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PubMed2002

Learning to report.

RATIONALE AND OBJECTIVES: In radiology residency programs it is the task of residents to learn how to effectively report the findings and impressions from patient images they review, generally from an apprenticeship design. The authors sought to learn residents' perceptions of the value this apprenticeship model holds for them. MATERIALS AND METHODS: Thirty-eight residents were interviewed in a 1-month field study and asked four questions about their experiences: How did you learn to report? What formal or organized dictation instruction have you received? What feedback do you receive? What is your opinion about your experience? RESULTS: It was found that residents perceive that the apprenticeship model is inadequate when learning to report. The authors found reporting issues could be classified into three categories: perceived lack of transferable learning from observation, lack of explicit direction from faculty, and need for a more structured approach to learning. CONCLUSION: Although residents agreed that learning the skills to report would be gained eventually through the apprenticeship model, they also believed that it did not give them the confidence or competence a more structured program could provide.

Clinical Competence↗

PubMed1998

Environmental supports to enhance social-communication.

"Environmental support" is a general term used to define the systematic use of explicit visual and/or social cues to clarify meaning for children with autism. Environmental supports can serve as a compensatory means to structure and enhance language understanding, social engagement, and social-communicative interactions. The unique and atypical developmental patterns associated with autism provide the rationale for the use of two environmental supports: visually cued instruction and modified sociolinguistic input. Using empirical research, multiple examples of environmental supports to enhance social-communication are provided.

Autistic Disorder↗

PubMed1988

A test of incident reporting.

OBJECTIVE: To evaluate the accuracy of incident reports completely by staff in a long term care facility and to test the adequacy of reporting for comprehensiveness by comparing incident rates to those of a similar facility using Spearman's rank correlation. METHOD: 1. Literature review. 2. Comparison of two long term care facilities in terms of incident reporting requirements, instructions to staff and categorisation of incidents. 3. Tabulation of rate of incidents over a specific time period. 4. Testing of comparability of the findings using the Spearman's rank correlation. RESULTS: The review of incident reports at one facility revealed an error rate of approximately 1% when 403 reports were examined for accuracy and completeness using 15 explicit requirements. The categorisation of incident reports by type proved adequate. The Spearman's rank computation confirmed that the rate of incident reporting between the two facilities was very similar.

British Columbia↗

PubMed2006

Go with the flow: How to master a nonlinear multiple-cue judgment task.

The authors examined the cognitive processes that participants use in linear and nonlinear multiple-cue judgment tasks, hypothesizing that people are unable to use explicit cue abstraction in a nonlinear task, instead turning to exemplar memory. Experiment 1 confirmed that people are unable to use cue abstraction in nonlinear tasks but failed to confirm the hypothesized, spontaneous shift to exemplar memory. Instead, the participants appeared to be trapped in persistent and futile attempts to abstract the cue-criterion relations. Only after being instructed to rely on exemplar memory in Experiment 2 did they master the nonlinear task. The results suggest that adaptive shifts of representation need not occur spontaneously and that analytical thought may sometimes harm performance in nonlinear tasks.

Adult↗

PubMedDate not supplied

Demonstrating the implicit processing of visually presented words and pseudowords.

This study demonstrates that even when subjects are instructed to perform a nonlinguistic visual feature detection task, the mere presence of words or pseudowords in the visual field activates a widespread neuronal network that is congruent with classical language areas. The implication of this result is that subjects will process words beyond the functional demands of the task. Therefore, contrasting brain activity in a word task that explicitly requires a cognitive function with a word task in which the function is activated implicitly will not necessarily isolate the brain area of interest. Furthermore, in most brain regions, we found that pseudowords, which have unfamiliar phonological associations and no associated semantic association, produce greater activation than words. Greater brain activity associated with pseudowords illustrates that unfamiliar stimuli that are unable to access word associations may activate the neuronal network more strongly than familiar words for which access occurs with ease.

Brain↗

PubMed2006

Don't talk about pink elephants! Speaker's control over leaking private information during language production.

Speakers' descriptions sometimes inappropriately refer to information known only to them, thereby "leaking" knowledge of that private information. We evaluated whether speakers can explicitly control such leakage in light of its communicative consequences. Speakers described mutually known objects (e.g., a triangle) that had size-contrasting matches that were privileged to the speakers (e.g., a larger triangle visible to the speakers only), so that use of a contrasting adjective (e.g., small) involved referring to the privileged information. Half the time, speakers were instructed to conceal the identity of the privileged object. If speakers can control their leaked references to privileged information, this conceal instruction should make such references less likely. Surprisingly, the conceal instruction caused speakers to refer to privileged objects more than they did in the baseline condition. Thus, not only do speakers have difficulty not leaking privileged information, but attempts to avoid such leakage only make it more likely.

