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PubMed1984

Patient education evaluation: beyond intuition.

Intuitive ideas about problem areas gleaned from the literature as well as practice settings can provide nurses with a multitude of patient education evaluation issues. The nurse who is interested in evaluating patient education should review existing studies in the literature, sampling both process and outcome. Thoughtful planning and implementation of a patient education study can be personally satisfying. In addition, such an undertaking will contribute to the body of knowledge in patient education and provide valuable information to other patient educators. It is natural that nurses should pursue the rewards of patient education evaluation for themselves and their patients.

Evaluation Studies as Topic↗

PubMed1999

Immunohistochemical differentiation between primary adenocarcinomas of the ovary and ovarian metastases of colonic and breast origin. Comparison between a statistical and an intuitive approach.

AIM: To discriminate between adenocarcinomas that are primary to the ovary and metastatic to the ovary, especially of colonic and breast origin, by immunohistochemistry, using stepwise discriminant analysis or a decision tree. METHODS: 312 routinely processed, formalin fixed tissue specimens were used. The tumours were divided into a learning set (n = 159), composed of primary tumours of ovary, breast, and colon, and a test set, comprising 134 metastases from these sites and an additional 19 primary ovarian carcinomas. The immunohistochemical panel was composed of antibodies against cytokeratin 7 (CK7) and 20 (CK20), CA125, vimentin, carcinoembryonic antigen (CEA), gross cystic disease fluid protein-15 (GCDFP-15), and the oestrogen receptor (ER). The staining results of the tumours were expressed as the product of the staining intensity and the percentage of positive tumour cells. Analyses were first performed on the learning set and then evaluated on the test set. RESULTS: Although the immunostaining patterns showed a considerable overlap between the three types of adenocarcinoma, the breast carcinomas were typically positive for GCDFP-15 and often for ER, and negative for vimentin. Ovarian carcinomas were always positive for CK7 and to a lesser extent for CA125. Colonic carcinomas showed prominent positivity for CEA and CK20, while no staining was seen for ER and vimentin. In discriminant analysis, six antibodies (alpha CK7, alpha CK20, alpha CA125, alpha CEA, alpha ER, and alpha GCDFP-15) appeared to be necessary for optimal classification: 89% of the learning set and 82% of the test set were classified correctly. In the decision tree, only four antibodies (alpha CK7, alpha CEA, alpha ER, and alpha GCDFP-15) were used to obtain a correct classification score of 89% for the learning set and 84% for the test set. CONCLUSIONS: Using a semiquantitative assessment of the immunostaining results by a restricted panel of six antibodies with stepwise discriminant analysis, 80-90% of the adenocarcinomas of colon, breast, and ovary can be correctly classified. Discriminant analysis is computer aided and therefore an easy method and for each case a probability value of the classification result is obtained. The intuitive decision tree method provides a slightly better result, requires only four antibodies, and offers a more practical method for the surgical pathologist.

Adenocarcinoma↗

PubMed1990

Moral intuition, good deaths and ordinary medical practitioners.

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death.

Aged↗

PubMed2003

When protocols are not enough. Intuitive decision making by novice nurse practitioners.

The pressing need for health care reform in this century has contributed to an increasing interest in educating health care providers who can deliver cost-effective, high-quality care. Demand for primary care nurse practitioners has risen significantly, and nursing education has responded by increasing the numbers and graduates of nurse practitioner programs. Although this century brings new opportunities for expanded nursing roles, it also presents challenges for nurse practitioners to sustain a holistic perspective while providing quality care. The purpose of this interpretive phenomenological study was to discover, describe, and analyze the stories of 10 novice nurse practitioners who used intuition in clinical decision making. The authors maintained a critical social consciousness and postmodern perspective to analyze and describe the shared meanings and common practices of participants. This article discusses the six themes and constitutive process that emerged from the data and addresses implications for nurse practitioner education and practice.

Adult↗

PubMed2005

Perceptions of local HIV/AIDS prevalence and risks for HIV/AIDS and other sexually transmitted infections: preliminary study of intuitive epidemiology.

BACKGROUND: Risk perceptions are theoretically important in predicting health behavior but have only shown modest evidence in predicting sexual risk behavior. PURPOSE: Our purpose is to investigate whether perceptions of the local prevalence of disease serve as a predictor of health behavior, particularly behaviors associated with infectious diseases such as HIV/AIDS. METHODS: Four hundred eighty-seven men and 236 women receiving diagnostic and treatment services at a sexually transmitted infections (STI) clinic in a moderate-size U.S. city completed anonymous surveys of perceived prevalence of HIV/AIDS and other STI and sexual risk and protective behaviors. RESULTS: Participants who estimated a lower AIDS burden in their city relative to other U.S. cities demonstrated greater numbers of sex partners, higher rates of sexual risk practices, and higher rates of STI. They were also less likely to have been tested for HIV. CONCLUSIONS: This initial study of intuitive epidemiology suggests that STI clinic patients may have a sense for the relative burden of AIDS in their city and estimates of local disease prevalence may predict sexual risk behaviors.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Intuition and expert clinical practice in nursing.

