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PubMed1994

Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital.

BACKGROUND: Although laparoscopic cholecystectomy has replaced open cholecystectomy for the majority of patients, it is clear that a substantial minority will require laparotomy for safe and successful removal of the gallbladder. PATIENTS AND METHODS: Seven hundred forty-six laparoscopic cholecystectomies performed at LAC+USC Medical Center for January 1991 to May 1993 were retrospectively reviewed. Hospital stay, laboratory values, and complications, as well as the need for and reason for conversion to open cholecystectomy were recorded. There were 661 females and 85 males, with a mean age of 38 years (range 15 to 92). RESULTS: One hundred one (14%) of the 746 patients were converted to open cholecystectomy. Difficult dissection secondary to inflammation or adhesions and the need to treat common-bile-duct stones were the most common reasons for conversion. Patients requiring conversion to open cholecystectomy were more likely to have been admitted through the emergency department (72% versus 46%, P < 0.0001), have had prolonged hospital stays prior to surgery (mean time from admission to surgery 4.4 days versus 2.8 days, P < 0.0001), and to have had a thickened gallbladder wall on preoperative ultrasound (54% versus 20%, P < 0.001). CONCLUSIONS: The most common reasons for conversion to open cholecystectomy are inflammation and adhesions secondary to severe acute and chronic disease and/or the need for clearance of the common bile duct. Patients who were admitted to the emergency department, particularly if they were managed nonoperatively for a period of time and had a preoperative diagnosis of acute cholecystitis, were more likely to require conversion to open cholecystectomy.

Adolescent↗
PubMed2003

The emotional reasoning heuristic in children.

A previous study by Arntz, Rauner, and Van den Hout (1995; Behaviour Research and Therapy, 33, 917-925) has shown that adult anxiety patients tend to infer danger not only on the basis of objective danger information, but also on the basis of anxiety response information. The current study examined whether this so-called emotional reasoning phenomenon also occurs in children. Normal primary school children (N = 101) first completed scales tapping anxiety disorders symptoms, anxiety sensitivity, and trait anxiety. Next, they were asked to rate danger levels of scripts in which objective danger versus objective safety and anxiety response versus no anxiety response were systematically varied. Evidence was found for a general emotional reasoning effect. That is, children's danger ratings were not only a function of objective danger information, but also, in the case of objective safety scripts, by anxiety response information. This emotional reasoning effect was predicted by levels of anxiety sensitivity and trait anxiety. More specifically, high levels of anxiety sensitivity and trait anxiety were accompanied by a greater tendency to use anxiety-response information as an heuristic for assessing dangerousness of safety scripts. Implications of these findings are briefly discussed.

Anxiety↗
PubMed1998

Hypochondriasis: the role of fear-confirming reasoning.

We investigated whether hypochondriacal patients are prone to selectively search for danger-confirming information when asked to judge the validity of conditional rules in the context of general and health threats. Therefore, hypochodtriacal patients (n = 27) and a healthy control group (n = 27) were presented with modified Wason Selection Tasks (WSTs) pertaining to general and health threats. The WSTs contained safety rules (If P then safe) and danger rules (If P then danger). Subjects adopted a verificationistic strategy in case of danger rules and tended to look for falsifications in case of safety rules. This danger-confirming reasoning pattern was similar for both types of contexts and not particularly pronounced in hypochondriacal persons. These findings argue against the idea that such a reasoning pattern directly causes hypochondriasis. Yet, in the presence of anxiogenic (hypochondriasis related) convictions such danger-confirming reasoning pattern logically serves to maintain or even enhance hypochondriacal complaints.

Adult↗
PubMed2000

Conditional reasoning by mental models: chronometric and developmental evidence.