Communication↗

PubMed1998

Limits of the dual-strategy hypothesis in an isometric plantar flexion contraction.

Movements have been described as being governed by a speed-sensitive (SS) or speed-insensitive (SI) strategy. The SS strategy is used when the subject controls, either explicitly or implicitly, movement speed or time. In contrast, the SI strategy is utilized when there is no intention or requirement to control movement speed. The different strategies demonstrate a specific relationship between torque trajectories and muscle activity. The purpose of this study was to determine the effect of accuracy and force level on strategy selection. Ten healthy adults were instructed to generate isometric pulse contractions of the right soleus at 20%, 40%, and 60% of maximum voluntary contraction (MVC) to reach five target sizes of percentage MVC (4%, 8%, 12%, 16%, 20%). The following results were observed: (1) there was no difference in time to peak force, peak dF/dt, slope of force, and electromyographic (EMG) measures between the 12%, 16%, and 20% target sizes; (2) differences were noted, however, between the 12%, 16%, and 20% targets and the smaller targets; (3) for the dependent measures there were significant differences between each force level. No difference between the larger targets implies that subjects do not need to implement a strategy and suggests an upper limit to the dual-strategy hypothesis. The difference between the smaller and larger targets and the difference between the force levels is indicative of an SS strategy. When asked to use different force levels, subjects controlled the rate of rise of force and regulated time to peak force. Between target sizes, force and time were modulated equally.

Adult↗

PubMed2001

Improving advance care planning by accommodating family preferences.

CONTEXT: Family members often lack the knowledge of patients' values and preferences needed to function well as surrogate decision-makers. OBJECTIVE: To determine whether differences in values and preferences for the advance care planning process may be reasons family members are inadequately informed to act as surrogates. DESIGN: Face-to-face and telephone surveys using structured questionnaires. PARTICIPANTS: Two hundred forty-two pairs of dialysis patients and their designated surrogates. MAIN OUTCOME MEASURES: Content and number of end-of-life care discussions; patient and surrogate attitudes toward having patients express preferences explicitly; factors most important to surrogates in decision making; and within-pair agreement about the values of suffering and certainty. RESULTS: Ninety percent of patients designated a family member as their surrogate. In most cases, having more conversations about end-of-life issues did not increase surrogate knowledge of patients' values or preferences. Surrogates wanted written and oral instructions more often than patients wanted to provide them (62% vs. 39%, p < 0.001). Knowing the patient's wish to stop treatment in the present condition was more important to most surrogates than the physician's recommendation to stop treatment (62% vs. 45%, p < 0.001). Compared to patients, surrogates were less likely to want to prolong the patient's life if it entailed suffering (12% vs. 23%, p < 0.01) and were more concerned about being certain before stopping life-sustaining treatments (85% vs. 77%, p < 0.02). CONCLUSIONS: Differences in preferences for the advance care planning process between patients and their surrogates and failure to discuss specific end-of-life values and preferences may explain why surrogates often lack information needed to serve as surrogate decision-makers.

Adolescent↗

PubMed1985

Counseling patients to counsel physicians on future care in the event of patient incompetence.

Physicians and patients share a common interest in clarifying and maximizing the powers and protection of advanced directives for future care in the event of patient incompetence. Although the complexity and unpredictability of health care circumstances make it impossible to guarantee complete control over therapeutic measures to be used when survival is in question, physicians should offer their patients the opportunity to reflect on their values and wishes and to express them explicitly. The ideal advanced directive should clearly state the author's intentions; contain clear documentation regarding authorship; be flexible, allowing family and caregivers to respond appropriately to changing circumstances; be available when needed; and be supported by legal powers that grant patients the right of enforcement and grant health care providers protection from liability. Advanced directives can be set as instruction directives or proxy directives, each form having advantages and disadvantages.

Attitude to Health↗

PubMed1999

Clinical practice guidelines for bipolar disorder from the Department of Veterans Affairs.

BACKGROUND: For the last several years, the Department of Veterans Affairs (VA) has been involved in the development of practice guidelines for major medical, surgical, and mental disorders. This article describes the development and content of the VA-Clinical Practice Guidelines for Bipolar Disorder, which are available in their entirety on the Journal Web site (http://www. psychiatrist.com). METHOD: A multidisciplinary work group composed of content experts in the field of bipolar disorder and practitioners in general clinical practice was convened by the VA's Office of Performance and Quality and the Mental Health Strategic Health Group. The work group was instructed in algorithm development and methods of evidence evaluation. Draft guidelines were developed over the course of 6 months of meetings and conference calls, and that draft was then sent to nationally prominent content experts for final critique. RESULTS: The Bipolar Guidelines are part of the family of the VA Clinical Guidelines for Management of Persons with Psychosis and consist of explicit algorithms supplemented by annotations that explain the specific decision points and their basis in the scientific literature. The guidelines are organized into 5 modules: a Core Module for diagnosis and assignment to mood state plus 4 treatment modules (Manic/Hypomanic/Mixed Episode, Bipolar Depressive Episode, Rapid Cycling, and Bipolar Disorder With Psychotic Features). The modules specify particular diagnostic and treatment tasks at each step, including both somatotherapeutic and psychotherapeutic interventions. CONCLUSION: The VA Bipolar Guidelines are designed for easy clinical reference in decision making with individual patients, as well as for use as a scholarly reference tool. They also have utility in training activities and quality improvement programs.