The quest for the essence of nursing in the UK continues unabated. Similarly, the concept of what constitutes expert clinical practice and the problem of how it can be achieved are topical issues. This article considers the notion of a developmental process in nursing and the concept of reflective practice, and examines the idea of intuition as a key component in the functioning of the expert nurse.

Clinical Competence↗

PubMed2003

A non-intuitive design of a cyclic decapeptide library with unique backbone structural features.

An analysis of hydrogen bonding patterns of cyclic decapeptide (CDP) beta-sheet structures has resulted in a 'non-intuitive' design of cyclic decapeptides wherein their beta-turns and residue positions can be fixed by choosing 2 of the 10 residues, i.e. positions i and i+4, to be Prolines or N-substituted residues. This sequence relationship between the two Pro or N-substituted residues is shown to uniquely define the conformation of the CDP. Furthermore, this design of the 2 beta-turn, beta-sheet CDP structure is expected to be characterised by residues disposed in an exclusive fashion in which four residues are on one side of the ring, two on the other and the four corner residues in the beta-turn are in the plane of the ring. This opens up the possibility of fine-tuning the four residues facing one way and /or the two residues facing the other way such that a library containing a myriad of chemically diverse systems could be obtained. The design process along with the molecular modelling of specific CDP-s and the building of a CDP library are discussed in detail.

Amino Acids↗

PubMed1994

Intuition: two caregivers' descriptions of how they provide severely demented patients with loving care.

To understand how caregivers reason when faced with patients in late states of dementia, two recognized expert caregivers were interviewed about their experiences of caring for severely demented patients. Combined in the precontext were hermeneutic, psychodynamic, and existentialist perspectives with regard to theories of human development and care ethics. Ethical reasoning, exemplified by tender descriptions of relatedness to patients, indicated that expert caregivers use sound knowledge combined with imagination, empathy, and intuition, to reach a total grasp of the situation, where the patient is regarded as a person with worth, dignity, and integrity.

Adaptation, Psychological↗

PubMed2006

Evaluation of an intuitive writing interface in robot-aided laser laparoscopic surgery.

OBJECTIVE: The feasibility of the conceptual Intuitive Writing Interface (IWI) in robot-aided laser laparoscopic surgery has been demonstrated previously. This paper investigates the potential improvement of IWI by comparing conventional manipulation (CM) and IWI manipulation (IM) and conducting an animal experiment. MATERIALS AND METHODS: Three tasks were designed that were considered to be representative of laser laparoscopic surgical procedures. All test participants used both CM and IM in all tasks. Completion time and error level of each task were taken as comparative indices and were integrated into a self-defined Index of Time and Error (ITE). Six sequential in vitro trials were carried out to investigate learning curves. In addition, nephrectomy was performed on a rabbit by employing IWI in robot-aided laser laparoscopic surgery. RESULTS: The results showed significant advantages for IM, with shorter completion time, more successful shots, and smaller error length in the three tasks, as compared to CM. The learning curve showed a promising trend for IM. More than half of the participants performed better with IM. The animal model experiment demonstrated the clinical feasibility of IM, but at the same time revealed some limitations. CONCLUSIONS: The new IWI interface definitely improved laser laparoscopic procedures by taking advantage of familiar writing skills. With its flexibility of implementation and ease of use, IWI has clear potential for use in laser laparoscopic procedures.

Animals↗

PubMed2002

Comparison of an 'intuitive' NHS hearing aid prescription method with DSL 4.1 targets for amplification.

This study aimed to evaluate current practice in a National Health Service Trust in setting hearing aid output to meet amplification targets prescribed by desired sensation level (DSL) using a range of NHS hearing aids. A consecutive sample of 33 patients was drawn from the hearing aid waiting list of the Royal Devon & Exeter Hospital (RD&E). The age range was 33-83 years. Patients not giving written consent and those with complex hearing losses were excluded. At review, pure-tone audiogram, uncomfortable loudness levels, real-ear coupler difference, user gain and maximum output were recorded. Data were entered into DSL 4.1 prescription software. Wilcoxon tests were used to compare the measured user gain and maximum output with DSL 4.1-generated targets. The results demonstrate significant differences (p<0.05) at 0.25, 0.5, 0.75, 1.5, 2, 3, 4 and 6 kHz between target and measured values for user gain. This study reveals that the routine intuitive method for prescribing hearing aids at the RD&E is not effective in meeting targets for amplified speech as prescribed by DSL.

Adult↗

PubMed1997

Accountability and intuition: justifying nursing practice.

This article examines how promoting individual accountability and justifying nursing practice using scientific evidence appears to contradict theories of intuitive nursing. The author considers the professional and legal implications raised by the contradiction and advocates that evidence-based practice must be the justification in law for nursing action.

Evidence-Based Medicine↗

PubMed2000

Intuitive operation planning based on force feedback.

