Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Intuition”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources
PubMed2005

Experimental assessment of a new mechanical endoscopic solosurgery system: Endofreeze.

BACKGROUND: The assistance received by the surgeon from support personnel during operative laparoscopy is extremely important. This includes retraction of instruments and endoscope positioning. However, human assistance is costly and often does not provide satisfaction for the surgeon. The aim of this study was to develop a mechanical arm capable of allowing easy handling and holding of laparoscopic instruments under the surgeon's control. METHODS: We designed a system, named Endofreeze, based on a particular kinematical construction that maintains an invariant point of constraint motion just above the trocar puncture site through the abdominal wall. The goal was to develop this way a highly intuitive mechanical holding system for laparoscopic instruments, with sufficient precision of action, activated by a single hand movement. We tested a couple of prototypes with different holding arms while performing cholecystectomy in phantom models with swine inserts and compared the results obtained in similar conditions using different holding and positioning systems. RESULTS: The system allows transparent and intuitive operation, and its setup is easy and quick. It may be adapted either as an instrument retractor or as an optic positioning device. Compared to different systems available or prototypes previously tested, such as AESOP 2000, ENDOASSIST, FIPS Endoarm, TISKA Endoarm, and the Martin Arm, in similar conditions, it was more intuitive, allowing shorter time for completion of surgery. CONCLUSION: Endofreeze is a new intuitive mechanical positioning system for endoscopic solo surgery. In phantom models, it demonstrated a shorter time requirement for completion of surgery when compared to other systems available. In our opinion, it represents a valid compromise between human and robotic control for conventional laparoscopic instruments.

Animals↗
PubMed1979

The overburdened manager and decision making.

This article discusses three methods managers can use to make decisions: intuition, management analysis, and Type 1 and Type 2 error analysis. Olson identifies studies that have shown that top managers work at an unrelenting pace and jump from one activity to another. He claims that managers do not have time to plan in a reflective, systematic manner. In fact, in his view, decision makers usually react intuitively to situations that can no longer be ignored. The author presents evidence that top managers prefer verbal media such as telephone calls and meeting for decision making because of their timeliness. He points out that the strategic data bank of the organization is largely in the mind of the manager. As a consequence, he states, an effective analysis requires that the manager communicate to the analyst the relevant data stored in his head. This process often makes it easier for the manager to solve the problem himself rather than delegate it to others. Olson identifies five organizational conditions that enable a top manager to effectively delegate problem solving tasks to management analysts: (1) the analyst must have the confidence of the same people who influence the manager; (2) the analyst must be able to adapt the techniques to the specific needs of the manager; (3) there must be sufficient time for the analyst to structure the problem and evaluate the alternatives; (4) the analyst must share in information gathered by the manager from verbal contacts; and (5) the manager must be part of an organization large enough to make it profitable for him to seek assistance from an analyst. When the above organizational conditions are not met, the author suggests Type 1 and Type 2 error analysis. He promotes this form of analysis as a method for using logic and intuition to consider various forms of information. This management tool is named for Type 1 error (accepting a proposal that should have been rejected) and Type 2 error (rejecting a proposal that should have been accepted). The author advocates the use of this methodology because, in his view, it focuses the attention of the manager on the facts when a decision needs to be made. In this process, the manager must identify and evaluate the likelihood and consequences of each alternative strategy. Olson sees Type 1 and Type 2 error analysis as providing explicit logic to strengthen the intuitive decision making process.

Administrative Personnel↗
PubMed2002

Quantitative evaluation of the diagnostic thinking process in medical students.

OBJECTIVE: To explore the diagnostic thinking process of medical students. SUBJECTS AND METHODS: Two hundred twenty-four medical students were presented with 3 clinical scenarios corresponding to high, low, and intermediate pre-test probability of coronary artery disease. Estimates of test characteristics of the exercise stress test, and pre-test and post-test probability for each scenario were elicited from the students (intuitive estimates) and from the literature (reference estimates). Post-test probabilities were calculated using Bayes' theorem based upon the intuitive estimates (Bayesian estimates of post-test probability) and upon the reference estimates (reference estimates of post-test probability). The differences between the reference estimates and the intuitive estimates, and between Bayesian estimates and the intuitive estimates were used for assessing knowledge of test characteristics, and ability of estimating pre-test and post-test probability of disease. RESULTS: Medical students could not rule out disease in low or intermediate pre-test probability settings, mainly because of poor pre-test estimates of disease probability. They were also easily confused by test results that differed from their anticipated results, probably because of their inaptitude in applying Bayes' theorem to real clinical situations. These diagnostic thinking patterns account for medical students or novice physicians repeating unnecessary examinations. CONCLUSIONS: Medical students' diagnostic ability may be enhanced by the following educational strategies: 1) emphasizing the importance of ruling out disease in clinical practice, 2) training in the estimation of pre-test disease probability based upon history and physical examination, and 3) incorporation of the Bayesian probabilistic thinking and its application to real clinical situations.