The aim of this article is to verify two predictions resulting from the mental models theory of conditional reasoning. First, the denial of antecedent (DA) and modus tollens (MT) inferences should take longer to verify than modus ponens (MP) and affirmation of consequent (AC) because the former require subjects to flesh out the initial model whereas the latter do not. This prediction was confirmed in two reaction time experiments in adults. In line with Evans' proposal (Evans, J. St. B. T. (1993). The mental model theory of conditional reasoning: critical appraisal and revision. Cognition, 48, 1-20), there was a strong directionality effect: inferences from antecedent to consequent (MP and DA) took less time to verify than the inferences in the opposite direction (AC and MT). Second, the development of conditional reasoning should result from the increasing capacity to construct and coordinate more and more models. As a consequence, the pattern of conditional inference production should evolve with age from a one-model conjunctive pattern (production of MP and AC more frequent than DA and MT) to a three-model conditional production pattern (higher production rate for MP and MT than for DA and AC). This prediction was confirmed using an inference production task in children, adolescents, and adults.

Adolescent↗
PubMed2000

The task-specific nature of domain-general reasoning.

This paper develops a theory of how interpretative processes constrain inferential performance on conditional reasoning tasks. Experiment 1 investigated the hypothesis that performance on common reasoning tasks is mediated by different interpretive variables. Necessity and sufficiency relations predicted performance on the conditional arguments task, whereas on the Wason task, performance was predicted by whether the conditional statement instantiated a deontic or a factual relation. Performance on the truth-table task was predicted by both sets of variables. Experiment 2 explored the mapping relation between interpretation, representation, and inference. It was observed that conditional responses to the Wason and arguments tasks were based on different representations of the conditional relationship. These data rule out a simple model of the interplay between interpretation and reasoning in which the interpretation of a statement is driven solely by its content, and instead, indicate that the interpretation of conditional relations is task-specific.

Concept Formation↗
PubMed2002

Turning the tables: language and spatial reasoning.

This paper investigates possible influences of the lexical resources of individual languages on the spatial organization and reasoning styles of their users. That there are such powerful and pervasive influences of language on thought is the thesis of the Whorf-Sapir linguistic relativity hypothesis which, after a lengthy period in intellectual limbo, has recently returned to prominence in the anthropological, linguistic, and psycholinguistic literatures. Our point of departure is an influential group of cross-linguistic studies that appear to show that spatial reasoning is strongly affected by the spatial lexicon in everyday use in a community (e.g. Brown, P., & Levinson, S. C. (1993). Linguistic and nonlinguistic coding of spatial arrays: explorations in Mayan cognition (Working Paper No. 24). Nijmegen: Cognitive Anthropology Research Group, Max Planck Institute for Psycholinguistics; Cognitive Linguistics 6 (1995) 33). Specifically, certain groups customarily use an externally referenced spatial-coordinate system to refer to nearby directions and positions ("to the north") whereas English speakers usually employ a viewer-perspective system ("to the left"). Prior findings and interpretations have been to the effect that users of these two types of spatial system solve rotation problems in different ways, reasoning strategies imposed by habitual use of the language-particular lexicons themselves. The present studies reproduce these different problem-solving strategies in speakers of a single language (English) by manipulating landmark cues, suggesting that language itself may not be the key causal factor in choice of spatial perspective. Prior evidence on rotation problem solution from infants (e.g. Acredolo, L.P. (1979). Laboratory versus home: the effect of environment on the 9-month-old infant's choice of spatial reference system. Developmental Psychology, 15 (6), 666-667) and from laboratory animals (e.g. Restle, F. (1975). Discrimination of cues in mazes: a resolution of the place-vs.-response question. Psychological Review, 64, 217-228) suggests a unified interpretation of the findings: creatures approach spatial problems differently depending on the availability and suitability of local landmark cues. The results are discussed in terms of the current debate on the relation of language to thought, with particular emphasis on the question of why different cultural communities favor different perspectives in talking about space.

Adult↗
PubMed2002

What do you think I think you think?: Strategic reasoning in matrix games.

In reasoning about strategic interpersonal situations, such as in playing games, an individual's representation of the situation often includes not only information about the goals and rules of the game, but also a mental model of other minds. Often such mental models involve a hierarchy of reflexive reasoning commonly employed in social situations ("What do you think I think you think..."), and may be related to the developmental notion of 'theory of mind'. In two experiments, the authors formally investigate such interpersonal recursive reasoning in college-age adults within the context of matrix games. Participants are asked to predict the moves of another player (experimenter's confederate) in a two-choice, sequential-move game that may terminate at various stages with different payoffs for each player. Participants are also asked to decide optimally on their own moves based on the prediction made. Errors concerning the prediction, or translation of those predictions into decisions about one's action, were recorded. Results demonstrate the existence of a "default" mental model about the other player in the game context that is dynamically modified as new evidence is accumulated. Predictions about this other player's behavior are, in general, used consistently in decision-making, though the opponent tends to be modeled, by default, to behave in a myopic fashion not anticipating the participant's own action.

