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PubMedDate not supplied

Simulating an integrated critiquing system.

OBJECTIVE: To investigate factors that determine the feasibility and effectiveness of a critiquing system for asthma/COPD that will be integrated with a general practitioner's (GP's) information system. DESIGN: A simulation study. Four reviewers, playing the role of the computer, generated critiquing comments and requests for additional information on six electronic medical records of patients with asthma/COPD. Three GPs who treated the patients, playing users, assessed the comments and provided missing information when requested. The GPs were asked why requested missing information was unavailable. The reviewers reevaluated their comments after receiving requested missing information. MEASUREMENTS: Descriptions of the number and nature of critiquing comments and requests for missing information. Assessment by the GPs of the critiquing comments in terms of agreement with each comment and judgment of its relevance, both on a five-point scale. Analysis of causes for the (un-)availability of requested missing information. Assessment of the impact of missing information on the generation of critiquing comments. RESULTS: Four reviewers provided 74 critiquing comments on 87 visits in six medical records. Most were about prescriptions (n = 28) and the GPs' workplans (n = 27). The GPs valued comments about diagnostics the most. The correlation between the GPs' agreement and relevance scores was 0.65. However, the GPs' agreements with prescription comments (complete disagreement, 31.3%; disagreement, 20.0%; neutral, 13.8%; agreement, 17.5%; complete agreement, 17.5%) differed from their judgments of these comments' relevance (completely irrelevant, 9.0%; irrelevant, 24.4%; neutral, 24.4%; relevant, 32.1%; completely relevant, 10.3%). The GPs were able to provide answers to 64% of the 90 requests for missing information. Reasons available information had not been recorded were: the GPs had not recorded the information explicitly; they had assumed it to be common knowledge; it was available elsewhere in the record. Reasons information was unavailable were: the decision had been made by another; the GP had not recorded the information. The reviewers left 74% of the comments unchanged after receiving requested missing information. CONCLUSION: Human reviewers can generate comments based on information currently available in electronic medical records of patients with asthma/COPD. The GPs valued comments regarding the diagnostic process the most. Although they judged prescription comments relevant, they often strongly disagreed with them, a discrepancy that poses a challenge for the presentation of critiquing comments for the future critiquing system. Requested additional information that was provided by the GPs led to few changes. Therefore, as system developers faced with the decision to build an integrated, non-inquisitive or an inquisitive critiquing system, the authors choose the former.

Asthma↗
PubMedDate not supplied

Automated evidence-based critiquing of orders for abdominal radiographs: impact on utilization and appropriateness.

OBJECTIVE: Inappropriate utilization of diagnostic testing has been well documented. The purpose of this study was to measure the impact of presenting real time, evidence-based critiques about the appropriateness of abdominal radiograph (KUB) orders on physician decision making. DESIGN: Prospective trial where evidence-based critiques were presented to ordering clinicians in two kinds of situations: (1) a KUB was likely to have a low probability of providing useful information, or (2) an alternative view(s) was more appropriate given the clinical circumstance. There were two phases of the trial: Phase 1 was a 9-week period where evidence-based critiques were presented at the time of ordering a KUB, followed by Phase 2, a 19-week period in which orderers were randomized to receive critiques either amended to include both institutional data regarding the utility of the critiques and stronger messages about the lack of utility of the study, or the same critiques as presented in Phase 1, depending upon indication. Based upon the radiologist's report of their interpretation of the exams, the results of the examinations were scored as positive, equivocal, or negative using structured criteria. RESULTS: 299 KUBs in Phase 1 and 385 KUBs in Phase 2 received at least one critique. Cancellation rates of low yield films were low, and were similar in Phase 1 and 2, 8/258 (3%) vs. 10/283 (4%). Compliance with the recommendation for alternative view(s) was higher: 19/104 (38%) in Phase 1 vs. 96/176 (55%) in Phase 2 (p = 0.006). The results differentiated low-yield from non-low-yield films: 5% of low-yield films vs. 20% of non-low-yield films were positive in Phase 2 (p < 0.0001). Surgical physicians were less likely to cancel (p = 0.07) or to change to the suggested view(s) (p < 0.0001) than medical physicians or nurses. CONCLUSIONS: The intervention identified clinical situations in which KUBs appeared to have a low clinical yield. In response to evidence-based critiques, providers were reluctant to cancel their order, but were more willing to change to different views. To reduce the number of inappropriate radiographic films, stronger incentives or interventions may be required.

