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Sample records for clinical reasoning knowledge

  1. A Framework for a Clinical Reasoning Knowledge Warehouse

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus; Boye, Niels

    2004-01-01

    , Knowledge Management Systems and Business Intelligence to make context based, patient case specific analysis and knowledge management. The knowledge base integrates three sources of information that supports clinical reasoning: general information, guidelines and health records. New generalized knowledge...

  2. A Framework for a Clinical Reasoning Knowledge Warehouse

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus; Boye, Niels

    2004-01-01

    In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. This paper presents a framework for a Clinical Reasoning Knowledge Warehouse that combines theories and models from Artificial Intelligence...... is stored and made accessible when relevant to the reasoning context and the specific patient case. Furthermore, the information structure supports the creation of new generalized knowledge using data mining tools. The patient case is divided into an observation level and an opinion level. At the opinion...

  3. Semantics-based plausible reasoning to extend the knowledge coverage of medical knowledge bases for improved clinical decision support.

    Science.gov (United States)

    Mohammadhassanzadeh, Hossein; Van Woensel, William; Abidi, Samina Raza; Abidi, Syed Sibte Raza

    2017-01-01

    Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians' experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mechanisms apply patterns from human thought processes, such as generalization, similarity and interpolation, based on attributional, hierarchical, and relational knowledge. Plausible reasoning mechanisms include inductive reasoning, which generalizes the commonalities among the data to induce new rules, and analogical reasoning, which is guided by data similarities to infer new facts. By further leveraging rich, biomedical Semantic Web ontologies to represent medical knowledge, both known and tentative, we increase the accuracy and expressivity of plausible reasoning, and cope with issues such as data heterogeneity, inconsistency and interoperability. In this paper, we present a Semantic Web-based, multi-strategy reasoning approach, which integrates deductive and plausible reasoning and exploits Semantic Web technology to solve complex clinical decision support queries. We evaluated our system using a real-world medical dataset of patients with hepatitis, from which we randomly removed different percentages of data (5%, 10%, 15%, and 20%) to reflect scenarios with increasing amounts of incomplete medical knowledge. To increase the reliability of the results, we generated 5 independent datasets for each percentage of missing values, which resulted in 20 experimental datasets (in addition to the original dataset). The results show that plausibly inferred knowledge extends the coverage of the knowledge base by, on average, 2%, 7%, 12%, and 16% for datasets with, respectively, 5%, 10%, 15%, and

  4. Measuring knowledge and clinical reasoning skills in a problem-based curriculum

    NARCIS (Netherlands)

    H.P.A. Boshuizen (Henny); C. van der Vleuten; H.G. Schmidt (Henk); M. Machiels-Bongaerts

    1997-01-01

    textabstractThe purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the Prog

  5. Measuring knowledge and clinical reasoning skills in a problem-based curriculum

    NARCIS (Netherlands)

    H.P.A. Boshuizen (Henny); C. van der Vleuten; H.G. Schmidt (Henk); M. Machiels-Bongaerts

    1997-01-01

    textabstractThe purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the

  6. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking.

    Science.gov (United States)

    Norman, Geoffrey R; Monteiro, Sandra D; Sherbino, Jonathan; Ilgen, Jonathan S; Schmidt, Henk G; Mamede, Silvia

    2017-01-01

    Contemporary theories of clinical reasoning espouse a dual processing model, which consists of a rapid, intuitive component (Type 1) and a slower, logical and analytical component (Type 2). Although the general consensus is that this dual processing model is a valid representation of clinical reasoning, the causes of diagnostic errors remain unclear. Cognitive theories about human memory propose that such errors may arise from both Type 1 and Type 2 reasoning. Errors in Type 1 reasoning may be a consequence of the associative nature of memory, which can lead to cognitive biases. However, the literature indicates that, with increasing expertise (and knowledge), the likelihood of errors decreases. Errors in Type 2 reasoning may result from the limited capacity of working memory, which constrains computational processes. In this article, the authors review the medical literature to answer two substantial questions that arise from this work: (1) To what extent do diagnostic errors originate in Type 1 (intuitive) processes versus in Type 2 (analytical) processes? (2) To what extent are errors a consequence of cognitive biases versus a consequence of knowledge deficits?The literature suggests that both Type 1 and Type 2 processes contribute to errors. Although it is possible to experimentally induce cognitive biases, particularly availability bias, the extent to which these biases actually contribute to diagnostic errors is not well established. Educational strategies directed at the recognition of biases are ineffective in reducing errors; conversely, strategies focused on the reorganization of knowledge to reduce errors have small but consistent benefits.

  7. Learning clinical reasoning.

    Science.gov (United States)

    Pinnock, Ralph; Welch, Paul

    2014-04-01

    Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions.

  8. Knowledge and critical thinking skills increase clinical reasoning ability in urogenital disorders: a Universitas Sriwijaya Medical Faculty experience

    Directory of Open Access Journals (Sweden)

    Irfannuddin Irfannuddin

    2009-03-01

    Full Text Available Aim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning.Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculum of the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summative assessments, and student characteristics. Data were analyzed by Cox regression.Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct: 1.10 -2.42. When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 95% CI: 1.55 - 3.41.Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability. (Med J Indones 2009; 18: 53-9Keywords: clinical reasoning, basic knowledge, critical thinking, competency-based curriculum

  9. Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors.

    Science.gov (United States)

    Vaughan-Graham, Julie; Cott, Cheryl

    2016-10-09

    Clinical reasoning is an essential aspect of clinical practice, however is largely ignored in the current rehabilitation sciences evidence base. Literature related to clinical reasoning and clinical expertise has evolved concurrently although rehabilitation reasoning frameworks remain relatively generic. The purpose of this study was to explicate the clinical reasoning process of Bobath instructors of a widely used neuro-rehabilitation approach, the Bobath concept. A qualitative interpretive description approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews. Purposive sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA). Interview transcripts were transcribed verbatim providing the raw data. Data analysis was progressive, iterative, and inductive. Twenty-two IBITA instructors from 7 different countries participated. Ranging in clinical experience from 12 to 40 years, and instructor experience from 1 to 35 years. Three themes were developed, (a) a Bobath clinical framework, (b) person-centered, and (c) a Bobath reasoning approach, highlighting the role of practical wisdom, phronesis in the clinical reasoning process. In particular the role of visuospatial-kinesthetic perception, an element of technical expertise, was illuminated as an integral aspect of clinical reasoning in this expert group. This study provides an interpretive understanding of the clinical reasoning process used by IBITA instructors illustrating an inactive embodied view of clinical reasoning, specifically the role of phronesis, requiring further investigation in nonexpert Bobath therapists, as well as in novice and experienced therapists in other specialty areas. © 2016 John Wiley & Sons, Ltd.

  10. Context based support for Clinical Reasoning

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus

    2004-01-01

    Intelligence, Knowledge Management Systems and Business Intelligence to make context sensitive, patient case specific analysis and knowledge management. The knowledge base consists of patient health records, reasoning process information and clinical guidelines. Patient specific information and knowledge...

  11. Clinical reasoning in massage therapy.

    Science.gov (United States)

    Lemoon, Kim

    2008-08-20

    Clinical reasoning has long been a valuable tool for health care practitioners, but it has been under-researched in the field of massage therapy. Case reports have been a useful method for exploring the clinical reasoning process in various fields of manual therapy and can provide a model for similar research in the field of massage therapy. A diagnostically challenging case concerning a client with low back pain serves as a guideline for examining the clinical reasoning process of a massage therapist. A two-part methodology was employed: Client profileReflective inquiry The inquiry included questions pertaining to beliefs about health problems; beliefs about the mechanisms of pain; medical conditions that could explain the client's symptoms; knowledge of the client's anatomy, assessment, and treatment choices; observations made during treatment; extent of experience in treating similar problems; and ability to recognize clinical patterns. The clinical reasoning process of a massage therapist contributed to a differential diagnosis, which provided an explanation for the client's symptoms and led to a satisfactory treatment resolution. The present report serves as an example of the value of clinical reasoning in the field of massage therapy, and the need for expanded research into its methods and applications. The results of such research could be beneficial in teaching the clinical reasoning process at both the introductory and the advanced levels of massage therapy education.

  12. The Influence of an Orthopedic, Manual Therapy Residency Program on Improved Knowledge, Psychomotor Skills, and Clinical Reasoning in Nairobi, Kenya.

    Science.gov (United States)

    Cunningham, Shala; McFelea, Joni

    2017-01-01

    The purpose of this study was to describe the influence of a post-graduate orthopedic manual therapy residency program in Kenya on the development of physical therapists' (PTs) knowledge and clinical reasoning related to the performance of a musculoskeletal examination and evaluation as compared to an experience-matched control group of PTs waiting to enter the program. A cross-sectional design was utilized in which 12 graduating residents and 10 PTs entering the residency program completed a live-patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination and evaluation of musculoskeletal conditions. The assessment utilized was based on the tasks, procedures, and knowledge areas identified as important to advanced clinicians in the US as outlined by the Orthopaedic Description of Specialty Practice. Inclusion criteria included participation in or acceptance to the residency program, practice as a PT between 3 and 25 years, and 50% of workday being involved in direct patient care. Overall pass rates were analyzed using the Pearson chi-square and Fisher's exact tests to determine if the graduating residents achieved significantly higher scores than experience-matched controls consisting of PTs entering the residency program. PTs completing a post-graduate orthopedic manual therapy residency in Nairobi, Kenya, achieved higher scores and passing rates compared to their colleagues who had not completed a residency program as determined by a live-patient practical examination. Graduating residents demonstrated statistically significant higher scores in the categories of examination, evaluation, and diagnosis. The average live-patient practical examination score for PTs without residency training was 38.2%, and their pass rate was 0.0%. The average live-patient practical examination score for residency-trained PTs was 83.4%, and their pass rate was 92.3%. These findings are statistically significant (p

  13. The Pursuit of Understanding in Clinical Reasoning.

    Science.gov (United States)

    Feltovich, Paul J.; Patel, Vimla L.

    Trends in emphases in the study of clinical reasoning are examined, with attention to three major branches of research: problem-solving, knowledge engineering, and propositional analysis. There has been a general progression from a focus on the generic form of clinical reasoning to an emphasis on medical content that supports the reasoning…

  14. Educational strategies for improving clinical reasoning.

    Science.gov (United States)

    Cutrer, William B; Sullivan, William M; Fleming, Amy E

    2013-10-01

    Clinical reasoning serves as a crucial skill for all physicians regardless of their area of expertise. Helping trainees develop effective and appropriate clinical reasoning abilities is a central aim of medical education. Teaching clinical reasoning however can be a very difficult challenge for practicing physicians. Better understanding of the different cognitive processes involved in physician clinical reasoning provides a foundation from which to guide learner development of effective reasoning skills, while pairing assessment of learner reasoning abilities with understanding of different improvement strategies offers the opportunity to maximize educational efforts for learners. Clinical reasoning errors often can occur as a result of one of four problems in trainees as well as practicing physicians; inadequate knowledge, faulty data gathering, faulty data processing, or faulty metacognition. Educators are encouraged to consider at which point a given learner's reasoning is breaking down. Experimentation with different strategies for improving clinical reasoning can help address learner struggles in each of these domains. In this chapter, various strategies for improving reasoning related to knowledge acquisition, data gathering, data processing, and clinician metacognition will be discussed. Understanding and gaining experience using the different educational strategies will provide practicing physicians with a toolbox of techniques for helping learners improve their reasoning abilities.

  15. Teaching and Assessing Clinical Reasoning Skills.

    Science.gov (United States)

    Modi, Jyoti Nath; Anshu; Gupta, Piyush; Singh, Tejinder

    2015-09-01

    Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.

  16. Supporting Knowledge Transfer through Decomposable Reasoning Artifacts

    Energy Technology Data Exchange (ETDEWEB)

    Pike, William A.; May, Richard A.; Turner, Alan E.

    2007-01-03

    Technology to support knowledge transfer and cooperative inquiry must offer its users the ability to effectively interpret knowledge structures produced by collaborators. Communicating the reasoning processes that underlie a finding is one method for enhancing interpretation, and can result in more effective evaluation and application of shared knowledge. In knowledge management tools, interpretation is aided by creating knowledge artifacts that can expose their provenance to scrutiny and that can be transformed into diverse representations that suit their consumers’ perspectives and preferences. We outline the information management needs of inquiring communities characterized by hypothesis generation tasks, and propose a model for communication, based in theories of hermeneutics, semiotics, and abduction, in which knowledge structures can be decomposed into the lower-level reasoning artifacts that produced them. We then present a proof-of-concept implementation for an environment to support the capture and communication of analytic products, with emphasis on the domain of intelligence analysis.

  17. Context Impact of Clinical Scenario on Knowledge Transfer and Reasoning Capacity in a Medical Problem-Based Learning Curriculum

    Science.gov (United States)

    Collard, A.; Brédart, S.; Bourguignon, J.-P.

    2016-01-01

    Since 2000, the faculty of Medicine at the University of Liège has integrated problem-based learning (PBL) seminars from year two to seven in its seven-year curriculum. The PBL approach has been developed to facilitate students' acquisition of reasoning capacity. This contextualized learning raises the question of the de- and re-contextualization…

  18. Clinical reasoning as social deliberation

    DEFF Research Database (Denmark)

    2014-01-01

    In this paper I will challenge the individualistic model of clinical reasoning. I will argue that sometimes clinical practice is rather machine-like, and information is called to mind and weighed, but the clinician is not just calculating how to use particular means to reach fixed ends. Often...

  19. Clinical reasoning as social deliberation

    DEFF Research Database (Denmark)

    2014-01-01

    the ends are contested. The clinician deliberates together with colleagues and patients if particular means should be used under these circumstances. Deliberation is a public process and is not just taking place in the mind of the individual decision maker. It is a social and dialogical negotiation......In this paper I will challenge the individualistic model of clinical reasoning. I will argue that sometimes clinical practice is rather machine-like, and information is called to mind and weighed, but the clinician is not just calculating how to use particular means to reach fixed ends. Often...

  20. Reasoning about Protocol Change and Knowledge

    Science.gov (United States)

    Wang, Yanjing

    In social interactions, protocols govern our behaviour and assign meaning to actions. In this paper, we investigate the dynamics of protocols and their epistemic effects. We develop two logics, inspired by Propositional Dynamic Logic (PDL) and Public Announcement Logic (PAL), for reasoning about protocol change and knowledge updates. We show that these two logics can be translated back to the standard PDL and PAL respectively.

  1. Teaching clinical reasoning to medical students

    OpenAIRE

    Gay, S; Bartlett, M; McKinley, R.

    2013-01-01

    BACKGROUND: Keele Medical School's new curriculum includes a 5-week course to extend medical students' consultation skills beyond those historically required for competent inductive diagnosis. CONTEXT: Clinical reasoning is a core skill for the practice of medicine, and is known to have implications for patient safety, yet historically it has not been explicitly taught. Rather, it has been assumed that these skills will be learned by accumulating a body of knowledge and by observing expert cl...

  2. Understanding clinical reasoning in osteopathy: a qualitative research approach

    OpenAIRE

    Grace, Sandra; Orrock, Paul; Vaughan, Brett; Blaich, Raymond; Coutts, Rosanne

    2016-01-01

    Background Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it wa...

  3. Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

    Science.gov (United States)

    Hunter, Sharyn; Arthur, Carol

    2016-05-01

    Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.

  4. Elements Explaining Learning Clinical Reasoning Using Simulation Games

    Directory of Open Access Journals (Sweden)

    Jaana-Maija Koivisto

    2016-12-01

    Full Text Available This article presents the findings on which elements in a game-based simulation affect learning clinical reasoning in nursing education. By using engaging gaming elements in virtual simulations and integrating the clinical reasoning process into game mechanics, games can enhance learning clinical reasoning and offer meaningful learning experiences. The study was designed to explore how nursing students experience gaming and learning when playing a simulation game, as well as which gaming elements explain learning clinical reasoning. The data was collected by questionnaire from nursing students (N = 166 in autumn 2014 over thirteen gaming sessions. The findings showed that usability, application of nursing knowledge, and exploration have the most impact on learning clinical reasoning when playing simulation games. Findings also revealed that authentic patient-related experiences, feedback, and reflection have an indirect effect on learning clinical reasoning. Based on these results, more efficient simulation games to improve clinical reasoning may be developed.   

  5. Clinical reasoning in undergraduate nursing education: a scoping review

    Directory of Open Access Journals (Sweden)

    Sáskia Sampaio Cipriano de Menezes

    2015-12-01

    Full Text Available Abstract OBJECTIVE This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. METHODS A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. RESULTS From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1 the experience of developing critical thinking/clinical reasoning/decision-making process; 2 teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3 measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4 relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5 theoretical development models of critical thinking/clinical reasoning/decision-making process for students. CONCLUSION The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

  6. Teaching Children Real-World Knowledge and Reasoning.

    Science.gov (United States)

    Williams, Wendy M.

    2002-01-01

    Introduces this special issue topic by asserting that empirically powerful and theoretically guided educational research needs to be designed with the teacher in mind. Provides rationale for research focus on real-world knowledge and reasoning, and reasons for selecting research projects on inductive reasoning, mathematical reasoning, map skills,…

  7. Survey of Knowledge Representation and Reasoning Systems

    Science.gov (United States)

    2009-07-01

    from the header. As discussed in [Smith, Welty & McGuinness 2004] much of an OWL ontology concerns classes, instances of classes, class individuals...OWL language has only scratched the surface; we refer the reader to [Smith, Welty & McGuinness 2004] for a complete guide. As a Semantic Web technology...Parsia, B., Grau, B. C., Kalyanpur, A. & Katz, Y. (2007) Pellet: A pratical OWL DL reasoner, Journal of Web Semantics 5(2). Smith, M. K., Welty , C

  8. Spatial Proportional Reasoning Is Associated with Formal Knowledge about Fractions

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    Möhring, Wenke; Newcombe, Nora S.; Levine, Susan C.; Frick, Andrea

    2016-01-01

    Proportional reasoning involves thinking about parts and wholes (i.e., about fractional quantities). Yet, research on proportional reasoning and fraction learning has proceeded separately. This study assessed proportional reasoning and formal fraction knowledge in 8- to 10-year-olds. Participants (N = 52) saw combinations of cherry juice and water…

  9. What variables can influence clinical reasoning?

    Directory of Open Access Journals (Sweden)

    Vahid Ashoorion

    2012-01-01

    Full Text Available Background: Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Materials and Methods: Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. Results: There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34 (R 2 chnage = 0.46, P Value = 0.000. Conclusion: Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales is the only variable that can be used for clinical reasoning prediction.