Adult↗
PubMed1998

Conditional reasoning with inducements and advice.

In an earlier study of conditional reasoning, Newstead et al. [Newstead, S.E., Ellis, C.E., Evans, J.St.B.T., Dennis, I., (1997). Conditional reasoning with realistic material. Thinking and Reasoning 3, 49-96] found that people drew more inferences from conditionals framed as inducements (threats and promises) than from conditionals phrased as advice (tips and warnings). The present study was designed to test the hypothesis that this difference arose from the fact that the speaker of an inducement is normally seen to have control over the consequent event whereas the giver of advice does not. In the experiment reported here, inducement and advice conditionals were constructed in brief contexts such that in either case the speaker could be seen to have high or low control. Participants drew many more conditional inferences of all kinds for high control than for low control conditionals in either context. A second finding of interest was that participants drew many more forward (antecedent to consequent) inferences than backward inferences with these kinds of realistic conditionals.

Adolescent↗
PubMed1999

The role of imagination in facilitating deductive reasoning in 2-, 3- and 4-year-olds.

When 4- and 6-year-olds are cued to use their imagination, they can overcome the belief bias effect and demonstrate deductive reasoning ability on syllogisms containing contrary-to-fact material. This study tested whether 2- and 3-year-olds could also reason with incongruent syllogisms when encouraged to use their imagination. Eighty-four 2-, 3- and 4-year-olds were randomly assigned to one of four conditions: no cue, word cue, fantasy planet or imagery. Children were then presented with six syllogistic reasoning problems containing incongruent information. In the imagination conditions, 2- and 3-year-olds performed as competently as 4-year-olds. The findings are discussed in relation to other research which suggests that under certain circumstances 2- and 3-year-olds have the capacity for counterfactual thinking.

Age Factors↗
PubMed2000

Lack of progress in labor as a reason for cesarean.

OBJECTIVE: To estimate the prevalence of lack of progress in labor as a reason for cesarean delivery and to compare published diagnostic criteria with the labor characteristics of women with this diagnosis. METHODS: We reviewed medical records and did a postpartum telephone survey to collect data from 733 women who delivered full-term, nonbreech infants by unplanned cesarean between March 1993 and February 1994. These were a subset of 2447 births sampled at delivery from 30 hospitals in Los Angeles County and Iowa. We measured the proportion of unplanned cesareans done for lack of progress in labor, the cervical dilatation at the time of cesarean, length of the second stage, and slope of the active phase among the women. We estimated the proportion of these cesareans that conformed to the ACOG criteria for the diagnosis of lack of progress. RESULTS: Lack of progress was a reason for 68% of unplanned, vertex cesareans. At least 16% of the subjects who had cesareans for lack of progress were in the latent phase of labor according to ACOG criteria. The second stage was not prolonged in 36% of the women who delivered at 10 cm. CONCLUSION: Lack of progress in labor is a dominant reason for cesarean delivery. Many cesareans are done during the latent phase of labor, and in the second stage of labor when it is not prolonged. These practices do not conform to published diagnostic criteria for lack of progress.

Adolescent↗
PubMed1997

Returns to service after mating and removal of sows for reproductive reasons from commercial swine farms.

