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PubMed1994

Prescription drug costs as a reason for changing physicians.

The authors conducted a telephone survey of 200 patients who had recently transferred their health care to a Veterans Affairs (VA) medical center. Of the study patients, 56% considered prescription drug costs to be the main reason or a major contributing reason for transfer (95% confidence interval 49% to 63%). The mean out-of-pocket prescription drug cost for these patients was $139 per month, compared with $47 per month for patients for whom drug costs were a minor reason or not a reason at all (p < 0.001). Drug costs are a principal reason for patients to transfer their health care to the VA.

Aged↗

PubMedDate not supplied

The reasons patients request "checkups": implications for office practice.

When patients request checkups, physicians may assume it is for detection of asymptomatic disease. However, such patients may have other, covert reasons for seeking medical care which might not be addressed by a periodic health examination. The authors interviewed 38 consecutive patients who requested a new appointment at an academic, hospital-based general medical practice, and said the appointment was for a checkup and not an acute problem. Health screening was the principal reason for requesting evaluation of only 24% of patients. Fifty-two per cent had two or more reasons: psychosocial problems, health concerns, or symptoms. Psychosocial problems, with and without other problems, were the reason 45% of patients requested checkups. Physicians should be alert to the various reasons why patients request checkups, and not assume that a periodic health examination alone is an appropriate response.

Adolescent↗

PubMed2003

The ANZPIC registry diagnostic codes: a system for coding reasons for admitting children to intensive care.

OBJECTIVE: To describe the uniform diagnostic coding system used in Australia and New Zealand to code reasons for admitting children to intensive care, and to highlight the benefits of a uniform approach. DESIGN: International, multicentre, observational study. SETTING: A registry of children admitted to intensive care in Australia and New Zealand. PATIENTS: The records of 19249 children admitted to intensive care between 1997 and 2000 were analysed. MEASUREMENTS AND RESULTS: The system was designed empirically using expert consensus. The principal diagnosis or main reason for intensive care admission and up to five associated diagnoses are coded. The system has four levels of coding: non-operative or post-procedural admission, diagnostic group, specific condition, and for injury and infection the aetiological factor. The main reason for intensive care admission was coded in all patient records, however, for 11.1% of records the code was limited to diagnostic group with the specific condition coded as "other diagnosis". Two or more diagnoses were coded in 61% of records. The most frequent reason for admission was asthma. CONCLUSIONS: The major advantage of the system is that units in the region use the same method of coding. A uniform international approach to coding reasons for admitting children to intensive care is needed.

Australia↗

PubMed2007

Reasons why medicines are returned to Swedish pharmacies unused.

OBJECTIVE: To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused. SETTING: A random sample of the pharmacies in Sweden. METHOD: Interviews using a semi-structured interview form with pharmacy customers returning unused medicines to the pharmacy. MAIN OUTCOME MEASURE: Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy. RESULTS: The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons. CONCLUSION: Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines.

Adolescent↗

PubMed1989

The logic of social exchange: has natural selection shaped how humans reason? Studies with the Wason selection task.

In order to successfully engage in social exchange--cooperation between two or more individuals for mutual benefit--humans must be able to solve a number of complex computational problems, and do so with special efficiency. Following Marr (1982), Cosmides (1985) and Cosmides and Tooby (1989) used evolutionary principles to develop a computational theory of these adaptive problems. Specific hypotheses concerning the structure of the algorithms that govern how humans reason about social exchange were derived from this computational theory. This article presents a series of experiments designed to test these hypotheses, using the Wason selection task, a test of logical reasoning. Part I reports experiments testing social exchange theory against the availability theories of reasoning; Part II reports experiments testing it against Cheng and Holyoak's (1985) permission schema theory. The experimental design included eight critical tests designed to choose between social exchange theory and these other two families of theories; the results of all eight tests support social exchange theory. The hypothesis that the human mind includes cognitive processes specialized for reasoning about social exchange predicts the content effects found in these experiments, and parsimoniously explains those that have already been reported in the literature. The implications of this line of research for a modular view of human reasoning are discussed, as well as the utility of evolutionary biology in the development of computational theories.

Adolescent↗

PubMed1992

Domain-specific reasoning: social contracts, cheating, and perspective change.