  10. What variables can influence clinical reasoning?

    Science.gov (United States)

    Ashoorion, Vahid; Liaghatdar, Mohammad Javad; Adibi, Peyman

    2012-12-01

    Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34) (R(2) chnage = 0.46, P Value = 0.000). Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction.

  11. Integrating Relational Reasoning and Knowledge Revision during Reading

    Science.gov (United States)

    Kendeou, Panayiota; Butterfuss, Reese; Van Boekel, Martin; O'Brien, Edward J.

    2017-01-01

    Our goal in this theoretical contribution is to connect research on knowledge revision and relational reasoning. To achieve this goal, first, we review the "knowledge revision components framework" (KReC) that provides an account of knowledge revision processes, specifically as they unfold during reading of texts. Second, we review a…

  12. Scientific reasoning during adolescence: The influence of instruction in science knowledge and reasoning strategies

    Science.gov (United States)

    Linn, M. C.; Clement, C.; Pulos, S.; Sullivan, P.

    The mechanism linking instruction in scientific topics and instruction in logical reasoning strategies is not well understood. This study assesses the role of science topic instruction combined with logical reasoning strategy instruction in teaching adolescent students about blood pressure problems. Logical reasoning instruction for this study emphasizes the controlling-variables strategy. Science topic instruction emphasizes variables affecting blood pressure. Subjects receiving logical reasoning instruction link their knowledge of blood pressure variables to their knowledge of controlling variables more effectively than those receiving science topic instruction alone - their specific responses show how they attempt to integrate their understanding.Received: 15 April 1988

  13. Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

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    Musgrove, John L; Morris, Jason; Estrada, Carlos A; Kraemer, Ryan R

    2016-05-01

    Background Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown. Objective We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators. Methods A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013. Results The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators. Conclusions Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms.

  14. Teacher Pedagogical Content Knowledge (PCK) and Students’ Reasoning and Wellbeing

    Science.gov (United States)

    Widodo, A.

    2017-02-01

    This paper summarizes findings of a study on efforts to improve teachers Pedagogical Content Knowledge and how it affects students’ reasoning and wellbeing. It was found that improvement of teachers’ PCK was not very strong but we managed to develop strategies to facilitate their developments. In the second year, the research was focused on identifying students’ reasoning skills both informal reasoning and formal reasoning. Data showed that students reasoning is relatively low (level 2 of five levels) and they could not construct highly coherence arguments. In addition alternative strategies to promote students’ reasoning were explored. Attempts to support teachers to conduct lessons that facilitate students’ reasoning found that teachers need intensive and continuous support. The study also identifies students’ wellbeing as the impact of improvement of lessons and other activities designed to improve students’ wellbeing. Research on students’ wellbeing is not yet given attention in Indonesian schools although it plays very important roles in students’ academic and nonacademic achievements.

  15. Integrated case learning: teaching clinical reasoning.

    Science.gov (United States)

    Radomski, Natalie; Russell, John

    2010-05-01

    Learning how to 'think like doctors' can be difficult for undergraduate medical students in their early clinical years. Our model of collaborative Integrated Case Learning (ICL) and simulated clinical reasoning aims to address these issues. Taking a socio-cultural perspective, this study investigates the reflective learning interactions and practices of clinical thinking that emerged in the ICL environment. We also explore how third year medical students perceived their ICL experiences in relation to the clinical situations encountered in the hospital setting. The context for the inquiry is a rural Clinical School in North West Victoria, Australia. We used a qualitative case study methodology following eight third-year medical students over an academic year. Individual and group interviews were conducted, together with observations and document/artefact analysis. Data was analysed using content and narrative methods. The ICL program was well received. Findings suggest that the group-based, simulated clinical reasoning process appears to help undergraduate medical students to rehearse, articulate and question their clinical decision-making pathways. We argue that the ICL process offers a professionally challenging, but supportive group learning 'space' for students to practise what it might mean to 'think', 'talk' and 'perform' like doctors in real settings. The ICL environment also appears to create a connective bridge between the 'classroom' and clinical practice.

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

    Science.gov (United States)

    Su, Whei Ming; Osisek, Paul J; Starnes, Beth

    2005-01-01

    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.

  17. Clinical expertise and reasoning with uncertain categories.

    Science.gov (United States)

    Hayes, Brett K; Chen, Tsan-Hsiang Jessamine

    2008-10-01

    Expert clinical psychologists, clinical psychology graduates, and nonclinical graduate students were presented with clinical and nonclinical cases in which the diagnosis or category membership of a character was uncertain; they then made feature predictions about the character. For each case, there was a diagnosis or category that was highly probable and a less likely alternative that either did (relevant condition) or did not (neutral condition) alter predictions. For clinical cases, clinical experts and graduate clinicians gave different predictions for the relevant and neutral conditions, indicating that they had considered the uncertain nature of the diagnosis in their predictions. Although they acknowledged that the diagnosis was uncertain, nonclinical students ignored the less likely diagnostic alternatives when making predictions. For the nonclinical cases, all three groups made predictions based on only the most likely category alternative. The results showed that clinical training and/or experience promote multiple-category reasoning, but that this effect is domain specific.

  18. An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran.

    Science.gov (United States)

    Amini, Mitra; Moghadami, Mohsen; Kojuri, Javad; Abbasi, Hamidreza; Abadi, Ali Arhami Doolat; Molaee, Nezar Ali; Pishbin, Elham; Javadzade, Hamid Reza; Kasmaee, Vahid Monsef; Vakili, Hasan; Sadat, Mohamad Ali Reis; Akbari, Roghaye; Omidvar, Bita; Shafaghi, Afshin; Dehbozorgian, Marzie; Jafari, Mohammad Morad; Monajemi, Alireza; Arabshahi, Kamran Soltani; Adibi, Peyman; Charlin, Bernard

    2011-10-17

    Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest

  19. The curse of knowledge in reasoning about false beliefs.

    Science.gov (United States)

    Birch, Susan A J; Bloom, Paul

    2007-05-01

    Assessing what other people know and believe is critical for accurately understanding human action. Young children find it difficult to reason about false beliefs (i.e., beliefs that conflict with reality). The source of this difficulty is a matter of considerable debate. Here we show that if sensitive-enough measures are used, adults show deficits in a false-belief task similar to one used with young children. In particular, we show a curse-of-knowledge bias in false-belief reasoning. That is, adults' own knowledge of an event's outcome can compromise their ability to reason about another person's beliefs about that event. We also found that adults' perception of the plausibility of an event mediates the extent of this bias. These findings shed light on the factors involved in false-belief reasoning and are discussed in light of their implications for both adults' and children's social cognition.

  20. How Exemplary Inpatient Teaching Physicians Foster Clinical Reasoning.

    Science.gov (United States)

    Houchens, Nathan; Harrod, Molly; Fowler, Karen E; Moody, Stephanie; Saint, Sanjay

    2017-09-01

    Clinical reasoning is a crucial component of training in health professions. These cognitive skills are necessary to provide quality care and avoid diagnostic error. Much previous literature has focused on teaching clinical reasoning in nonclinical environments and does not include learner reflections. The authors sought to explore, through multiple perspectives including learners, techniques used by exemplary inpatient clinician-educators for explicitly cultivating clinical reasoning. The authors conducted (2014-2015) a multisite, exploratory qualitative study examining how excellent clinician-educators foster clinical reasoning during general medicine rounds. This was accomplished through interviews of educators, focus group discussions with learners, and direct observations of clinical teaching. The authors reviewed field notes and transcripts using techniques of thematic analysis. Twelve clinician-educators, 57 current learners, and 26 former learners participated in observations and interviews. The techniques and behaviors of educators were categorized into 4 themes, including 1) emphasizing organization and prioritization, 2) accessing prior knowledge, 3) thinking aloud, and 4) analyzing the literature. The findings of this comprehensive study both confirm strategies found in previous literature and provide novel approaches. This is the first study to incorporate the perspectives of learners. Educators' techniques and behaviors, identified through direct observation and supported by reflections from the entire team, can inform best practices for the teaching of clinical reasoning. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A knowledge-based system for prototypical reasoning

    Science.gov (United States)

    Lieto, Antonio; Minieri, Andrea; Piana, Alberto; Radicioni, Daniele P.

    2015-04-01

    In this work we present a knowledge-based system equipped with a hybrid, cognitively inspired architecture for the representation of conceptual information. The proposed system aims at extending the classical representational and reasoning capabilities of the ontology-based frameworks towards the realm of the prototype theory. It is based on a hybrid knowledge base, composed of a classical symbolic component (grounded on a formal ontology) with a typicality based one (grounded on the conceptual spaces framework). The resulting system attempts to reconcile the heterogeneous approach to the concepts in Cognitive Science with the dual process theories of reasoning and rationality. The system has been experimentally assessed in a conceptual categorisation task where common sense linguistic descriptions were given in input, and the corresponding target concepts had to be identified. The results show that the proposed solution substantially extends the representational and reasoning 'conceptual' capabilities of standard ontology-based systems.

  2. Causal knowledge and the development of inductive reasoning.

    Science.gov (United States)

    Bright, Aimée K; Feeney, Aidan

    2014-06-01

    We explored the development of sensitivity to causal relations in children's inductive reasoning. Children (5-, 8-, and 12-year-olds) and adults were given trials in which they decided whether a property known to be possessed by members of one category was also possessed by members of (a) a taxonomically related category or (b) a causally related category. The direction of the causal link was either predictive (prey→predator) or diagnostic (predator→prey), and the property that participants reasoned about established either a taxonomic or causal context. There was a causal asymmetry effect across all age groups, with more causal choices when the causal link was predictive than when it was diagnostic. Furthermore, context-sensitive causal reasoning showed a curvilinear development, with causal choices being most frequent for 8-year-olds regardless of context. Causal inductions decreased thereafter because 12-year-olds and adults made more taxonomic choices when reasoning in the taxonomic context. These findings suggest that simple causal relations may often be the default knowledge structure in young children's inductive reasoning, that sensitivity to causal direction is present early on, and that children over-generalize their causal knowledge when reasoning.

  3. Clinical reasoning skills of speech and language therapy students.

    Science.gov (United States)

    Hoben, Kirsty; Varley, Rosemary; Cox, Richard

    2007-03-01

    Difficulties experienced by novices in clinical reasoning have been well documented in many professions, especially medicine (Boshuizen and Schmidt 1992, 2000; Elstein, Shulman and Sprafka 1978; Patel and Groen 1986; Rikers, Loyens and Schmidt 2004). These studies have shown that novice clinicians have difficulties with both knowledge and strategy in clinical reasoning tasks. Speech and language therapy students must also learn to reason clinically, yet to date there is little evidence of how they learn to do so. In this paper, we report the clinical reasoning difficulties of a group of speech and language therapy students. We make a comparison of a subgroup of these with experienced speech and language therapists' reasoning and proposes some methods and materials to aid the development of clinical reasoning in speech and language therapy students. Student diagnostic reasoning difficulties were analysed during the assessment of unseen cases on an electronic patient database, the Patient Assessment and Training System (PATSy http://www.patsy.ac.uk) (Lum et al. 2006). Pairs of students were videoed as they completed a one hour assessment of one of three 'virtual patients'. One pair of experienced speech and language therapists, who were not part of the project team, also completed an assessment of one of these cases under the same conditions. Screen capture was used to record all on screen activity within PATSy web pages (i.e. mouse pointer position, hyperlink and button presses, page scrolling, browser navigation interactions and data entered); Verbal comments made by participants were analysed via a seven-level coding scheme that aimed to describe the events that occur in the process of diagnostic reasoning. Students displayed a range of competence in making an accurate diagnosis. Diagnostically accurate students showed use of specific professional vocabulary, and a greater use of firm diagnostic statements. For the diagnostically inaccurate students, typical

  4. Knowledge Representation and Fuzzy Reasoning of an Agricultural Expert System

    Institute of Scientific and Technical Information of China (English)

    吴顺祥; 倪子伟; 李茂青

    2002-01-01

    The design scheme of an agricultural expert system based on longan and cauliflower planting techniques is presented. Using an object-oriented design and a combination of the techniques in multimedia, database, expert system and artificial intelligence, an in-depth analysis and summary are made of the knowledge features of the agricultural multimedia expert system and data models involved. According to the practical problems in agricultural field, the architectures and functions of the system are designed, and some design ideas about the hybrid knowledge representation and fuzzy reasoning are proposed.

  5. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

    Directory of Open Access Journals (Sweden)

    Paans Wolter

    2012-08-01

    Full Text Available Abstract Background This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses. Knowledge sources can support nurses in deriving diagnoses. A nurse’s disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses. Method A randomised factorial design was used in 2008–2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1 a knowledge inventory, (2 the California Critical Thinking Disposition Inventory, and (3 the Health Science Reasoning Test. Nurses (n = 249 were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor. Results The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse’s age and the reasoning skills of `deduction’ and `analysis’. Conclusions Improving nurses’ dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

  6. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study.

    Science.gov (United States)

    Paans, Wolter; Sermeus, Walter; Nieweg, Roos Mb; Krijnen, Wim P; van der Schans, Cees P

    2012-08-01

    This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses.Knowledge sources can support nurses in deriving diagnoses. A nurse's disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses. A randomised factorial design was used in 2008-2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor. The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse's age and the reasoning skills of `deduction' and `analysis'. Improving nurses' dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

  7. Conciliating cognition and consciousness: the perceptual foundations of clinical reasoning.

    Science.gov (United States)

    Braude, Hillel D

    2012-10-01

    Clinical reasoning has been defined as a form of cognition applied to evaluating and managing a patient's medical problem. As a kind of cognition, a product of the human psyche, it is logical to expect that clinical reasoning should be best understood through methods derived from psychology, neuropsychology and the cognitive sciences. However, the application of scientific methods to evaluating clinical reasoning is unable to analyse clinical reasoning in terms of first-person experience and consciousness. By reducing clinical reasoning to its cognitive components the cognitivist approach tends to ignore the larger context in which clinical reasoning occurs. By reducing its conception of clinical reasoning to its cognitive components, the neuropsychological approach fails to acknowledge clinical reasoning as a form of intentionality, a gestalt, grounded in human perception. A full epistemology of clinical reasoning requires a phenomenological analysis that can make sense of the relation between pre-reflective consciousness and explicit forms of knowing. In this paper I conciliate cognition and consciousness in medicine through analysing the phenomenology of perception in clinical reasoning. I compare the application of phenomenology to clinical reasoning with the attempt to model clinical reasoning on Aristotelian practical wisdom or phronesis. Finally, I analyse empathy as a type of perception critical for effective clinical interaction and exemplary for reflecting on perception as the intersubjective foundation of clinical reasoning.

  8. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

    NARCIS (Netherlands)

    Paans, W.; Sermeus, W.; Nieweg, R.M.; Krijnen, W.P.; van der Schans, C.P.

    2012-01-01

    ABSTRACT: BACKGROUND: This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the

  9. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

    NARCIS (Netherlands)

    Paans, W.; Sermeus, W.; Nieweg, R.M.; Krijnen, W.P.; van der Schans, C.P.

    2012-01-01

    ABSTRACT: BACKGROUND: This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the acc

  10. OWL reasoning framework over big biological knowledge network.

    Science.gov (United States)

    Chen, Huajun; Chen, Xi; Gu, Peiqin; Wu, Zhaohui; Yu, Tong

    2014-01-01

    Recently, huge amounts of data are generated in the domain of biology. Embedded with domain knowledge from different disciplines, the isolated biological resources are implicitly connected. Thus it has shaped a big network of versatile biological knowledge. Faced with such massive, disparate, and interlinked biological data, providing an efficient way to model, integrate, and analyze the big biological network becomes a challenge. In this paper, we present a general OWL (web ontology language) reasoning framework to study the implicit relationships among biological entities. A comprehensive biological ontology across traditional Chinese medicine (TCM) and western medicine (WM) is used to create a conceptual model for the biological network. Then corresponding biological data is integrated into a biological knowledge network as the data model. Based on the conceptual model and data model, a scalable OWL reasoning method is utilized to infer the potential associations between biological entities from the biological network. In our experiment, we focus on the association discovery between TCM and WM. The derived associations are quite useful for biologists to promote the development of novel drugs and TCM modernization. The experimental results show that the system achieves high efficiency, accuracy, scalability, and effectivity.

  11. OWL Reasoning Framework over Big Biological Knowledge Network

    Directory of Open Access Journals (Sweden)

    Huajun Chen

    2014-01-01

    Full Text Available Recently, huge amounts of data are generated in the domain of biology. Embedded with domain knowledge from different disciplines, the isolated biological resources are implicitly connected. Thus it has shaped a big network of versatile biological knowledge. Faced with such massive, disparate, and interlinked biological data, providing an efficient way to model, integrate, and analyze the big biological network becomes a challenge. In this paper, we present a general OWL (web ontology language reasoning framework to study the implicit relationships among biological entities. A comprehensive biological ontology across traditional Chinese medicine (TCM and western medicine (WM is used to create a conceptual model for the biological network. Then corresponding biological data is integrated into a biological knowledge network as the data model. Based on the conceptual model and data model, a scalable OWL reasoning method is utilized to infer the potential associations between biological entities from the biological network. In our experiment, we focus on the association discovery between TCM and WM. The derived associations are quite useful for biologists to promote the development of novel drugs and TCM modernization. The experimental results show that the system achieves high efficiency, accuracy, scalability, and effectivity.