Computer Systems↗
PubMed1986

Extending computer-based critiquing to a new domain: ATTENDING, ESSENTIAL-ATTENDING, and VQ-ATTENDING.

The paper describes a research project which is developing expert computer systems to critique a physician's plan of medical management. In particular, the paper outlines the evolution of three computer systems: ATTENDING, a system designed to critique anesthetic management, ESSENTIAL-ATTENDING, a domain-independent system-building system, and VQ-ATTENDING, a prototype system implemented using ESSENTIAL-ATTENDING to critique aspects of ventilator management. The goals of the research project are to explore the critiquing approach in several different medical domains, to understand the design problems involved in implementing such systems, and to help other researchers build critiquing systems in further domains.

Anesthesiology↗
PubMed2006

Multiple roles and successes in public bioethics: a response to the public forum critique of bioethics commissions.

National bioethics commissions have been critiqued for a variety of structural, procedural, and political aspects of their work. A more recent critique published by Dzur and Levin uses political philosophy to constructively critique the work of national bioethics commissions as public deliberative forums. However, this public forum critique of bioethics commissions ignores empirical research in political science and normative claims that suggest that advisory commissions can and should have diverse of functions beyond that of being public forums. The present paper argues that the public forum critique too narrowly considers the roles that bioethics commissions can play in public bioethics and ignores the moral obligation of commissions to fulfill their mandates. Evaluations of commissions must consider that these institutions can serve in capacities other than those of a public deliberative forum and use additional measures to evaluate the multiple roles and successes of bioethics commissions in public policy.

Advisory Committees↗
PubMed1990

Computer-critiqued blood ordering using the HELP system.

Recently the medical risk of blood transfusions has emphasized the need to improve the safe use of blood products. For the past 2 1/2 years at LDS Hospital we have used the HELP computer system to assist and critique ordering of blood products "on-line" by physicians and nurses. This report details the computer methods used to order blood products and to critique the appropriateness of those orders. Physicians personally enter the orders for more than 45% of the blood products using computer terminals, whereas 7% are from physician standing orders. Nurses enter the remaining orders from written orders (26%), verbal orders (14%), and phone orders (8%). There were 3396 blood orders for 1043 patients generated by 273 physicians during the fourth quarter of 1989. Each order is justified at the time it is entered by selecting from a menu of physician-approved criteria. The criteria are linked to supportive data in the data base, i.e., laboratory results and clinical data. The computer verified that 82% of these orders met criteria. Quality Assurance nurses verified the remaining 18%. Of these 18% only one in eight required manual chart review. After computer and Quality Assurance review, only eight (0.24%) of the orders were found to be true exceptions to established criteria. Physicians and nurses have accepted the computerized critiquing system. Through use of the computer we provide "on-line" critiquing and improve the use of scarce blood product resources.

Blood Banks↗
PubMedDate not supplied

A worksheet for critiquing quantitative nursing research.

Teaching an introductory course in research methods and critique to baccalaureate nursing students can be challenging for both students and instructor. One of the difficulties is teaching students to critique research while simultaneously learning basic terminology and research processes. A critique worksheet was developed to help students extract complex information from a research report for analysis and critique.

Education, Nursing, Baccalaureate↗
PubMed1994

Skilled expert practice: is it 'all in the mind'? A response to English's critique of Benner's novice to expert model.

In a recent critique of the work of Patricia Benner in relation to expertise, skilled intuitive grasp and the Dreyfus model of skill acquisition, English (Journal of Advanced Nursing 1993, vol. 18, pp. 387-393) uses the tenets of positivism and cognitive psychology to criticize Benner's work for lacking objectivity, validity, generalizability and predictive power. In this response to English's critique I show how he has misread, failed to read, and consequently misunderstood her work, and, equally importantly, its philosophical basis. Benner's work is developed from a philosophical foundation grounded in interpretive and Heideggerian phenomenology. This wholly different 'take' on the world and on human behaviour embodies a strong critique of those very same traditional-science worldviews which English uses to damn her work. English's critique is valuable in highlighting the ways in which Benner's work can be misrepresented and this response tries to remedy this misunderstanding by attempting to clarify the fundamental differences between phenomenological and cognitive understandings. These differences are crucial to understanding Dreyfus's and Benner's work. Here, I also attempt to correct some of English's wilder assertions regarding Benner's work. Finally, I try to show how Benner's work has empowered, enthused and challenged, rather than being 'denigrating to the majority of nurses'.