What counts as human rationality: reasoning processes that embody content-independent formal theories, such as propositional logic, or reasoning processes that are well designed for solving important adaptive problems? Most theories of human reasoning have been based on content-independent formal rationality, whereas adaptive reasoning, ecological or evolutionary, has been little explored. We elaborate and test an evolutionary approach. Cosmides' (1989) social contract theory, using the Wason selection task. In the first part, we disentangle the theoretical concept of a "social contract" from that of a "cheater-detection algorithm". We demonstrate that the fact that a rule is perceived as a social contract--or a conditional permission or obligation, as Cheng and Holyoak (1985) proposed--is not sufficient to elicit Cosmides' striking results, which we replicated. The crucial issue is not semantic (the meaning of the rule), but pragmatic: whether a person is cued into the perspective of a party who can be cheated. In the second part, we distinguish between social contracts with bilateral and unilateral cheating options. Perspective change in contracts with bilateral cheating options turns P & not-Q responses into not-P & Q responses. The results strongly support social contract theory, contradict availability theory, and cannot be accounted for by pragmatic reasoning schema theory, which lacks the pragmatic concepts of perspectives and cheating detection.

Adult↗

PubMed1989

Reasoning with contrary-to-fact propositions.

In the initial study, the ability of subjects at four age levels (10, 13, 15, 18 years) (1) to accept if-then premises as a basis for reasoning and (2) to reason correctly with if-then premises was examined. Half the subjects were assessed with four reasoning problems involving factually accurate premises. The other half received factually inaccurate premises which were derived from the preceding ones by altering a single term. Both tests included an abstract problem which preceded the concrete propositions. Results indicate that the 10 year olds, and to a lesser extent the 13 year olds, did have difficulty in accepting contrary-to-fact premises as a basis for reasoning. The 15 and 18 year olds did not, but did find reasoning correctly more difficult with contrary-to-fact premises. The second study examined the ability of 5 and 7 year olds to accept contrary-to-fact premises. Subjects were given factually false premises either alone or within a fantasy context. Results indicate that the fantasy context decreases the extent to which empirical knowledge interferes with accepting contrary-to-fact premises. This result supports the notion that a representational process may be involved in accepting contrary-to-fact premises.

Adolescent↗

PubMed1983

Predictors of relapse: interaction of drinking-related locus of control and reasons for drinking.

Pretreatment scores from the drinking-related locus of control scale (DRIE) and reasons for drinking were investigated as predictors of drinking relapse over a nine-month follow-up in a sample of 232 male alcoholics. A significant relationship was found between reasons for drinking and the probability of relapse, with the lowest relapse rates occurring among patients who identified interpersonal conflicts or positive emotional states as the most important reasons for their pretreatment drinking. Results of a reasons for drinking by relapse status ANOVA on DRIE scores revealed no significant main effects. There was, however, a significant interaction. Among patients who attributed their drinking to negative emotional states, those who either relapsed or were lost to follow-up had significantly more external DRIE scores. Among patients who identified negative physical states (i.e., craving) as their primary reason for drinking, relapse or attrition was associated with significantly more internal DRIE scores. Results support assessment of these cognitive social learning constructs for differential treatment planning with patients at increased risk of relapse.

Alcohol Drinking↗

PubMedDate not supplied

Alcohol and drug abusers' reasons for seeking treatment.

Clients at two different treatment facilities were asked at assessment how influential each of 10 possible reasons were in their decision to change their alcohol or drug use. Clients at both facilities most often endorsed "weighing the pros and cons of drinking or drug use" and a "warning from spouse." Client's reasons for seeking treatment were also examined in relation to treatment compliance. Three reasons--"weighing the pros and cons," "hitting rock bottom," and experiencing a "major lifestyle change"--were predictive of treatment compliance. Clients who rated any of these reasons as influential were more likely to enter and complete treatment. Although more research is needed, knowledge of clients' reasons for seeking treatment might be useful in treatment matching.

Adult↗

PubMed1996

Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways.