  12. Factors affecting clinical reasoning of occupational therapists: a qualitative study

    Science.gov (United States)

    Shafaroodi, Narges; Kamali, Mohammad; Parvizy, Soroor; Mehraban, Afsoon Hassani; O’Toole, Giyn

    2014-01-01

    Background: Clinical reasoning is generally defined as the numerous modes of thinking that guide clinical practice but little is known about the factors affecting how occupational therapists manage the decision-making process. The aim of this qualitative study was to explore the factors influencing the clinical reasoning of occupational therapists. Methods: Twelve occupational therapy practitioners working in mental and physical dysfunction fields participated in this study. The sampling method was purposeful and interviews were continued until data saturation. All the interviews were recorded and transcribed. The data were analyzed through a qualitative content analysis method. Results: There were three main themes. The first theme: socio-cultural conditions included three subthemes: 1- client beliefs; 2- therapist values and beliefs; 3- social attitude to disability. The second theme: individual attributions included two subthemes 1- client attributions; 2- therapist attributions. The final theme was the workplace environment with the three subthemes: 1- knowledge of the managers of rehabilitation services, 2- working in an inter-professional team; 3- limited clinical facilities and resources. Conclusion: In this study, the influence of the attitudes and beliefs of client, therapist and society about illness, abilities and disabilities upon reasoning was different to previous studies. Understanding these factors, especially the socio-cultural beliefs basis can play a significant role in the quality of occupational therapy services. Accurate understanding of these influential factors requires more extensive qualitative and quantitative studies. PMID:25250253

  13. Knowledge, expectations, and inductive reasoning within conceptual hierarchies.

    Science.gov (United States)

    Coley, John D; Hayes, Brett; Lawson, Christopher; Moloney, Michelle

    2004-01-01

    Previous research (e.g. Cognition 64 (1997) 73) suggests that the privileged level for inductive inference in a folk biological conceptual hierarchy does not correspond to the "basic" level (i.e. the level at which concepts are both informative and distinct). To further explore inductive inference within conceptual hierarchies, we examine relations between knowledge of concepts at different hierarchical levels, expectations about conceptual coherence, and inductive inference. In Experiments 1 and 2, 5- and 8-year-olds and adults listed features of living kind (Experiments 1 and 2) and artifact (Experiment 2) concepts at different hierarchical levels (e.g. plant, tree, oak, desert oak), and also rated the strength of generalizations to the same concepts. For living kinds, the level that showed a relative advantage on these two tasks differed; the greatest increase in features listed tended to occur at the life-form level (e.g. tree), whereas the greatest increase in inductive strength tended to occur at the folk-generic level (e.g. oak). Knowledge and induction also showed different developmental trajectories. For artifact concepts, the levels at which the greatest gains in knowledge and induction occurred were more varied, and corresponded more closely across tasks. In Experiment 3, adults reported beliefs about within-category similarity for concepts at different levels of animal, plant and artifact hierarchies, and rated inductive strength as before. For living kind concepts, expectations about category coherence predicted patterns of inductions; knowledge did not. For artifact concepts, both knowledge and expectations predicted patterns of induction. Results suggest that beliefs about conceptual coherence play an important role in guiding inductive inference, that this role may be largely independent of specific knowledge of concepts, and that such beliefs are especially important in reasoning about living kinds.

  14. Introducing an Evidential Reasoning Approach for Selecting Knowledge Management Strategies

    Directory of Open Access Journals (Sweden)

    Mohammad Shariatmadari

    2013-04-01

    Full Text Available In a knowledge economy, a key source of sustainable competitive advantage relies on the way to create, share, and utilize knowledge. In order to react to an increasingly competitive business environment, many companies emphasize the importance of Knowledge Management (KM, and base their KM strategy on their unique resources and capabilities. Although numerous works discuss the issues of how to perform a KM strategy and implement it successfully, few have provided methods that can systematically evaluate and model the KM strategy involving several complex factors. In this paper, the evidential reasoning (ER approach is applied as a method for KM strategy selection. The process of building a multiple criteria decision model of a hierarchical structure is presented, in which both quantitative and qualitative information is represented in a unified manner. The KM strategy selection is then fully investigated using the ER approach in a real case study in Academic Center for Education, Culture and Research (ACECR. Both the advantages of applying this model in practice and the analysis process itself are discussed.

  15. Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.

    Science.gov (United States)

    Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong

    2016-11-01

    As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Online discussions develop students' clinical reasoning skills during fieldwork.

    Science.gov (United States)

    Scanlan, Justin Newton; Hancock, Nicola

    2010-12-01

    Pilot study to examine if the addition of a structured framework improved the quality of clinical reasoning demonstrated within clinically based online discussions by occupational therapy students undertaking fieldwork. Cognitive elements of the clinical reasoning process present within students' discussions were compared before (2005 cohort) and after (2007 cohort) the introduction of a structured framework to guide discussions. Students' self reports (2007 cohort) of clinical reasoning skills were also analysed before and after two consecutive fieldwork placements. The structured framework increased the proportion of postings containing the advanced 'evaluate' element of clinical reasoning and decreased the proportion of postings containing only the basic 'understand' elements. Self-reported clinical reasoning skills improved following the first fieldwork placement and this improvement was sustained following the second placement. The structured framework appears useful in enhancing students' depth of clinical reasoning during fieldwork, although further investigation is required. © 2010 The Authors. Australian Occupational Therapy Journal © 2010 Australian Association of Occupational Therapists.

  17. Context based support for Clinical Reasoning

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus

    2004-01-01

    In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. Computer based decision support systems has usually been focusing on the outcome of the decision making and treated it as a single task. In this p...

  18. Diagnostic reasoning and underlying knowledge of students with preclinical patient contacts in PBL.

    Science.gov (United States)

    Diemers, Agnes D; van de Wiel, Margje W J; Scherpbier, Albert J J A; Baarveld, Frank; Dolmans, Diana H J M

    2015-12-01

    Medical experts have access to elaborate and integrated knowledge networks consisting of biomedical and clinical knowledge. These coherent knowledge networks enable them to generate more accurate diagnoses in a shorter time. However, students' knowledge networks are less organised and students have difficulties linking theory and practice and transferring acquired knowledge. Therefore we wanted to explore the development and transfer of knowledge of third-year preclinical students on a problem-based learning (PBL) course with real patient contacts. Before and after a 10-week PBL course with real patients, third-year medical students were asked to think out loud while diagnosing four types of paper patient problems (two course cases and two transfer cases), and explain the underlying pathophysiological mechanisms of the patient features. Diagnostic accuracy and time needed to think through the cases were measured. The think-aloud protocols were transcribed verbatim and different types of knowledge were coded and quantitatively analysed. The written pathophysiological explanations were translated into networks of concepts. Both the concepts and the links between concepts in students' networks were compared to model networks. Over the course diagnostic accuracy increased, case-processing time decreased, and students used less biomedical and clinical knowledge during diagnostic reasoning. The quality of the pathophysiological explanations increased: the students used more concepts, especially more model concepts, and they used fewer wrong concepts and links. The findings differed across course and transfer cases. The effects were generally less strong for transfer cases. Students' improved diagnostic accuracy and the improved quality of their knowledge networks suggest that integration of biomedical and clinical knowledge took place during a 10-week course. The differences between course and transfer cases demonstrate that transfer is complex and time-consuming. We

  19. Neural basis of nonanalytical reasoning expertise during clinical evaluation

    NARCIS (Netherlands)

    Durning, S.J.; Costanzo, M.E.; Artino, A.R.; Graner, J.; Vleuten, C.P.M. van der; Beckman, T.J.; Wittich, C.M.; Roy, M.J.H.M. van; Holmboe, E.S.; Schuwirth, L.

    2015-01-01

    INTRODUCTION: Understanding clinical reasoning is essential for patient care and medical education. Dual-processing theory suggests that nonanalytic reasoning is an essential aspect of expertise; however, assessing nonanalytic reasoning is challenging because it is believed to occur on the subconsci

  20. A Framework for Teachers' Knowledge of Mathematical Reasoning

    Science.gov (United States)

    Herbert, Sandra

    2014-01-01

    Exploring and developing primary teachers' understanding of mathematical reasoning was the focus of the "Mathematical Reasoning Professional Learning Research Program." Twenty-four primary teachers were interviewed after engagement in the first stage of the program incorporating demonstration lessons focused on reasoning conducted in…

  1. Consequences of Contextual Factors on Clinical Reasoning in Resident Physicians

    Science.gov (United States)

    McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R., Jr.; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J.

    2015-01-01

    Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have…

  2. Determinants of the accuracy of nursing diagnoses: influence of ready knowledge, knowledge sources, disposition toward critical thinking, and reasoning skills.

    Science.gov (United States)

    Paans, Wolter; Sermeus, Walter; Nieweg, Roos; van der Schans, Cees

    2010-01-01

    The purpose of this study was to determine how knowledge sources, ready knowledge, and disposition toward critical thinking and reasoning skills influence the accuracy of student nurses' diagnoses. A randomized controlled trial was conducted to determine the influence of knowledge sources. We used the following questionnaires: (a) knowledge inventory, (b) California Critical Thinking Disposition Inventory, and (c) Health Science Reasoning Test (HSRT). The use of knowledge sources had very little influence on the accuracy of nursing diagnoses. Accuracy was significantly related to the analysis domain of the HSRT. Students were unable to operationalize knowledge sources to derive accurate diagnoses and did not effectively use reasoning skills. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Knowledge expression and reasoning process in an expert system for welding procedure qualification

    Institute of Scientific and Technical Information of China (English)

    Zhang Jianxun; Wang Hongyu; Song Xu

    2007-01-01

    After analyzing the welding procedure knowledge in Chinese national standards for welding procedure qualification of steel pressure vessel from the point of establishing expert system, it can be divided into five types of knowledge, i.e. practice, definition, regularity, process and description knowledge. The knowledge expression methods are established according to the different type of welding procedure knowledge. The reasoning process based on rule is adopted. And the reasoning engine is embedded among objects integrated with the knowledge base.

  4. Determining the reasons for medication prescriptions in the EHR using knowledge and natural language processing.

    Science.gov (United States)

    Li, Ying; Salmasian, Hojjat; Harpaz, Rave; Chase, Herbert; Friedman, Carol

    2011-01-01

    Knowledge of medication indications is significant for automatic applications aimed at improving patient safety, such as computerized physician order entry and clinical decision support systems. The Electronic Health Record (EHR) contains pertinent information related to patient safety such as information related to appropriate prescribing. However, the reasons for medication prescriptions are usually not explicitly documented in the patient record. This paper describes a method that determines the reasons for medication uses based on information occurring in outpatient notes. The method utilizes drug-indication knowledge that we acquired, and natural language processing. Evaluation showed the method obtained a sensitivity of 62.8%, specificity of 93.9%, precision of 90% and F-measure of 73.9%. This pilot study demonstrated that linking external drug indication knowledge to the EHR for determining the reasons for medication use was promising, but also revealed some challenges. Future work will focus on increasing the accuracy and coverage of the indication knowledge and evaluating its performance using a much larger set of drugs frequently used in the outpatient population.

  5. Teaching clinical reasoning: case-based and coached.

    Science.gov (United States)

    Kassirer, Jerome P

    2010-07-01

    Optimal medical care is critically dependent on clinicians' skills to make the right diagnosis and to recommend the most appropriate therapy, and acquiring such reasoning skills is a key requirement at every level of medical education. Teaching clinical reasoning is grounded in several fundamental principles of educational theory. Adult learning theory posits that learning is best accomplished by repeated, deliberate exposure to real cases, that case examples should be selected for their reflection of multiple aspects of clinical reasoning, and that the participation of a coach augments the value of an educational experience. The theory proposes that memory of clinical medicine and clinical reasoning strategies is enhanced when errors in information, judgment, and reasoning are immediately pointed out and discussed. Rather than using cases artificially constructed from memory, real cases are greatly preferred because they often reflect the false leads, the polymorphisms of actual clinical material, and the misleading test results encountered in everyday practice. These concepts foster the teaching and learning of the diagnostic process, the complex trade-offs between the benefits and risks of diagnostic tests and treatments, and cognitive errors in clinical reasoning. The teaching of clinical reasoning need not and should not be delayed until students gain a full understanding of anatomy and pathophysiology. Concepts such as hypothesis generation, pattern recognition, context formulation, diagnostic test interpretation, differential diagnosis, and diagnostic verification provide both the language and the methods of clinical problem solving. Expertise is attainable even though the precise mechanisms of achieving it are not known.

  6. Statistical reasoning in clinical trials: hypothesis testing.

    Science.gov (United States)

    Kelen, G D; Brown, C G; Ashton, J

    1988-01-01

    Hypothesis testing is based on certain statistical and mathematical principles that allow investigators to evaluate data by making decisions based on the probability or implausibility of observing the results obtained. However, classic hypothesis testing has its limitations, and probabilities mathematically calculated are inextricably linked to sample size. Furthermore, the meaning of the p value frequently is misconstrued as indicating that the findings are also of clinical significance. Finally, hypothesis testing allows for four possible outcomes, two of which are errors that can lead to erroneous adoption of certain hypotheses: 1. The null hypothesis is rejected when, in fact, it is false. 2. The null hypothesis is rejected when, in fact, it is true (type I or alpha error). 3. The null hypothesis is conceded when, in fact, it is true. 4. The null hypothesis is conceded when, in fact, it is false (type II or beta error). The implications of these errors, their relation to sample size, the interpretation of negative trials, and strategies related to the planning of clinical trials will be explored in a future article in this journal.

  7. Inferences of clinical diagnostic reasoning and diagnostic error.

    Science.gov (United States)

    Lawson, Anton E; Daniel, Erno S

    2011-06-01

    This paper discusses clinical diagnostic reasoning in terms of a pattern of If/then/Therefore reasoning driven by data gathering and the inference of abduction, as defined in the present paper, and the inferences of retroduction, deduction, and induction as defined by philosopher Charles Sanders Peirce. The complex inferential reasoning driving clinical diagnosis often takes place subconsciously and so rapidly that its nature remains largely hidden from the diagnostician. Nevertheless, we propose that raising such reasoning to the conscious level reveals not its basic pattern and basic inferences, it also reveals where errors can and do occur and how such errors might be reduced or even eliminated.

  8. Web-based unfolding cases: a strategy to enhance and evaluate clinical reasoning skills.

    Science.gov (United States)

    Johnson, Gail; Flagler, Susan

    2013-10-01

    Clinical reasoning involves the use of both analytical and nonanalytical intuitive cognitive processes. Fostering student development of clinical reasoning skills and evaluating student performance in this cognitive arena can challenge educators. The use of Web-based unfolding cases is proposed as a strategy to address these challenges. Unfolding cases mimic real-life clinical situations by presenting only partial clinical information in sequential segments. Students receive immediate feedback after submitting a response to a given segment. The student's comparison of the desired and submitted responses provides information to enhance the development of clinical reasoning skills. Each student's set of case responses are saved for the instructor in an individual-student electronic file, providing a record of the student's knowledge and thinking processes for faculty evaluation. For the example case given, the approaches used to evaluate individual components of clinical reasoning are provided. Possible future uses of Web-based unfolding cases are described. Copyright 2013, SLACK Incorporated.

  9. Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

    Science.gov (United States)

    Snodgrass, Suzanne

    2011-01-01

    Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

  10. Case-based reasoning: The marriage of knowledge base and data base

    Science.gov (United States)

    Pulaski, Kirt; Casadaban, Cyprian

    1988-01-01

    The coupling of data and knowledge has a synergistic effect when building an intelligent data base. The goal is to integrate the data and knowledge almost to the point of indistinguishability, permitting them to be used interchangeably. Examples given in this paper suggest that Case-Based Reasoning is a more integrated way to link data and knowledge than pure rule-based reasoning.

  11. The recommendation system knowledge representation and reasoning procedures under uncertainty for metal casting

    Directory of Open Access Journals (Sweden)

    S. Kluska-Nawarecka

    2015-01-01

    Full Text Available The paper presents an information system dedicated to requirements recommendation and knowledge sharing. It presents methodology of constructing domain knowledge base and application procedure on the example of production technology of Austempered Ductile Iron (ADI. For knowledge representation and reasoning Logic of Plausible Reasoning (LPR is used. Both equally applicable LPR for formalization the knowledge of foundry technology, as well as the described system solution have the unique character.

  12. Essentialist Reasoning and Knowledge Effects on Biological Reasoning in Young Children

    Science.gov (United States)

    Herrmann, Patricia A.; French, Jason A.; DeHart, Ganie B.; Rosengren, Karl S.

    2013-01-01

    Biological kinds undergo a variety of changes during their life span, and these changes vary in degree by organism. Understanding that an organism, such as a caterpillar, maintains category identity over its life span despite dramatic changes is a key concept in biological reasoning. At present, we know little about the developmental trajectory of…

  13. Reasoning Processes Used by Paramedics to Solve Clinical Problems

    Science.gov (United States)

    Alexander, Melissa

    2009-01-01

    The purpose of this exploratory qualitative study was to determine the reasoning processes used by paramedics to solve clinical problems. Existing research documents concern over the accuracy of paramedics' clinical decision-making, but no research was found that examines the cognitive processes by which paramedics make either faulty or accurate…

  14. DETERMINANTS OF THE ACCURACY OF NURSING DIAGNOSES : INFLUENCE OF READY KNOWLEDGE, KNOWLEDGE SOURCES, DISPOSITION TOWARD CRITICAL THINKING, AND REASONING SKILLS

    NARCIS (Netherlands)

    Paans, Wolter; Sermeus, Walter; Nieweg, Roos; Van der Schans, Cees

    2010-01-01

    The purpose of this study was to determine how knowledge sources, ready knowledge, and disposition toward critical thinking and reasoning skills influence the accuracy of student nurses' diagnoses. A randomized controlled trial was conducted to determine the influence of knowledge sources. We used t

  15. DETERMINANTS OF THE ACCURACY OF NURSING DIAGNOSES : INFLUENCE OF READY KNOWLEDGE, KNOWLEDGE SOURCES, DISPOSITION TOWARD CRITICAL THINKING, AND REASONING SKILLS

    NARCIS (Netherlands)

    Paans, Wolter; Sermeus, Walter; Nieweg, Roos; Van der Schans, Cees

    2010-01-01

    The purpose of this study was to determine how knowledge sources, ready knowledge, and disposition toward critical thinking and reasoning skills influence the accuracy of student nurses' diagnoses. A randomized controlled trial was conducted to determine the influence of knowledge sources. We used

  16. Knowledge at work: learning and transferring expert reasoning through storytelling

    NARCIS (Netherlands)

    Hernandez-Serrano, J.; Stefanou, S.E.

    2009-01-01

    There is plenty of evidence in many fields of knowledge that storytelling is a bona fide human activity for problem-solving. We believe that a storytelling model for problem-solving can be constructed to organize this discourse. To that end, we carried out a qualitative study using the Grounded Theo

  17. Visualizing complex processes using a cognitive-mapping tool to support the learning of clinical reasoning.

    Science.gov (United States)

    Wu, Bian; Wang, Minhong; Grotzer, Tina A; Liu, Jun; Johnson, Janice M

    2016-08-22

    Practical experience with clinical cases has played an important role in supporting the learning of clinical reasoning. However, learning through practical experience involves complex processes difficult to be captured by students. This study aimed to examine the effects of a computer-based cognitive-mapping approach that helps students to externalize the reasoning process and the knowledge underlying the reasoning process when they work with clinical cases. A comparison between the cognitive-mapping approach and the verbal-text approach was made by analyzing their effects on learning outcomes. Fifty-two third-year or higher students from two medical schools participated in the study. Students in the experimental group used the computer-base cognitive-mapping approach, while the control group used the verbal-text approach, to make sense of their thinking and actions when they worked with four simulated cases over 4 weeks. For each case, students in both groups reported their reasoning process (involving data capture, hypotheses formulation, and reasoning with justifications) and the underlying knowledge (involving identified concepts and the relationships between the concepts) using the given approach. The learning products (cognitive maps or verbal text) revealed that students in the cognitive-mapping group outperformed those in the verbal-text group in the reasoning process, but not in making sense of the knowledge underlying the reasoning process. No significant differences were found in a knowledge posttest between the two groups. The computer-based cognitive-mapping approach has shown a promising advantage over the verbal-text approach in improving students' reasoning performance. Further studies are needed to examine the effects of the cognitive-mapping approach in improving the construction of subject-matter knowledge on the basis of practical experience.