Clinical Competence↗
PubMed1996

"The measure of my days" critiqued by the oldest old.

The practice of nursing begins by listening to individual stories--to personal interpretations. This project elicited personal interpretations of aging. The biographical book by Florida Scott-Maxwell, A Measure of My Days, was critiqued by eight men and women over the age of 85. Each person was visited two to three times. Discussions during the visits were audiotaped and transcribed. Transcriptions were reviewed by the participant and researcher together to create critiques. Excerpts of the critiques presented are a result of each participant's interpretation of the text and are written in the participant's words. These individual interpretations of The Measure of My Days are just that, individual interpretations. Left in story form, they serve a different purpose than themes or categories developed to illuminate or define. Thematizing or categorizing critiques serves to describe an aggregate reaction. While useful, aggregate reactions may be of limited use for nurses working with any single individual.

Aged↗
PubMedDate not supplied

The research critique. General criteria for evaluating a research report.

General criteria for evaluating a research report are addressed. This outline of criteria can be used as a guide for nurses in critiquing research studies. A sample research report is summarized followed by a critique of the study. Readers have an opportunity to practice critiquing by doing their own analyses before reading the critique presented in the article.

Data Collection↗
PubMedDate not supplied

Automated critiquing of medical decision trees.

The authors developed a decision tree-critiquing program (called BUNYAN) that identifies potential modeling errors in medical decision trees. The program's critiques are based on the structure of a decision problem, obtained from an abstract description specifying only the basic semantic categories of the model's components. A taxonomy of node and branch types supplies the primitive building blocks for representing decision trees. Bunyan detects potential problems in a model by matching general pattern expressions that refer to these primitives. A small set of general principles justifies critiquing rules that detect four categories of potential structural problems: impossible strategies, dominated strategies, unaccountable violations of symmetry, and omission of apparently reasonable strategies. Although critiquing based on structure alone has clear limitations, principled structural analysis constitutes the core of a methodology for reasoning about decision models.

Decision Trees↗
PubMed2001

Irreducible subjectivity and interactionism: a critique.

The authors offer a critique of the privileging of subjectivity in psychoanalysis characteristic of what Hanly has called interactionism, with specific reference to the work of Renik. First, Renik's argument for the irreducible subjectivity of the analyst is explored and critiqued from a philosophical perspective. The need for and plausibility of a subtler notion of objectivity that takes into account the limitations of human subjectivity and that analysts can meaningfully pursue is defended. Second, Renik's 're-visioning' of psychoanalysis, which follows from his notion of irreducible subjectivity, is explored and critiqued. Renik's view of enactments is contrasted with a 'totalistic' perspective of countertransference that allows for important, finer conceptual distinctions. Renik's conceptualisation of countertransference enactments is characterised as a 'special case' of countertransference as a vice. Next, Renik's view of transference is critiqued for privileging the adaptive dimensions of transference, and for potentially sidelining archaic dimensions. Finally, Renik's conclusions and 're-visioning' of psychoanalysis are shown to follow from his modifying or jettisoning certain features of the analytic situation and process. These features and their implications are elaborated on. The conclusion outlines the extent to which the arguments presented can be extended to other advocates of interactionism.

Ego↗
PubMed1984

An expert system which critiques patient workup: modeling conflicting expertise.

PHEO-ATTENDING is an expert system designed to critique a physician's workup of a patient with a suspected pheochromocytoma. To use PHEO-ATTENDING, a physician describes his patient and indicates any tests or procedures which he has ordered or plans to order and any results already obtained. PHEO-ATTENDING then critiques the workup, discussing its appropriateness for the patient described, and mentioning any other approaches which might be preferred. The goal is to explore the design issues involved in building a computer system which critiques patient workup. A major focus is how best to incorporate conflicting expertise, which occurs when domain experts themselves advocate different approaches to a problem.

Adrenal Gland Neoplasms↗
PubMed1985

Goal-directed critiquing by computer: ventilator management.

VQ-ATTENDING is an expert system which critiques aspects of the ventilator management of a patient receiving mechanical respiratory support. To use VQ-ATTENDING, the physician first inputs medical information describing a patient, a current set of arterial blood gas results, the current ventilator settings, and a proposed set of new ventilator settings. VQ-ATTENDING then critiques the appropriateness of the proposed settings. In its current developmental implementation, VQ-ATTENDING explores a particular expert system designed feature: the ability to assess appropriate treatment goals, and to use those goals to guide the system's critiquing analysis.

