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PubMed1997

A longitudinal framework for fostering critical thinking and diagnostic reasoning.

Nurses' reasoning skills are of interest to nurse researchers, managers, clinicians, educators and students. Recent emphasis on critical thinking has raised important questions regarding the modes of reasoning necessary for practice and appropriate measures to improve nurses' cognitive skills. This paper analyses critical thinking and diagnostic reasoning. A longitudinal framework for promoting both modes of reasoning, beginning with nursing students through to experienced clinicians, is proposed as a model worth testing in nurse samples.

Education, Nursing↗
PubMed1998

Establishing an international network on nurses' clinical reasoning.

A recent review of the relevant literature indicates that different approaches to the exploration of nurses' clinical reasoning are being adopted in North America, Australia and the United Kingdom. These differing approaches, which tend to cluster chronologically and which include decision analysis, information processing and skills acquisition theory and their limitations will be outlined; it will be argued that it is through their conflation that nurses' collective understanding of nurses' clinical reasoning is deepened. The author is attempting to develop an international network of nurse scholars interested in clinical reasoning with the aim of achieving this. The purposes of this network will be to facilitate international collaboration to expedite both the growth of knowledge related to nurses' clinical reasoning and the development of programs of international comparative research related to it. The setting up of this network and progress to date is described.

Australia↗
PubMed2003

Periodontal reasons for tooth extraction in an adult population in Jordan.

This survey studies the reasons for periodontal extraction of permanent teeth in an adult Jordanian population. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. Of these, the 26 dentists who participated in this study were asked to record teeth extracted and give reasons for extraction. Personal and demographic information and clinical details were obtained from 898 patients aged from 20 to 60 years. A total of 1,098 teeth were extracted during the 3-month study period. The results of this study revealed that dental caries (56.4% overall) was the main reason for tooth extraction, especially in 20-39 year olds. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. Other reasons for tooth loss accounted for only 20.2% of the series. Advanced periodontal disease represented by pocketing were the dominant pathology when tooth loss occurred as the result of periodontal disease. As far as the type of tooth was concerned, the most frequently extracted teeth were molars followed by premolars, regardless of whether their loss was the result of the caries or the periodontal disease. This study suggests that caries and its consequences are responsible for more tooth loss in patients less than 40 years of age while extraction because of periodontal problems increases with age, and more commonly related to pocketing.

Adult↗
PubMed2003

Doctors' reasons for rejecting initial choices of specialties as long-term careers.

OBJECTIVES: To report on rejected choices of specialty as long-term careers and reasons for rejection. DESIGN: Postal questionnaire survey. SETTING: United Kingdom. PARTICIPANTS: All graduates of 1996 and 1999 from UK medical schools during their first year after qualification. MAIN OUTCOME MEASURES: Any career choice which had been seriously considered and rejected and the reason for its rejection. RESULTS: In all, 33.1% (1871) of respondents named a rejected choice and gave reasons for its rejection. Disproportionately high numbers rejected the surgical specialties, paediatrics and obstetrics and gynaecology (O&G), using the specialty distribution of positive choices as the comparator. Relatively few doctors rejected general practice (GP) after giving it serious consideration. Doctors rejecting the hospital medical and surgical specialties or paediatrics were most likely to specify reasons relating to quality of life. Three-quarters of the graduates of 1999 who rejected O&G did so because of poor career prospects. CONCLUSIONS: Quality of life issues, and concerns about working relationships, are sufficiently influential to persuade many doctors to abandon an initial choice of medical career. It is unlikely that much of the decline in entry to GP is attributable to rejection of GP by doctors who initially chose it. The decline must therefore represent an increase in the number of doctors who had never seriously considered it as a long-term career choice.

Career Choice↗
PubMed2003

Diagnostic reasoning strategies and diagnostic success.

PURPOSE: Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. METHODS: Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. RESULTS: Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. CONCLUSIONS: These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

Clinical Competence↗
PubMed1995

Clinical reasoning and pain.