  18. Education strategies to foster health professional students' clinical reasoning skills.

    Science.gov (United States)

    Rochmawati, Erna; Wiechula, Rick

    2010-06-01

    Clinical reasoning is an important skill for health professionals that should be developed to achieve high levels of expertise. Several education strategies have been suggested for implementation by health professional educators to foster their students' clinical reasoning skills. The strategies have included the following: problem-based learning, the integrative curriculum, reflection, and concept mapping. This review assesses which is the most effective education strategy for developing the clinical reasoning skills of health professional students. Four publications, from a total of 692 identified records, were included. Overall, this review was not able to make a final conclusion to answer the question. Therefore, there is a need to conduct more studies with larger samples and to undertake research that evaluates the following aspects: more alternate education interventions, variations in the delivery of education interventions, and the cost-effectiveness of implementing education strategies.

  19. Applications of Out-of-Domain Knowledge in Students' Reasoning about Computer Program State

    Science.gov (United States)

    Lewis, Colleen Marie

    To meet a growing demand and a projected deficit in the supply of computer professionals (NCWIT, 2009), it is of vital importance to expand students' access to computer science. However, many researchers in the computer science education community unproductively assume that some students lack an innate ability for computer science and therefore cannot be successful learning to program. In contrast, I hypothesize that the degree to which computer science students make productive use of their out-of-domain knowledge can better explain the range of success of novices learning to program. To investigate what non-programming knowledge supports students' success, I conducted and videotaped approximately 40 hours of clinical interviews with 30 undergraduate students enrolled in introductory programming courses. During each interview, a participant talked as they solved programming problems, many of which were multiple-choice problems that were highly correlated with success on an Advanced Placement Computer Science exam. In the analysis of the interviews I focused on students' strengths rather than the typical decision to focus on students' weaknesses. I documented specific competencies of the participants and applied analytic tools from the Knowledge in Pieces theoretical framework (diSessa, 1993) to attempt to understand the source and nature of these competencies. I found that participants appeared to build upon several kinds of out-of-domain knowledge. For example, many students used algebraic substitution techniques when tracing the state of recursive functions. Students appeared to use metaphors and their intuitive knowledge of both iteration and physics to understand infinite loops and base cases. On the level of an individual students' reasoning, a case study analysis illustrated the ways in which a participant integrated her linguistic knowledge of "and" into her reasoning about the computer science command "and." In addition to identifying these specific

  20. Diagnostic reasoning by hospital pharmacists: assessment of attitudes, knowledge, and skills.

    Science.gov (United States)

    Chernushkin, Kseniya; Loewen, Peter; de Lemos, Jane; Aulakh, Amneet; Jung, Joanne; Dahri, Karen

    2012-07-01

    Hospital pharmacists participate in activities that may be considered diagnostic. Two reasoning approaches to diagnosis have been described: non-analytic and analytic. Of the 6 analytic traditions, the probabilistic tradition has been shown to improve diagnostic accuracy and reduce unnecessary testing. To the authors' knowledge, pharmacists' attitudes toward having a diagnostic role and their diagnostic knowledge and skills have never been studied. To describe pharmacists' attitudes toward the role of diagnosis in pharmacotherapeutic problem-solving and to characterize the extent of pharmacists' knowledge and skills related to diagnostic literacy. Pharmacists working within Lower Mainland Pharmacy Services (British Columbia) who spent at least 33% of their time in direct patient care were invited to participate in a prospective observational survey. The survey sought information about demographic characteristics and attitudes toward diagnosis. Diagnostic knowledge and skills were tested by means of 3 case scenarios. The analysis included simple descriptive statistics and inferential statistics to evaluate relationships between responses and experience and training. Of 266 pharmacists invited to participate, 94 responded. The attitudes section of the survey was completed by 90 pharmacists; of these, 80 (89%) agreed with the definition of "diagnosis" proposed in the survey, and 83 (92%) agreed that it is important for pharmacists to have diagnosis-related skills. Respondents preferred an analytic to a non-analytic approach to diagnostic decision-making. The probabilistic tradition was not the preferred method in any of the 3 cases. In evaluating 5 clinical scenarios that might require diagnostic skills, on average 84% of respondents agreed that they should be involved in assessing such problems. Respondents' knowledge of and ability to apply probabilistic diagnostic tools were highest for test sensitivity (average of 61% of respondents with the correct answers) and

  1. [Description of the mental processes occurring during clinical reasoning].

    Science.gov (United States)

    Pottier, P; Planchon, B

    2011-06-01

    Clinical reasoning is a highly complex system with multiple inter-dependent mental activities. Gaining a better understanding of those cognitive processes has two practical implications: for physicians, being able to analyse their own reasoning method may prove to be helpful in diagnostic dead end; for medical teachers, identifying problem-solving strategies used by medical students may foster an appropriate individual feed-back aiming at improving their clinical reasoning skills. On the basis of a detailed literature review, the main diagnostic strategies and their related pattern of mental processes are described and illustrated with a concrete example, going from the patient's complaint to the chosen solution. Inductive, abductive and deductive diagnostic approaches are detailed. Different strategies for collecting data (exhaustive or oriented) and for problem-building are described. The place of problem solving strategies such as pattern-recognition, scheme inductive process, using of clinical script, syndrome grouping and mental hypotheses test is considered. This work aims at breaking up mental activities in process within clinical reasoning reminding that expert reasoning is characterised by the ability to use and structure the whole of these activities in a coherent system, using combined strategies in order to guarantee a better accuracy of their diagnosis.

  2. Clinical reasoning in nursing: teaching strategies and assessment tools

    Directory of Open Access Journals (Sweden)

    Emília Campos de Carvalho

    Full Text Available ABSTRACT Objective: To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice. Method: This is a theoretical reflection based on scientific studies. Results: Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning. Conclusion: The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making.

  3. [Clinical reasoning in the learning of the technical side of nursing].

    Science.gov (United States)

    Grousset, Sylvie; Malavaux, Christophe

    2012-11-01

    The 2009 reference framework for nursing training revises the principle of the theoretical and practical aspects of learning constructed simultaneously in nursing training institutes and work placements. Making the learning of technical procedures outside real work situations credible requires a specific pedagogical approach blending supplementary knowledge and clinical reasoning.

  4. Exploring Clinical Reasoning in Novices: A Self-Regulated Learning Microanalytic Approach

    Science.gov (United States)

    2013-07-05

    of reasons, including knowledge and skill deficits, poor motivation, and even learning or emotional disabilities . However, there is an emerging...and small-group activities that expose students to various symptoms, physical exam findings, laboratory test abnormalities, and syndromes. Within the...diagnosis, and initial management plan. Prior to the ICR course, students had no prior didactic or significant clinical experiences in diagnostic

  5. The role of emotions in clinical reasoning and decision making.

    Science.gov (United States)

    Marcum, James A

    2013-10-01

    What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic (hypothetico-deductive thinking) or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention-especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper's main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care.

  6. Characterizing the Development of Specialized Mathematical Content Knowledge for Teaching in Algebraic Reasoning and Number Theory

    Science.gov (United States)

    Bair, Sherry L.; Rich, Beverly S.

    2011-01-01

    This article characterizes the development of a deep and connected body of mathematical knowledge categorized by Ball and Bass' (2003b) model of Mathematical Knowledge for Teaching (MKT), as Specialized Content Knowledge for Teaching (SCK) in algebraic reasoning and number sense. The research employed multiple cases across three years from two…

  7. Introducing Advanced Clinical Reasoning to an Adult Learning Disability Service

    Science.gov (United States)

    Stansfield, Jois; Matthews, Alison

    2014-01-01

    The advanced clinical reasoning approach is widely adopted in speech and language therapy practice. This article reports on the introduction of the approach across a multidisciplinary adult learning disability service and staff reports on the impact of this initiative. Staff and team managers reported that the training had a positive impact on…

  8. Self-explanation fosters clinical reasoning among medical students

    NARCIS (Netherlands)

    M. Chamberland (Martine)

    2014-01-01

    markdownabstract__Abstract__ This thesis explores the use of self-explanation by medical students as a tool supporting the learning of clinical reasoning in the clerkship. Self-explanation (SE) is a learning technique in which students explain to themselves pieces of a learning material for the pur

  9. University Students' Knowledge Structures and Informal Reasoning on the Use of Genetically Modified Foods: Multidimensional Analyses

    Science.gov (United States)

    Wu, Ying-Tien

    2012-12-01

    This study aims to provide insights into the role of learners' knowledge structures about a socio-scientific issue (SSI) in their informal reasoning on the issue. A total of 42 non-science major university students' knowledge structures and informal reasoning were assessed with multidimensional analyses. With both qualitative and quantitative analyses, this study revealed that those students with more extended and better-organized knowledge structures, as well as those who more frequently used higher-order information processing modes, were more oriented towards achieving a higher-level informal reasoning quality. The regression analyses further showed that the "richness" of the students' knowledge structures explained 25 % of the variation in their rebuttal construction, an important indicator of reasoning quality, indicating the significance of the role of students' sophisticated knowledge structure in SSI reasoning. Besides, this study also provides some initial evidence for the significant role of the "core" concept within one's knowledge structure in one's SSI reasoning. The findings in this study suggest that, in SSI-based instruction, science instructors should try to identify students' core concepts within their prior knowledge regarding the SSI, and then they should try to guide students to construct and structure relevant concepts or ideas regarding the SSI based on their core concepts. Thus, students could obtain extended and well-organized knowledge structures, which would then help them achieve better learning transfer in dealing with SSIs.

  10. Research on a Dispersed Knowledge Bases Based Multi-reasoning Press Process Decision System

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Based on the Internet technology and artificial int el ligence (AI) technology, this paper presents a dispersed press process knowledge bases based multi-reasoning press process decision system (DKB-MRPPD). The di spersed press process knowledge bases have been organized into case bases and ru le bases, which may be located at different enterprises, and employed to plan pr ess process by a multi-reasoning engine made up of the ART1, case reasoning and rule-based reasoning net. The architecture model of DK...

  11. Informal reasoning regarding socioscientific issues: The influence of morality and content knowledge

    Science.gov (United States)

    Sadler, Troy Dow

    This study focused on informal reasoning regarding socioscientific issues. It explored how morality and content knowledge influenced the negotiation and resolution of contentious and complex scenarios based on genetic engineering. Two hundred and sixty-nine undergraduate students completed a quantitative test of genetics concepts. A sub-set of the students (n = 30) who completed this instrument and represented divergent levels of content knowledge participated in two individual interviews, during which they discussed their ideas, reactions, and solutions to three gene therapy scenarios and three cloning scenarios. A mixed-methods approach was used to examine patterns of informal reasoning and the influence of morality, the effects of content knowledge on the use of informal reasoning patterns, and the effects of content knowledge on the quality of informal reasoning. Students demonstrated evidence of rationalistic, emotive, and intuitive forms of informal reasoning. Rationalistic informal reasoning described reason-based considerations; emotive informal reasoning described care-based considerations; and intuitive reasoning described considerations based on immediate reactions to the context of a scenario. Participants frequently relied on combinations of these reasoning patterns as they worked to resolve individual socioscientific scenarios. Most of the participants appreciated at least some of the moral implications of their decisions, and these considerations were typically interwoven within an overall pattern of informal reasoning. Although differences in content knowledge were not found to be related to modes of informal reasoning (rationalistic, emotive, and informal), data did indicate that differences in content knowledge were related to variations in informal reasoning quality. Participants, with more advanced understandings of genetics, demonstrated fewer instances of reasoning flaws, as defined by a priori criteria (intra-scenario coherence, inter

  12. Feedback on students' clinical reasoning skills during fieldwork education.

    Science.gov (United States)

    de Beer, Marianne; Mårtensson, Lena

    2015-08-01

    Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students' professional development. The nature of supervisors' feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors' feedback on final-year occupational therapy students' clinical reasoning skills through comparing the nature of feedback with the students' subsequent clinical reasoning ability. A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation. Students' clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students. Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students. © 2015 The Authors. Australian Occupational Therapy Journal published by Wiley Publishing Asia Pty Ltd on behalf of Occupational Therapy Australia.

  13. Assessing progression of clinical reasoning through virtual patients: An exploratory study.

    Science.gov (United States)

    Forsberg, Elenita; Ziegert, Kristina; Hult, Håkan; Fors, Uno

    2016-01-01

    To avoid test-driven learning, there have been discussions regarding the use of more formative assessments in health care education to promote students' deep learning. Feedback is important in formative assessment, but many students ignore it; therefore, interventions should be introduced which stimulate them to reflect on the new knowledge. The aim for this study was to explore if Virtual Patient (VP)-based formative assessments, in connection with self-evaluations, had an impact on postgraduate pediatric nursing students' development of clinical reasoning abilities. Students' self-evaluations served as the basis for measuring progress. Data was analysed using deductive content analysis. The findings showed a clear progression of the clinical reasoning ability of the students. After the first assessment, the students described feelings of uncertainty and that their knowledge gaps were exposed. At the mid-course assessment the awareness of improved clinical reasoning was obvious and the students were more certain of knowing how to solve the VP cases. In the final assessment, self-efficacy was expressed. VP-based assessments, in connection with self-evaluations, early in the education resulted in a gain of students' own identification of the concept of clinical reasoning, awareness of what to focus on during clinical practice and visualised expected clinical competence.

  14. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators.

    Science.gov (United States)

    Delany, Clare; Golding, Clinton

    2014-01-30

    Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student's reasoning skills. Data included participants' written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning. Two overriding themes emerged from participants' reports about using the 'making thinking visible approach'. The first was a specific focus by participating educators on students' understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning. We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.

  15. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators

    Science.gov (United States)

    2014-01-01

    Background Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. Methods Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student’s reasoning skills. Data included participants’ written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning. Results Two overriding themes emerged from participants’ reports about using the ‘making thinking visible approach’. The first was a specific focus by participating educators on students’ understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning. Conclusions We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use. PMID:24479414

  16. Documenting Art Therapy Clinical Knowledge Using Interviews

    Science.gov (United States)

    Regev, Dafna

    2017-01-01

    Practicing art therapists have vast stores of knowledge and experience, but in most cases, their work is not documented, and their clinical knowledge does not enter the academic discourse. This article proposes a systematic approach to the collection of practice knowledge about art therapy based on conducting interviews with art therapists who…

  17. Learning of Content Knowledge and Development of Scientific Reasoning Ability: A Cross Culture Comparison

    CERN Document Server

    Bao, Lei; Cai, Tianfang; Wang, Jing; Yang, Lijia; Cui, Lili; Han, Jing; Ding, Lin; Luo, Ying

    2008-01-01

    Student content knowledge and general reasoning abilities are two important areas in education practice and research. However, there hasn't been much work in physics education that clearly documents the possible interactions between content learning and the development of general reasoning abilities. In this paper, we report one study of a systematic research to investigate the possible interactions between students' learning of physics content knowledge and the development of general scientific reasoning abilities. Specifically, this study seeks to answer the research question of whether and to what extent content learning may affect the development of general reasoning abilities. College entrance testing data of freshman college students in both USA and China were collected using three standardized tests, FCI, BEMA, and Lawson's Classroom Test of Scientific Reasoning (Lawson Test). The results suggest that years of rigorous training of physics knowledge in middle and high schools have made significant impac...

  18. Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education.

    Science.gov (United States)

    Christensen, Nicole; Black, Lisa; Furze, Jennifer; Huhn, Karen; Vendrely, Ann; Wainwright, Susan

    2017-02-01

    Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. A descriptive, cross-sectional survey was administered to physical therapist program representatives. An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or

  19. A Probabilistic Reasoning Method for Predicting the Progression of Clinical Findings from Electronic Medical Records.

    Science.gov (United States)

    Goodwin, Travis; Harabagiu, Sanda M

    2015-01-01

    In this paper, we present a probabilistic reasoning method capable of generating predictions of the progression of clinical findings (CFs) reported in the narrative portion of electronic medical records. This method benefits from a probabilistic knowledge representation made possible by a graphical model. The knowledge encoded in the graphical model considers not only the CFs extracted from the clinical narratives, but also their chronological ordering (CO) made possible by a temporal inference technique described in this paper. Our experiments indicate that the predictions about the progression of CFs achieve high performance given the COs induced from patient records.

  20. Graph Models for Knowledge Representation and Reasoning for Contemporary and Emerging Needs – A Survey

    Directory of Open Access Journals (Sweden)

    Engels Rajangam

    2016-02-01

    Full Text Available —Reasoning is the fundamental capability which requires knowledge. Various graph models have proven to be very valuable in knowledge representation and reasoning. Recently, explosive data generation and accumulation capabilities have paved way for Big Data and Data Intensive Systems. Knowledge Representation and Reasoning with large and growing data is extremely challenging but crucial for businesses to predict trends and support decision making. Any contemporary, reasonably complex knowledge based system will have to consider this onslaught of data, to use appropriate and sufficient reasoning for semantic processing of information by machines. This paper surveys graph based knowledge representation and reasoning, various graph models such as Conceptual Graphs, Concept Graphs, Semantic Networks, Inference Graphs and Causal Bayesian Networks used for representation and reasoning, common and recent research uses of these graph models, typically in Big Data environment, and the near future needs and challenges for graph based KRR in computing systems. Observations are presented in a table, highlighting suitability of the surveyed graph models for contemporary scenarios.

  1. Effects of Conceptual Knowledge and Availability of Information Sources on Law Students' Legal Reasoning

    Science.gov (United States)

    Nievelstein, Fleurie; van Gog, Tamara; Boshuizen, Henny P. A.; Prins, Frans J.

    2010-01-01

    Due to the complexity of the legal domain, reasoning about law cases is a very complex skill. For novices in law school, legal reasoning is even more complex because they have not yet acquired the conceptual knowledge needed for distilling the relevant information from cases, determining applicable rules, and searching for rules and exceptions in…

  2. Effects of Conceptual Knowledge and Availability of Information Sources on Law Students' Legal Reasoning

    Science.gov (United States)

    Nievelstein, Fleurie; van Gog, Tamara; Boshuizen, Henny P. A.; Prins, Frans J.