OBJECTIVES: The purpose of this study was to categorize the reasons for a prolonged or failed procedure in a series of patients undergoing catheter ablation of an accessory pathway. BACKGROUND: Radiofrequency ablation of accessory pathways at times requires a lengthy procedure or a second ablation session, or both, and not prior studies have systematically investigated the reasons for this. METHODS: In a consecutive series of 619 patients undergoing catheter ablation of an accessory pathway, the mean ablation time +/- SD was 68 +/- 64 min. The subjects of this study were 14 patients who had an ablation time >2 SD greater than the mean (>196 min) and 51 patients who required a second ablation session for a successful outcome. The accessory pathway in the 65 patients in this study was located in the right free wall in 19 patients (29%), septum in 14 (22%) and left free wall in 32 (49%). RESULTS: The primary reasons for a lengthy or failed ablation attempt were 1) inability to position the ablation catheter at the effective target site (16 patients, 25%); 2) instability of the ablation catheter or inadequate tissue contact at the target site, or both (15 patients, 23%); 3) mapping error due to an oblique course of the accessory pathway (7 patients, 11%); 4) failure to recognize a posteroseptal accessory pathway as being left-sided instead of right-sided (4 patients, 6%); 5) other errors in accessory pathway localization (6 patients, 9%); 6) epicardial location of the accessory pathway (5 patients, 8%); 7) recurrent atrial fibrillation (2 patients, 3%); 8) occurrence of a complication (2 patients, 3%); 9) unusual right-sided accessory pathway that inserted in the anterior right ventricle, 2 cm away from the lateral tricuspid annulus (1 patient, 1.5%); and 10) unexplained factors (7 patients, 11%). The most common effective strategies employed to achieve a successful outcome in these patients were 1) substitution of a more experienced operator; 2) use of ablation catheters of varying configurations; 3) switching from a retrograde aortic to a trans-septal approach; 4) switching from an inferior to a superior vena caval approach; 5) use of a 60-cm guiding sheath; 6) detailed mapping of the atrial or ventricular insertion of the accessory pathway; and 7) searching within the coronary sinus for a presumed accessory pathway potential. CONCLUSIONS: A lengthy or failed attempt at catheter ablation of an accessory pathway may be due to a variety of reasons, the most common of which are problems related to some aspect of catheter manipulation and errors in accessory pathway localization. Knowledge of the most common reasons for a lengthy or ineffective procedure may facilitate successful outcome of accessory pathway ablation.

Adult↗

PubMed1988

Reasons for job loss: a review of employment termination studies of mentally retarded workers.

The current emphasis on employment preparation for mentally retarded people requires that more attention be focused on job retention. Knowledge of the reasons why mentally retarded workers were fired from their jobs could contribute to that effort. This article reviews studies over a 35 year period that have examined job loss in mentally retarded workers. First, reasons for job loss that relate to workers' vocational competence were separated from other reasons for job loss, such as economic and family factors. Then, reasons relating to vocational competence were classified into four categories: job responsibility, task-production skills, task-related social skills, and personal-social skills. Reasons for job loss among mentally retarded workers are broadly distributed across both social and nonsocial domains, including job responsibility factors such as attendance and punctuality, task-production factors such as inadequate quality and rate of work, task-related social skill deficits such as not following instructions and responding inappropriately to criticism, and personal-social inadequacies such as inappropriate dress, bizarre and aggressive behavior, and inadequate or offensive verbal repertoires. The results of the review are discussed in relation to training issues for job retention of mentally retarded workers.

Employment↗

PubMed2005

Part-whole representation and reasoning in formal biomedical ontologies.

OBJECTIVE: Biomedical ontologies are typically structured in a biaxial way, reflecting both a taxonomic (is-a) and a partonomic (part-of) hierarchy. Commonly used biomedical terminologies, which incorporate such distinctions excel in terms of broad coverage but lack a rigid formal foundation. The latter, however, is a prerequisite for automated reasoning. For the biomedical domain, it is not only crucial to cope with ontological dependencies between wholes and their parts but also with specific reasoning patterns which underlie the propagation of roles across partonomic hierarchies. METHODS: We scale down part-whole reasoning to subsumption-based taxonomic reasoning within the formal framework of a parsimonious variant of description logics (viz. ALC). RESULTS: We provide a formal basis for ontological engineering in the domain of biomedicine, as far as part-whole relationships are concerned, by addressing typical reasoning patterns encountered in this domain.

