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Biomedical subjects

F M Wolf

Publications and source records attributed to F M Wolf.

At least 55 records · Page 3Linked to original sources
PubMed1988

Use of the competing-hypotheses heuristic to reduce 'pseudodiagnosticity'.

A quasiexperimental research design involving a nonequivalent control group was used to examine the efficacy of a brief educational intervention in teaching medical students to select optimal diagnostic data consistent with the competing-hypotheses heuristic and Bayes' theorem when solving clinical problems. There was no significant difference between intervention (n = 119) and control (n = 89) groups in performance at baseline, but the intervention group performed significantly better (p less than .001) than the control group after training. The results suggest that some problem-solving skills, such as learning to use the competing-hypotheses heuristic, can be enhanced or learned independent of the acquisition of content knowledge.

Bayes Theorem↗
PubMed1988

The influence of general and case-related experience on primary care treatment decision making.

In an effort to examine how general vs case-related clinical experience influenced physicians' treatment decisions, four clinical case vignettes (rheumatoid arthritis, fever of undetermined origin, exercise-induced asthma, and cor pulmonale) were presented to 387 primary care physicians. For each case, physicians indicated (1) their willingness to proceed with treatment without seeking additional information, (2) their preferences for sources of supplementary information, and (3) their preferences for continued care responsibility. The results indicated that the nature of the particular vignette had a major impact on how physicians made treatment decisions. Also, having greater case-related experience and being younger led to greater willingness to proceed with treatment and preferences for continued care responsibility. Preferences for information sources were largely independent of either form of experience. Treatment decision making appears to be quite dependent on experience with similar problems and being up-to-date on current treatment procedures.

Adult↗
PubMed1988

The contribution of different components of the clinical encounter in generating and eliminating diagnostic hypotheses.

An examination of the diagnostic hypotheses generated by physicians in 119 primary care encounters showed that "correct" diagnostic hypotheses were produced simply on the basis of the patient's chief complaint in 78% of the cases and on the basis of the history in 16%; the physical examination and "stat" laboratory tests contributed little to generating "correct" hypotheses but more to eliminating alternatives. The early generation of frequently accurate diagnostic hypotheses on the basis of very limited information suggests that considerable clinical reasoning takes place in the earliest stages of a problem.

Clinical Competence↗
PubMed1988

Case differences in the problem solving strategies of medical students and physicians.

Using a broad range of written patient management problems, this study examined 1) the influences of three medical information-gathering processes (history-taking, physical examination, and diagnostic studies) on the formulation of the differential and principal diagnosis by 175 medical students and 2) the extent to which the information-gathering processes used by the students paralleled the emphasis that experienced clinicians placed on these same processes. Results suggested that in 11 of 14 cases, the students appeared to be relying on specific information-gathering strategies in the formulation of the differential diagnosis, and that there were both similarities and differences in the relative emphases that these processes received from students and physicians.

Clinical Competence↗
PubMed1987

Information-seeking strategies and differences among primary care physicians.

Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Choice Behavior↗
PubMed1987

A controlled experiment in teaching students to respond to patients' emotional concerns.

Medical education faces increasing criticism because of the perception that it is difficult to produce physicians who are both technically competent and compassionate. One approach to addressing this problem is to train physicians to address the emotional concerns that patients experience as a result of their medical problems. Results of the authors' randomized, controlled experiment in training medical students to respond to patients' emotional concerns provide evidence of the efficacy and feasibility of such training. Only students who received small-group instruction in addition to large-group lectures exhibited statistically significant (p less than .001) improvement in their ability to respond to the emotional concerns of patients in hypothetical cases. The students who received only the lectures exhibited significant improvement (p less than .001) in their preference for responses that addressed patients' emotional concerns but not in their responses to written, hypothetical patient cases. Even though these students' preferences for responses to emotional concerns on the average did increase significantly, the preferences were significantly (p less than .001) less favorable than the preferences of the students who received small-group instruction. The small group instruction consisted of both interviews with elderly nursing home residents, who served as simulated patients, and structured practice and review sessions.

Clinical Competence↗
PubMed1986

Interpreting behavioral, biomedical, and psychological relationships in chronic disease from 2 x 2 tables using correlation.

Correlations of 0.3 and 0.4 in psychological studies in chronic illness (e.g. diabetes) have been criticized as having little clinical importance. The present article suggests that correlation coefficients be interpreted as binomial effect size displays (BESD) as a means of gleaning the clinical importance of a given correlation coefficient. The BESD is easily understood, computed, and applied to research in chronic disease. An illustration is provided in which a r of 0.2 is shown to correspond to a BESD in which the success rate is improved from 40 to 60%. Using BESD to interpret the meaningfulness of relationships, correlations as low as 0.2 may have clinical importance.

Behavioral Medicine↗
PubMed1986

Retention of knowledge and self-care skills after an intensive in-patient diabetes education program.

Diabetes knowledge and self-care skills were studied in 35 adults with IDDM and NIDDM before and after an intensive in-patient education program and 6-12 months after discharge. Knowledge and skills were compared to fasting serum glucose levels and percent ideal body weight (%IBW). Although knowledge improved during hospitalization and knowledge and skills were maintained at follow-up, there was not a significant relationship between fasting serum glucose levels and knowledge or self-care skills or %IBW.

Adult↗
PubMed1986

Evaluation of an education program on the management of rheumatic diseases for physical therapists.

An educational program on the management of rheumatic diseases was developed for physical therapists. It was community based and designed to measure changes in patient care and physician behavior in the utilization of physical therapy services. Substantial changes in the utilization of physical therapy services were documented in 3 intervention communities, but not in control communities. In patients undergoing total hip arthroplasty, there was a 1.8 day reduction in the hospitalization, significant increases in the use of preoperative physical therapy and a shift in the use of walking aids. These data suggest that physical therapists can play an important role in physician and patient education, and this may result in lower costs and improved outcomes.

Arthritis, Rheumatoid↗
PubMed1985

Differential diagnosis and the competing-hypotheses heuristic. A practical approach to judgment under uncertainty and Bayesian probability.

Evaluating the same diagnostic information across the plausible competing diagnoses is a practical strategy (ie, heuristic) to guide decision making in the face of uncertainty. The prevalence of use of this competing-hypotheses heuristic by 89 first-year house officers was examined in three simulated patient cases. Results indicated that only a minority (24%) of the house officers selected optimal diagnostic information consistent with this Bayesian heuristic across all three cases. Almost all (97%) of the house officers selecting optimal diagnostic information were able to identify the most probable diagnosis specified by Bayes' theorem, while only a chance number (53%) of house officers selecting nonoptimal information were able to identify the most probable diagnosis. The competing-hypotheses heuristic is discussed within the context of diagnostic problem-solving models derived from the literature on medical decision making and clinicopathological conference case records. It is suggested that the heuristic, which does not necessitate any mathematical calculations, may be useful as a complement to clinical judgment.

Bayes Theorem↗