Clinical reasoning is reviewed with respect to the historical and continuing need for critical inquiry skills, the hypothetico-deductive basis of sound reasoning, factors influencing therapists' reasoning, and ways of promoting critical yet creative reasoning. The importance of clinicians' organisation of biomedical and clinical knowledge and the inclusion of the patient in the problem solving and decision making processes are emphasised.

Journal Article↗
PubMed2003

Schizophrenic patients' subjective reasons for compliance and noncompliance with neuroleptic treatment.

Although several factors influencing schizophrenic patients' compliance with neuroleptic treatment have been investigated, the subjective reasons that patients are willing or reluctant to take medication have rarely been examined. In a follow-up study of a sample of schizophrenic patients currently undergoing psychiatric treatment in the city of Leipzig, 307 patients were asked about their subjective reasons for medication compliance or noncompliance by administering the Rating of Medication Influences (ROMI) Scale. The perceived benefit from medication proved to be the main reason for patients' compliance with neuroleptic treatment. Respectively, patient-reported noncompliance was mainly explained by negative side effects of medication. However, there were no statistically significant differences in responses between the patients receiving conventional versus second-generation antipsychotics. A positive relationship with the therapist and a positive attitude of significant others toward neuroleptic treatment contributed to patients' medication compliance. Reasons for noncompliance with neuroleptic treatment were lack of acceptance of the necessity of pharmacological treatment and lack of insight into the disease. The results emphasize the importance of psychoeducation in enhancing patient compliance with neuroleptic treatment.

Adolescent↗
PubMed2006

[Discrepancy between objective measurement and subjective recognition of sicca syndrome before and after blepharochalasis operation for cosmetic or medical reasons].

BACKGROUND: This study was designed to examine if patients undergoing the same operative procedure (blepharochalasis operation) have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons. PATIENTS AND METHOD: The study included 32 patients (25 women, 7 men, mean age 57.8 +/- 12.1 years), who underwent blepharochalasis operation between 1/2005 and 5/2005. In 17 patients (group 1) the operation was done for cosmetic reasons, in 15 patients we found a medical indication (group 2). We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre- or postoperative recognition of dry eye problems (all done by scales). Additionally we measured tear secretion by Schirmer's test and break-up time before and after operation. RESULTS: The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation (p < 0.005), but objective data were nearly identically (BUT, Schirmer's test). CONCLUSION: When operated due to cosmetic reasons the stronger recognition of sicca problems (while objectively lacking) is may be caused by a stronger fixation on the lid disease itself. It seems necessary to document objective data for that reason.

Blepharoplasty↗
PubMed2005

Reasons for switching between antipsychotics in daily clinical practice.

BACKGROUND: Previous research that atypical antipsychotics were switched less often compared to typical antipsychotics, suggesting overall better treatment satisfaction. The objective of this study was to investigate the reasons for switching antipsychotics after initiating oral treatment with either typical or atypical antipsychotics in a clinical setting. PATIENTS AND METHODS: A total of 123 patients that switched antipsychotic therapy were recruited from 17 psychiatric hospitals, of which 46 % switched because of lack of effect and 45 % because of adverse effects. RESULTS: No significant differences were found between users of atypical versus typical antipsychotics in reasons for switching, both for overall adverse events, and lack of effect. In users of atypical antipsychotics extrapyramidal effects were reported less often as reason for switching (adjusted OR = 0.18 (95 % CI = (0.07 - 0.51)). Patients on atypical antipsychotics switched more often because of weight gain (adjusted OR = 12.8 (95 % CI = (1.50 - 109)). CONCLUSION: In conclusion, when switching occurred, no difference was found in the frequency of general tolerability or reported lack of effectiveness. However, the type of adverse event as a reason for switching differed between atypical and typical antipsychotics.

Adolescent↗
PubMed1986

[Reasonableness of surgical interventions and compliance responsibilities in various insurance fields and under the social compensation law].