We studied the records of 30 herds with an average inventory of 11,705 sows, 25,719 farrowings and 25,040 daily feed intake logs. Production events were recorded by producers using the PigCHAMP production information system. Of 21,505 matings, 7.2% of sows subsequently returned to estrus after service. The proportionate rates of intervals from service to the subsequent post service event were 0 to 17 d, 2.1%; 18 to 25 d, 27.9%; 26 to 37 d, 13.8%; 38 to 46 d, 15.8%; 47 to 108 d, 30.4%; and >108 d, 10.0%. Sows returned to service after mating were categorized into groups that either regularly or irregularly returned to service after mating. Of a total inventory of 19,076 sows, 10.0% were removed following weaning for reproductive reasons. The reasons for removal included those of anestrus (25.2%), failure to conceive (37.0%), failure to farrow (15.0%), not pregnant (1.4%), negative pregnancy check (14.0%), and abortion (7.4%). The last 5 types of post weaning reproductive failure were grouped into the category of did not farrow. Categorical additive models and comparisons using contrasts were used to analyze the influence of risk factors on reproductive failure. Parity 1 sows had a higher proportion (P < 0.01) of returns to service and a greater proportion of sows remaining anestrous post weaning relative to Parity 3 sows. The proportion of sows that did not farrow was higher (P < 0.01) in Parities 9 and 10 than in Parity 3. More sows were removed for anestrus during the spring (P < 0.01) and summer (P = 0.06) than during the winter. All categories of lactation length had similar rates of reproductive failure except for the lactation length 1 to 7 d, which had a higher (P < 0.05) proportion of reproductive failure. Lower lactational feed intake was associated with an increased risk of occurrence of each reproductive failure category. The odds ratios of lactation feed intake in logistic regression analyses were 0.84, 0.89, 0.82 and 0.88 for regularly and irregularly returned to service, anestrus, and did not farrow groups, respectively. This means, for example, that a sow was 0.88 times less likely to have an occurrence of not farrowing for each 1 kg increase in average daily feed intake during lactation. Our results indicate that lower and higher parities, spring and summer seasons, a lactation length of less than 8 d and lower feed intake during lactation affect the occurrence of return to service after mating and of herd removal for reproductive reasons.

Journal Article↗
PubMed1997

The impact of political violence on moral reasoning in children.

OBJECTIVE: The moral development of three groups of children, who had been subjected to varying degrees of political violence and economic advantage, was examined in an attempt to determine if group membership or gender influenced the level of moral reasoning or orientation. METHOD: Ninety-three 8- to 13-year-old Israeli Jewish and Bedouin school children, and Palestinian West Bank school children were asked various moral reasoning questions based on an animal fable involving a moral dilemma under three (hypothetical, role-taking, political) conditions. RESULTS: Results indicate that mutuality solutions to moral dilemmas were given more frequently by Israeli Jewish children than Israeli Bedouin or Palestinian children as the questions shifted from abstract to real-life situations. No significant gender differences were found between Jewish children and Bedouin children in hypothetical issues; however, violence and limited resources were found to affect moral judgment in real-life situations for boys, but not for girls. CONCLUSIONS: These findings supported the hypothesis that moral reasoning in children is significantly linked to real-life situations and resources. The results were discussed in terms of their relevance to future researchers and the manner in which children interpret moral questions.

Adolescent↗
PubMed1996

Reasons for delay in administration of antibiotics to patients with meningitis and meningococcaemia.

To determine the extent of, and reasons for, delay in treatment of patients with bacterial meningitis or meningococcal septicaemia, we reviewed the case notes of all adults admitted to Addenbrooke's Hospital, Cambridge with these diagnoses over a 3 year period. Thirty-three patients were identified. Some 70% (21/30) patients admitted via their GPs were not treated before admission. In 12 of these cases, the diagnosis was not considered. Nine patients were not treated despite the diagnosis of meningitis being considered possible or likely; in two cases this was due to suspected penicillin allergy, but no reason was given for the remaining seven. Of 24 patients untreated prior to hospital admission, only nine were given antibiotics before lumbar puncture had been performed. Failure to treat meningitis and meningococcaemia most often resulted from failure to consider the diagnosis, but treatment was delayed in a significant number of cases for no obvious reason. General practitioners and hospital doctors need to have a low threshold for administering antibiotics as soon as the diagnosis of bacterial meningitis or meningococcaemia is considered possible.

Adult↗
PubMedDate not supplied

Attempted suicide. Do we understand the patients' reasons?