Adult↗
PubMed2005

Project quality rating by experts and practitioners: experience with Preffi 2.0 as a quality assessment instrument.

Preffi 2.0 is an evidence-based Dutch quality assessment instrument for health promotion interventions. It is mainly intended for both planning and assessing one's own projects but can also be used to assess other people's projects (external use). This article reports a study on the reliability of Preffi as an external quality assessment instrument. Preffi is used to assess quality at three levels: (i) specific criteria, (ii) clusters of criteria and (iii) entire projects. The study compared Preffi-based assessments of 20 projects by three practitioners with their intuitive assessments of the same projects and with assessments by three experts, which were to be used as external criteria. The intuitive assessments only related to the cluster and project levels. Our main hypothesis was that intuitive assessments by practitioners would be less reliable and accurate than their Preffi-based assessments and the experts' assessments. On the whole, we failed to confirm this hypothesis: the experts' assessments proved less reliable and accurate than the practitioners' intuitive and Preffi-based assessments and differed too much from each other to be used as external criteria. The Preffi-based assessments by the practitioners had an acceptable generalizability coefficient (G) and accuracy (standard error of measurement). At the level of the entire project, two assessors are needed to produce sufficiently reliable and accurate assessments, whereas three are needed for assessment at cluster level. The study also showed that different assessors use different perspectives and base their assessment on a variety of aspects. This was regarded as inevitable and even useful by the assessors themselves. Discussions between assessors are important to achieve consensus. The article suggests some improvements to Preffi to further increase its reliability.

Health Promotion↗
PubMed2001

Generation, description and storage of dendritic morphology data.

It is generally assumed that the variability of neuronal morphology has an important effect on both the connectivity and the activity of the nervous system, but this effect has not been thoroughly investigated. Neuroanatomical archives represent a crucial tool to explore structure-function relationships in the brain. We are developing computational tools to describe, generate, store and render large sets of three-dimensional neuronal structures in a format that is compact, quantitative, accurate and readily accessible to the neuroscientist. Single-cell neuroanatomy can be characterized quantitatively at several levels. In computer-aided neuronal tracing files, a dendritic tree is described as a series of cylinders, each represented by diameter, spatial coordinates and the connectivity to other cylinders in the tree. This 'Cartesian' description constitutes a completely accurate mapping of dendritic morphology but it bears little intuitive information for the neuroscientist. In contrast, a classical neuroanatomical analysis characterizes neuronal dendrites on the basis of the statistical distributions of morphological parameters, e.g. maximum branching order or bifurcation asymmetry. This description is intuitively more accessible, but it only yields information on the collective anatomy of a group of dendrites, i.e. it is not complete enough to provide a precise 'blueprint' of the original data. We are adopting a third, intermediate level of description, which consists of the algorithmic generation of neuronal structures within a certain morphological class based on a set of 'fundamental', measured parameters. This description is as intuitive as a classical neuroanatomical analysis (parameters have an intuitive interpretation), and as complete as a Cartesian file (the algorithms generate and display complete neurons). The advantages of the algorithmic description of neuronal structure are immense. If an algorithm can measure the values of a handful of parameters from an experimental database and generate virtual neurons whose anatomy is statistically indistinguishable from that of their real counterparts, a great deal of data compression and amplification can be achieved. Data compression results from the quantitative and complete description of thousands of neurons with a handful of statistical distributions of parameters. Data amplification is possible because, from a set of experimental neurons, many more virtual analogues can be generated. This approach could allow one, in principle, to create and store a neuroanatomical database containing data for an entire human brain in a personal computer. We are using two programs, L-NEURON and ARBORVITAE, to investigate systematically the potential of several different algorithms for the generation of virtual neurons. Using these programs, we have generated anatomically plausible virtual neurons for several morphological classes, including guinea pig cerebellar Purkinje cells and cat spinal cord motor neurons. These virtual neurons are stored in an online electronic archive of dendritic morphology. This process highlights the potential and the limitations of the 'computational neuroanatomy' strategy for neuroscience databases.

