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PubMed2005

[Should a minor, unattended by a parent, be given medical services? Use of an algorithm to critique the Israel Ministry of Health regulations].

BACKGROUND: Parents are the natural custodians of their children, thus minors need parental approval to receive medical services. In February 2004, the Israel Ministry of Health issued a set of regulations titled "Visits of unaccompanied minors to primary care clinics", aimed at assisting primary care clinicians in their decision-making process on this sensitive issue. AIMS: (1) To convert the above mentioned regulations into an algorithmic format in order to facilitate their use by community clinicians, and (2) To review and critique the regulations, using the process of algorithm conversion. METHODS: The regulations were studied thoroughly. Three rounds of Delphi process for reaching consensus were used to create an algorithm, based on these regulations. The algorithm building process was used to critique the regulations. RESULTS: The Israel Ministry of Health regulations, "Visits of unaccompanied minors to primary care clinics", were found to be long and complicated. The process of building the algorithm revealed several difficulties certain concepts were not well defined, many exceptional situations were found and a large portion of the regulations was dedicated to reporting and record keeping. Converting the regulations into an algorithmic format simplified them and assisted in their CONCLUSIONS: Converting complex regulations into an algorithmic format can facilitate their daily use by community clinicians. Parts of the regulations for "Visits of unaccompanied minors to primary care clinics" are incompatible with present clinic routine and, therefore, difficult to implement.

Adolescent↗
PubMed2005

Nursing contributions to the elimination of health disparities among African-Americans: review and critique of a decade of research.

The excessive burden of disease experienced by African-Americans has long been described by authorities in the public, private, and professional sector as a national health concern. Several reports have been published in the peer-reviewed literature that describe the outcomes of nurse-directed studies aimed at addressing the factors associated with the disparities experienced by African-Americans and these reports were also aimed toward the design of interventions to reduce and/or eliminate them. However, little is known about the scope, quality, and impact of these efforts relative to the promotion of health and the prevention of disease among African-Americans. This report presents the results of a review, analysis, and critique of reports of outcomes of nursing research aimed toward reducing health-related disparities among African-Americans. These reports were described in a selected group of African-American nursing organizations and journals dedicated to providing a forum for the discussion of issues focused on cultural diversity, transcultural nursing, and multicultural health care issues. Included among the journals were the Journal of the National Black Nurses Association, the Journal of the Association of Black Nursing Faculty, the Journal of Chi Eta Phi Sorority, the Journal of Cultural Diversity, the Journal of Transcultural Nursing, and the Journal of Multicultural Nursing and Health. Results of the review will be reported in three parts, the first of which was reported in an earlier edition (Journal of National Black Nurses Association, Volume 15, No. 1) and the second part of which is reported here. The third part will be reported in a future issue of the Journal of National Black Nurses Association. The results revealed that this body of nursing research provides the profession with a broad base of knowledge and insights. This knowledge is relative to the individual and familial impact of cardiovascular disease, cancer, diabetes, HIV/AIDS, mental health and mental illness, and Sickle Cell Disease within the African-American community. Knowledge and insights relative to the concerns and needs of childbearing, parenting the elderly caregivers and caregiving in African-American population groups is essential if health-care disparities are to be truly eliminated. This review, analysis, and critique also revealed several gaps and limitations within this body of nursing research.

Black or African American↗
PubMed2006

Computed critiquing integrated into daily clinical practice affects physicians' behavior--a randomized clinical trial with AsthmaCritic.

OBJECTIVE: We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners' electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice. METHODS: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV 1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice. RESULTS: The number of contacts increased in the age group of 12-39 years. The number of FEV1 , peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. CONCLUSIONS: Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.

Adolescent↗
PubMedDate not supplied

[Experiment in sense and behavior therapy. Critique of J. Wolpe and St. Rachman on S. Freud's study].

In 1960 Wolpe and Rachman published a critique of psychoanalytic evidence based on Freud's case of Little Hans. No one has yet attempted to contest their argument. In a review of this classic critique it is shown that Wolpe and Rachman misrepresent and misunderstand central points of Freud's study. The alternative view of Hans' phobia which Wolpe and Rachman put up was already considered by Freud himself and rejected for good reasons. Some fundamental assumptions of behavior therapy and psychoanalysis are contrasted. The authors point out that psychologists have to develop their own philosophy of science.

Behavior Therapy↗
PubMed1994

Critical science and the critique of technology.

Environmental and occupational epidemiology are in the tradition of "critical science." Critical science is a mode of science in which scientific methods are used to critique the adverse consequences of technological development. Critical science should be explicitly recognized as a paradigm in interdisciplinary research. It is the "mode" in which environmental and occupational epidemiology function and the role that these and related disciplines play in society. As the feedback to society on the performance of technology, critical science has assumed a major role in modern society by providing an acceptable critique of technological development. The close association between scientific research and technology of the last three and one-half centuries has been the exception to the historical rule. Intelligent guidance of technology in modern society makes public participation and education in scientific, biomedical, and technical affairs imperative. Critical science in its interdisciplinary dimension is imperative to this public process. Truly interdisciplinary work can only be accomplished when the disciplinary underpinnings are strong and when individual investigators are encouraged to pursue their individual priorities. Critical science is no exception and requires encouragement of skepticism on the part of the investigator toward conventional assumptions.