This explorative study compared the patients', doctors', and nurses' views regarding their attribution of reasons for attempting suicide and the patients' emotional state immediately preceding their suicide attempts. A sample of 30 out of 94 consecutive patients seen in the emergency room of University Hospital were examined shortly after they had attempted suicide. Immediately after the routine clinical interview, conducted by a psychiatric resident and a nurse, patients filled in a questionnaire giving 14 possible reasons for attempting suicide as well as 8 feelings characterizing the emotional state preceding the suicide attempt. In the meantime, and without prior discussion of the case, the resident and the nurse independently completed the same questionnaire. In addition, sociodemographic and clinical data were obtained. Intrapersonal reasons such as to get relief from a terrible state of mind or from an unbearable situation were most frequently chosen by patients, nurses, and doctors alike. The most striking difference was found for "loss of control": this item was chosen significantly more often by patients than by nurses and doctors. Accordingly, patients reported significantly more often feelings of anxiety/panic and emptiness (mental vacuum), whereas feelings of despair and powerlessness/hopelessness were mentioned most frequently by nurses and doctors. Mental health professionals should bear in mind that many suicide attempters experience feelings of anxiety/panic prior to their suicidal act, and that a majority report having lost control over themselves, thus indicating a state of emotional crisis.

Adult↗
PubMedDate not supplied

A self-training program in inductive reasoning for low-education elderly: tutor-guided training vs. self-training.

The main aim of this study was to compare the effectiveness of a self-training program in inductive reasoning run for elderly with low levels of education. Two different training settings were considered, i.e. tutor-guided training and self-training, to ascertain whether results obtained in both settings would be similar. A total of 25 subjects took part in this study (average age = 68.266, range = 60-85 years), all volunteers and residents of the city of Granada. A quasi-experimental design was used with random assignment to either training setting. The design was applied in four stages: pre-test, cognitive training (tutor-guided vs. self-trained inductive reasoning), post-test immediately after training and follow-up at 3 months. Results show considerable gains in inductive reasoning training both in tutor-guided and self-trained groups.

Journal Article↗
PubMedDate not supplied

Reasons for adherence with antihypertensive medication.

BACKGROUND: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients' self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. METHODS: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. RESULTS: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. CONCLUSIONS: The interview is a powerful tool for ascertaining patients' concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients' doubts and difficulties with therapy can be detected and addressed. For this, effective patient-physician communication is of vital importance.

Adult↗
PubMed2002

Fairness, accountability for reasonableness, and the views of priority setting decision-makers.

Fairness is a key goal of priority setting and 'accountability for reasonableness' has emerged as the leading framework for fair priority setting. However, it has not been shown acceptable to those engaged in priority setting. In particular, since it was developed in the context of a primarily privately funded health system, its applicability in a primarily publicly funded system is uncertain. In this paper, we describe elements of fairness identified by decision-makers engaged in priority setting for new technologies in Canada (a primarily publicly funded system). According to these decision makers, accountability for reasonableness is acceptable and applicable. Our findings also provide refinements to accountability for reasonableness.

Advisory Committees↗
PubMed2003

Reasons for non-enrollment in a cohort study of ARF: the Program to Improve Care in Acute Renal Disease (PICARD) experience and implications for a clinical trials network.

BACKGROUND: Acute renal failure (ARF) is associated strongly with in-hospital mortality and morbidity. Previous clinical trials of ARF have been hampered by the heterogeneous population affected, difficulty defining ARF, delays in identification of ARF, and significant comorbid conditions, among other factors. METHODS: The Program to Improve Care in Acute Renal Disease (PICARD) phase I was a multicenter cohort study aimed to identify clinical characteristics and practice patterns associated with adverse and favorable outcomes in patients with ARF in intensive care units. Although PICARD used no interventions, signed informed consent was required of all study subjects or their proxies. RESULTS: Signed informed consent was obtained in 645 of 1,243 ARF episodes (52%). The fraction of patients not enrolled and reasons for non-enrollment varied widely across the 5 PICARD centers. Refusal by potential study subjects was infrequent, although the absence of family or proxy (15%) and refusal by family or proxy (18%) accounted for large fractions of non-enrolled subjects. Death (23%) and discharge (11%) before study personnel could evaluate patients were additional important reasons for non-enrollment. CONCLUSION: Understanding reasons for non-enrollment may help rationalize mortality and other outcome differences seen in clinical trials and cohort studies that require informed consent compared with historic reports of "all comers" with ARF.

Acute Kidney Injury↗