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At least 1,333 records · Page 74Linked to original sources
PubMed1998

Reasons for removal of rigid internal fixation devices in craniofacial surgery.

Despite the widespread use of rigid fixation techniques in craniofacial surgery, there is a paucity of studies in the literature that serve to better define the reasons for the subsequent removal of plates and screws. The current study appears to be the first to attempt to assess these issues among a broad range of craniofacial surgery patients. Fifty-five patients who underwent hardware removal following craniofacial surgery at the University of Michigan Medical Center between 1989 and 1995 were retrospectively studied via an in-depth chart review. Common reasons for hardware removal included palpable/prominent hardware in 19 patients (34.5%), loosening of plates and screws in 14 patients (25.5%), pain in 14 patients (25.5%), infection in 13 patients (23.6%), wound dehiscence/exposure of hardware in 11 patients (20%), and removal at the time of secondary procedures in 5 patients (9.1%). It is hoped that this study will serve as a tool to define more completely the risk of needing subsequent hardware removal among craniofacial surgery patients treated with rigid internal fixation.

Adolescent↗
PubMed1987

Use of a medical reasoning aptitude test to help predict performance in medical school.

A medical reasoning aptitude test (MRAT) was designed to assess aptitude for clinical problem-solving in medical school applicants. The purpose of the study reported here was to determine whether the information provided by this test, when used in conjunction with college grade-point averages (GPAs) and scores on the Medical College Admission Test (MCAT), would improve the prediction of medical school performance. Specifically, the authors investigated the incremental predictive value of the MRAT relative to students' overall performance in medical school and, more specifically, to their knowledge and clinical reasoning during preclinical years and clinical performance during the clerkship year. Overall, it was found that, with the exception of the first year, the addition of MRAT scores to the GPAs and MCAT scores increased precision in identifying students who performed poorly or exceptionally well in the second year and the clinical clerkship year. This last finding is especially useful, since few other tests have provided that information. On the basis of the preliminary findings, the authors propose further use and validation of the MRAT.

Achievement↗
PubMed2000

Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.

Medical diagnosis is a categorization task that allows physicians to make predictions about features of clinical situations and to determine appropriate course of action. The script concept, which first arose in cognitive psychology, provides a theoretical framework to explain how medical diagnostic knowledge can be structured for diagnostic problem solving. The main characteristics of the script concept are pre-stored knowledge, values acceptable or not acceptable for each illness attribute, and default values. Scripts are networks of knowledge adapted to goals of clinical tasks. The authors describe how scripts are used in diagnostic tasks, how the script concept fits within the clinical reasoning literature, how it contrasts with competing theories of clinical reasoning, how educators can help students build and refine scripts, and how scripts can be used to assess clinical competence.

Diagnosis↗
PubMed2001

Reasons reviewers reject and accept manuscripts: the strengths and weaknesses in medical education reports.

PURPOSE: Scientific journals rely on peer review to maintain the high quality and standards of papers accepted for publication. The purpose of this study was to explore the strengths and weaknesses of medical education reports by analyzing the ratings and written comments given by external reviewers. METHOD: The author conducted a content analysis of reviewers' comments on 151 research manuscripts submitted to the 1997 and 1998 Research in Medical Education conference proceedings. The negative comments on 123 manuscripts that received "questionable, probably exclude" or "definitely exclude" overall ratings from at least one reviewer were evaluated. A similar analysis was performed on reviewers' positive comments for 28 manuscripts recommended unanimously for acceptance. RESULTS: On average, four peers (4.1, SD = 0.97, range = 2-6) reviewed each manuscript. Of those recommended for exclusion, a mean of 2.3 reviewers recommended exclusion and each reviewer wrote a mean of 8.1 (SD = 5.7) reasons. The top ten reasons for rejection were: inappropriate or incomplete statistics; overinterpretation of results; inappropriate or suboptimal instrumentation; sample too small or biased; text difficult to follow; insufficient problem statement; inaccurate or inconsistent data reported; incomplete, inaccurate, or outdated review of the literature; insufficient data presented; and defective tables or figures. The main strengths noted in accepted manuscripts were the importance or timeliness of the problem studies, excellence of writing, and soundness of study design. CONCLUSION: While overstating the results and applying the wrong statistics can be fixed, other problems that the reviewers identified (ignoring the literature, designing poor studies, choosing inappropriate instruments, and writing poor manuscripts) are likely to be fatal flaws warranting rejection.

Curriculum↗
PubMed2005

The role of biomedical knowledge in clinical reasoning: a lexical decision study.