Ecology↗
PubMed1993

Criteria for critiquing clinical nursing research reports.

The primary goal of nursing research is to develop a scientific knowledge base for practice. Postanesthesia nurses are expected to critique nursing research before applying findings to clinical practice. As consumers of research, postanesthesia nurses must be able to employ critical evaluation skills to judge the merit and relevance of research to their clinical practice. This article presents criteria for critiquing clinical nursing research reports to determine their relevance to practice.

Evaluation Studies as Topic↗
PubMed1993

Critiquing research instruments for postanesthesia studies.

A recent series of articles instructed PACU nurses on steps in developing pencil-and-paper instruments for research studies. What questions should PACU nurses ask when considering the use of existing pencil-and-paper instruments for use in research studies? The purpose of this article is to present nine steps in critiquing existing instrument before conducting research studies. Included are ethical considerations when using instruments and a checklist to assist PACU nurses in critiquing existing instruments.

Ethics, Nursing↗
PubMed1997

Critique of the National Cancer Institute of Canada's framework for cancer control.

This paper offers a critique of the National Cancer Institute of Canada's (NCIC) framework for cancer control. The critique has been prepared by researchers who used the framework to review the literature in 5 substantive areas. These reviews, published in the current and previous issues of CPC, were designed to begin to outline a research agenda for the Sociobehavioural Cancer Research Network. In this paper, the authors reflect on the strengths and limitations of the framework. Perceived strengths are that the framework (a) facilitates systematic thinking about research options and priorities, (b) helps foster clear communication, (c) links science and practice, (d) may assist grant review panels to place proposed studies in context and (e) emphasizes important values. Perceived concerns include the following: (a) potential users are not familiar with the framework, (b) lack of clarity of definitions and classification criteria, (c) the utility of the framework is not immediately self-evident to potential users, (d) the framework lacks emphasis on environmental and policy interventions and (e) it is not clear how the values espoused are to be integrated with other dimensions of the framework. The concerns were seen as remediable. In short, the framework was seen to be valuable in its current form; refinement may enhance its value.

Canada↗
PubMed1985

The multiaxial system of DSM-III: where did it come from and where should it go? I. Its origins and critiques.

The multiaxial system for evaluation is widely regarded as one of the most important contributions of DSM-III. The concept of multiaxial evaluation, that an individual is evaluated in terms of several different domains of information that are assumed to be of high clinical value, was introduced in the United States in the mid-1970s. Its value for clinical and research work was quickly recognized, and in the first year of the development of DSM-III, in 1976, a decision was made to incorporate such a system in the manual. This report reviews both the background of the development of the DSM-III multiaxial system and critiques that have been made of each of the axes since its publication in 1980. A companion report reviews empirical studies of the system and offers suggestions for its further development.

Attitude of Health Personnel↗
PubMed1981

The esophageal obturator airway. A critique.

The esophageal obturator airway (EOA) has been used in cardiopulmonary resuscitation since 1973. The device is inserted into the esophagus and isolates the stomach from the airways by an occlusive balloon located below the tracheal bifurcation. It aims to prevent gastrointestinal inflation and regurgitation and to provide ventilation. A critique and literature review point out the speed and ease of insertion (5 s), short training period, and efficacy as it relates to blood gases and tidal volumes, which are comparable with those obtained with endotracheal intubation. Complications, including esophageal trauma and tracheal entry, are discussed, indicating their low incidence. As optimal endoscopic facilities are often unavailable at the site of cardiopulmonary arrest, the use of the EOA by trained personnel as an alternative or preceding technique is advocated.

Esophagus↗
PubMed1984

Reply to "Validity of five MMPI alcoholism scales: a critique and reanalysis".

Replied to Hays and Stacy's critique of an article by Holmes, Dungan and McLaughlin in which the validity of MMPI alcoholism scales was questioned. Hays and Stacy asserted that the original authors misinterpreted the results of the statistical analyses. The present article presents support for the original conclusions and comments on Hays and Stacy's reanalysis.

Alcoholism↗
PubMed1998

A critique of the use of the Kolmogorov-Smirnov (KS) statistic for the analysis of BOLD fMRI data.

The use of the Kolmogorov-Smirnov (KS) statistic for testing hypotheses regarding activation in blood oxygenation level-dependent functional MRI data is critiqued on both theoretical and empirical grounds. Theoretically, it is argued that the KS test is formally unable to support inferences of interest to most neuro-imaging studies and has reduced sensitivity compared with parametric alternatives. Empirically, false-positive rates yielded by the KS test in human data collected under the null hypothesis were significantly in excess of tabular values. These excessive false-positive rates could be explained by the presence of temporal autocorrelation. We also present evidence that the distribution of blood oxygenation level-dependent functional MRI data is only slightly nonnormal, questioning the initial impetus for the use of the KS test in this context. Finally, it is noted that parametric alternatives exist that do provide adequate control of the false-positive rate and can support inferences of interest.