    2010-01-01

    Due to the complexity of the legal domain, reasoning about law cases is a very complex skill. For novices in law school, legal reasoning is even more complex because they have not yet acquired the conceptual knowledge needed for distilling the relevant information from cases, determining applicable rules, and searching for rules and exceptions in…

  3. TEACHING CLINICAL REASONING TO PHYSIOTHERAPISTS IN SAUDI ARABIA: A THEORETICAL REPORT

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    Mansour Abdullah Alshehri

    2017-04-01

    Full Text Available Background: Clinical reasoning (CR is an essential skill that should be taught to all healthcare professionals. In physiotherapy, it is a cognitive process whereby physiotherapists collect and assess patient data to make a diagnosis and develop an effective treatment plan. Several teaching and learning theories have been developed and used in healthcare education. The purpose of teaching is to facilitate the learning process and the successful development of practitioners in the community. Learning is defined as a knowledge process that is developed through experience which is used to manage daily life situations. The aim of this report is to explore teaching and learning theories and strategies to teach clinical reasoning to physiotherapy students in Saudi Arabia. Discussion: Although it is challenging to completely change the teaching methods in Saudi universities due to the education system rules already in place, some modules in physiotherapy are different, as they are practical and based mainly in a clinical hospital setting. As such, certain teaching and learning theories could be employed to facilitate student teaching. Indeed, a mixed method based on several theories taking into consideration the context, culture, students’ learning styles and the type of knowledge would be most appropriate. Conclusion: There is a debate about the best theory for teaching physiotherapy students. In the context of clinical reasoning, a behaviorism approach is not suitable, in contrast, constructivism is more appropriate, and thus, Saudi physiotherapy educators should consider constructivism strategies for teaching clinical reasoning.

  4. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation.

    Science.gov (United States)

    Dreifuerst, Kristina Thomas

    2012-06-01

    Debriefing is critical to learning from simulation experiences, yet the literature reports little research describing best practices within nursing. Debriefing for Meaningful Learning (DML) is a systematic process for debriefing in which teachers and students explicate different aspects of reflection and generate new meanings from simulation experiences. The purpose of this exploratory, quasi-experimental, pretest-posttest study was to test the relationship of DML on the development of clinical reasoning skills in prelicensure nursing students when compared with customary debriefing strategies and on students' perception of quality of the debriefing experience. Analysis of data demonstrated a greater change in clinical reasoning skills and identification of higher-quality debriefing and a positive correlation between clinical reasoning and perception of quality. Findings demonstrate that DML is an effective debriefing method. It contributes to the body of knowledge supporting the use of debriefing in simulation learning and supports the development of best teaching practices.

  5. Intelligent tutoring system for clinical reasoning skill acquisition in dental students.

    Science.gov (United States)

    Suebnukarn, Siriwan

    2009-10-01

    Learning clinical reasoning is an important core activity of the modern dental curriculum. This article describes an intelligent tutoring system (ITS) for clinical reasoning skill acquisition. The system is designed to provide an experience that emulates that of live human-tutored problem-based learning (PBL) sessions as much as possible, while at the same time permitting the students to participate collaboratively from disparate locations. The system uses Bayesian networks to model individual student knowledge and activity, as well as that of the group. Tutoring algorithms use the models to generate tutoring hints. The system incorporates a multimodal interface that integrates text and graphics so as to provide a rich communication channel between the students and the system, as well as among students in the group. Comparison of learning outcomes shows that student clinical reasoning gains from the ITS are similar to those obtained from human-tutored sessions.

  6. A functional neuroimaging study of the clinical reasoning of medical students.

    Science.gov (United States)

    Chang, Hyung-Joo; Kang, June; Ham, Byung-Joo; Lee, Young-Mee

    2016-12-01

    As clinical reasoning is a fundamental competence of physicians for good clinical practices, medical academics have endeavored to teach reasoning skills to undergraduate students. However, our current understanding of student-level clinical reasoning is limited, mainly because of the lack of evaluation tools for this internal cognitive process. This functional magnetic resonance imaging (fMRI) study aimed to examine the clinical reasoning processes of medical students in response to problem-solving questions. We recruited 24 2nd-year medical students who had completed their preclinical curriculum. They answered 40 clinical vignette-based multiple-choice questions during fMRI scanning. We compared the imaging data for 20 problem-solving questions (reasoning task) and 20 recall questions (recall task). Compared to the recall task, the reasoning task resulted in significantly greater activation in nine brain regions, including the dorsolateral prefrontal cortex and inferior parietal cortex, which are known to be associated with executive function and deductive reasoning. During the recall task, significant activation was observed in the brain regions that are related to memory and emotions, including the amygdala and ventromedial prefrontal cortex. Our results support that medical students mainly solve clinical questions with deductive reasoning involving prior knowledge structures and executive functions. The problem-solving questions induced the students to utilize higher cognitive functions compared with the recall questions. Interestingly, the results suggested that the students experienced some emotional distress while they were solving the recall questions. In addition, these results suggest that fMRI is a promising research tool for investigating students' cognitive processes.

  7. Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning.

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    Baird, Joanne M; Raina, Ketki D; Rogers, Joan C; O'Donnell, John; Holm, Margo B

    2015-01-01

    We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan(®) and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. On average, students completed 66%-88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  8. Scientific evidence of dockworker illness to nursing clinical reasoning.

    Science.gov (United States)

    Almeida, Marlise Capa Verde de; Cezar-Vaz, Marta Regina

    2016-04-01

    To identify scientific evidence of occupational illness of dockworkers published in the literature. systematic review of the literature, developed according to the Cochrane method. The databases searched were: Cochrane, LILACS, MEDLINE/PubMed, CINAHL and SciELO. Studies from 1988 to 2014 were selected. The data were analyzed according to the level of evidence and Strengthening the Reporting of Observational Studies in Epidemiology. We included 14 studies, in which 11 (78.6%) were from international journals. The year of 2012 showed greater number of studies. All studies were classified as: Level of Evidence 4, highlighting lung cancer, musculoskeletal and ischemic diseases, causal link in chemical risks. The development of preventive measures should especially include chemical exposure of workers applying the clinical reasoning of nurses' environmental knowledge to care for illnesses. Identificar evidências científicas de adoecimento ocupacional do trabalhador portuário publicadas na literatura. Revisão sistemática da literatura, construída conforme o método Cochrane. As bases de dados pesquisadas foram Cochrane, LILACS, MEDLINE/PubMed, CINAHL e SciELO. Foram selecionados artigos publicados de 1988 a 2014. Os dados foram analisados conforme o Nível de Evidência e Strengthening the Reporting of Observational Studies in Epidemiology. Foram selecionadas 14 publicações, das quais 11 (78,6%) de revistas internacionais. O ano de 2012 reuniu maior número de publicações no período de estudo. Todas as publicações pertenciam ao Nível de Evidência 4, destacando o câncer pulmonar, doenças osteomusculares e isquêmicas, com nexo causal nos riscos químicos. A elaboração de medidas preventivas deve prever especialmente a exposição química do trabalhador, aplicando ao raciocínio clínico do enfermeiro um conhecimento ambiental para a assistência aos adoecimentos.

  9. THE RELATIONSHIP BETWEEN FUZZY REASONING AND ITS TEMPORAL CHARACTERISTICS FOR KNOWLEDGE MANAGEMENT

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    Daniela SARPE

    2006-01-01

    Full Text Available The knowledge management systems based on artificial reasoning (KMAR tries to provide computers the capabilities of performing various intelligent tasks for which their human users resort to their knowledge and collective intelligence. There is a need for incorporating aspects of time and imprecision into knowledge management systems, considering appropriate semantic foundations. The aim of this paper is to present the FRTES, a real-time fuzzy expert system, embedded in a knowledge management system. Our expert system is a special possibilistic expert system, developed in order to focus on fuzzy knowledge.

  10. Collaborative case-based reasoning for knowledge discovery of elders health assessment system.

    Science.gov (United States)

    Hu, Ping; Gu, Dong-Xiao; Zhu, Yu

    2014-01-01

    The existing Elders Health Assessment (EHA) system based on single-case-library reasoning has low intelligence level, poor coordination, and limited capabilities of assessment decision support. To effectively support knowledge reuse of EHA system, this paper proposes collaborative case reasoning and applies it to the whole knowledge reuse process of EHA system. It proposes a multi-case library reasoning application framework of EHA knowledge reuse system, and studies key techniques such as case representation, case retrieval algorithm, case optimization and correction, and reuse etc.. In the aspect of case representation, XML-based multi-case representation for case organization and storage is applied to facilitate case retrieval and management. In the aspect of retrieval method, Knowledge-Guided Approach with Nearest-Neighbor is proposed. Given the complexity of EHA, Gray Relational Analysis with weighted Euclidean Distance is used to measure the similarity so as to improve case retrieval accuracy.

  11. Self-Explanation, An Instructional Strategy to Foster Clinical Reasoning in Medical Students

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    Martine Chamberland

    2015-12-01

    Full Text Available Clinical reasoning is a critical and complex skill that medical students have to develop in the course of their training. Although research on medical expertise has successfully examined the different components of that skill, designing educational interventions that support the development of clinical reasoning in students remains a challenge for medical educators. The theory of medical expertise describes how students׳ medical knowledge develops and is progressively restructured during their training and in particular through clinical exposure to patient problems. Instructional strategies to foster students’ learning from practice with clinical cases are scarce. This article describes the use of self-explanation as such a strategy. Self-explanation is an active learning technique of proven effectiveness in other domains which consists of having students explaining to themselves information on to-be-learned materials. The mechanisms through which self-explanation fosters learning are described. Self-explanation promotes knowledge development and revision of mental representations through elaboration on new information, organisation and integration of new knowledge into existing cognitive structures and monitoring of the learning process. Subsequently, the article shows how self-explanation has recently been investigated in medicine as an instructional strategy to support students׳ clinical reasoning. Available studies have demonstrated that students׳ diagnostic performance improves when they use self-explanation while solving clinical problems of a less familiar clinical topic. Unfamiliarity seems to trigger more self-explanations and to stimulate students to reactivate relevant biomedical knowledge, which could lead to the development of more coherent representations of diseases. The benefit of students׳ self-explanation is increased when it is combined with listening to residents׳ self-explanation examples and with prompts. The

  12. Categories by Heart: Shortcut Reasoning in a Cardiology Clinic

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    Katarina Jacobsson

    2014-09-01

    Full Text Available This article examines the practice of doctors and nurses to invoke the categories of age, sex, class, ethnicity, and/or lifestyle factors when discussing individual patients and patient groups. In what situations are such references explicitly made, and what does this practice accomplish? The material consists of field notes from a cardiology clinic in Sweden, and a theory of descriptive practice guided the analysis. When professionals describe patients, discuss decisions, or explain why a patient is ill, age, sex, class, ethnicity, and/or lifestyle serve as contextualization cues, often including widespread results from epidemiological research about groups of patients at higher or lower risk for cardiac disease. These categories work as shortcut reasoning to nudge interpretations in a certain direction, legitimize decisions, and strengthen arguments. In general, studying the descriptions of patients/clients/students provides an entrance to professional methods of reasoning, including their implicit moral assumptions.

  13. The engine of thought is a hybrid: roles of associative and structured knowledge in reasoning.

    Science.gov (United States)

    Bright, Aimée K; Feeney, Aidan

    2014-12-01

    Across a range of domains in psychology different theories assume different mental representations of knowledge. For example, in the literature on category-based inductive reasoning, certain theories (e.g., Rogers & McClelland, 2004; Sloutsky & Fisher, 2008) assume that the knowledge upon which inductive inferences are based is associative, whereas others (e.g., Heit & Rubinstein, 1994; Kemp & Tenenbaum, 2009; Osherson, Smith, Wilkie, López, & Shafir, 1990) assume that knowledge is structured. In this article we investigate whether associative and structured knowledge underlie inductive reasoning to different degrees under different processing conditions. We develop a measure of knowledge about the degree of association between categories and show that it dissociates from measures of structured knowledge. In Experiment 1 participants rated the strength of inductive arguments whose categories were either taxonomically or causally related. A measure of associative strength predicted reasoning when people had to respond fast, whereas causal and taxonomic knowledge explained inference strength when people responded slowly. In Experiment 2, we also manipulated whether the causal link between the categories was predictive or diagnostic. Participants preferred predictive to diagnostic arguments except when they responded under cognitive load. In Experiment 3, using an open-ended induction paradigm, people generated and evaluated their own conclusion categories. Inductive strength was predicted by associative strength under heavy cognitive load, whereas an index of structured knowledge was more predictive of inductive strength under minimal cognitive load. Together these results suggest that associative and structured models of reasoning apply best under different processing conditions and that the application of structured knowledge in reasoning is often effortful.

  14. MANAGEMENT OF AN ATYPICAL ANKLE SPRAIN PATIENT THROUGH HYPOTHETICO DEDUCTIVE REASONING MODEL OF CLINICAL REASONING IMPLEMENTED BY INTERNATIONAL CLASSIFICATION OF FUNCTIONING DISABILITY AND HEALTH A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Mohammad Habibur Rahman

    2016-09-01

    Full Text Available Background: Clinical reasoning is a process by which physiotherapists interacted with patients, their family and other health- care professionals. It is the thinking process that professionals tend to apply in clinical practice. Given that novice as well as expert practitioners prefer to go through some steps while they were dealing with unfamiliar cases. This process is known as hypothetico deductive reasoning. This reasoning approach involved the generation of hypothesis based on clinical data and knowledge and testing of hypothesis through further inquiry. We are expert in musculoskeletal physiotherapy treatment and favoring the atypical history of patient we went through step by step from assessment to discharge Methods: A case based study through hypothetico deductive reasoning model of clinical reasoning. The objective of the study was to investigate the physiotherapy management strategies of an atypical ankle sprain patient through hypothetico deductive reasoning which comprised of cue acquisition, hypothesis generation, cue interpretation and hypothesis evaluation by implementing International Classification of Functioning, Disability and Health (ICF. Results: The patient responded well to treatment as patient reported that 100% swelling decreased, could bear more weight (95% on foot, decrease pain (1 cm on 10 cm VAS scale, improved muscle strength by manual muscle testing by grade V in ankle planter flexors (PF as well as dorsiflexors (DF, invertors as well as evertors and the functional status of patient was improved by 80% according to lower extremity functional scale. Conclusion: Clinical reasoning is an important approach in physiotherapy. It helps the practitioners in decision making and choosing the best alternative options for the well being of patients. We think it is necessary for all practitioners to have sound propositional and non-propositional knowledge in order to provide effective management protocol for patients focusing

  15. Clinical sensitivity: the inseparability of ethical perceptiveness and clinical knowledge.

    Science.gov (United States)

    Nortvedt, P

    2001-01-01

    This article argues that there is an important connection between ethical sensitivity and clinical competency in nursing. This is more than a defense for ethical attitudes and virtues in clinical practice, however. I will show in what way ethical sensitivity is important not only to moral judgment, but to professional clinical knowledge and judgment as well. Drawing on central insights from continental philosophy, Husserl, Heidegger, Levinas and Foucault, as well as classical virtue theory, the article elucidates the inseparability of ethical sensitivity and clinical knowledge in nursing. Ethical sensitivity has bearing upon clinical knowledge and awareness in two important ways. First, what we consider relevant clinical knowledge and therapeutic measures frequently encounter the realities of clinical conditions, realities which embody certain moral qualities and appeal to moral values. In clinical nursing, it is important to understand how this encounter between professional knowledge and moral values informs clinical action, making it morally as well as professionally proper. Second, sensitivity to vulnerability qualifies clinical knowledge in the way that it alerts clinical sensitivity altogether. Perception of morally salient features informs the nurse about significant changes in the patient's pathological condition. The ability to be touched morally by the patient's condition, his or her vulnerability or vitality and positive experience is epistemologically and prognostically significant.

  16. Preclerkship assessment of clinical skills and clinical reasoning: the longitudinal impact on student performance.

    Science.gov (United States)

    LaRochelle, Jeffrey S; Dong, Ting; Durning, Steven J

    2015-04-01

    Many medical schools across the United States are undergoing curriculum reform designed, in part, to integrate basic sciences and clinical skills. Evidence has suggested that preclerkship courses in clinical skills and clinical reasoning are predictive of student performance on the clerkship. We hypothesized that a combination of outcome measures from preclerkship clinical skills and clinical reasoning courses (Objective Structured Clinical Examination scores, preceptor evaluations, National Board of Medical Examiners subject examination scores, and small group participation grades) would be correlated to performance in internship (program director [PD]evaluation form at end of first postgraduate year). Outcome measures from preclerkship clinical skills and clinical reasoning courses and PD evaluation forms from 514 medical students graduating between 2009 and 2011 were analyzed in a multiple linear regression model. Preclerkship clinical skills and clinical reasoning outcome measures were significant contributors to the linear regression model and were able to explain 13.9% of the variance in expertise and 7.6% of the variance in professionalism as measured by the PD evaluation form. Clinical skills and clinical reasoning courses during the preclerkship period explained a significant amount of performance at the graduate medical education level. Our data suggest that these courses provide valuable information regarding student abilities in internship. Early recognition of struggling students may provide an opportunity to break a cycle of poor performance that can persist into residency training. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  17. The Significance of Content Knowledge for Informal Reasoning regarding Socioscientific Issues: Applying Genetics Knowledge to Genetic Engineering Issues

    Science.gov (United States)

    Sadler, Troy D.; Zeidler, Dana L.

    2005-01-01

    This study focused on informal reasoning regarding socioscientific issues. It sought to explore how content knowledge influenced the negotiation and resolution of contentious and complex scenarios based on genetic engineering. Two hundred and sixty-nine students drawn from undergraduate natural science and nonnatural science courses completed a…

  18. The Role of Biomedical Knowledge in Diagnosis of Difficult Clinical Cases

    Science.gov (United States)

    Woods, Nicole N.; Brooks, Lee R.; Norman, Geoffrey R.