PURPOSE: To investigate the role of biomedical and diagnostic inferences in clinical reasoning of advanced medical students and experienced family physicians using a lexical decision task. METHOD: In 2002, 15 family physicians and 20 fourth-year medical students at Maastricht University medical school in The Netherlands were instructed to carefully study 60 short clinical texts consisting of signs and symptoms associated with a particular disease. Participants read the texts on a computer screen and responded using a computer keyboard. Each text was followed by a target item (i.e., biomedical item, diagnostic item, or a nonword). Participants had to decide as quickly and accurately as possible whether the presented target item was a word or a nonword. For both groups, mean response time and mean error rate for all levels of item type were analyzed. RESULTS: Findings indicate that both physicians and medical students judged diagnostic target items faster and more accurately than biomedical target items. However, physicians were considerably faster than were students on judging biomedical and diagnostic target items. CONCLUSIONS: These findings are largely in line with knowledge encapsulation in that biomedical knowledge still plays a prominent role in the physician's clinical reasoning.

Adult↗
PubMed1996

Reasons for failure of prevention of Toxoplasma encephalitis. Swiss HIV Cohort Study.

OBJECTIVE: To study whether absence of prophylaxis is a risk factor for cerebral toxoplasmosis, and to determine the reasons for absence of prophylaxis among AIDS patients diagnosed with Toxoplasma encephalitis (TE). DESIGN: Retrospective chart review and matched case-control study. PATIENTS: Patients (104 first episodes and 26 relapses of TE) were registered in the Swiss HIV Cohort Study from three centres from July 1992 to December 1994; 91 matched controls were included for 52 patients with a first episode, and 17 matched controls for 17 patients with relapse of TE. RESULTS: Prophylaxis was prescribed to 17 patients (16%) with a first episode and 19 patients (73%) with a relapse of TE. Reasons for the absence of prophylaxis included patient refusal (25%), non-proposal by physicians (17%), and drug intolerance (17%). Reduced absorption due to non-compliance, diarrhoea or vomiting was identified among 12 patients with a first episode and 14 patients with a relapse of TE. Absence of prescription of prophylaxis was associated with a 10-fold increased risk of a first episode of TE (odds ratio, 9.8; 95% confidence interval, 2.7-35.4) in the matched case-control study. CONCLUSIONS: TE continues to occur among patients not receiving prophylaxis. At least one-half of the cases may be prevented with better motivation of physicians and increased compliance of patients.

AIDS-Related Opportunistic Infections↗
PubMed2001

Reasons for modification and discontinuation of antiretrovirals: results from a single treatment centre.

OBJECTIVE: To describe the reasons for, and factors associated with, modification and discontinuation of highly active antiretroviral therapy (HAART) regimens at a single clinic. SUBJECTS: A total of 556 patients who started HAART at the Royal Free Hospital were included in analyses. Modification was defined as stopping or switching any antiretrovirals in the regimen, whereas discontinuation was defined as the simultaneous stopping of all antiretrovirals included in the initial regimen. Reasons were classified as immunological/virological failure (IVF) and toxicities and patient choice/poor compliance (TPC). RESULTS: The median CD4 count at starting HAART was 171 x 10(6) cells/l and viral load 5.07 log copies/ml. During a median follow-up of 14.2 months, 247 patients (44.4%) modified their HAART regimen, 72 due to IVF (29.1%) and 159 due to TPC (64.4%) and a total of 148 patients (26.6%) discontinued HAART. Older patients were less likely to modify HAART [relative hazard (RH), 0.73 per 10 years; P = 0.0008], as were previously treatment-naive patients (RH, 0.65; P = 0.0050), those in a clinical trial (RH, 0.64; P = 0.027) and those who started nelfinavir (RH, 0.57; P = 0.035). Patients who started with four or more drugs (RH, 2.21, P < 0.0001), who included ritonavir in the initial regimen (RH, 1.41; P = 0.035) or who had higher viral loads during follow-up (RH per log increase, 1.51; P < 0.0001) were more likely to modify HAART. CONCLUSIONS: There was a high rate of modification and discontinuation of HAART regimens in the first 12 months, particularly due to toxicities, patient choice or poor compliance.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

Examination of deficits in conceptual reasoning abilities associated with spina bifida.

