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PubMedDate not supplied

Sensory acuity and reasoning in delusional disorder.

Systematic research on delusional disorder (DD) is limited. The goal of this study was to assess DD patients in the following areas: sensory capacities, decision-making style, and complex reasoning. Ten DD patients and 10 matched normal controls completed the following (1) smell, taste, and vision testing; (2) a probabilistic inference test in which subjects made probability decisions; and (3) a gambling task assessing complex reasoning. No significant difference was found between DD subjects and normals for taste acuity, olfactory acuity, or olfactory discrimination. No difference in visual acuity was noted, but sample size was limited. In addition, DD subjects required significantly less data to make probability decisions than normal controls. Despite using less data, DD subjects were as certain as controls regarding the accuracy of their decisions. As for complex reasoning, DD subjects performed as well as normal controls, but tended to surmise the purpose of the task sooner than normals, a difference that approached significance. In conclusion, these results suggest no differences between DD and normal subjects regarding olfaction, taste, and vision. The reasoning studies suggest that DD subjects may have a "cognitive set" that predisposes them to make conclusions with significantly less data than normals. Further, the study suggests that this reasoning difference generalizes to events outside the DD subjects' delusional realm and can be evoked in an experimental environment.

Adult↗
PubMed2003

Patients' reasons for undergoing total hip arthroplasty can change over time.

The purpose of this study was to determine if a patient's reasons for undergoing a primary total hip arthroplasty (THA) changed at 1 year follow-up and, if the reasons did change, how does this change influence patient satisfaction with the procedure. Patients undergoing THA (101 patients) were evaluated with the McMaster Toronto Arthritis Patient Preference Disability (MACTAR) questionnaire and questions related to their expectations regarding the procedure. With the exception of pain and walking, most patients did not select the same preoperative and postoperative reasons for undergoing the procedure. In fact, 60% chose 2 new postoperative items. Patients whose expectations were not met were less likely to choose the same reasons for undergoing THA. Surgeons need to clarify patients' reasons for wanting a THA and attempt to identify new factors at follow-up that may influence patient satisfaction with the procedure.

Adult↗
PubMed2002

Student nurse attrition: use of an exit-interview procedure to determine students' leaving reasons.

This study is part of a research programme at the University of Glamorgan aimed at reducing student nurse discontinuation. A number of methodological limitations in previous studies on attrition have been identified and are addressed in this study. A preliminary picture of attrition within this school is established and the validity of the data examined. The average attrition rate for the school over an 8-year period was 19%, which compares favourably with national rates. Data on students' leaving reasons were obtained through an exit-interview procedure; this achieved high response rates which for exceed those represented in previous studies. Academic difficulties and wrong career choice were among the most commonly reported leaving reasons; this is similar to findings from previous research. However family, health and financial difficulties emerge as equally important categories. The exit form facilitated the recording of multiple leaving reasons for each student, an innovative approach in attrition research. Almost half the students discontinued for at least two reasons; the interrelationships between leaving reasons and possible explanations for the findings are considered. The complexity of factors contributing to attrition are discussed and will be tackled in subsequent stages of the research programme.

Attitude of Health Personnel↗
PubMed1998

How children reason about ability from report card grades: a developmental study.

Elementary school students were interviewed to see how they reason about ability in the context of report card grades. Eighty-four 2nd, 4th, and 6th graders were presented with hypothetical children's report card grades for performance and effort and were asked to compare the children's "smartness." Four age-related levels of reasoning about ability were identified, in accordance with findings from past research. However, 6th graders did not use the expected highest levels of reasoning, which involve covariation of performance and effort information; rather, their reasoning emphasized the efficacy of effort. Reasons for differences between the present and previous findings are discussed.

Achievement↗
PubMed2003

Understanding our mistakes: a primer on errors in clinical reasoning.

Clinical reasoning allows physicians to move from areas of clinical uncertainty to points where the medical literature offers guidance, and is equally important in deducing whether the results of clinical trials are applicable to an individual patient. However, studies in the field of cognitive psychology indicate that the reasoning skills of clinicians are imperfect. Moreover, clinicians may be aware of their mistakes but often do not understand the cognitive processes underlying their errors. Greater understanding of the reasoning process has the potential to improve patient care but independent study of clinical reasoning can be difficult, as the literature is complex and unfamiliar to most physicians. This article provides an introduction to diagnostic reasoning and highlights some of the cognitive factors that lead to errors in clinical problem solving. Clinical scenarios are used to illustrate key points and place the material in a readily accessible framework.

Clinical Competence↗
PubMed2003

The clinical reasoning characteristics of diagnostic experts.