Artificial Intelligence↗
PubMed1986

Critiquing the process of radiologic differential diagnosis.

ICON is a developmental expert system designed to critique the process of radiologic differential diagnosis. To use ICON, a physician outlines (1) findings observed in a chest radiograph, (2) a small amount of clinical information describing the patient, and (3) a proposed diagnosis. ICON critiques the appropriateness of that diagnosis in detail, analyzing why and how well the findings serve to confirm it, or to rule it out. ICON may also suggest further information to look for. ICON explores the design issues involved in critiquing the process of differential diagnosis, and is currently implemented in a limited domain: the radiographic diagnosis of a lung mass in a patient with Hodgkin's disease.

Artificial Intelligence↗
PubMedDate not supplied

Effective use of critique and dialogue at scholarly conferences.

In this article, the authors offer a solution to a phenomenon identified as "silencing" among nurse colleagues during national, regional, and international scholarly conferences. Through an electronic anonymous survey, data were collected regarding perceptions of the structure and process at scholarly nursing conferences. The need for critique and dialogue while sharing research ideas or findings is identified as a means to encourage direct exchange at professional conferences. Based on an examination of the process of critique and dialogue, and theories that explain why honest and direct dialogue are sometimes subdued, the authors propose a model of constructive scholarly dialogue for conference participation. The goals of implementing this model are to make scholarly exchanges normative at nursing conferences, and to revise standard conference formats so that constructive critique and dialogue are encouraged actively. The likely outcomes include improved nursing science and professional development of nurses.

Assertiveness↗
PubMed2006

Mechanical explanation of nature and its limits in Kant's Critique of judgment.

In this paper I discuss two questions. What does Kant understand by mechanical explanation in the Critique of judgment? And why does he think that mechanical explanation is the only type of the explanation of nature available to us? According to the interpretation proposed, mechanical explanations in the Critique of judgment refer to a particular species of empirical causal laws. Mechanical laws aim to explain nature by reference to the causal interaction between the forces of the parts of matter and the way in which they form into complex material wholes. Just like any other empirical causal law, however, mechanical laws can never be known with full certainty. The conception according to which we can explain all of nature by means of mechanical laws, it turns out, is based on what Kant calls 'regulative' or 'reflective' considerations about nature. Nothing in Kant's Critique of judgment suggests that these considerations can ever be justified by reference to how the natural world really is. I suggest that what, upon first consideration, appears to be a thoroughly mechanistic conception of nature in Kant is much more limited than one might have expected.

Causality↗
PubMed2000

A checklist for critiquing treatment fidelity studies.

My assignment was to critique and integrate the previous papers. I have organized this paper as follows: (1) a description and rationale for a checklist which can be used in judging the quality of a fidelity measure; (2) a critique of the Schaedle and Epstein paper; (4) a critique of the Lucca paper; and (4) a review of the paper by Bond, Evans, Salyers, Williams, and Kim.

Humans↗
PubMed1993

A critique of Fawcett's 'Conceptual models and nursing practice: the reciprocal relationship'.

This paper offers a critique of Fawcett's paper 'Conceptual models and nursing practice: the reciprocal relationship' published in 1992, in which it is argued that 'conceptual models inform and transform nursing practice by informing and transforming the way in which nursing is experienced and understood, and that nursing practice informs and transforms conceptual models by informing and transforming the content of the conceptual model'. The critique begins by locating Fawcett's view of the relationship of nursing models to nursing practice within the intellectual tradition of positivism. For the purposes of the critique, Fawcett's positivism is not taken as being problematic in itself; however, it is argued that the standards of evidence upon which some of her arguments are based are not compatible with the practice of positivist social science, with the result that the paper is internally inconsistent. In particular, Fawcett's suggestion that nursing models are validated as evidence accumulates in their favour is contrasted with Popper's view that the validity of theoretical statements is established as they withstand attempts to demonstrate their falsity; and Fawcett's belief that nursing models are models in the scientific sense, which can be inferred from her adoption of the terminology of Kuhnian epistemology, is not found to be justified. If, for the positivist, the validity of practice is directly proportional to the validity of the theory upon which it is based, then nursing models which lack 'scientific' validity cannot be regarded as a proper basis for nursing practice. Finally, Fawcett has been criticized for failing to produce evidence of any kind to demonstrate that nursing models have a beneficial effect upon nursing outcomes.

Models, Nursing↗