This study explores the "higher order" cognitive abilities of conceptual reasoning, problem solving, mental flexibility, and efficiency in 36 adolescents with spina bifida. The subjects, age 10 to 23 years, were assessed on a set of neuropsychological measures, and an individual profile analysis was conducted. All subjects, regardless of intelligence quotient, evidenced significant impairments of mental flexibility, efficiency of processing, conceptualization, or problem-solving ability. Separate data analysis was carried out for subjects with an average intelligence quotient. Results indicated a high degree of variability within profiles with at least one area of dysfunction (as determined by performance less than the 15th percentile) for each subject. This study demonstrates the need for individual analysis of "higher order" cognitive functions including conceptual reasoning, problem solving, mental flexibility, and efficiency of thinking for children who have spina bifida, regardless of level of lesion or general intelligence level. It is argued that neuropsychological deficits underlie the "motivational" and academic difficulties observed often among this population, especially for those with an average intelligence quotient. These data support the need to assess conceptual abilities in children with spina bifida and to provide consultation and early intervention services.

Adolescent↗
PubMed1990

Paradigm case analysis and stimulated recall: strategies for developing clinical reasoning skills.

Development of clinical reasoning skills was a major objective of a collaborative venture between a university school of nursing and a tertiary care teaching hospital. Two elective courses and an 8-month practicum were offered at the graduate level to students specializing in perinatal nursing. Through analysis of their own cases and those of clinical experts, students gained expertise in tracing the development of their decision-making skills. In the clinical practicum, where it was less feasible for the student and preceptor to withdraw from the clinical setting to discuss the decision-making process, "stimulated recall" was employed. This strategy uses segments of nurses' actual practice, on site, at the time of care delivery. In this way, the total context of the clinical reasoning process of nurses can be examined. In this paper, the two strategies are discussed with illustrations from the actual teaching/learning situations.

Decision Making↗
PubMed2000

Moral reasoning, professionalism, and the teaching of ethics to orthopaedic surgeons.

Moral reasoning is not the only component of moral behavior, but it is an important and measurable constituent. Eighty orthopaedists, who took a standardized test of moral reasoning, showed marked heterogeneity in scores, ranging from the level of junior high students to the level of moral philosophers. This variability poses difficulty for those who plan educational courses in ethics, but is not an insurmountable difficulty.

Ethics, Medical↗
PubMedDate not supplied

Reasons for the selection of burn-scar-support suppliers by burn centers in the United States: a survey.

Several companies currently market anti-burn-scar pressure garments to burn centers. Because of the numerous available choices, decisions about the reasons for selecting a garment are often confusing to those who are responsible for ordering the supports. This study was conducted to assist in decision making about garment selection by determining the relative importance of various factors in selecting brands of anti-burn-scar supports. A survey questionnaire was sent to 101 randomly selected burn centers in the United States, asking about the reasons for their choice of pressure-support suppliers. Sixty-two survey (61%) respondents indicated factors used in selection of a manufacturer. The factors included ease of accessibility for orders (97%), ease of measurement methods (90%), reliability of fit with the first garment ordered (90%), ability to fashion either a nonstandard support (77%) or special options into a garment (76%), provision of measurement materials (65%), and costs of the support (63%). Availability of standard garment options (50%) and/or choice of colors (31%) were listed less frequently. Twenty-four burn centers (39%) use only one company for orders, whereas 20 (31%) use two, 9 (15%) use three, and 9 (15%) use four different suppliers. Industry responses to these findings were gathered and presented as well. The results of this survey would indicate that burn staff have viable options of pressure-garment suppliers to assist them in responding to the scar-control needs of their patients.

Bandages↗
PubMed1998

Reasoning about moral aspects of illness and treatment by preschoolers who are healthy or who have a chronic illness.

Our study evaluates the moral reasoning skills of healthy and chronically ill 3 and 4 year olds with respect to illness and treatment, by use of an interview technique that reduces verbal demands on the child. We presented children with pairs of scenarios comparing ill characters with characters acting immorally and characters being punished, as well as with pairs of scenarios comparing treated characters with characters acting immorally and characters being punished. We asked children to point to the character who did something "naughty." With the exception of the chronically ill 3 year olds, the children performed consistently above chance and did not confuse illness and immorality. Older and healthy children performed better than younger and chronically ill ones (differences were the result of differing receptive vocabulary skill levels). This research has implications for evaluating young children's reasoning abilities and suggests that medical professionals should use tools that reduce demands on children's verbal proficiency.

Attitude to Health↗
PubMed1991

Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task.

