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Clinical practice guidelines and performance measures are becoming increasingly pervasive. They epitomize the evidence-based movement, which recognizes that mere "clinical judgment" is often inadequate to synthesize all the important data to determine the best management for a particular patient. This movement has at its core the fundamental expectation that medical decisions be based on sound data rather than anecdote. Unfortunately, this concept rarely manifests in daily practices where significant variations in care still exist. Guidelines were designed to improve patient care, reduce unnecessary variation, and reduce attributed costs. Therefore, it is not surprising that associated recommendations are now being incorporated into health care legislation as part of the Patient Protection and Affordable Care Act. In this environment, there is growing urgency for otolaryngologists to participate in rigorous comparative effectiveness research that will direct our Academy's guideline developers and policy makers to make recommendations that optimize care for all our patients.

Decision making is an integral part of surgical practice and is a skill that is as important as the ability to operate. Sound decision making is the result of acquiring 'surgical wisdom', which is achieved through learning, experience and reflection. This paper reviews the processes of surgical decision making with respect to choosing the correct procedure and deciding when to operate, and how operative decisions are made, together with the factors that influence our surgical decisions.

This study used simulation techniques to evaluate the technical adequacy of three methods for the identification of specific learning disabilities via patterns of strengths and weaknesses in cognitive processing. Latent and observed data were generated and the decision-making process of each method was applied to assess concordance in classification for specific learning disabilities between latent and observed levels. The results showed that all three methods had excellent specificity and negative predictive values, but low to moderate sensitivity and very low positive predictive values. Only a very small percentage of the population (1%-2%) met criteria for specific learning disabilities. In addition to substantial psychometric issues underlying these methods, general application did not improve the efficiency of the decision model, may not be cost effective because of low base rates, and may result in many children receiving instruction that is not optimally matched to their specific needs. (Contains 4 tables and 1 figure.)

Assessment of student performance is critical for developing effective instructional policy and designing programs responsive to individual students' needs. To gauge the adequacy of available assessment tools for achieving these ends, the Reading First Assessment Committee (RFAC) developed criteria for evaluating the adequacy of reading measures for use in kindergarten through Grade 3 and applied those criteria to a sample of prominently used assessments (Kame'enui et al., 2002). The authors describe the RFAC's framework, outline its process for judging the technical merits of reading measures, and comment on the current state of assessment tools available to practitioners for supporting effective reading instruction in the primary grades. (Contains 2 tables and 1 note.)

Many states now mandate early screening for dyslexia, but vary in how they address these mandates. There is confusion about the nature of screening versus diagnostic assessments, risk versus diagnosis, concurrent versus predictive validity, and inattention to indices of classification accuracy as the basis for determining risk. To help define what constitutes a screening assessment, we summarize efforts to develop short (3–5 min), teacher-administered screens that used multivariate strategies for variable selection, item response theory to select items that are most discriminating at a threshold for predicting risk, and statistical decision theory. These methods optimize prediction and lower the burden on teachers by reducing the number of items needed to evaluate risk. A specific goal of these efforts was to minimize decision errors that would result in the failure to identify a child as at risk of dyslexia/reading problems (false negatives) despite the inevitable increase in identifications of children who eventually perform in the typical range (false positives). Five screens, developed for different periods during kindergarten, Grade 1, and Grade 2, predicted outcomes measured later in the same school year (Grade 2) or in the subsequent year (Grade 1). The results of this approach to development are applicable to other screening methods, especially those that attempt to predict those children at risk of dyslexia prior to the onset of reading instruction. Without reliable and valid early predictive screening measures that reduce the burden on teachers, early intervention and prevention of dyslexia and related reading problems will be difficult. [ABSTRACT FROM AUTHOR]