In the craniofacial surgery image-slices obtained from tomographies are used for planning and simulation of surgical interventions. Using these image-slices three-dimensional geometric models can be reconstructed, representing bones and soft tissue. However, for planning complex surgical interventions simulation methods are needed additionally to the pure visualisation. Exemplary, planning a Frontal Orbital Advancement (FOA) operation the cutting trajectories, their depth and orientation in each point, the drill hole, the position, orientation and deformation of bones, etc. are the point of interest. Especially for intraoperative execution supported by navigation systems or robots. In order to be able to plan such complex interventions with the help of computers, geometrical and haptical models must be generated from the image-slices. On the one hand these models represent the anatomical structures exactly, on the other hand they are needed for the simulation of the different activities, which have to be performed during the surgical intervention like drilling, milling, deforming, positioning, etc. Beside the geometrical and haptical models methods for interactions must be supplied to the physician for an accurate and intuitive planning of the surgical intervention. We developed such an operation planning system which is already used in clinical practise in Heidelberg.

Artificial Intelligence↗

PubMed1992

Colorimeter for the intuitive manipulation of hue and saturation and its role in the study of perceptual distortion.

A simple optical method for mixing coloured light is described. The observer has intuitive and approximately independent control over hue and saturation at constant brightness. The method facilitates colour matching by unpracticed observers. It allows children with reading difficulties to select a colour that reduces perceptual distortion of text. The chromaticity coordinates of this colour vary from one observer to another but can be very specific. Complementary colours can exacerbate the distortions and induce pain. For the majority of children reporting beneficial perceptual effects, the u' coordinate is less than 0.25.

Adolescent↗

PubMed1992

[Intuitive prognostic assessment in rehabilitation of long-term psychiatric patients].

The significance of intuitive prognostic assessments by the nursing staff and the examining female doctor is studied with regard to the course and results of "late rehabilitation" of 30 psychiatric patients who had been hospitalised for many years. Using standardised assessment criteria and catamnestic data on readmission as inpatients (covering a period of 20 months) patients were compared who had been discharged from the psychiatric hospital, transferred to long-term residential quarters, and assessed before discharge as likely or unlikely to be readmitted to the hospital. The group of patients who had been given an unfavourable prognosis--most of them women--proved in course of time to be readmitted as inpatients more often and to be significantly more disturbed than the patients who had been discharged with a more favourable prognosis. These results are discussed with regard to sociopolitical and medical care aspects and to approaches for further research in this direction.

Activities of Daily Living↗

PubMed2004

[Preface: intuitive visualization of medical information].

Information technology(IT), visualization, and manipulation will be the key words for next generation surgery. In other words, it is awaited to make good use of intuitive visualization of medical information management by extensive use of IT in which medical science and engineering are merged and incorporated and of the process management or the visualization of treatment course using three-dimensional intraoperative images and simulation data base. In order to put it into practice, it is inevitable to establish a treatment strategy system that certainly enables surgeons to provide constantly high quality medicine. This means that to achieve the goal while optimizing the strategy toward the goal(a road map) by monitoring real-timely the pre- and intraoperative surgical planning and the operating condition of surgical devices under the control of the surgical strategy system.

Decision Making, Computer-Assisted↗

PubMed1988

Technical intuition in system diagnosis, or accessing the libraries of the mind.

Expert diagnosticians draw upon rich, integrated structures of knowledge and associated action rules to achieve their prodigious performances. Studies in both medical diagnosis and electronic troubleshooting have revealed that it is particularized knowledge that plays a vital role for experts in both domains, not inexplicable powers of intuition. Advanced knowledge engineering methods have been developed and applied in a number of Air Force technical domains so that experts' mental databases and procedural libraries can be made explicit enough to serve as targets of instruction. Instructional principles have been derived from this knowledge engineering work and are guiding the development of a new generation of Air Force technical training systems. The training dictum is to teach from realistic cases so that theory of system operation and specialized solution methods are taught in tandem. The learning environments will further foster the welding of factual knowledge to action rules by providing "assisted laboratory" experiences via intelligent tutoring systems. In these environments, trainees can practice carrying out diagnoses on increasingly complex problems with the help of an articulate expert coach.

Expert Systems↗

PubMed1988

[What is the contribution of intuitive diagnosis in cardiac pain?].

This study reports on a new type of experiment developed by the author for general practice and tested over a period of 1 1/2 years. In the course of the test period all patients presenting with uncharacteristic precordial pain were once again solely counselled according to the dictate of experience. Previously the author had based his diagnosis on intuitive assessment over 25 years, followed by a further period of 10 years in which he had acted according to a programmed schedule as far as possible. The consulations were recorded on tape during the period and this recording was subsequently tested against the parameter supplied by the specific diagnostic programme. The outcome of the test was even less favourable than had been anticipated. The young doctor can work appreciably more efficiently without any further investment, than previously. It follows that it would appear essential to proceed in general practice according to the outlined programme given for 86 problematic situations.

Angina Pectoris↗

PubMed1995

Pulse oximetry and intuition in the neonatal intensive care unit.

This article poses an argument supporting the position that it is important for nurses to become involved, at every level, in the development of the technology that they use. The advantages and disadvantages of one commonly used technological device in the intensive care nursery, the pulse oximeter, are identified. An example of how nursing intuition affected and was incorporated into the design of a new neonatal pulse oximeter is described.

Equipment Failure↗