According to the German Social Legal Code I (I. Sozialgesetzbuch, SGB I) the recipient of social benefits is under obligation to submit to medical treatment if such treatment would result in an improvement of his/her condition or in the prevention of further deterioration (section 63 SGB I). In certain situations, lack of cooperation may result in total or partial refusalor withdrawal of benefits (section 66 SGB I). This social law parallels the civil law which can recognize, in the area of private liability, co-delinquency in cases of refusal of reasonable treatment (section 157. section 242 and 254 GBG). In private liability insurance, the acceptance of reasonable medical treatments is contractually anchored. - In practice, the underwriter is generally unable to enforce surgical interventions. In the administration of social benefits surgical measures are exempt from the obligation of cooperation through administrative rules and guidelines of the regional state departments. The entitlement to pensions for the visually handicapped ("Blindengeld"), based on the Federal Social Benefit Law (BSHG), is regulated at the state level through state organizations. The corresponding state laws do not provide for the termination of support in cases of refusal of reasonable and prognostically promising operations. The recipients of pensions for the blind are not addressed in SGB I. Benefit recipients are therefore not penalized for refusing reasonable medical measures. - In legal accident insurance and legal social security insurance there exist, under certain conditions, obligations to cooperate in line with SGB I.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics, Medical↗
PubMed2001

Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons--an approach with explicit criteria.

BACKGROUND: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. METHODS: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. RESULTS: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). CONCLUSION: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

Adult↗
PubMed1995

Adolescents' attachment representations and moral reasoning.

Theoretical speculations and empirical data on the relation between attachment and moral reasoning are presented. An autonomous attachment representation was hypothesized to be an important personality dimension facilitating higher levels of moral (Type B) reasoning in adolescence. A sample of 47 U.S. college students (mean age 19.5 years) completed the Adult Attachment Interview (Main & Goldwyn, 1985-1993) and the Sociomoral Reflection Measure-Short Form (Gibbs, Basinger, & Fuller, 1992). Although the overall score for sociomoral reflection was not associated with attachment representation, moral Type B reasoning was more prevalent in respondents with an autonomous attachment representation; thus, autonomous attachment may be at the core of mature moral reasoning.

Adolescent↗
PubMed1988

An attempt to induce lower moral reasoning under hypnotic and task-motivated age regression.

In this study, we attempted to partially replicate and extend the findings of the Page (1985) study of hypnotic age regression and moral reasoning. The Kohlberg (1976) Moral Judgment Interview (MJI) was used to assess the initial stage of moral reasoning in 32 adults who were preselected on the basis of their hypnotic susceptibility. Subjects were hypnotized and age regressed to two of four possible ages (16, 13, 10, and 7), or were given task-motivation instructions before being age regressed. All were then administered the MJI, which involves the resolution of certain dilemmas. Both groups were able to lower their moral reasoning scores when given age regression instructions, but no significant differences were found between groups. Thus the results of this study are inconsistent with those of Page (1985), but are consistent with those of O'Brien et al. (1977). Reasons for the failure to reaffirm the earlier results of Page (1985) are discussed.

Adolescent↗
PubMed2003

Increased vaginal bleeding: the reasons women give for consulting primary care.

A previous study identified interference with life as the main reason for consultation with increased vaginal bleeding. The purpose of this study was to determine the reasons why the heaviness of periods interferes with life and how this may be related to consultation. The design was a case-control study in which questionnaires were sent to women who consulted primary care with new episodes of increased vaginal bleeding and two groups of controls: consulting controls with another illness and non-consulting community controls. Of the 186 women who reported that heaviness of periods interfered with life the most common reason given was 'mood' (87%). There was no difference in the reporting of 'mood' interfering with life or general health questionnaire score between cases, consulting controls and non-consulting controls. Women who report heavy periods interfering with life complain most commonly of mood as one of the reasons. This does not distinguish consulters and non-consulters and is not reflected in objective measures of psychological distress. Clinicians should focus initially on treating the presenting physical symptoms.