Algorithms↗
PubMed2000

A critique of surgical cytoreduction in advanced ovarian cancer.

Due in most part to the abundant retrospective evidence suggesting that surgical cytoreduction is essential to the management of advanced ovarian cancer, most clinicians do not question its application. Irrespective, there are many who still doubt its value, given its unique role in ovarian cancer, in comparison to other solid tumors. While many papers have extolled the virtues of debulking surgery, few have taken the opposing view. This paper attempts to expose the weaknesses in the current available data regarding surgical cytoreduction in advanced ovarian cancer. By reviewing the retrospective data, the theoretical benefits of surgery, cellular kinetics, the fallacies of residual disease, interval debulking surgery, and neoadjuvant chemotherapy, a critique of debulking surgery is made. Issues surrounding perioperative morbidity and its impact on quality of life have not been adequately addressed. Despite the need for randomized trials of surgery in advanced ovarian cancer, they are unlikely to occur. The window of opportunity with respect to studying the questions on the optimal timing, degree of aggressiveness, and patient selection for surgery has likely passed. Biases and ethical issues based upon the data cited in this paper have and will continue to hamper our ability to fully elaborate the benefits of surgery with respect to survival and quality of life.

Female↗
PubMed2001

A critique of EPA's index of watershed indicators.

Numerous indices have been developed to assess water quality and the impact of programs to improve quality. The Index of Watershed Indicators (IWI) is one such index created by the US Environmental Protection Agency to assess watershed vulnerability and condition in the United States. The credibility and applicability of subjective indices such as IWI depends upon their ability to withstand tests that challenge their internal consistency and interpretation. This paper critiques IWI on the basis of these tests and other considerations, and suggests that explicitly basing the index on multiattribute utility theory and methods could help resolve many of these difficulties.

Biomarkers↗
PubMed1980

A critique of the contributions of immunoperoxidase cytochemistry to our understanding of pituitary cell function, as illustrated by our current studies of gonadotropes, corticotropes and endogenous pituitary GnRH and TRH.

The peroxidase-antiperoxidase technique has been used to study sites of pituitary hormone storage and binding. Some recent findings from our laboratory show that the technique can make intriguing contributions to our understanding of pituitary cell function. In serial, ultra-thin sections, one can identify two or three hormones in a given cell. During pre-pubertal development, gonadotropes may contain adrenocorticotropin immunoreactivity. Brain releasing hormones may be stored or sequestered in granules of cells they stimulate. This report includes a discussion and critique of our recent findings and interpretations which must be considered before one draws any conclusions about their biological significance.

Adrenocorticotropic Hormone↗
PubMed1977

A diagnostic system for organic brain disorders: critique and suggestion.

Organic brain disorders (OBD) are among the most complex psychiatric diagnostic problems. A critique of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM II) and the proposed DSM III suggests that the diagnostic outline for organic brain disorders contained in these publications (Organic Brain Syndromes in the DSM II; Organic Mental Syndromes in the proposed DSM III) is inadequate to describe the potential range of organic-based behavioral disorders and their possible organic etiologies. A new diagnostic system is proposed, with examples, of its use, which should fit in with the DSM II and the proposed DSM III and be flexible enough to overcome the problems of the present diagnostic system.

Affective Symptoms↗
PubMed1995

A review and critique of the process approach in neuropsychological assessment.

This paper surveys the process approach literature with an emphasis on higher level cognitive functions like attention and concentration, learning and memory, and problem solving and executive functioning. In particular, it discusses organizational strategies and kinds of errors found on a variety of tests as well as behavioral, situational, and interpersonal issues as they relate to test procedures. It critiques the process approach and suggests future directions.

Cognition↗
PubMed2002

Riparian livestock exclosure research in the western United States: a critique and some recommendations.

Over the last three decades, livestock exclosure research has emerged as a preferred method to evaluate the ecology of riparian ecosystems and their susceptibility to livestock impacts. This research has addressed the effects of livestock exclusion on many characteristics of riparian ecosystems, including vegetation, aquatic and terrestrial animals, and geomorphology. This paper reviews, critiques, and provides recommendations for the improvement of riparian livestock exclosure research. Exclosure-based research has left considerable scientific uncertainty due to popularization of relatively few studies, weak study designs, a poor understanding of the scales and mechanisms of ecosystem recovery, and selective, agenda-laden literature reviews advocating for or against public lands livestock grazing. Exclosures are often too small (<50 ha) and improperly placed to accurately measure the responses of aquatic organisms or geomorphic processes to livestock removal. Depending upon the site conditions when and where livestock exclosures are established, postexclusion dynamics may vary considerably. Systems can recover quickly and predictably with livestock removal (the "rubber band" model), fail to recover due to changes in system structure or function (the "Humpty Dumpty" model), or recover slowly and remain more sensitive to livestock impacts than they were before grazing was initiated (the "broken leg" model). Several initial ideas for strengthening the scientific basis for livestock exclosure research are presented: (1) incorporation of meta-analyses and critical reviews. (2) use of restoration ecology as a unifying conceptual framework; (3) development of long-term research programs; (4) improved exclosure placement/ design; and (5) a stronger commitment to collection of pretreatment data.

Animals↗