Algorithms↗
PubMed2004

A neuroscientific approach to normative judgment in law and justice.

Developments in cognitive neuroscience are providing new insights into the nature of normative judgment. Traditional views in such disciplines as philosophy, religion, law, psychology and economics have differed over the role and usefulness of intuition and emotion in judging blameworthiness. Cognitive psychology and neurobiology provide new tools and methods for studying questions of normative judgment. Recently, a consensus view has emerged, which recognizes important roles for emotion and intuition and which suggests that normative judgment is a distributed process in the brain. Testing this approach through lesion and scanning studies has linked a set of brain regions to such judgment, including the ventromedial prefrontal cortex, orbitofrontal cortex, posterior cingulate cortex and posterior superior temporal sulcus. Better models of emotion and intuition will help provide further clarification of the processes involved. The study of law and justice is less well developed. We advance a model of law in the brain which suggests that law can recruit a wider variety of sources of information and paths of processing than do the intuitive moral responses that have been studied so far. We propose specific hypotheses and lines of further research that could help test this approach.

Cognition↗
PubMed1995

Sacrificing one to save many.

Attempts to solve the Trolley Problem by means of a single principle have proved unpersuasive. Nor can the intuition about Transplant be adequately grounded in the hypothetical dissent of rational contractors. It is explained by the initial liability principle, that loss should lie where it falls unless there is sufficient reason to shift it. If we did not think we should accept misfortune in such cases and thought that minimising loss of life was sufficient reason to shift the loss we should not be according others the minimum respect and treatment we feel is their due. The intuition about Trolley is explained by the affinity of that case to the pure case where the choice is between saving many and saving fewer, where minimising misfortune is the only credible option. But these considerations are not yet enough to accommodate the cases that lie between the extremes of Trolley and Transplant. We can handle the intermediate cases by attempting to assimilate them to one or other paradigm and to one another with a sensitivity to morally relevant and irrelevant differences that seeks initially to be faithful to the values reflected by our moral intuitions. Those intuitive judgements are unlikely to survive such an examination wholly unmodified.

Double Effect Principle↗
PubMed2003

The employment of an iterative design process to develop a pulmonary graphical display.

OBJECTIVE: Data representations on today's medical monitors need to be improved to advance clinical awareness and prevent data vigilance errors. Simply building graphical displays does not ensure an improvement in clinical performance because displays have to be consistent with the user's clinical processes and mental models. In this report, the development of an original pulmonary graphical display for anesthesia is used as an example to show an iterative design process with built-in usability testing. DESIGN: The process reported here is rapid, inexpensive, and requires a minimal number of subjects per development cycle. Three paper-based tests evaluated the anatomic, variable mapping, and graphical diagnostic meaning of the pulmonary display. MEASUREMENTS: A confusion matrix compared the designer's intended answer with the subject's chosen answer. Considering deviations off the diagonal of the confusion matrix as design weaknesses, the pulmonary display was modified and retested. The iterative cycle continued until the anatomic and variable mapping cumulative test scores for a chosen design scored above 90% and the graphical diagnostic meaning test scored above 75%. RESULTS: The iterative development test resulted in five design iterations. The final graphical pulmonary display improved the overall intuitiveness by 18%. The display was tested in three categories: anatomic features, variable mapping, and diagnostic accuracy. The anatomic intuitiveness increased by 25%, variable mapping intuitiveness increased by 34%, and diagnostic accuracy decreased slightly by 4%. CONCLUSION: With this rapid iterative development process, an intuitive graphical display can be developed inexpensively prior to formal testing in an experimental setting.

Anesthesia, General↗
PubMed1989

Nursing practice. Developing a philosophy.

The application of nursing models has been a recent theme in British nursing. Part of this process is the development of a nursing philosophy which underpins the model. Nurses at clinical level are often required to define their philosophy to meet clinical, educational and managerial objectives. The first part of this two-part article explores the significance of nursing philosophy to practice. In the second part, a case study is used to illustrate how clinical nurses can set about defining a philosophy of nursing for themselves. Dickoff et al (1) indicate that a philosophy is significant in the generation of theory. By identifying the nature of practice, theoretical relationships become apparent. It is also significant as Johnson (2) states in nursing's development as a profession. Johnson further asserts that nurses should use their beliefs to build a conceptual system of the person to be served and an abstract model for practice which allows such purpose to be fulfilled. However a nurse's beliefs and values about nursing may have no theoretical substance to them. They may be purely intuitive in nature. Writing a philosophy legitimates intuition. Kitson (3) considers that nurse theorists who believe that only developing a knowledge base through a scientific approach are at risk of throwing away the intuitive sources of knowledge within nursing. Yet gut reactions have been shown to be critical in the development of excellence in nursing (4). Kitson believes that intuitions can lead to developing 'grassroots standards of care' and a clearer definition of what nursing is.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[The importance of language in psychotherapy education].