Adolescent↗
PubMed2005

Assessment of subtle cognitive-communication deficits following acquired brain injury: A normative study of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES).

PRIMARY OBJECTIVE: To present a new measure, the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES), with evidence for its reliability and validity in a normative study. The FAVRES is designed to evaluate the subtle cognitive-communication deficits of individuals with ABI. METHODS AND PROCEDURES: The FAVRES consists of four complex, contextually rich, verbal reasoning tasks that simulate everyday situations and require processing of text and discourse. Scoring considers the time, accuracy and justification of reasoning responses. The FAVRES scores of 52 adults with ABI were compared to those of 101 adults without ABI. OUTCOMES: FAVRES scores clearly differentiated the performances of individuals with and without ABI. Individuals with ABI were slower and less accurate in reasoning and presented fewer adequate rationales for their decisions. Inter-rater reliability for scoring was acceptable. CONCLUSIONS: The FAVRES provides a reliable, functional and quantifiable measure of the cognitive-communication difficulties of individuals with ABI.

Adolescent↗
PubMed1996

Utility of a verbal reasoning test in indicating vocational readiness following traumatic brain injury.

Present tests are often inadequate to assess subtle aspects of cognitive-communicative functioning following traumatic brain injury (TBI), making it difficult to predict vocational readiness, particularly for those in professional occupations. This study examined the viability of the Ross Test of Higher Cognitive Processes (RTHCP) as a measure of verbal reasoning deficits following TBI. The verbal reasoning performance of a 43-year-old lawyer with TBI was compared, at two stages in his rehabilitation, to that of a peer group of lawyers (n = 43). The RTHCP detected noticeable differences in speed and accuracy of performance at different stages of recovery. The RTHCP also revealed individual differences among the peer group, who presumably were competent in verbal reasoning. Thus, the RTHCP may be an effective tool to measure subtle deficits in verbal reasoning post-TBI. Some cautions in using this test for the TBI population are presented, as well as suggestions for further test development and validation.

Adult↗
PubMed2004

The difference between generating counter examples and using them during reasoning.

The aim of this article is to provide insight into the types of long-term knowledge that are used for solving causal conditional inferences. Two taxonomies were constructed to map the types of counter example. The available counter examples are traditionally probed via a counter example generation task. We observed that there are some significant differences in the types of counter example retrieved in the reasoning task versus the generation task. The generation task can be used for predicting answers that sprout from a reasoning process that takes counter example into account, but some participants use a different reasoning process in which the available semantic information is not used as contrasting evidence. Nonetheless, we found that the results of the generation task validly predicted the proportion of inferences accepted as well as the number of counter examples used during reasoning.

Classification↗
PubMedDate not supplied

Reasons for discharge from methadone maintenance for addicts at high risk of HIV infection or transmission.

This article reports on a methadone maintenance program that had the goal of retaining in treatment heroin addicts at high risk of HIV infection and/or transmission. Subjects were recruited from four-high-risk target groups and randomly assigned to either an enhanced or standard methadone maintenance group. The analysis examined predictors of any type of discharge, negative discharge, and circumstantial discharge. Discharge for any reason was more likely for younger individuals, sex industry workers, and high-risk sex partners. Legal supervision at intake and coercion into treatment reduced the probability of discharge for any reason. HIV-positive individuals were more likely to discharge for circumstantial reasons than negative reasons. The probability of circumstantial discharge was increased for males, individuals reporting suicidal ideation, and those scoring higher on an impulse expression scale. The likelihood of circumstantial discharge was decreased for individuals who reported more sources of legal income or who lived someone using illegal drugs. Participation in the enhanced treatment group appeared to reduce the probability of negative, compared with circumstantial, discharge. The findings should assist methadone treatment providers in targeting individuals at high probability of discharge for special efforts to increase treatment retention and to reengage them back into treatment after discharge, as part of a harm-reduction strategy to minimize risks of HIV infection and/or transmission.

Adult↗