    2007-01-01

    Although biomedical knowledge is believed to be of little value in diagnosis of routine clinical cases, studies of clinical reasoning have found that physicians revert to use of basic biomedical knowledge when faced with challenging clinical problems. The current paper presents two experiments that empirically examine the role of biomedical…

  19. Bayesian Diagnostic Network: A Powerful Model for Representation and Reasoning of Engineering Diagnostic Knowledge

    Institute of Scientific and Technical Information of China (English)

    HU Zhao-yong

    2005-01-01

    Engineering diagnosis is essential to the operation of industrial equipment. The key to successful diagnosis is correct knowledge representation and reasoning. The Bayesian network is a powerful tool for it. This paper utilizes the Bayesian network to represent and reason diagnostic knowledge, named Bayesian diagnostic network. It provides a three-layer topologic structure based on operating conditions, possible faults and corresponding symptoms. The paper also discusses an approximate stochastic sampling algorithm. Then a practical Bayesian network for gas turbine diagnosis is constructed on a platform developed under a Visual C++ environment. It shows that the Bayesian network is a powerful model for representation and reasoning of diagnostic knowledge. The three-layer structure and the approximate algorithm are effective also.

  20. Maximizing scientific knowledge from randomized clinical trials

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Atar, Dan; Pitt, Bertram

    2010-01-01

    Trialists have an ethical and financial responsibility to plan and conduct clinical trials in a manner that will maximize the scientific knowledge gained from the trial. However, the amount of scientific information generated by randomized clinical trials in cardiovascular medicine is highly...

  1. Issues and challenges of knowledge representation and reasoning methods in situation assessment (Level 2 Fusion)

    Science.gov (United States)

    Blasch, Erik; Kadar, Ivan; Salerno, John; Kokar, Mieczyslaw M.; Das, Subrata; Powell, Gerald M.; Corkill, Daniel D.; Ruspini, Enrique H.

    2006-05-01

    Situation assessment (SA) involves deriving relations among entities, e.g., the aggregation of object states (i.e. classification and location). While SA has been recognized in the information fusion and human factors literature, there still exist open questions regarding knowledge representation and reasoning methods to afford SA. For instance, while lots of data is collected over a region of interest, how does this information get presented to an attention constrained user? The information overload can deteriorate cognitive reasoning so a pragmatic solution to knowledge representation is needed for effective and efficient situation understanding. In this paper, we present issues associated with Level 2 (Situation Assessment) including: (1) user perception and perceptual reasoning representation, (2) knowledge discovery process models, (3) procedural versus logical reasoning about relationships, (4) user-fusion interaction through performance metrics, and (5) syntactic and semantic representations. While a definitive conclusion is not the aim of the paper, many critical issues are proposed in order to characterize future successful strategies to knowledge representation and reasoning strategies for situation assessment.

  2. Using script theory to cultivate illness script formation and clinical reasoning in health professions education

    Directory of Open Access Journals (Sweden)

    Stuart Lubarsky

    2015-12-01

    Full Text Available Background: Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals’ interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called ‘illness scripts’ that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold. These knowledge networks become updated and refined through experience and learning. The implications of script theory on medical education are profound. Since clinician-teachers cannot simply transfer their customized collections of illness scripts into the minds of learners, they must create opportunities to help learners develop and fine-tune their own sets of scripts. In this essay, we provide a basic sketch of script theory, outline the role that illness scripts play in guiding reasoning during clinical encounters, and propose strategies for aligning teaching practices in the classroom and the clinical setting with the basic principles of script theory.

  3. Using script theory to cultivate illness script formation and clinical reasoning in health professions education.

    Science.gov (United States)

    Lubarsky, Stuart; Dory, Valérie; Audétat, Marie-Claude; Custers, Eugène; Charlin, Bernard

    2015-01-01

    Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals' interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called 'illness scripts' that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold. These knowledge networks become updated and refined through experience and learning. The implications of script theory on medical education are profound. Since clinician-teachers cannot simply transfer their customized collections of illness scripts into the minds of learners, they must create opportunities to help learners develop and fine-tune their own sets of scripts. In this essay, we provide a basic sketch of script theory, outline the role that illness scripts play in guiding reasoning during clinical encounters, and propose strategies for aligning teaching practices in the classroom and the clinical setting with the basic principles of script theory.

  4. Clinical reasoning in nursing: teaching strategies and assessment tools.

    Science.gov (United States)

    Carvalho, Emília Campos de; Oliveira-Kumakura, Ana Railka de Souza; Morais, Sheila Coelho Ramalho Vasconcelos

    2017-01-01

    To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice. This is a theoretical reflection based on scientific studies. Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning. The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making. Apresentar o conceito de raciocínio clínico, seu desenvolvimento, as estratégias para seu ensino e os instrumentos de avaliação para uma prática acurada. Trata-se de uma reflexão teórica fundamentada em estudos científicos. A compreensão dos conceitos essenciais do processo de pensamento e sua articulação com as diferentes estratégias de ensino e com os instrumentos de avaliação permitiram exemplificar meios de aprimorar o processo de raciocínio clínico diagnóstico ou terapêutico. A utilização de novas estratégias e instrumentos de avaliação deve ser estimulado para contribuir com o desenvolvimento das habilidades que culminam na tomada de decisão segura e eficaz.

  5. Improving the learning of clinical reasoning through computer-based cognitive representation

    Directory of Open Access Journals (Sweden)

    Bian Wu

    2014-12-01

    Full Text Available Objective: Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems. Methods: Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process. Results: A significant improvement was found in students’ learning products from the beginning to the end of the study, consistent with students’ report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment. Conclusions: The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge

  6. Improving the learning of clinical reasoning through computer-based cognitive representation.

    Science.gov (United States)

    Wu, Bian; Wang, Minhong; Johnson, Janice M; Grotzer, Tina A

    2014-01-01

    Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems. Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process. A significant improvement was found in students' learning products from the beginning to the end of the study, consistent with students' report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment. The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction.

  7. Socio-demographic and academic correlates of clinical reasoning in a dental school in South Africa.

    Science.gov (United States)

    Postma, T C; White, J G

    2017-02-01

    There are no empirical studies that describe factors that may influence the development of integrated clinical reasoning skills in dental education. Hence, this study examines the association between outcomes of clinical reasoning in relation with differences in instructional design and student factors. Progress test scores, including diagnostic and treatment planning scores, of fourth and fifth year dental students (2009-2011) at the University of Pretoria, South Africa served as the outcome measures in stepwise linear regression analyses. These scores were correlated with the instructional design (lecture-based teaching and learning (LBTL = 0) or case-based teaching and learning (CBTL = 1), students' grades in Oral Biology, indicators of socio-economic status (SES) and gender. CBTL showed an independent association with progress test scores. Oral Biology scores correlated with diagnostic component scores. Diagnostic component scores correlated with treatment planning scores in the fourth year of study but not in the fifth year of study. 'SES' correlated with progress test scores in year five only, while gender showed no correlation. The empirical evidence gathered in this study provides support for scaffolded inductive teaching and learning methods to develop clinical reasoning skills. Knowledge in Oral Biology and reading skills may be important attributes to develop to ensure that students are able to reason accurately in a clinical setting. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Problem-Oriented Corporate Knowledge Base Models on the Case-Based Reasoning Approach Basis

    Science.gov (United States)

    Gluhih, I. N.; Akhmadulin, R. K.

    2017-07-01

    One of the urgent directions of efficiency enhancement of production processes and enterprises activities management is creation and use of corporate knowledge bases. The article suggests a concept of problem-oriented corporate knowledge bases (PO CKB), in which knowledge is arranged around possible problem situations and represents a tool for making and implementing decisions in such situations. For knowledge representation in PO CKB a case-based reasoning approach is encouraged to use. Under this approach, the content of a case as a knowledge base component has been defined; based on the situation tree a PO CKB knowledge model has been developed, in which the knowledge about typical situations as well as specific examples of situations and solutions have been represented. A generalized problem-oriented corporate knowledge base structural chart and possible modes of its operation have been suggested. The obtained models allow creating and using corporate knowledge bases for support of decision making and implementing, training, staff skill upgrading and analysis of the decisions taken. The universal interpretation of terms “situation” and “solution” adopted in the work allows using the suggested models to develop problem-oriented corporate knowledge bases in different subject domains. It has been suggested to use the developed models for making corporate knowledge bases of the enterprises that operate engineer systems and networks at large production facilities.

  9. Maximizing scientific knowledge from randomized clinical trials

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Atar, Dan; Pitt, Bertram;

    2010-01-01

    Trialists have an ethical and financial responsibility to plan and conduct clinical trials in a manner that will maximize the scientific knowledge gained from the trial. However, the amount of scientific information generated by randomized clinical trials in cardiovascular medicine is highly...... variable. Generation of trial databases and/or biobanks originating in large randomized clinical trials has successfully increased the knowledge obtained from those trials. At the 10th Cardiovascular Trialist Workshop, possibilities and pitfalls in designing and accessing clinical trial databases were......, in particular with respect to collaboration with the trial sponsor and to analytic pitfalls. The advantages of creating screening databases in conjunction with a given clinical trial are described; and finally, the potential for posttrial database studies to become a platform for training young scientists...

  10. Integrating reasoning and clinical archetypes using OWL ontologies and SWRL rules.

    Science.gov (United States)

    Lezcano, Leonardo; Sicilia, Miguel-Angel; Rodríguez-Solano, Carlos

    2011-04-01

    Semantic interoperability is essential to facilitate the computerized support for alerts, workflow management and evidence-based healthcare across heterogeneous electronic health record (EHR) systems. Clinical archetypes, which are formal definitions of specific clinical concepts defined as specializations of a generic reference (information) model, provide a mechanism to express data structures in a shared and interoperable way. However, currently available archetype languages do not provide direct support for mapping to formal ontologies and then exploiting reasoning on clinical knowledge, which are key ingredients of full semantic interoperability, as stated in the SemanticHEALTH report [1]. This paper reports on an approach to translate definitions expressed in the openEHR Archetype Definition Language (ADL) to a formal representation expressed using the Ontology Web Language (OWL). The formal representations are then integrated with rules expressed with Semantic Web Rule Language (SWRL) expressions, providing an approach to apply the SWRL rules to concrete instances of clinical data. Sharing the knowledge expressed in the form of rules is consistent with the philosophy of open sharing, encouraged by archetypes. Our approach also allows the reuse of formal knowledge, expressed through ontologies, and extends reuse to propositions of declarative knowledge, such as those encoded in clinical guidelines. This paper describes the ADL-to-OWL translation approach, describes the techniques to map archetypes to formal ontologies, and demonstrates how rules can be applied to the resulting representation. We provide examples taken from a patient safety alerting system to illustrate our approach.

  11. A case-based reasoning tool for breast cancer knowledge management with data mining concepts and techniques

    Science.gov (United States)

    Demigha, Souâd.

    2016-03-01

    The paper presents a Case-Based Reasoning Tool for Breast Cancer Knowledge Management to improve breast cancer screening. To develop this tool, we combine both concepts and techniques of Case-Based Reasoning (CBR) and Data Mining (DM). Physicians and radiologists ground their diagnosis on their expertise (past experience) based on clinical cases. Case-Based Reasoning is the process of solving new problems based on the solutions of similar past problems and structured as cases. CBR is suitable for medical use. On the other hand, existing traditional hospital information systems (HIS), Radiological Information Systems (RIS) and Picture Archiving Information Systems (PACS) don't allow managing efficiently medical information because of its complexity and heterogeneity. Data Mining is the process of mining information from a data set and transform it into an understandable structure for further use. Combining CBR to Data Mining techniques will facilitate diagnosis and decision-making of medical experts.

  12. Effects of Conceptual Knowledge and Availability of Information Sources on Law Students Legal Reasoning

    NARCIS (Netherlands)

    Nievelstein, Fleurie; Van Gog, Tamara; Boshuizen, Els; Prins, Frans

    2010-01-01

    Nievelstein, F., Van Gog, T., Boshuizen, H. P. A., & Prins, F. J. (2010). Effects of Conceptual Knowledge and Availability of Information Sources on Law Students Legal Reasoning. Instructional Science, 38, 23-35. doi:10.1007/s11251-008-9076-3

  13. The Knowledge-Based Reasoning of Physical Education Teachers: A Comparison between Groups with Different Expertise

    Science.gov (United States)

    Reuker, Sabine

    2017-01-01

    The study addresses professional vision, including the abilities of selective attention and knowledge-based reasoning. This article focuses on the latter ability. Groups with different sport-specific and pedagogical expertise (n = 60) were compared according to their observation and interpretation of sport activities in a four-field design. The…

  14. Tacit knowledge and visual expertise in medical diagnostic reasoning: implications for medical education

    DEFF Research Database (Denmark)

    Heiberg Engel, Peter Johan

    2008-01-01

    BACKGROUND: Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having foc...

  15. Eighth Grade In-Service Teachers' Knowledge of Proportional Reasoning and Functions: A Secondary Data Analysis

    Science.gov (United States)

    Masters, Jessica

    2012-01-01

    A secondary data analysis was conducted using a large dataset from a study related to online professional development for eighth grade teachers of mathematics. Using this data, the paper provides a snapshot of the current state of teachers' knowledge related to proportional reasoning and functions. The paper also considers how teachers' knowledge…

  16. Effects of Conceptual Knowledge and Availability of Information Sources on Law Students Legal Reasoning

    OpenAIRE

    Nievelstein, Fleurie; Gog, Tamara; Boshuizen, Els; Prins, Frans

    2010-01-01

    Nievelstein, F., Van Gog, T., Boshuizen, H. P. A., & Prins, F. J. (2010). Effects of Conceptual Knowledge and Availability of Information Sources on Law Students Legal Reasoning. Instructional Science, 38, 23-35. doi:10.1007/s11251-008-9076-3

  17. Knowledge of Computer Ethics: Its Relationship to Computer Attitude and Sociomoral Reasoning.

    Science.gov (United States)

    Bear, George G.

    1990-01-01

    Describes study of seventh graders that was conducted to examine the relationship of a knowledge of computer ethics to attitudes toward computers and sociomoral reasoning. Variables of gender and verbal ability are examined, a measure of computer ethics is described, and results are analyzed. (31 references) (LRW)

  18. Eighth Grade In-Service Teachers' Knowledge of Proportional Reasoning and Functions: A Secondary Data Analysis

    Science.gov (United States)

    Masters, Jessica

    2012-01-01

    A secondary data analysis was conducted using a large dataset from a study related to online professional development for eighth grade teachers of mathematics. Using this data, the paper provides a snapshot of the current state of teachers' knowledge related to proportional reasoning and functions. The paper also considers how teachers' knowledge…

  19. Checking the Quality of Clinical Guidelines using Automated Reasoning Tools

    CERN Document Server

    Hommersom, Arjen; van Bommel, Patrick

    2008-01-01

    Requirements about the quality of clinical guidelines can be represented by schemata borrowed from the theory of abductive diagnosis, using temporal logic to model the time-oriented aspects expressed in a guideline. Previously, we have shown that these requirements can be verified using interactive theorem proving techniques. In this paper, we investigate how this approach can be mapped to the facilities of a resolution-based theorem prover, Otter, and a complementary program that searches for finite models of first-order statements, Mace. It is shown that the reasoning required for checking the quality of a guideline can be mapped to such fully automated theorem-proving facilities. The medical quality of an actual guideline concerning diabetes mellitus 2 is investigated in this way.

  20. Junior doctors' knowledge of applied clinical anatomy.

    Science.gov (United States)

    Gupta, Yuri; Morgan, Mia; Singh, Annika; Ellis, Harold

    2008-05-01

    This study examines the level of knowledge of applied clinical anatomy among junior doctors. A multiple-choice questionnaire was designed, which covered 15 areas of anatomical knowledge essential to clinical practice, for example, important surface landmarks and interpretation of radiographs. The questionnaire was completed by 128 individuals. They comprised anatomy demonstrators, preregistration house officers (PRHOs), senior house officers (SHOs) and specialist registrars (SpRs) across the range of medical and surgical specialities. Answers were scored and analyzed by group, allowing comparison not only between newly qualified PRHOs and more senior doctors, but also with anatomy demonstrators who had undergone more traditional anatomical training. The results reveal a wide variation of knowledge among junior doctors, with PRHOs scoring an average of 72.1%, SHOs 77.1%, SpRs 82.4%, and demonstrators 82.9%. This progression in knowledge up the clinical hierarchy may reflect clinical experience building upon the foundations laid in medical school, although with demonstrators topping the league table, it seems that intensive academic training is the most beneficial. With junior doctors' training in the UK currently in flux, these results highlight the need for training in clinical anatomy to hold an important place in the development of tomorrow's clinicians.

  1. A Knowledge-reuse Based Intelligent Reasoning Model for Worsted Process Optimization

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The textile process planning is a knowledge reuse process in nature, which depends on the expert's knowledge and experience. It seems to be very difficult to build up an integral mathematical model to optimize hundreds of the processing parameters. In fact, the existing process cases which were recorded to ensure the ability to trace production steps can also be used to optimize the process itself. This paper presents a novel knowledge-reuse based hybrid intelligent reasoning model (HIRM) for worsted process optimization. The model architecture and reasoning mechanism are respectively described. An applied case with HIRM is given to demonstrate that the best process decision can be made, and important processing parameters such as for raw material optimized.

  2. Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.

    Science.gov (United States)

    Koivisto, Jaana-Maija; Multisilta, Jari; Niemi, Hannele; Katajisto, Jouko; Eriksson, Elina

    2016-10-01

    Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. Cross-sectional descriptive study. Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. Nursing students from the surgical nursing course of autumn 2014 (N=166). Data were collected by means of an online questionnaire. In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

    Science.gov (United States)

    Orban, Kristina; Ekelin, Maria; Edgren, Gudrun; Sandgren, Olof; Hovbrandt, Pia; Persson, Eva K

    2017-09-11

    Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

  4. [Knowledge management system for laboratory work and clinical decision support].

    Science.gov (United States)

    Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko

    2011-05-01

    This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.

  5. Effects of additional team-based learning on students' clinical reasoning skills: a pilot study.

    Science.gov (United States)

    Jost, Meike; Brüstle, Peter; Giesler, Marianne; Rijntjes, Michel; Brich, Jochen

    2017-07-14

    In the field of Neurology good clinical reasoning skills are essential for successful diagnosing and treatment. Team-based learning (TBL), an active learning and small group instructional strategy, is a promising method for fostering these skills. The aim of this pilot study was to examine the effects of a supplementary TBL-class on students' clinical decision-making skills. Fourth- and fifth-year medical students participated in this pilot study (static-group comparison design). The non-treatment group (n = 15) did not receive any additional training beyond regular teaching in the neurology course. The treatment group (n = 11) took part in a supplementary TBL-class optimized for teaching clinical reasoning in addition to the regular teaching in the neurology course. Clinical decision making skills were assessed using a key-feature problem examination. Factual and conceptual knowledge was assessed by a multiple-choice question examination. The TBL-group performed significantly better than the non-TBL-group (p = 0.026) in the key-feature problem examination. No significant differences between the results of the multiple-choice question examination of both groups were found. In this pilot study participants of a supplementary TBL-class significantly improved clinical decision-making skills, indicating that TBL may be an appropriate method for teaching clinical decision making in neurology. Further research is needed for replication in larger groups and other clinical fields.