A common central postulate in theories and practices of the Occidental psychotherapies requires that both patient's experiences of himself and therapist's experiences of his patient must be transmissible with language. The possibility to verbalize one's experience is also an indispensable prerequisite for education in psychotherapy. In the Japanese culture language (kotoba) is considered to be able to express only surface of reality, while the true reality (koto) can be found out with an "acting intuition" (K. Nishida), i.e. a sort of cognitive function inherent in practical acts before the separation of subject and object. Experiences acquired in the acting intuition cannot be articulated in any rational language. The deep layer of experiences consists of a long history of such an intuition from the birth. The only way to participate in the live experiences of patient is to come into contact with him not only through verbal channel but rather through the acting intuition beyond the verbalization. Psychotherapeutic education by means of theoretical, rational language may be useful as instruction for candidates, but one must bear in mind that it cannot cultivate by itself any ability of true empathy.

Cross-Cultural Comparison↗
PubMed1993

Physician judgment in clinical settings: methodological influences and cognitive performance.

Understanding the quality of physicians' intuitive judgments is essential in determining the appropriate use of their judgments in medical decision-making (vis-a-vis analytical or actuarial approaches). As part of this process, the quality of physicians' predictions must be assessed because prediction is fundamental to common clinical tasks: determining diagnosis, prognosis, and therapy; establishing monitoring intervals; performing screening and preventive maneuvers. Critical evaluation of predictive capabilities requires an assessment of the components of the prediction process: the data available for prediction, the method used for prediction, and the accuracy of prediction. Although variation in and uncertainty about the underlying data elements are often acknowledged as a source of inaccurate predictions, prediction also can be confounded by both methodological and cognitive limitations. During the past two decades, numerous factors have been recognized that may bias test characteristics (sensitivity and specificity). These same factors may also produce bias in intuitive judgments. The use of cognitive processes to simplify judgment tasks (e.g., the availability and representativeness heuristics) and the presence of certain biases in the judgment process (e.g., ego, regret) may present obstacles to accurate estimation of probabilities by physicians. Limitations on the intuitive use of information (cognitive biases) have been demonstrated in both medical and nonmedical decision-making settings. Recent studies have led to a deepening understanding of the advantages and disadvantages of intuitive and analytical approaches to decision making. Here, many aspects of the basis for this understanding are reviewed.

Chemistry, Clinical↗
PubMed2002

Context and the interpretation of likelihood information: the role of intergroup comparisons on perceived vulnerability.

Four experiments investigated how people's perceptions about a group's (e.g., women's) vulnerability to a disease are influenced by information about the prevalence of the disease in a comparable group (e.g., men). Participants read symptom and prevalence infomation about fictitious diseases before answering questions regarding target group vulnerability. Participants used the prevalence rate for a nontarget group as an immediate comparison standard for intuitively interpreting the degree of vulnerability of a target group, resulting in robust contrast effects. Experiments 3 and 4 illustrated that these contrast effects can cause a person's intuitive perceptions about a group's vulnerability to selected diseases to conflict with his or her knowledge of the prevalence rates for the diseases. The results support a distinction between 2 components of psychological uncertainty-beliefs in objective probability and more intuitive perceptions of certainty.

Adult↗
PubMed2002

[Treatment regulations and treatment limits: factors influencing clinical decision-making].

BACKGROUND: Providing or withholding of treatment is based on a variety of factors. We sought for criteria in clinical decision making and reviewed attitudes towards clinical intuition and the patient's will. METHODS: 503 physicians (25.6 % females; mean age 36.3) in 49 departments at nine hospitals of the universities Bochum and Magdeburg filled in a validated questionnaire. RESULTS: The most important factors in the decision to carry out a therapy were "international standards" and "own experience". The decision to omit a therapy was mainly influenced by the "patient's wish". Physicians with a higher status judged their own experience higher than young physicians, who considered the experience of colleagues more important. "Severe accompanying illnesses" and "multimorbidity" were the most frequently named reasons to withdraw a therapy. Intuitive decision-making was rare, especially in young physicians, although these decisions were seldom risky and often successful. CONCLUSIONS: A patient's will plays a prominent role in clinical decision making, especially in decisions to withdraw or to withhold treatment. Cost containment and research interest have been called less important, a remarkable response from research-based university hospitals. Also remarkable is the recognition and importance of clinical intuition in situations of complex or missing information. This important aspect is rarely discussed in the literature or in medical education. The widely voiced concern that priorities in clinical care are guided by scientific interest, financial or technical possibilities could not be confirmed.