Artificial Intelligence↗

PubMed2006

Using ontologies linked with geometric models to reason about penetrating injuries.

OBJECTIVE: Medical assessment of penetrating injuries is a difficult and knowledge-intensive task, and rapid determination of the extent of internal injuries is vital for triage and for determining the appropriate treatment. Physical examination and computed tomographic (CT) imaging data must be combined with detailed anatomic, physiologic, and biomechanical knowledge to assess the injured subject. We are developing a methodology to automate reasoning about penetrating injuries using canonical knowledge combined with specific subject image data. METHODS AND MATERIAL: In our approach, we build a three-dimensional geometric model of a subject from segmented images. We link regions in this model to entities in two knowledge sources: (1) a comprehensive ontology of anatomy containing organ identities, adjacencies, and other information useful for anatomic reasoning and (2) an ontology of regional perfusion containing formal definitions of arterial anatomy and corresponding regions of perfusion. We created computer reasoning services ("problem solvers") that use the ontologies to evaluate the geometric model of the subject and deduce the consequences of penetrating injuries. RESULTS: We developed and tested our methods using data from the Visible Human. Our problem solvers can determine the organs that are injured given particular trajectories of projectiles, whether vital structures--such as a coronary artery--are injured, and they can predict the propagation of injury ensuing after vital structures are injured. CONCLUSION: We have demonstrated the capability of using ontologies with medical images to support computer reasoning about injury based on those images. Our methodology demonstrates an approach to creating intelligent computer applications that reason with image data, and it may have value in helping practitioners in the assessment of penetrating injury.

Diagnosis, Computer-Assisted↗

PubMed2006

Temporal representation and reasoning in medicine: Research directions and challenges.

OBJECTIVE: The main aim of this paper is to propose and discuss promising directions of research in the field of temporal representation and reasoning in medicine, taking into account the recent scientific literature and challenging issues of current interest as viewed from the different research perspectives of the authors of the paper. BACKGROUND: Temporal representation and reasoning in medicine is a well-known field of research in the medical as well as computer science community. It encompasses several topics, such as summarizing data from temporal clinical databases, reasoning on temporal clinical data for therapeutic assessments, and modeling uncertainty in clinical knowledge and data. It is also related to several medical tasks, such as monitoring intensive care patients, providing treatments for chronic patients, as well as planning and scheduling clinical routine activities within complex healthcare organizations. METHODOLOGY: The authors jointly identified significant research areas based on their importance as for temporal representation and reasoning issues; the subjects were considered to be promising topics of future activity. Every subject was addressed in detail by one or two authors and then discussed with the entire team to achieve a consensus about future fields of research. RESULTS: We identified and focused on four research areas, namely (i) fuzzy logic, time, and medicine, (ii) temporal reasoning and data mining, (iii) health information systems, business processes, and time, and (iv) temporal clinical databases. For every area, we first highlighted a few basic notions that would permit any reader--including those who are unfamiliar with the topic--to understand the main goals. We then discuss interesting and promising directions of research, taking into account the recent literature and underlining the yet unresolved medical/clinical issues that deserve further scientific investigation. The considered research areas are by no means disjointed, because they share common theoretical and methodological features. Moreover, subjects of imminent interest in medicine are represented in many of the fields considered. CONCLUSIONS: We propose and discuss promising subjects of future research that deserve investigation to develop software systems that will properly manage the multifaceted temporal aspects of information and knowledge encountered by physicians during their clinical work. As the subjects of research have resulted from merging the different perspectives of the authors involved in this study, we hope the paper will succeed in stimulating discussion and multidisciplinary work in the described fields of research.

Artificial Intelligence↗

PubMed2005

A diagnostic reasoning and optimal treatment model for bacterial infections with fuzzy information.