  6. Teaching Skills to Promote Clinical Reasoning in Early Basic Science Courses

    Science.gov (United States)

    Elizondo-Omana, Rodrigo Enrique; Morales-Gomez, Jesus Alberto; Morquecho-Espinoza, Orlando; Hinojosa-Amaya, Jose Miguel; Villarreal-Silva, Eliud Enrique; Garcia-Rodriguez, Maria de los Angeles; Guzman-Lopez, Santos

    2010-01-01

    Basic and superior reasoning skills are woven into the clinical reasoning process just as they are used to solve any problem. As clinical reasoning is the central competence of medical education, development of these reasoning skills should occur throughout the undergraduate medical curriculum. The authors describe here a method of teaching…

  7. Teaching Skills to Promote Clinical Reasoning in Early Basic Science Courses

    Science.gov (United States)

    Elizondo-Omana, Rodrigo Enrique; Morales-Gomez, Jesus Alberto; Morquecho-Espinoza, Orlando; Hinojosa-Amaya, Jose Miguel; Villarreal-Silva, Eliud Enrique; Garcia-Rodriguez, Maria de los Angeles; Guzman-Lopez, Santos

    2010-01-01

    Basic and superior reasoning skills are woven into the clinical reasoning process just as they are used to solve any problem. As clinical reasoning is the central competence of medical education, development of these reasoning skills should occur throughout the undergraduate medical curriculum. The authors describe here a method of teaching…

  8. The role of professional knowledge in case-based reasoning in practical ethics.

    Science.gov (United States)

    Pinkus, Rosa Lynn; Gloeckner, Claire; Fortunato, Angela

    2015-06-01

    The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one's professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: (1) Experts in a research domain in bioengineering. (2) Novices in a research domain in bioengineering. (3) The non-research group--students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student's level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills.

  9. Childless women's beliefs and knowledge about oocyte freezing for social and medical reasons.

    Science.gov (United States)

    Daniluk, J C; Koert, E

    2016-10-01

    What factors inform a woman's decision-making about oocyte freezing to preserve fertility for social and medical reasons? Women lacked knowledge about the costs and viability of oocyte freezing as a fertility preservation option for social and medical reasons, and identified health consequences, costs, and viability as being particularly influential in their decision-making. Having only recently become a viable fertility preservation option, relatively little is known about childless women's beliefs or knowledge about oocyte freezing for social or medical reasons. A cross sectional study of 500 childless women was conducted in August, 2015. A total of 500 childless, presumed fertile, women from 18 to 38 years of age completed an online, self-report questionnaire assessing beliefs and knowledge about oocyte freezing to preserve fertility for social or medical reasons. Financial costs (85.6%), health risks to themselves (86.4%) or their offspring (87.8%), and success rates (82%) were the primary factors that women felt would influence their decision to freeze their oocytes. Partner's feelings (88.6%), prognosis for a full recovery (85.4%), and concerns about the health effects of the hormones or oocyte retrieval procedure (85.4%) were identified as being particularly important when considering oocyte freezing for medical reasons. Consistent with their perceptions of having little or no knowledge about oocyte freezing, there was an overall correct response rate of 33% to the 12 knowledge questions. The online format and use of a survey company to recruit participants may have increased the risk of self-selection bias and limit the generalizability of these findings. The findings may also be limited by the fact that the participants were not facing cancer treatments, and the younger participants were not nearing the end of their reproductive lifespan, and therefore would not have had reason to learn about, or consider, fertility preservation for medical or social

  10. George Santayana’s Teleological Poetics: Inspiration, Knowledge and Happiness in Reason in Art

    Directory of Open Access Journals (Sweden)

    Rocío Badía Fumaz

    2012-04-01

    Full Text Available With The Life of Reason George Santayana earned his reputation as philosopher; this is due to its length but also because it is his most detailed moral work. The fourth volume of the work, entitled Reason in Art, analyzes both the historical and synchronic origin of the work of art. Santayana’s Poetics are built on the strained relationship he draws between, ethics and aesthetics, ingenium and ars, literature and philosophy. He develops a teleological and eudaimonistic approach which centres on three concrete loci: inspiration, knowledge and happiness.

  11. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    Science.gov (United States)

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Knowledge engineering tools for reasoning with scientific observations and interpretations: a neural connectivity use case

    Directory of Open Access Journals (Sweden)

    Bota Mihail

    2011-08-01

    Full Text Available Abstract Background We address the goal of curating observations from published experiments in a generalizable form; reasoning over these observations to generate interpretations and then querying this interpreted knowledge to supply the supporting evidence. We present web-application software as part of the 'BioScholar' project (R01-GM083871 that fully instantiates this process for a well-defined domain: using tract-tracing experiments to study the neural connectivity of the rat brain. Results The main contribution of this work is to provide the first instantiation of a knowledge representation for experimental observations called 'Knowledge Engineering from Experimental Design' (KEfED based on experimental variables and their interdependencies. The software has three parts: (a the KEfED model editor - a design editor for creating KEfED models by drawing a flow diagram of an experimental protocol; (b the KEfED data interface - a spreadsheet-like tool that permits users to enter experimental data pertaining to a specific model; (c a 'neural connection matrix' interface that presents neural connectivity as a table of ordinal connection strengths representing the interpretations of tract-tracing data. This tool also allows the user to view experimental evidence pertaining to a specific connection. BioScholar is built in Flex 3.5. It uses Persevere (a noSQL database as a flexible data store and PowerLoom® (a mature First Order Logic reasoning system to execute queries using spatial reasoning over the BAMS neuroanatomical ontology. Conclusions We first introduce the KEfED approach as a general approach and describe its possible role as a way of introducing structured reasoning into models of argumentation within new models of scientific publication. We then describe the design and implementation of our example application: the BioScholar software. This is presented as a possible biocuration interface and supplementary reasoning toolkit for a larger

  13. Clinical reasoning assessment through medical expertise theories: past, present and future directions.

    Science.gov (United States)

    Boushehri, Elham; Soltani Arabshahi, Kamran; Monajemi, Alireza

    2015-01-01

    Exploration into the concept of "medical expert" dates back to more than 50 years ago, yet yielding three leading theories in the area of clinical reasoning, namely, knowledge structure, hypotheticdeductive, and dual process. Each theory defines "medical expert" in a dissimilar way. Therefore, the methods of assessment through which the experts are identified have been changed during the time. In this paper, we tried to categorize and introduce some widely used tests for identification of experts within the framework of existing main theories. Implementation of the proposed categorization for providing future assessment tools is discussed.

  14. Characteristics, reasons, behavior and knowledge towards waterpipe smoking in Saudi Arabia.

    Science.gov (United States)

    Venkatesh, Elluru; Al Jemal, Mohammad Yousef; Al Samani, Abdullah Saleh

    2017-08-18

    Background The present scenario shows that waterpipe smoking, one of tobacco smoking methods, the practice off which dates back at least 400 year is appealing to the youth. Waterpipe tobacco smoking is frequently linked with nations of the Eastern Mediterranean Region (EMR) comprising Egypt, Kuwait, Lebanon and Syria. The present study shows the socio-demographic characteristics, behavior and knowledge of youth towards waterpipe smoking. Recognizing these features may help emphasize intervention methods. Methods A self-administered questionnaire was used to collect the data about waterpipe smoking comprising sociodemographic, behavior, reasons and knowledge from 230 university students. Results 230 questionnaires were distributed from which only 199 were included in the study as 31 were excluded because of incompleteness of the survey. The mean age for starting smoking was 19.49 ± 3.75 years with 32.5% of family members and the majority of their friends engaged with waterpipe smoking. Pleasure and happiness (76%), helps me to deal with pressure (78%) and acceptance by society (91%), were the major reasons cited for waterpipe smoking. It being less harmful and less addictive (55%) compared to cigarettes and no objection from the parents (58%) were the other cited reasons. Furthermore, less than 50% of the participants had correct knowledge of its harmful effects. Conclusion It is clearly evident from our findings that there is a meagre amount of knowledge regarding the harmful effects of waterpipe smoking. It is essential that programs to impart knowledge regarding the harmful effects of waterpipe smoking and dependence should be of the utmost importance.

  15. [Relevance of nutrition knowledge on clinical practice: medical opinion survey].

    Science.gov (United States)

    Alvares, Luísa; Moreira, Isabel; Oliveira, António

    2007-01-01

    Although previous studies show that physicians generally agree that nutrition knowledge is important for their daily clinical practice, several other studies report their poor knowledge of the subject. One of the strongest reasons given for this is the non-incorporation of Nutrition as a compulsory subject for the medical sciences degree. Dietary counselling and assessment of the patients' nutritional status don't seem to be systematic. The aim of this study is to asses how relevant physicians consider Nutrition to be in the successful running of a good practice. The study was undertaken at the general hospital of Vila Real/Peso da Régua (CHVR/PR) by distribution of a self- administered questionnaire to 153 of the physicians of the clinical body. Mean values were compared with the Student's t test and proportions with the Chi-square test. Of the 153 physicians, 108 replies were received (70,6%). Of these 108 replies, 53,3% consider nutrition knowledge important although 29,6% state their knowledge is poor. More than half say that Clinical Nutrition should be a compulsory subject of the Medical Sciences syllabus, and 99,1% deem it important to assess the patient's nutritional status. About 95% stated they provided written or verbal nutritional guidance, and most of the physicians had already sought the assistance of a nutritionist. This study shows that the clinical body of the CHVR/PR is aware of the importance nutrition knowledge has in their daily practice. It must be noted, though, that although almost one third of the physicians rate their nutrition knowledge poor, most of them provide nutritional guidance to their patients.

  16. Involvement of Technical Reasoning more than Functional Knowledge in development of tool use in childhood

    Directory of Open Access Journals (Sweden)

    Chrystelle Remigereau

    2016-11-01

    Full Text Available It is well-known that even toddlers are able to manipulate tools in an appropriate manner according to their physical properties. The ability of children to make novel tools in order to solve problems is, however, surprisingly limited. In adults, mechanical problem solving has been proposed to be supported by technical reasoning skills, which are thought to be involved in every situation requiring the use of a tool (whether conventional or unusual. The aim of this study was to investigate the typical development of real tool use skills and its link with technical reasoning abilities in healthy children. Three experimental tasks were adapted from those used with adults: mechanical problem solving (three different apparatus, real tool use (10 familiar tool-object pairs, and functional knowledge (10 functional picture matching with familiar tools previously used. The tasks were administered to 85 healthy children divided into six age groups (from 6 to 14 years of age. The results revealed that real tool use (p = .01 and mechanical problem solving skills improve with age, even if this improvement differs according to the apparatus for the latter (p < .01 for the Hook task and p < .05 for the Sloping task. Results also showed that mechanical problem solving is a better predictor of real tool use than functional knowledge, with a significant and greater weight (importance weight: 0.65; Estimate±Standard Error: 0.27±0.08. Ours findings suggest that real tool use and technical reasoning develop jointly in children, independently from development of functional knowledge. In addition, technical reasoning appears partially operative from the age of 6 onwards, even though the outcome of these skills depends of the context in which they are applied (i.e., the type of apparatus.

  17. University Students' Knowledge Structures and Informal Reasoning on the Use of Genetically Modified Foods: Multidimensional Analyses

    Science.gov (United States)

    Wu, Ying-Tien

    2013-01-01

    This study aims to provide insights into the role of learners' knowledge structures about a socio-scientific issue (SSI) in their informal reasoning on the issue. A total of 42 non-science major university students' knowledge structures and informal reasoning were assessed with multidimensional analyses. With both qualitative and…

  18. University Students' Knowledge Structures and Informal Reasoning on the Use of Genetically Modified Foods: Multidimensional Analyses

    Science.gov (United States)

    Wu, Ying-Tien

    2013-01-01

    This study aims to provide insights into the role of learners' knowledge structures about a socio-scientific issue (SSI) in their informal reasoning on the issue. A total of 42 non-science major university students' knowledge structures and informal reasoning were assessed with multidimensional analyses. With both qualitative and…

  19. Clarifying assumptions to enhance our understanding and assessment of clinical reasoning

    NARCIS (Netherlands)

    Durning, S.J.; Artino, A.R.; Schuwirth, L.; Vleuten, C.P.M. van der

    2013-01-01

    Deciding on a diagnosis and treatment is essential to the practice of medicine. Developing competence in these clinical reasoning processes, commonly referred to as diagnostic and therapeutic reasoning, respectively, is required for physician success. Clinical reasoning has been a topic of research

  20. Recruitment of a clinical field trial population: reasons for nonparticipation.

    Science.gov (United States)

    Weintraub, J; Leske, G S; Ripa, L W; Levinson, A

    1980-01-01

    Open-ended telephone interviews were conducted with 294 families who refused participation in a school-based program of professionally applied topical fluoride. While the program was conducted in a flouride-deficient community, the level of topical fluoride contact in the homes of the nonparticipants was high. The traditional antifluoridationist reasons for nonparticipation were not expressed with frequency. Instead, the most frequent reason for returning a negative consent form was that the child was already receiving topical flouride applications from the family dentist. The second most frequent reason was that the child did not wish to participate. Many of the reasons given for nonparticipation were not cogent, suggesting that if the parents had been more informed about the nature of the project and about fluoride in general their responses might have been positive.

  1. Exploring Clinical Reasoning Strategies and Test-Taking Behaviors During Clinical Vignette Style Multiple-Choice Examinations: A Mixed Methods Study.

    Science.gov (United States)

    Heist, Brian Sanjay; Gonzalo, Jed David; Durning, Steven; Torre, Dario; Elnicki, David Michael

    2014-12-01

    Clinical vignette multiple-choice questions (MCQs) are widely used in medical education, but clinical reasoning (CR) strategies employed when approaching these questions have not been well described. The aims of the study were (1) to identify CR strategies and test-taking (TT) behaviors of physician trainees while solving clinical vignette MCQs; and (2) to examine the relationships between CR strategies and behaviors, and performance on a high-stakes clinical vignette MCQ examination. Thirteen postgraduate year-1 level trainees completed 6 clinical vignette MCQs using a think-aloud protocol. Thematic analysis employing elements of grounded theory was performed on data transcriptions to identify CR strategies and TT behaviors. Participants' CR strategies and TT behaviors were then compared with their US Medical Licensing Examination Step 2 Clinical Knowledge scores. Twelve CR strategies and TT behaviors were identified. Individuals with low performance on Step 2 Clinical Knowledge demonstrated increased premature closure and increased faulty knowledge, and showed comparatively less ruling out of alternatives or admission of knowledge deficits. High performers on Step 2 Clinical Knowledge demonstrated increased ruling out of alternatives and admission of knowledge deficits, and less premature closure, faulty knowledge, or closure prior to reading the alternatives. Different patterns of CR strategies and TT behaviors may be used by high and low performers during high-stakes clinical vignette MCQ examinations.

  2. Using the Script Concordance Test to Evaluate Clinical Reasoning Skills in Psychiatry.

    Science.gov (United States)

    Kazour, François; Richa, Sami; Zoghbi, Marouan; El-Hage, Wissam; Haddad, Fady G

    2017-02-01

    Although clinical reasoning is a major component of psychiatric training, most evaluating tools do not assess this skill properly. Clinicians mobilize networks of organized knowledge (scripts) to assess ambiguous or uncertain situations. The Script Concordance Test (SCT) was developed to assess clinical reasoning in an uncertainty context. The objective of this study was to test the usefulness of the SCT to assess the reasoning capacities of interns (7th year medical students) during the psychiatry training. The authors designed a SCT for psychiatry teaching, adapted to interns. The test contained 20 vignettes of five questions each. A reference panel of senior psychiatrists underwent the test, and we used their scoring as a reference for the student group. The SCT assessed the competence of students at the beginning and the end of their training in psychiatry. A panel of 10 psychiatrists and 47 interns participated to this study. As expected, the reference panel performed significantly (preasoning competence. It can provide a valid alternative to classical evaluation methods.

  3. Dynamic Uncertain Causality Graph for Knowledge Representation and Reasoning: Discrete DAG Cases

    Institute of Scientific and Technical Information of China (English)

    Qin Zhang

    2012-01-01

    Developed from the dynamic causality diagram (DCD) model,a new approach for knowledge representation and reasoning named as dynamic uncertain causality graph (DUCG) is presented,which focuses on the compact representation of complex uncertain causalities and efficient probabilistic inference.It is pointed out that the existing models of compact representation and inference in Bayesian Network (BN) is applicable in single-valued cases,but may not be suitable to be applied in multi-valued cases.DUCG overcomes this problem and beyond.The main features of DUCG are:1) compactly and graphically representing complex conditional probability distributions (CPDs),regardless of whether the cases are single-valued or multi-valued; 2) able to perform exact reasoning in the case of the incomplete knowledge representation;3) simplifying the graphical knowledge base conditional on observations before other calculations,so that the scale and complexity of problem can be reduced exponentially; 4) the efficient two-step inference algorithm consisting of (a) logic operation to find all possible hypotheses in concern for given observations and (b) the probability calculation for these hypotheses; and 5) much less relying on the parameter accuracy.An alarm system example is provided to illustrate the DUCG methodology.

  4. Temporal data representation, normalization, extraction, and reasoning: A review from clinical domain.

    Science.gov (United States)

    Madkour, Mohcine; Benhaddou, Driss; Tao, Cui

    2016-05-01

    We live our lives by the calendar and the clock, but time is also an abstraction, even an illusion. The sense of time can be both domain-specific and complex, and is often left implicit, requiring significant domain knowledge to accurately recognize and harness. In the clinical domain, the momentum gained from recent advances in infrastructure and governance practices has enabled the collection of tremendous amount of data at each moment in time. Electronic health records (EHRs) have paved the way to making these data available for practitioners and researchers. However, temporal data representation, normalization, extraction and reasoning are very important in order to mine such massive data and therefore for constructing the clinical timeline. The objective of this work is to provide an overview of the problem of constructing a timeline at the clinical point of care and to summarize the state-of-the-art in processing temporal information of clinical narratives. This review surveys the methods used in three important area: modeling and representing of time, medical NLP methods for extracting time, and methods of time reasoning and processing. The review emphasis on the current existing gap between present methods and the semantic web technologies and catch up with the possible combinations. The main findings of this review are revealing the importance of time processing not only in constructing timelines and clinical decision support systems but also as a vital component of EHR data models and operations. Extracting temporal information in clinical narratives is a challenging task. The inclusion of ontologies and semantic web will lead to better assessment of the annotation task and, together with medical NLP techniques, will help resolving granularity and co-reference resolution problems. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Does Problem Solving = Prior Knowledge + Reasoning Skills in Earth Science? An Exploratory Study

    Science.gov (United States)

    Chang, Chun-Yen

    2010-03-01

    This study examined the interrelationship between tenth-grade students’ problem solving ability (PSA) and their domain-specific knowledge (DSK) as well as reasoning skills (RS) in a secondary school of Taiwan. The PSA test was designed to emphasize students’ divergent-thinking ability (DTA) and convergent-thinking ability (CTA) subscales in the area of Earth science. Two hundred and sixty tenth graders who were enrolled in six Earth science classes at a public senior high school located in the eastern region of Taiwan were participants. Major findings are as follows: (a) A significantly positive correlation existed between students’ PSA and their DSK and RS, approaching large effect sizes; (b) Both students’ DSK and RS significantly explained the variance of their PSA with large effect sizes; (c) Students’ RS could more significantly explain the variance of their DTA subscale with medium effect size while DSK might more significantly explain the variance of their CTA, approaching large effect size. The research suggests that more emphasis should be placed on the reasoning skills when developing students’ divergent-thinking abilities, while stressing more domain-specific knowledge when students’ convergent-thinking ability is considered.

