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Stephen G. Pauker

Bio: Stephen G. Pauker is an academic researcher from Tufts Medical Center. The author has contributed to research in topics: Decision analysis & Cost effectiveness. The author has an hindex of 70, co-authored 269 publications receiving 23206 citations. Previous affiliations of Stephen G. Pauker include University of Illinois at Chicago & Brigham and Women's Hospital.


Papers
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Journal ArticleDOI
01 Feb 2012-Chest
TL;DR: In this article, the authors focus on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT following major orthopedic surgery, and suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives.

2,516 citations

Journal ArticleDOI
01 Feb 2012-Chest
TL;DR: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.

1,778 citations

Journal ArticleDOI
TL;DR: It is suggested that an awareness of variations in the way information is presented to patients influence their choices between alternative therapies could help reduce bias and improve the quality of medical decision making.
Abstract: We investigated how variations in the way information is presented to patients influence their choices between alternative therapies. Data were presented summarizing the results of surgery and radiation therapy for lung cancer to 238 ambulatory patients with different chronic medical conditions and to 491 graduate students and 424 physicians. We asked the subjects to imagine that they had lung cancer and to choose between the two therapies on the basis of both cumulative probabilities and life-expectancy data. Different groups of respondents received input data that differed only in whether or not the treatments were identified and whether the outcomes were framed in terms of the probability of living or the probability of dying. In all three populations, the attractiveness of surgery, relative to radiation therapy, was substantially greater when the treatments were identified rather than unidentified, when the information consisted of life expectancy rather than cumulative probability, and when the problem was framed in terms of the probability of living rather than in terms of the probability of dying. We suggest that an awareness of these effects among physicians and patients could help reduce bias and improve the quality of medical decision making.

1,532 citations

Journal ArticleDOI
TL;DR: Using the concepts of decision analysis, expressions for two threshold probabilities involved in the choice of whether to withhold treatment, obtain more data by testing, or treat without subjecting the patient to the risks of further diagnostic tests are derived.
Abstract: The physician's estimate of the probability that a patient has a particular disease is a principal factor in the determination of whether to withhold treatment, obtain more data by testing, or treat without subjecting the patient to the risks of further diagnostic tests. Using the concepts of decision analysis, we have derived expressions for two threshold probabilities involved in this choice: a "testing" threshold and a "test-treatment" threshold. Values can be assigned to these thresholds from data on the reliability and potential risks of the diagnostic test and the benefits and risks of a specific treatment. Treatment should be withheld if the probability of disease is smaller than the testing threshold, and treatment should be given without further testing if the probability of disease is greater than the test-treatment threshold. The test should be performed (with treatment depending on the test outcome) only if the probability of disease is between the two thresholds. The method exposes important principles of decision making and helps the clinician develop a rational, quantitative approach to the use of diagnostic tests.

1,199 citations

Journal ArticleDOI
TL;DR: A general- purpose model of medical prognosis based on the Markov process is described and it is shown how this simple mathematical tool may be used to generate detailed and accurate assessments of life expectancy and health status.
Abstract: The physician's estimate of prognosis under alternative treatment plans is a principal factor in therapeutic decision making. Current methods of reporting prognosis, which include five-year survivals, survival curves, and quality-adjusted life expectancy, are crude estimates of natural history. In this paper we describe a general-purpose model of medical prognosis based on the Markov process and show how this simple mathematical tool may be used to generate detailed and accurate assessments of life expectancy and health status.

939 citations


Cited by
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Book
01 Jan 1988
TL;DR: Probabilistic Reasoning in Intelligent Systems as mentioned in this paper is a complete and accessible account of the theoretical foundations and computational methods that underlie plausible reasoning under uncertainty, and provides a coherent explication of probability as a language for reasoning with partial belief.
Abstract: From the Publisher: Probabilistic Reasoning in Intelligent Systems is a complete andaccessible account of the theoretical foundations and computational methods that underlie plausible reasoning under uncertainty. The author provides a coherent explication of probability as a language for reasoning with partial belief and offers a unifying perspective on other AI approaches to uncertainty, such as the Dempster-Shafer formalism, truth maintenance systems, and nonmonotonic logic. The author distinguishes syntactic and semantic approaches to uncertainty—and offers techniques, based on belief networks, that provide a mechanism for making semantics-based systems operational. Specifically, network-propagation techniques serve as a mechanism for combining the theoretical coherence of probability theory with modern demands of reasoning-systems technology: modular declarative inputs, conceptually meaningful inferences, and parallel distributed computation. Application areas include diagnosis, forecasting, image interpretation, multi-sensor fusion, decision support systems, plan recognition, planning, speech recognition—in short, almost every task requiring that conclusions be drawn from uncertain clues and incomplete information. Probabilistic Reasoning in Intelligent Systems will be of special interest to scholars and researchers in AI, decision theory, statistics, logic, philosophy, cognitive psychology, and the management sciences. Professionals in the areas of knowledge-based systems, operations research, engineering, and statistics will find theoretical and computational tools of immediate practical use. The book can also be used as an excellent text for graduate-level courses in AI, operations research, or applied probability.