The aim of this study was to identify and describe the clinical reasoning characteristics of diagnostic experts. A group of 21 experienced general practitioners were asked to complete the Diagnostic Thinking Inventory (DTI)and a set of 10 clinical reasoning problems (CRP) to evaluate their clinical reasoning. Both the DTI and the CRPs were scored, and the CRP response patterns of each GP examined in terms of the number and type of errors contained in them. Analysis of these data showed that six GPs were able to reach the correct diagnosis using significantly less clinical information than their colleagues. These GPs also made significantly fewer interpretation errors but scored lower on both the DTI and the CRPs. Additionally, this analysis showed that more than 20% of misdiagnoses occurred despite no errors being made in the identification and interpretation of relevant clinical information. These rests indicate that these six GPs diagnose efficiently,effectively and accurately using relatively few clinical data and can therefore be classified as diagnostic experts. They also indicate that a major cause of misdiagnoses is failure to properly integrate clinical data. We suggest that increased emphasis on this step in the reasoning process should prove beneficial to the development of clinical reasoning skill in undergraduate medical students.

Adult↗
PubMed2003

Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis.

The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process--identification of relevant information, interpretation or hypothesis generation--at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. Results indicate that hypothesis errors decrease as expertise increases but that identification and interpretation errors increase. This may be due to inappropriate use of pattern recognition or to failure of the knowledge base. Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.

Attitude of Health Personnel↗
PubMed1997

Music training causes long-term enhancement of preschool children's spatial-temporal reasoning.

Predictions from a structured cortical model led us to test the hypothesis that music training enhances young children's spatial-temporal reasoning. Seventy-eight preschool children participated in this study. Thirty-four children received private piano keyboard lessons, 20 children received private computer lessons, and 24 children provided other controls. Four standard, age-calibrated, spatial reasoning tests were given before and after training; one test assessed spatial-temporal reasoning and three tests assessed spatial recognition. Significant improvement on the spatial-temporal test was found for the keyboard group only. No group improved significantly on the spatial recognition tests. The magnitude of the spatial-temporal improvement from keyboard training was greater than one standard deviation of the standardized test and lasted at least one day, a duration traditionally classified as long term. This represents an increase in time by a factor of over 100 compared to a previous study in which listening to a Mozart piano sonata primed spatial-temporal reasoning in college students. This suggests that music training produces long-term modifications in underlying neural circuitry in regions not primarily concerned with music and might be investigated using EEG. We propose that an improvement of the magnitude reported may enhance the learning of standard curricula, such as mathematics and science, that draw heavily upon spatial-temporal reasoning.

Attention↗
PubMed1998

Frequent attenders in a Finnish health centre: morbidity and reasons for encounter.

OBJECTIVE: To describe the proportion of frequent attenders among primary health care patients and their sociodemographic characteristics, morbidity and reasons for encounter. DESIGN: A cross-sectional case-control study. SETTING: A municipal health centre in Oulainen, a small rural town in northern Finland. PARTICIPANTS: Three hundred and four frequent attenders (eight or more visits to health centre physicians (GPs) during the year 1994) and 304 age- and sex-matched controls. MAIN OUTCOME MEASURES: Sociodemographic characteristics, numbers of encounters, chronic diseases classified by ICD-9 and reasons for encounter coded by the International Classification of Primary Care chapter codes (ICPC). RESULTS: 4.7% of the population aged 15 years or older and 6.8% of the annual patients were frequent attenders and they made 23.5% of all encounters with GPs. The frequent attenders had lower basic education and there were more people on disability pension among them. They had significantly more mental disorders and diseases of the musculoskeletal and digestive systems than the controls. The frequent attenders' most common reasons for encounter were musculoskeletal problems, and they had significantly more musculoskeletal, digestive system and psychiatric reasons for encounters than the controls. CONCLUSIONS: Frequent attenders express more somatic and less psychiatric reasons for encounter than can be assumed according to their morbidity. The role of somatization is discussed.

Adolescent↗
PubMedDate not supplied

Drug survival and reasons for discontinuation of intramuscular methotrexate: a study of 212 consecutive patients switching from oral methotrexate.

OBJECTIVES: To assess the drug survival and reasons for discontinuation of intramuscular methotrexate (imMTX) in rheumatological patients who had switched to imMTX from oral methotrexate (oMTX). METHODS: Data from 212 consecutive patients who switched from oMTX to imMTX therapy at our outpatient clinic between April 1997 and January 2004 were collected retrospectively through survey of case records. Data included reason for discontinuation of oMTX, disease activity parameters, duration of imMTX therapy, and, in patients who withdrew, the reason for discontinuation of imMTX. RESULTS: The main reasons for switching from oMTX to imMTX were lack of efficacy (66%) and adverse events (28%). After 6 months, 114 patients (54%) were still receiving imMTX therapy, and their median serum C-reactive protein (CRP) and the percentage of patients who had received glucocorticoids during the previous 6 weeks had decreased (p<0.001). The median survival of imMTX therapy was 7.5 months (interquartile range 3-17). Twenty per cent of the patients received imMTX for more than 24 months. Of the 212 patients, 41% and 9% stopped imMTX therapy because of lack of efficacy and adverse events, respectively. Of the patients who had stopped oMTX because of adverse events, 22% also withdrew from imMTX because of adverse events. CONCLUSION: Half of the patients benefited from switching from oral to intramuscular methotrexate for at least 6 months, but only a minority adhered to the treatment for years. Lack of efficacy was the most frequent reason for discontinuation, while adverse events were rare.