Adult↗
PubMed1999

The suspiciousness factor: critical care nursing and forensics.

This conceptual article provides a guide for understanding the place of forensic nursing within the discipline of nursing. Ways of knowing in nursing and expert nursing practice are described to identify the role of intuition in nursing practice. The relationship between suspicion and intuition is explored. Strategies for developing forensic nursing expertise and increasing suspicion are described. Suspicion (intuition) is presented as a rapid, acquired, patient oriented perception that leads to decisive action.

Clinical Competence↗
PubMed2001

An exploratory study of clinical decision-making in five countries.

PURPOSE: To identify the cognitive processes nurses use in their decision-making in long- and short-term care settings in five countries, and the demographic variables associated with their decision-making. METHOD AND SAMPLES: The instrument used was a 56-item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States. FINDINGS: Five models of decision-making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of knowledge were significantly associated with decision-making models as well as with country of residence of the participants. The highest proportion of analytically oriented decision-makers was found among nurses in long-term care, the decision-making of nurses in short-term care was more intuitively oriented. CONCLUSIONS: The results indicate that decision-making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations.

Canada↗
PubMed2004

The history and future of melanoma staging.

The evolution and progressive refinement of an internationally accepted melanoma staging system over the last 50 years has resulted in much greater accuracy and increased utility, but the staging process has become more complex and less intuitive. This raises the question of whether melanoma staging should continue to develop with ever-increasing levels of complexity, or whether attempts should be made to produce an alternative system that is simpler and more intuitive. The current, TNM-based American Joint Committee on Cancer (AJCC) staging system for melanoma incorporates only some of the prognostic factors of proven significance. However, the information that is now available about these and other, well-documented prognostic factors allows accurate prediction of an individual melanoma patient's prognosis using a computer-generated estimate. Thus an alternative staging strategy that could be considered in the future would be to use such an estimate to obtain a numerical score for each patient, based on all available information agreed to be of prognostic relevance. A stage grouping could then be assigned on the basis of that score, according to previously determined score ranges for each stage and substage. The advantages of such a system would be that it would allow more reliable comparison of treatment results within and between institutions, and would provide more equivalent stratification groups for patients entering clinical trials of new therapies and those entering adjuvant therapy trials. A further advantage would be that because there would be a direct link between staging and prognostic estimate, such a system would be more readily able to be understood in an intuitive fashion.

Antigens, Neoplasm↗
PubMed2006

Curious phenomena in Bayesian adjustment for exposure misclassification.

Many epidemiologic investigations involve some discussion of exposure misclassification, but rarely is there an attempt to adjust for misclassification formally in the statistical analysis. Rather, investigators tend to rely on intuition to comment qualitatively on how misclassification might impact their findings. We point out several ways in which intuition might fail, in the context of unmatched case-control analysis with non-differential exposure misclassification. Particularly, we focus on how intuition can conflict with the results of a Bayesian analysis that accounts for the various uncertainties at hand. First, the Bayesian adjustment for misclassification can weaken the evidence about the direction of an exposure-disease association. Second, admitting uncertainty about the misclassification parameters can lead to narrower interval estimates concerning the association. We focus on the simple setting of unmatched case-control analysis with binary exposure and without adjustment for confounders, though much of our discussion should be relevant more generally.

Anti-Bacterial Agents↗
PubMed1980

Seriators' and nonseriators' comprehension of comparative adjective forms.

The relationship between comprehension of relational adjective forms and seriation ability was assessed for 60 children aged 4-6. Three groups, operational seriators, intuitive seriators, and nonseriators, were given a test measuring comprehension of affirmative and negative comparative and equative forms. Results indicated that operationals understood more forms than intuitives and that intuitives comprehended more than nonseriators. When age differences between groups were minimized, the latter but not the former difference was preserved. This suggests that significant growth in linguistic comprehension accompanies the emergence of the ability to order objects by size. Analysis of errors indicated that nonseriators interpreted statements dichotomously and ignored the standard more than seriators. Findings help to clarify the relationship between linguistic and cognitive development for parallel underlying structures.

Child↗