An experiment is described in which deluded subjects with a diagnosis of schizophrenia or of delusional disorder (paranoia) were compared with a nondeluded psychiatric control group and a normal control group on a probabilistic inference task. Factors relevant to belief formation and maintenance were investigated. Deluded subjects requested less information before reaching a decision and were more ready to change their estimates of the likelihood of an event when confronted with potentially disconfirmatory information. No differences were found between the two diagnostic groups of deluded subjects. The results are discussed in light of prevailing theories of the importance of abnormal experience rather than reasoning biases in the formation and maintenance of delusional beliefs. It is suggested that a reasoning abnormality is involved, which may coexist with perceptual abnormalities.

Adolescent↗
PubMed1993

Risk factors for secondary depression among Mexican Americans and non-Hispanic whites. Alcohol use, alcohol dependence, and reasons for drinking.

We evaluated demographic (age, gender, income), cultural (ethnicity, acculturation), clinical (alcohol use, alcohol dependence), and motivational (subjective reasons for drinking) potential risk factors for secondary depression in 372 persons with lifetime alcohol abuse or dependence (from a randomly selected community sample of 2393). Lifetime alcohol abuse or dependence increased the risk of major depression by a factor of approximately 2 to 7. Recent secondary depression was present in 2% to 18% of persons meeting criteria for alcohol use disorders. Low income, female gender, and among Mexican Americans, low acculturation were associated with increased risk of secondary depression. Persons with lifetime alcohol diagnoses who currently drank, but did not name relaxation as a reason for drinking, were also at higher risk for secondary depression. Drinking to forget was associated with increased risk of secondary depression among Mexican American alcoholics, but not among non-Hispanic white alcoholics. Current abstinence was associated with greater risk among lifetime alcoholics born in Mexico, but not among those born in the United States.

Adult↗
PubMed2001

Top 10 reasons for endoscopic maxillary sinus surgery failure.

OBJECTIVE/HYPOTHESIS: Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell-Luc procedure for correction of problems with the maxillary sinus. Unfortunately, a significant number of patients have persistent maxillary symptoms after one or more endoscopic sinus operations. Existing reviews of this issue have identified only a few general causes for surgical failure. METHODS: The records of 85 patients presenting to the author over a 5-year period with persistent maxillary sinus symptoms were reviewed. RESULTS: In reviewing the causes of persistent disease requiring revision surgery, the author identified 10 categories of reasons for failure to improve. Many patients have multiple causes that could be individually or sequentially identified. Some problems associated with surgical failure were likely present at the time of initial presentation, whereas others were undoubtedly caused by the first surgical procedure. Ten reasons for maxillary sinus surgical failure identified were clustered into the following categories: 1) obstructed natural ostia, 2) disease in the anterior ethmoid or frontal sinus, 3) resistant organisms, 4) intrasinus foreign body, 5) incurable mucosal disease, 6) noncompliant patient, 7) wrong primary diagnosis, 8) maxillary osteitis, 9) mucus maltransport, and 10) fundamental immunodeficiency. CONCLUSIONS: A careful assessment of each patient with persistent maxillary sinus disease is central to understanding each specific patient and should include a careful history, a detailed endoscopic examination, repeat computed tomography imaging, culture of secretions, and possible revision surgery.

Endoscopy↗
PubMedDate not supplied

Strengthening clinical reasoning in graduate nursing students.

Clinical reasoning skills are the cornerstone of successful nursing practice. To strengthen the clinical reasoning skills of graduate nursing students, faculty at one university developed an innovative course focusing on theoretical knowledge about clinical decision making and reflective exercises to foster student thinking.

Clinical Competence↗
PubMedDate not supplied

Enhancing diagnostic reasoning skills in nurse practitioner students: a teaching tool.

The Advanced Health Assessment course provides an opportunity to focus on critical thinking and diagnostic reasoning skills as students transition to the nurse practitioner role. The authors describe a structured teaching tool designed for faculty to use in facilitating diagnostic reasoning and clinical judgment. This tool gives faculty a format to use in the classroom or online for helping students decide which data to collect and which data are important in developing hypothesis driven differential diagnoses.

Humans↗
PubMedDate not supplied

Using the Revised Bloom's Taxonomy in the clinical laboratory: thinking skills involved in diagnostic reasoning.

Achieving effective transfer of theoretical knowledge to clinical practice requires knowledge of thinking paradigms in relation to specific nursing content. It is a challenge to develop instructional designs for teaching and assessing implicit thought processes involved in clinical reasoning. The authors demonstrate the use of the Revised Bloom's Taxonomy to teach thinking skills involved in diagnostic reasoning in a clinical laboratory.

Attitude of Health Personnel↗