15,671 citations

Journal ArticleDOI
TL;DR: It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management, and management of diseases.
Abstract: PREAMBLE......e4 APPENDIX 1......e121 APPENDIX 2......e122 APPENDIX 3......e124 REFERENCES......e124 It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

8,362 citations

Posted Content
TL;DR: Prospect theory as mentioned in this paper is an alternative to the classical utility theory of choice, and has been used to explain many complex, real-world puzzles, such as the principles of legal compensation, the equity premium puzzle in financial markets, and the number of hours that New York cab drivers choose to drive on rainy days.
Abstract: This book presents the definitive exposition of 'prospect theory', a compelling alternative to the classical utility theory of choice. Building on the 1982 volume, Judgement Under Uncertainty, this book brings together seminal papers on prospect theory from economists, decision theorists, and psychologists, including the work of the late Amos Tversky, whose contributions are collected here for the first time. While remaining within a rational choice framework, prospect theory delivers more accurate, empirically verified predictions in key test cases, as well as helping to explain many complex, real-world puzzles. In this volume, it is brought to bear on phenomena as diverse as the principles of legal compensation, the equity premium puzzle in financial markets, and the number of hours that New York cab drivers choose to drive on rainy days. Theoretically elegant and empirically robust, this volume shows how prospect theory has matured into a new science of decision making.

7,802 citations

Journal ArticleDOI
19 Jun 2004-BMJ
TL;DR: A system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts is developed, and a summary of the approach from the perspective of a guideline user is presented.
Abstract: Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations Systematic and explicit methods of making judgments can reduce errors and improve communication We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts In this article we present a summary of our approach from the perspective of a guideline user Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk It is also important to consider costs (resource utilisation) before making a recommendation Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues

7,608 citations

Book
25 Sep 2000
TL;DR: In this paper, the cognitive and psychophysical determinants of choice in risky and risk- less contexts are discussed, and the relation between decision values and experience values is discussed, as well as an approach to risky choice that sketches an approach for decision making that can be seen as the acceptance of a gamble that can yield various outcomes with different probabilities.
Abstract: We discuss the cognitive and the psy- chophysical determinants of choice in risky and risk- less contexts. The psychophysics of value induce risk aversion in the domain of gains and risk seeking in the domain of losses. The psychophysics of chance induce overweighting of sure things and of improbable events, relative to events of moderate probability. De- cision problems can be described or framed in multiple ways that give rise to different preferences, contrary to the invariance criterion of rational choice. The pro- cess of mental accounting, in which people organize the outcomes of transactions, explains some anomalies of consumer behavior. In particular, the acceptability of an option can depend on whether a negative outcome is evaluated as a cost or as an uncompensated loss. The relation between decision values and experience values is discussed. Making decisions is like speaking prose—people do it all the time, knowingly or unknowingly. It is hardly surprising, then, that the topic of decision making is shared by many disciplines, from mathematics and statistics, through economics and political science, to sociology and psychology. The study of decisions ad- dresses both normative and descriptive questions. The normative analysis is concerned with the nature of rationality and the logic of decision making. The de- scriptive analysis, in contrast, is concerned with peo- ple's beliefs and preferences as they are, not as they should be. The tension between normative and de- scriptive considerations characterizes much of the study of judgment and choice. Analyses of decision making commonly distin- guish risky and riskless choices. The paradigmatic example of decision under risk is the acceptability of a gamble that yields monetary outcomes with specified probabilities. A typical riskless decision concerns the acceptability of a transaction in which a good or a service is exchanged for money or labor. In the first part of this article we present an analysis of the cog- nitive and psychophysical factors that determine the value of risky prospects. In the second part we extend this analysis to transactions and trades. Risky Choice Risky choices, such as whether or not to take an umbrella and whether or not to go to war, are made without advance knowledge of their consequences. Because the consequences of such actions depend on uncertain events such as the weather or the opponent's resolve, the choice of an act may be construed as the acceptance of a gamble that can yield various out- comes with different probabilities. It is therefore nat- ural that the study of decision making under risk has focused on choices between simple gambles with monetary outcomes and specified probabilities, in the hope that these simple problems will reveal basic at- titudes toward risk and value. We shall sketch an approach to risky choice that

6,015 citations