This study proposes an optimization model for optimal treatment of bacterial infections. Using an influence diagram as the knowledge and decision model, we can conduct two kinds of reasoning simultaneously: diagnostic reasoning and treatment planning. The input information of the reasoning system are conditional probability distributions of the network model, the costs of the candidate antibiotic treatments, the expected effects of the treatments, and extra constraints regarding belief propagation. Since the prevalence of the pathogens and infections are determined by many site-by-site factors, which are not compliant with conventional approaches for approximate reasoning, we introduce fuzzy information. The output results of the reasoning model are the likelihood of a bacterial infection, the most likely pathogen(s), the suggestion of optimal treatment, the gain of life expectancy for the patient related to the optimal treatment, the probability of coverage associated with the antibiotic treatment, and the cost-effect analysis of the treatment prescribed.

Anti-Bacterial Agents↗

PubMed2006

Reasoning with conditionals: a test of formal models of four theories.

The four dominant theories of reasoning from conditionals are translated into formal models: The theory of mental models (Johnson-Laird, P. N., & Byrne, R. M. J. (2002). Conditionals: a theory of meaning, pragmatics, and inference. Psychological Review, 109, 646-678), the suppositional theory (Evans, J. S. B. T., & Over, D. E. (2004). If. Oxford: Oxford University Press), a dual-process variant of the model theory (Verschueren, N., Schaeken, W., & d'Ydewalle, G. (2005). A dual-process specification of causal conditional reasoning. Thinking &Reasoning, 11, 278-293), and the probabilistic theory (Oaksford, M., Chater, N., & Larkin, J. (2000). Probabilities and polarity biases in conditional inference. Journal of Experimental Psychology: Learning, Memory, and Cognition, 26, 883-899). The first three theories are formalized as multinomial models. The models are applied to the frequencies of patterns of acceptance or rejection across the four basic inferences modus ponens, acceptance of the consequent, denial of the antecedent, and modus tollens. Model fits are assessed for two large data sets, one representing reasoning with abstract, basic conditionals, the other reflecting reasoning with pseudo-realistic causal and non-causal conditionals. The best account of the data was provided by a modified version of the mental-model theory, augmented by directionality, and by the dual-process model.

Adolescent↗

PubMed2006

Reasons for early interventions by gynaecologists in a clinical follow-up study on cervical intraepithelial neoplasia.

OBJECTIVE: In a previous clinical follow-up study on psychosocial factors and cervical intraepithelial neoplasia (CIN), we had noticed a high percentage of early interventions to the cervix by gynaecologists, in discordance with the research protocol. The aim of the current study was to investigate the reasons for these interventions. STUDY DESIGN: We retrospectively analysed the study records of the clinical study, concerning the follow-up of 98 patients with a CIN 1 or 2 lesion for 2.25 years by colposcopy and cervical smears. We recorded the number of early interventions that had occurred in the clinical study as well as the reasons for these interventions. A distinction was made between acceptable and unacceptable reasons for early intervention. RESULTS: During follow-up, 39 out of 98 women (40%) had undergone intervention in discordance with the protocol. No acceptable reason for these interventions was found for 67% of these patients (26/39). In the majority of these cases either no reason for the intervention had been given, or the gynaecologist had feared for progression of the CIN lesion. CONCLUSION: Gynaecologists tend to intervene during follow-up of CIN, partly out of fear for progression. This tendency may complicate follow-up studies on CIN.

Colposcopy↗

PubMed2004

Analogical reasoning in schizophrenic delusions.

PURPOSE: Reasoning ability has often been argued to be impaired in people with schizophrenic delusions, although evidence for this is far from convincing. This experiment examined the analogical reasoning abilities of several groups of patients, including non-deluded and deluded schizophrenics, to test the hypothesis that performance by the deluded schizophrenic group would be impaired. SUBJECTS/MATERIALS: Eleven deluded schizophrenics, 10 depressed subjects, seven non-deluded schizophrenics and 16 matched non-psychiatric controls, who were matched on a number of key variables, were asked to solve an analogical reasoning task. RESULTS: Performance by the deluded schizophrenic group was certainly impaired when compared with the depressed and non-psychiatric control groups though less convincingly so when compared with the non-deluded schizophrenic group. The impairment shown by the deluded schizophrenic group seemed to occur at the initial stage of the reasoning task. DISCUSSION: The particular type of impairment shown by the deluded subjects was assessed in relation to other cognitive problems already researched and the implications of these problems on reasoning tasks and theories of delusions was discussed.

Adult↗