American Heart Association↗

PubMed1990

[Effect of emotions on the choice of goals and actions].

The present paper concerns the influence negative emotions exert on motivational processes, i.e., on the selection of goals and corresponding actions. It is assumed that, in a negative emotional state, the goal to overcome this negative mood state takes precedence over the goal to succeed in a nonemotional task. Correspondingly, emotion-related activities should be preferred to task-related ones. In order to test this assumption, subjects in a negative and a neutral emotional state were given a series of activities, some suited for coping, some suited for task fulfilment. They were instructed to name (Experiment I) or to carry out (Experiment II) those activities they preferred at the very moment and to give a short reason for each choice. Results showed that subjects in a negative mood compared to those of the neutral control group were less occupied with the nonemotional task, but instead more frequently chose emotion-related activities with the explicit reason that these activities served to overcome their negative emotions.

Adult↗

PubMed2003

Procedural learning in perceptual categorization.

In two experiments, observers learned two types of category structures: those in which perfect accuracy could be achieved via some explicit rule-based strategy and those in which perfect accuracy required integrating information from separate perceptual dimensions at some predecisional stage. At the end of training, some observers were required to switch their hands on the response keys, whereas the assignment of categories to response keys was switched for other observers. With the rule-based category structures, neither change in response instructions interfered with categorization accuracy. However, with the information-integration structures, switching response key assignments interfered with categorization performance, but switching hands did not. These results are consistent with the hypothesis that abstract category labels are learned in rule-based categorization, whereas response positions are learned in information-integration categorization. The association to response positions also supports the hypothesis of a procedural-learning-based component to information integration categorization.

Association Learning↗

PubMed2004

Endocrine controls of eating: CCK, leptin, and ghrelin.

The peripheral physiological and central nervous mechanisms contributing to the control of eating present formidable challenges to experimental analysis. One of the most productive approaches to these challenges has been endocrinological. This review introduces the endocrine control of eating by considering three hormonal signals that have been hypothesized to control hunger or satiation, cholecystokinin CCK, leptin, and ghrelin. The roles of these molecules in humans and in rodents are considered against a set of criteria established in classical endocrinology for establishing physiological endocrine action. It is concluded that according to these criteria, CCK's satiating action in humans is the best-established physiological endocrine action. In contrast, support for endocrine actions of leptin in satiation and of ghrelin in hunger is incomplete, and areas urgently requiring further research are identified. Finally, a review of work on these three hormones suggests the utility of a new conceptual scheme for understanding the endocrine control of eating. This scheme distinguishes between endocrine, in which the stimuli for hormonal secretion and the effect of secretion on eating are tightly coupled, and endocrine effects, in which one or both of these links is uncoupled. The implications of this concept for research design and interpretation of data are discussed. A vast literature links endocrine systems to the control of eating behavior [Geary, N. Hunger and satiation. In: Martini, L., ed. Encyclopedia of endocrine diseases. San Diego, CA: Academic Press, 2004, in press.]. This is fortunate for ingestive science. Endocrinology is a well-developed discipline with an impressive armamentarium of intellectual and technical tools. In contrast, ingestive science, i.e., the study of eating, drinking, and drug use, is at a more rudimentary stage of development. My general thesis here is that the adaptation and application of some of the well-accepted intellectual tools of endocrinology is likely to accelerate progress in ingestive science. The organization of the review is threefold. First, the treatment of endocrine controls of eating is selective. Just three hormones, CCK, leptin, and ghrelin, are considered. It is not clear that these are the three most important endocrine controls of eating, but they are each certainly interesting candidates, and comparisons among them are instructive. Second, I argue for the utility of the application of classical endocrine criteria for the identification of physiological effects of hormones, as adapted to eating behavior. This is done by introducing these criteria, considering each hormone's status with respect to them, and identifying the areas where relevant evidence is currently available or is lacking. Third, I argue for the utility of making explicit the distinction between endocrine actions, in which the stimuli for hormonal secretion and the effect of secretion on eating are tightly coupled, and endocrine actions, in which these links are uncoupled. This concept is assembled inductively in the course of the review.

Animals↗

PubMed2000

A small-to-large unit progression in metaphonological awareness and reading?