Administration, Oral↗
PubMed2001

A comparison of suicidal thinking and reasons for living among younger and older adults.

A cross-sectional design was used to examine age-related differences in suicidal thinking and reasons for living among younger (n = 82; M age = 21) and older (n = 82; M age = 68) adults. Volunteers anonymously completed the Beck Scale for Suicide Ideation and the Reasons for Living Inventory. Findings indicated that older adults do not manifest suicidal ideation differently than younger adults. However, there does appear to be some age-related differences in reasons for not committing suicide. Compared to the younger group, the older group reported moral objections and child-related concerns as stronger reasons for not committing suicide. An implication is that the identification of specific reasons that deter individuals from committing suicide may be clinically useful and provide some assistance in suicide prevention efforts.

Adaptation, Psychological↗
PubMed1997

Reasons for having sex and sexual risk-taking: a study of heterosexual male STD clinic patients.

Individuals report a variety of reasons for having sex. Understanding these reasons can improve HIV and STD prevention efforts because they may constitute an important component in the aetiology of sexual risk-taking behaviours. Relationships between self-reported reasons for having sex and frequency of participation in sexual practices among 146 heterosexual men recruited from public STD clinics in Southern California were examined. Using a self-administered questionnaire, respondents reported how often they engaged in sex for each of 16 reasons and how frequently they participated in high, moderate, and low-risk sexual practices. A principal components analysis identified five factors used to construct scales: love; compliance; pleasure; altered states; and potency. Higher-risk sexual practices were positively associated with the pleasure and potency scales, whereas lower-risk practices were positively associated with the love scale. These findings suggest that some reasons men report for having sex may influence sexual risk-taking. Interventions to reduce unsafe sex should explicitly address how men can practise safer sex and still experience pleasure and potency.

Adult↗
PubMed2005

Reasons for requesting emergency contraception: a survey of 506 Italian women.

OBJECTIVE: To evaluate the reason for requesting emergency contraception (EC), previous use of contraceptive methods and provision route in a Family Planning Clinic in Italy. METHODS: Women requesting EC were interviewed, through a questionnaire containing questions on demographic characteristics, about their reasons for requesting EC, their prior contraceptive use, their reasons for not using an effective contraceptive method (or possible reasons for its failure) and specifically about the so-called 'provision route' (i.e. whether and where they had previously requested EC receiving a negative response). RESULTS: Almost 70% of all women requesting EC were aged between 18 and 25 years. Some 80% of all women were in a stable relationship with their partner, with fewer than 20% having had an occasional intercourse. The vast majority of women (83%) reported prior use of a modern contraceptive method, i.e. 64% with a condom, 27% for combined oral contraceptives and 1.1% for the intrauterine device (IUD). In addition, 15% of the women had used more than one method (oral pills and condoms). Concerning the reasons for requesting EC, condom breakage or slipping was the most frequently cited (64%), followed by totally unprotected intercourse (28%), failed withdrawal (5%) and forgetting one or more pill (only 1.1%). CONCLUSIONS: More than one-third of the women interviewed had previously used an emergency contraceptive modality; although no one did so more than four times. Therefore, it can be inferred that-at least in the present series-EC had not been used as a routine contraceptive method. Finally, it seems clear that in Italy, even in large cities, information about the availability, proper usage and mechanism of action is lacking. This seems due to information being spread by word of mouth between peers and friends, with more formal communication channels lagging behind.

Adolescent↗
PubMed1997

Working memory constraints on linear reasoning with spatial and temporal contents.

The present article reports two experiments testing the use of working memory components during reasoning with temporal and spatial relations in four-term series problems. In the first experiment four groups of subjects performed reasoning tasks with temporal and with spatial contents either without (control) or with a secondary task (articulatory suppression, visuo-spatial suppression or central executive suppression). The second experiment tested the secondary task effects in a within-subjects design either on problems with a spatial content or on problems with a temporal content, and within each content domain either under conditions of self-paced or of fixed presentation of the premises. Both experiments found effects of all three secondary tasks on reasoning accuracy. This supports the hypothesis that the subjects construct spatial representations of the premise information with the support of visuo-spatial resources of working memory. The second experiment also showed that during premise intake, only visuo-spatial and central executive secondary tasks had an effect. The implications of the data for the working memory requirements of reasoning and for theories of linear reasoning are discussed.

