e.g., by implementing non-efficient technologies and by not abandoning harmful or low-value technologies. The objective of this article is to investigate this apparent paradox. How can it be explained? Accordingly, the research question is: What biases and imperatives are involved in the handling of medical technology that counter and hamper what is conceived of as rational handling of such technology in medicine and health care?MethodsKahneman's framework of System 1 and 2 modes of thinking from cognitive psychology is applied and combined with Mazarr's analysis of imperatives in order to study and develop a typology of irrational implementation of technology. Examples from health care are found by targeted searches in PubMed.ResultsHealth policy on technology assessment and implementation is based on measures, such as safety, effectiveness, and efficiency. Nevertheless, a range of technologies are implemented and used without obtaining such goals. This can be explained by, a range of affective biases, such as the Identifiability Effect, Affective Forecasting, and Impact bias, as well as cognitive biases, such as the Focusing Illusion, Prominence Effect, Status Quo Bias, Endowment Effect, Availability Heuristics, Anchoring Effect and others. Various imperatives also contribute to this, such as Positive feedback loops, Imperative of Action, Technology Placebo Effect, Imperative of Knowledge, the Boys and Toys Effect and others. Examples illustrate how all of these effects can distort rational technology implementation and policy.ConclusionWe need to include biases and imperatives in our theories and our strategies to handle medical technologies. Believing and acting as if we implement and use technology in health care as external means to our internal goals may be treacherous. Understanding technology indeed includes understanding of ourselves.     

1559例中药注射剂医嘱用药合理性分析

目的:分析中药注射剂不合理使用情况,为临床合理用药提供参考。方法:随机抽取2012年1月—2013年6月焦作市第二人民医院含中药注射剂的医嘱1 559例,对其合理性进行统计和分析。结果:中药注射剂在临床上存在溶剂选择不当、稀释比例不当、超剂量用药、超疗程用药、配伍不当、重复用药、使用禁忌等问题。结论:在临床用药过程中,应进一步规范中药注射剂的合理使用。     

Experiential Limitation in Judgment and Decision

The statistics of small samples are often quite different from those of large samples, and this needs to be taken into account in assessing the rationality of human behavior. Specifically, in evaluating human responses to environmental statistics, it is the effective environment that matters; that is, the environment actually experienced by the agent needs to be considered, not simply long‐run frequencies. Significant deviations from long‐run statistics may arise through experiential limitations of the agent that stem from resource constraints and/or information‐processing bounds. The article draws together recent work from a number of areas in judgment and decision making ranging from randomness perception (Hahn & Warren, 2009 ), information sampling (Hertwig & Pleskac, 2010 ; Kareev et al., 1992 ), and consequences of choice for exploration or exploitation (e.g., Denrell, 2007 ) to demonstrate how proper consideration of these deviations leads to reevaluation of behaviors that are otherwise deemed irrational.     

对120份使用替加环素处方的评价

对我院120份使用替加环素处方进行分析评价，仅15.0%患者符合适应症，60%的用法与药品说明书一致，平均疗程为9.1天，70.8%的患者经过专家会诊使用，所有超说明书用药未进行备案管理，尚存在诸多不合理的地方，尤其需对超说明使用应严格监管。     

基层医院Ⅰ类手术围手术期预防用抗菌药物干预对照研究

目的 探讨基层医院Ⅰ类手术围手术期预防用抗菌药物的合理性.方法 将医院骨科2009年第一、四季度同期出院的Ⅰ类切口手术患者179例进行干预对照研究,其中第一季度为干预前,第四季度为干预后.结果 干预前后比较,抗菌药物应用率由100.00％下降至80.00％(P＜0.05),其中用药无适应证比例由干预前55.96％下降为干预后34.29％干预前预防用抗菌药物共涉及9大类25种,居首位是头孢菌素类,占67.37％,前3位品种分别是阿洛西林、头孢西丁、头孢替安;干预后共涉及6大类13种,居首位为头孢菌素类,占73.21％,居前3位则为头孢唑林、左氧氟沙星、头孢拉定.结论 干预组实施综合干预措施可行、有效,能显著降低Ⅰ类切口手术围手术期预防用抗菌药物应用率,提高抗菌药物合理使用,并对促进临床安全、有效、经济地应用抗菌药物具有良好效果.     

2010年1—6月骨科Ⅰ类切口手术围术期抗菌药物应用分析

目的:调查与分析中国人民解放军空军总医院骨科Ⅰ类手术围术期抗菌药物应用合理性。方法:采用描述性统计方法中的构成比方法,回顾性调查我院2010年1—6月350例骨科Ⅰ类手术围术期抗菌药物应用情况,并对照2009年3月下发的《卫生部办公厅关于抗菌药物临床应用管理有关问题的通知》进行评价。结果:350例手术中,预防性使用抗菌药物的手术分别占一般手术和有植入物手术的90.4%和84.2%,抗菌药物的使用以单一用药为主;术前0～2 h预防性应用抗菌药物的手术266例,占总例数的76.0%;术后预防性应用抗菌药物疗程大于7 d的居第1位,共计147例,占总例数的42.0%。抗菌药物的选择主要集中在第3代头孢菌素、第2代头孢菌素和氨基糖苷类,其构成比分别为69.23%、32.69%和11.81%。结论:骨科Ⅰ类手术预防性应用抗菌药物的时间合适,抗菌药物选用基本得当,但存在联合用药与疗程较长的缺点。针对这些不足,应继续对医务人员进行抗菌药物合理应用的宣教工作。     

Homo Heuristicus: Why Biased Minds Make Better Inferences

Heuristics are efficient cognitive processes that ignore information. In contrast to the widely held view that less processing reduces accuracy, the study of heuristics shows that less information, computation, and time can in fact improve accuracy. We review the major progress made so far: (a) the discovery of less‐is‐more effects; (b) the study of the ecological rationality of heuristics, which examines in which environments a given strategy succeeds or fails, and why; (c) an advancement from vague labels to computational models of heuristics; (d) the development of a systematic theory of heuristics that identifies their building blocks and the evolved capacities they exploit, and views the cognitive system as relying on an “adaptive toolbox;” and (e) the development of an empirical methodology that accounts for individual differences, conducts competitive tests, and has provided evidence for people’s adaptive use of heuristics. Homo heuristicus has a biased mind and ignores part of the available information, yet a biased mind can handle uncertainty more efficiently and robustly than an unbiased mind relying on more resource‐intensive and general‐purpose processing strategies.     

1942例围术期患者用血合理性调查

目的 了解普洱市医院围术期临床用血合理性情况.方法 对普洱市医院2007-01～2010-01间,1942例围术期患者的输血合理性进行分析评估.结果 红细胞、血浆合理性输注比例分别为66.40%、27.06%,"少量血"和"搭配血"比例分别为46.04%、51.14%.结论 普洱市医院围术期输血患者存在较严重的不合理...     

酒钢医院儿科门诊抗菌药物应用分析

目的：了解我院儿科门诊抗茵药物的使用情况,并评价其合理性,以促进儿科合理使用抗茵药物。方法：抽取2012年我院儿科门诊处方共1887张,对处方中抗茵药物的使用情况进行统计、分析,并对其用药合理性进行评价。结果：1887张处方中,495张使用了抗茵药物,抗茵药物使用率为26．23％;抗茵药物给药途径以静脉滴注为主;使用率最高的为头孢菌素类抗茵药物;抗菌药物存在不合理使用的情况。结论：加强抗菌药物使用的管理、促进合理使用抗茵药物、摒弃医师不良的用药习惯使其转变合理用药是当前最重要的工作。