The paper reports a series of studies of reading and metaphonological processing by children in their second year in primary school (aged 6 years). An earlier study had established that, in the first year of learning, performance was characterized by a small-unit approach in which graphemes and phonemes were emphasized. In the second year, reading became more sensitive to the frequencies of rime structures in the lexicon. Capacity to generate word analogies for nonwords also showed increasing commitment to rime-based responses, and this trend was strongly linked to reading age. The present results suggest that a small-unit approach to reading is augmented by a large-unit approach as development proceeds. This trend was reflected in performance on a test of explicit phonological awareness. When asked to report the segment of sound shared by two spoken words, Primary 1 children were poor in reporting shared rimes but relatively adept in reporting shared phonemes. During Primary 2 there was an improvement in ability to report shared rimes, and this trend was also related to reading age. These results are discussed in relation to the influence of instruction and the nature of the orthography in determining the course of reading development.

Association Learning↗

PubMed2005

The power of a story: new, automatic associations from a single reading of a short scenario.

The implicit association test (IAT) is typically used to assess nonconscious categorization judgments that are "under control of automatically activated evaluation" (Greenwald, McGhee, & Schwartz, 1998, p. 1464) and that are usually considered independent of explicit judgments. The present study builds on recent work suggesting evidence of short-term modifiability of the IAT effect. Specifically, we show that reading a short text that describes a novel, fictional scenario, within which the to-be-evaluated categories are embedded, can produce substantial and immediate modulations of the IAT effect. This modulation effect does not occur when subjects are simply instructed to think about counterstereotypical associations (Experiment 1A and 1B). In Experiment 2, we use a variant of the IAT to show that scenario modulation cannot be explained in terms of strategic criterion shifts. These results suggest that a newly acquired knowledge structure targeting the abstract, category level can produce behavioral effects typically associated with automatic categorization.

Adult↗

PubMed2000

Design and use of clinical ontologies: curricular goals for the education of health-telematics professionals.

In computer science, the notion of a domain ontology--a formal specification of the concepts and of the relationships among concepts that characterize an application are a--has received considerable attention. In human-computer interaction, ontologies play a key role in defining the terms with which users and computer systems communicate. Such ontologies either implicitly or explicitly drive all dialogs between the computer and the user. In the construction of health-telematics applications, professionals need to understand how to design and apply domain ontologies to ensure effective communication with end-users. We currently are revising our training program in Medical Information Sciences at Stanford University to teach professional students in health telematics how to develop effective domain ontologies. Instruction concerning the construction and application of clinical domain ontologies should become an integral component of all health telematics curricula.

Attitude to Computers↗

PubMedDate not supplied

A study of the quality of prescriptions issued in a busy pediatric emergency room.

An analysis of 2,213 prescriptions written by physicians in a busy, urban pediatric emergency room revealed that only 110 or 5 percent had no errors or omissions of specifications. The quality of the prescriptions was evaluated according to the standards of acceptable prescribing for the following specifications: quantity, dosage, time interval between doses or specific hours to be given, and specific instructions. The hospital pharmacists, also under pressure, generally failed to monitor the prescriptions adequately--either they did not rectify the physicians' errors or at times they made incorrect changes. To improve the quality of prescriptions issued under pressure in an emergency room, several courses of action are recommended: Pharmacology departments of medical schools should place more emphasis on teaching students the art of writing explicit, comprehensible prescriptions. The physician and pharmacist should work as a team in the interest of providing patients with accurate and detailed prescriptions; or both the physician and the pharmacist should delegate the composition of prescriptions to an automated computer system, thereby reducing human error in writing and monitoring prescriptions and allowing both professionals more time for direct contact with patients.

Child↗

PubMed2000

Developing and implementing computerized protocols for standardization of clinical decisions.

Humans have only a limited ability to incorporate information in decision making. In certain situations, the mismatch between this limitation and the availability of extensive information contributes to the varying performance and high error rate of clinical decision makers. Variation in clinical practice is due in part to clinicians' poor compliance with guidelines and recommended therapies. The use of decision-support tools is a response to both the information revolution and poor compliance. Computerized protocols used to deliver decision support can be configured to contain much more detail than textual guidelines or paper-based flow diagrams. Such protocols can generate patient-specific instructions for therapy that can be carried out with little interclinician variability; however, clinicians must be willing to modify personal styles of clinical management. Protocols need not be perfect. Several defensible and reasonable approaches are available for clinical problems. However, one of these reasonable approaches must be chosen and incorporated into the protocol to promote consistent clinical decisions. This reasoning is the basis of an explicit method of decision support that allows the rigorous evaluation of interventions, including use of the protocols themselves. Computerized protocols for mechanical ventilation and management of intravenous fluid and hemodynamic factors in patients with the acute respiratory distress syndrome provide case studies for this discussion.

Algorithms↗