Adult↗
PubMed2004

College students' reasons for not drinking and not playing drinking games.

Few studies have examined college students' reasons for not drinking, and no studies have addressed their reasons for not playing drinking games. This study developed measures of both constructs using a sample of 147 college students. Principal components analysis identified six Reasons for Not Drinking factors and five Reasons for Not Playing Drinking Games factors. Internal consistency and intercorrelations of the factors were examined. The factors correlated in theoretically meaningful directions with measures of alcohol consumption, alcohol outcome expectancies, reasons for drinking, self-esteem, and personality. Research findings are discussed in regards to their relevance to prevention and treatment strategies among the college population.

Adolescent↗
PubMed2006

Women's reasons for complementary and alternative medicine use: racial/ethnic differences.

OBJECTIVES: Although racial/ethnic differences in the prevalence of complementary and alternative medicine (CAM) utilization have been documented, differences in the reasons for using CAM have not been empirically assessed. In an increasingly diverse society, understanding differences in rates of and reasons for CAM use could elucidate cultural and social factors of health behaviors and inform health care improvements. The current study examines reasons for CAM use among women in four racial/ethnic groups. DESIGN: A national telephone survey of 3172 women aged 18 years and older was conducted in four languages. Respondents were asked about their use of remedies or treatments not typically prescribed by a medical doctor. This study focuses on those women who used CAM in the previous year and their reasons for using CAM. RESULTS: Non-Hispanic white women were most likely to cite personal beliefs for CAM use. Cost of conventional medicine was most prevalent among Mexican-American women CAM users. Physician referral, family and friends, and media sources were all equally likely to lead to CAM use in non-Hispanic white women. In contrast, informal networks of family and friends were the most important social influences of CAM use among African-, Mexican-, and Chinese-American women. CONCLUSIONS: Racial/ethnic differences in reasons for CAM use highlight cultural and social factors that are important to consider in public evaluation of the risks and benefits of CAM remedies and treatments.

Adult↗
PubMed2000

Pharmacist job turnover, length of service, and reasons for leaving, 1983-1997.

Pharmacist job turnover from 1983 to 1997 was studied. Data were collected from a randomized 1997 mail survey of 1600 licensed pharmacists in four states (Ohio, Massachusetts, Oregon, and Alabama). The survey instrument included questions on pharmacist demographics, work schedules, salary, and work history. A total of 541 pharmacists responded, yielding an adjusted response rate of 34.5%. Information was provided on a total of 1697 jobs with start dates from 1931 to 1997. Pharmacist job turnover was fairly steady across the 1983-1997 period, averaging 11% annually. The average median tenure of pharmacists who left jobs was 32 months. The percentage of pharmacists leaving jobs and ranking stress as the reason for leaving increased, and the percentage of leavers ranking salary as the reason decreased. Women had a significantly higher annual turnover rate (15%) than men (9.7%), and they stayed in jobs for significantly less time (25.2 months) than men (56.5 months). There were no differences in turnover rates across practice settings. A larger percentage of pharmacists leaving jobs in large chain and institutional settings ranked stress as a reason for leaving than pharmacists leaving independent or small chain pharmacies. A larger percentage of pharmacists leaving independent or small chain pharmacies ranked salary as a reason than pharmacists in the other two settings. Pharmacist job turnover averaged 11% per year between 1983 and 1997. Pharmacists who left jobs typically stayed less than three years. The percentage citing stress as a reason for leaving increased, and the percentage citing salary decreased.

Female↗
PubMed2001

Development and testing of a hierarchical method to code the reason for admission to intensive care units: the ICNARC Coding Method. Intensive Care National Audit & Research Centre.

A computer-based hierarchical method was developed to code conditions leading to admission to intensive care in the UK. The hierarchy had five tiers: surgical status, body system, anatomical site, physiological or pathological process and medical condition. The hierarchy was populated initially using the free-text descriptions of the reason for admission from 10,806 admissions recorded as part of the Intensive Care Society's UK APACHE II study. After refinement and error-checking, a prospective evaluation was undertaken on 22,059 admissions to 62 UK intensive care units. Individual units coded between 60 and 1610 (mean 356) admissions. All but 50 (0.2%) of the admissions could be coded and 38 units coded every admission. Fifty admissions (0.2%) could not be coded within 24 h of admission but were coded subsequently when more information became available. Of the admissions, 96.1% were coded at all levels of the hierarchy in the coding method. Six hundred and thirty-seven of the 741 unique conditions (85.9%) were used in one of the five reasons for admission and 564 (76.1%) in the primary reason for admission. Five conditions account for 19.4% of all primary reasons for admission. This is the first method to be developed empirically for coding the reason for intensive care admission.

Diagnosis-Related Groups↗