  6. Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

    Science.gov (United States)

    Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

    2015-08-01

    This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts.

  7. Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices.

    Science.gov (United States)

    Burke, Adam; Nahin, Richard L; Stussman, Barbara J

    2015-01-01

    Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not. To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies. A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported. Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.

  8. Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices.

    Directory of Open Access Journals (Sweden)

    Adam Burke

    Full Text Available Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not.To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies.A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported.Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.

  9. Key-feature questions for assessment of clinical reasoning: a literature review.

    Science.gov (United States)

    Hrynchak, Patricia; Takahashi, Susan Glover; Nayer, Marla

    2014-09-01

    Key-feature questions (KFQs) have been developed to assess clinical reasoning skills. The purpose of this paper is to review the published evidence on the reliability and validity of KFQs to assess clinical reasoning. A literature review was conducted by searching MEDLINE (1946-2012) and EMBASE (1980-2012) via OVID and ERIC. The following search terms were used: key feature; question or test or tests or testing or tested or exam; assess or evaluation, and case-based or case-specific. Articles not in English were eliminated. The literature search resulted in 560 articles. Duplicates were eliminated, as were articles that were not relevant; nine articles that contained reliability or validity data remained. A review of the references and of citations of these articles resulted in an additional 12 articles to give a total of 21 for this review. Format, language and scoring of KFQ examinations have been studied and modified to maximise reliability. Internal consistency reliability has been reported as being between 0.49 and 0.95. Face and content validity have been shown to be moderate to high. Construct validity has been shown to be good using vector thinking processes and novice versus expert paradigms, and to discriminate between teaching methods. The very modest correlations between KFQ examinations and more general knowledge-based examinations point to differing roles for each. Importantly, the results of KFQ examinations have been shown to successfully predict future physician performance, including patient outcomes. Although it is inaccurate to conclude that any testing format is universally reliable or valid, published research supports the use of examinations using KFQs to assess clinical reasoning. The review identifies areas of further study, including all categories of evidence. Investigation into how examinations using KFQs integrate with other methods in a system of assessment is needed. © 2014 John Wiley & Sons Ltd.

  10. The impact of selected contextual factors on experts' clinical reasoning performance (does context impact clinical reasoning performance in experts?).

    NARCIS (Netherlands)

    Durning, S.J.; Artino, A.R.; Boulet, J.R.; Dorrance, K.; Vleuten, C.P.M. van der; Schuwirth, L.

    2012-01-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive

  11. The Impact of Selected Contextual Factors on Experts' Clinical Reasoning Performance (Does Context Impact Clinical Reasoning Performance in Experts?)

    Science.gov (United States)

    Durning, Steven J.; Artino, Anthony R.; Boulet, John R.; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

    2012-01-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we…

  12. Breaking down automaticity: Case ambiguity and the shift to reflective approaches in clinical reasoning

    NARCIS (Netherlands)

    S. Mamede (Silvia); H.G. Schmidt (Henk); R.M.J.P. Rikers (Remy); J.C. Penaforte (Julio); J.M. Coelho-Filho (João Macedo)

    2007-01-01

    textabstractContext: Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form of clinical reasoning is suggested to combine both modes. Conditions leading doctors to shift from the usual mode of non-analytical reasoning

  13. Reflections on clinical reasoning in mental health occupational therapy: the case of the occupational therapy dynamic method

    Directory of Open Access Journals (Sweden)

    Taís Quevedo Marcolino

    2014-12-01

    Full Text Available The Clinical Reasoning Study supported by the American Occupational Therapy Association/AOTA and the American Occupational Therapy Foundation/AOTF in the United States in the late 1980s, had inaugurated the scientific production in the field and offered an initial framework on clinical reasoning for understanding and conducting clinical cases in Occupational Therapy. Most of the researches in this field have focused on reasoning processes, and point out the need to understand the contents of clinical thoughts, or how occupational therapists act and elaborate hypotheses, based on their background knowledge, in order to produce an explanatory theory. In this direction, this article presents the results of two studies from the author focused on understanding aspects of clinical reasoning of occupational therapists who work sustained by Occupational Therapy Dynamic Method/ MTOD, highlighting similarities and differences on diagnostic and procedural reasoning. The discussion points out need to expand the production of this type of research, in particular with Brazilian professionals, as well as the dissemination and study of this subject in the initial and continuing training of occupational therapists.

  14. A data model that captures clinical reasoning about patient problems.

    Science.gov (United States)

    Barrows, R. C.; Johnson, S. B.

    1995-01-01

    We describe a data model that has been implemented for the CPMC Ambulatory Care System, and exemplify its function for patient problems. The model captures some nuances of clinical thinking about patients that are not accommodated in most other models, such as an evolution of clinical understanding about patient problems. A record of this understanding has clinical utility, and serves research interests as well as medical audit concerns. The model is described with an example, and advantages and limitations in the current implementation are discussed. PMID:8563311

  15. Clinical reasoning in the evaluation and management of undiagnosed chronic hip pain in a young adult.

    Science.gov (United States)

    Zimny, N J

    1998-01-01

    This case report describes the clinical reasoning used to manage chronic left hip pain in a 21-year-old woman who was recreationally active. The patient had a history of possible congenital hip dysplasia (CHD) and known recurrent lateral (external) patellar subluxations on the left side. She complained of experiencing hip pain when walking, sitting, playing soccer, and doing "step aerobics." Hip range of motion (ROM), muscle force, and joint stability problems were assessed. Abnormal movement patterns were observed during gait and step aerobics. Intervention was based on the working hypothesis that periarticular stiffness and muscle weakness from earlier trauma were superimposed on joint instability from CHD. Following intervention, the patient's hip ROM and muscle force improved concurrently with reduction of hip pain, increased ability to participate in recreational activities, and improvement in the movement pattern during step aerobics. An eclectic approach to analysis of the problem was used, combining data unique to the patient with knowledge of CHD and concepts proposed by Cyriax, Maitland, Sahrmann, and others. The clinical reasoning used to establish a basis for treatment and its limitations are discussed.

  16. Twelve tips to support the development of clinical reasoning skills using virtual patient cases.

    Science.gov (United States)

    Posel, Nancy; Mcgee, James B; Fleiszer, David M

    2015-01-01

    Clinical reasoning is a critical core competency in medical education. Strategies to support the development of clinical reasoning skills have focused on methodologies used in traditional settings, including lectures, small groups, activities within Simulation Centers and the clinical arena. However, the evolving role and growing utilization of virtual patients (VPs) in undergraduate medical education; as well as an increased emphasis on blended learning, multi-modal models that include VPs in core curricula; suggest a growing requirement for strategies or guidelines that directly focus on VPs. The authors have developed 12 practical tips that can be used in VP cases to support the development of clinical reasoning. These are based on teaching strategies and principles of instructional design and pedagogy, already used to teach and assess clinical reasoning in other settings. Their application within VPs will support educators who author or use VP cases that promote the development of clinical reasoning.

  17. Promoting the self-regulation of clinical reasoning skills in nursing students.

    Science.gov (United States)

    Kuiper, R; Pesut, D; Kautz, D

    2009-10-02

    The purpose of this paper is to describe the research surrounding the theories and models the authors united to describe the essential components of clinical reasoning in nursing practice education. The research was conducted with nursing students in health care settings through the application of teaching and learning strategies with the Self-Regulated Learning Model (SRL) and the Outcome-Present-State-Test (OPT) Model of Reflective Clinical Reasoning. Standardized nursing languages provided the content and clinical vocabulary for the clinical reasoning task. This descriptive study described the application of the OPT model of clinical reasoning, use of nursing language content, and reflective journals based on the SRL model with 66 undergraduate nursing students over an 8 month period of time. The study tested the idea that self-regulation of clinical reasoning skills can be developed using self-regulation theory and the OPT model. This research supports a framework for effective teaching and learning methods to promote and document learner progress in mastering clinical reasoning skills. Self-regulated Learning strategies coupled with the OPT model suggest benefits of self-observation and self-monitoring during clinical reasoning activities, and pinpoints where guidance is needed for the development of cognitive and metacognitive awareness. Thinking and reasoning about the complexities of patient care needs requires attention to the content, processes and outcomes that make a nursing care difference. These principles and concepts are valuable to clinical decision making for nurses globally as they deal with local, regional, national and international health care issues.

  18. Knowledge-based reasoning to annotate noncoding RNA using multi-agent system.

    Science.gov (United States)

    Arruda, Wosley C; Souza, Daniel S; Ralha, Célia G; Walter, Maria Emilia M T; Raiol, Tainá; Brigido, Marcelo M; Stadler, Peter F

    2015-12-01

    Noncoding RNAs (ncRNAs) have been focus of intense research over the last few years. Since characteristics and signals of ncRNAs are not entirely known, researchers use different computational tools together with their biological knowledge to predict putative ncRNAs. In this context, this work presents ncRNA-Agents, a multi-agent system to annotate ncRNAs based on the output of different tools, using inference rules to simulate biologists' reasoning. Experiments with data from the fungus Saccharomyces cerevisiae allowed to measure the performance of ncRNA-Agents, with better sensibility, when compared to Infernal, a widely used tool for annotating ncRNA. Besides, data of the Schizosaccharomyces pombe and Paracoccidioides brasiliensis fungi identified novel putative ncRNAs, which demonstrated the usefulness of our approach. NcRNA-Agents can be be found at: http://www.biomol.unb.br/ncrna-agents.

  19. Context and clinical reasoning: understanding the perspective of the expert's voice.

    NARCIS (Netherlands)

    Durning, S.; Artino, A.R.; Pangaro, L.; Vleuten, C.P.M. van der; Schuwirth, L.

    2011-01-01

    OBJECTIVES: Prior work has found that a doctor's clinical reasoning performance varies on a case-by-case (situation) basis; this is often referred to as 'context specificity'. To explore the influence of context on diagnostic and therapeutic clinical reasoning, we constructed a series of videotapes

  20. The feasibility, reliability, and validity of a post-encounter form for evaluating clinical reasoning.

    NARCIS (Netherlands)

    Durning, S.J.; Artino, A.; Boulet, J.; Rochelle, J. La; Vleuten, C.P.M. van der; Arze, B.; Schuwirth, L.

    2012-01-01

    BACKGROUND: Developing feasible, reliable and valid methods for the evaluation of clinical reasoning is challenging. AIM: To explore feasibility, reliability, and validity evidence for a post-encounter form assessing clinical reasoning. METHOD: A free-text, post-encounter form was used in an Objecti

  1. Context and clinical reasoning: understanding the perspective of the expert's voice.

    NARCIS (Netherlands)

    Durning, S.; Artino, A.R.; Pangaro, L.; Vleuten, C.P.M. van der; Schuwirth, L.

    2011-01-01

    OBJECTIVES: Prior work has found that a doctor's clinical reasoning performance varies on a case-by-case (situation) basis; this is often referred to as 'context specificity'. To explore the influence of context on diagnostic and therapeutic clinical reasoning, we constructed a series of videotapes

  2. "In this scenario, I do this, for these reasons": narrative, genre and ethical reasoning in the clinic.

    Science.gov (United States)

    Jordens, Christopher F C; Little, Miles

    2004-05-01

    Narrative analysis has been applied by health researchers to investigate (among other things) clinical reasoning, clinical ethics and human identity. The term 'narrative' is often used as a broad category that covers a variety of spoken genres, however, and it thereby lacks delicacy as an analytic tool. We introduce genre theory, which enables us to differentiate more clearly between story genres and other spoken genres. We then apply the theory to ten narrative-style interviews with clinicians involved in the treatment and management of colorectal cancer in Sydney, Australia. We characterise the narrative-style interview as a macro-genre, and draw attention to the occurrence of spoken genres other than stories. We focus our analysis on a policy genre that occurred naturally and frequently in the spoken discourse of the informants, but which has not been described before in either the literature of social linguistics or the health and medical literature. We analyse two examples of this genre in detail in order to characterise its main semantic features, and differentiate it from story genres. We then discuss the genre with reference to Aristotelian interpretations of ethical reasoning in the clinic. We conclude that the policy genre is both the unfolding of practical wisdom in speech, and the appropriate choice of genre where a display of ethical identity is called for. Finally, we discuss the implications of our findings for ongoing research, for ethics education, for bioethical theory, and for communication between some of the different stakeholder groups in clinical medicine.

  3. Knowledge Extraction for Discriminating Male and Female in Logical Reasoning from Student Model

    Directory of Open Access Journals (Sweden)

    A. E. E. ElAlfi

    2009-10-01

    Full Text Available The learning process is a process of communication and interaction between the teacher and his students on one side and between the students and each others on the other side. Interaction of the teacher with his students has a great importance in the process of learning and education. The pattern and style of this interaction is determined by the educational situation, trends and concerns, and educational characteristics. Classroom interaction has an importance and a big role in increasing the efficiency of the learning process and raising the achievement levels of students. Students need to learn skills and habits of study, especially at the university level. The effectiveness of learning is affected by several factors that include the prevailing patterns of interactive behavior in the classroom. These patterns are reflected in the activities of teacher and learners during the learning process. The effectiveness of learning is also influenced by the cognitive and non cognitive characteristics of teacher that help him to succeed, the characteristics of learners, teaching subject, and the teaching methods. This paper presents a machine learning algorithm for extracting knowledge from student model. The proposed algorithm utilizes the inherent characteristic of genetic algorithm and neural network for extracting comprehensible rules from the student database. The knowledge is used for discriminating male and female levels in logical reasoning as a part of an expert system course.

  4. KaM_CRK: Clustering and Ranking Knowledge for Reasonable Results Based on Behaviors and Contexts

    Directory of Open Access Journals (Sweden)

    Changhong Hu

    2013-01-01

    Full Text Available A model named KaM_CRK is proposed, which can supply the clustered and ranked knowledge to the users on different contexts. By comparing the attributes of contexts and JANs, our findings indicate that our model can accumulate the JANs, whose attributes are similar with the user’s contexts, together. By applying the KaM_CLU algorithm and Centre rank strategy into the KaM_CRK model, the model boosts a significant promotion on the accuracy of provision of user's knowledge. By analyzing the users' behaviors, the dynamic coefficient BehaviorF is first presented in KaM_CLU. Compared to traditional approaches of K_means and DBSCAN, the KaM_CLU algorithm does not need to initialize the number of clusters. Additionally, its synthetic results are more accurate, reasonable, and fit than other approaches for users. It is known from our evaluation through real data that our strategy performs better on time efficiency and user's satisfaction, which will save by 30% and promote by 5%, respectively.

  5. Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach.

    Science.gov (United States)

    Addy, Tracie Marcella; Hafler, Janet; Galerneau, France

    2016-01-01

    Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical

  6. Collective Construction of Knowledge in Clinical Biochemistry

    Directory of Open Access Journals (Sweden)

    S.B. Barreto

    2010-05-01

    Full Text Available The collective construction of knowledge occurs by the convergence of ideas and semantic. This paper was made for a graduation discipline, in 2009-2, with 240students who were separated into 4 groups: morning period (M1,M2 and night period (N1,N2. This study aims the collective construction of a abstract-manual of clinical biochemistry tests, due the difficulty in comprehension of certain concepts by the students; it intends to help them in the process of knowledge acquirement. The constructivist approach was adopted and the matters of the discipline were available in a “Student Group e-mail account”, a functional communication tool. The instructions were reachable on the web. M1,M2 and N1 made one part of the study at the first period. N2 did not conclude the study at the same time period of the other groups; therefore they received a new responsibility: they were supposed to conclude and correct the manual and its application which included 90 different kinds of labor exams. A textbook has been defined containing illustrative pictures of blood collection and biosecurity. Three banners were exposed inside the hall of the institution. Collective work is important for the effective arrangement in health area. In the process of teaching/learning, the teacher must proceed on practices and methodologies aiming the development of the student competences and skills which represent its professional identity.

  7. Knowledge towards post-mortem examination and reasons for not specialising in morbid anatomy: study among medical undergraduate students

    Directory of Open Access Journals (Sweden)

    Inderjit Singh Bagga

    2016-07-01

    Conclusions: Students possess a reasonable knowledge about post-mortem but knowledge alone may not be enough for increasing the post-mortem/autopsy rate, unless they acquire the skills required for the procedure as currently they are not provided with any training during their medical curriculum. [Int J Res Med Sci 2016; 4(7.000: 2792-2795

  8. Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

    Science.gov (United States)

    Carrier, Annie; Levasseur, Mélanie; Freeman, Andrew; Mullins, Gary; Quénec'hdu, Suzanne; Lalonde, Louise; Gagnon, Michaël; Lacasse, Francis

    2013-01-01

    Introduction In a context of constrained resources, the efficacy of interventions is a pivotal aim of healthcare systems worldwide. Efficacy of healthcare interventions is highly compromised if clinical reasoning (CR), the process that practitioners use to plan, direct, perform and reflect on client care, is not optimal. The CR process of health professionals is influenced by the institutional dimension (ie, legal, regulatory, administrative and organisational aspects) of their societal and practice contexts. Although several studies have been conducted with respect to the institutional dimension influencing health professionals’ CR, no clear integration of their results is yet available. The aim of this study is to synthesise and disseminate current knowledge on the influence of the institutional dimension of contexts on health professionals’ CR. Methods and analysis A scoping study of the scientific literature from January 1980 to March 2013 will be undertaken to summarise and disseminate research findings about the influence of the institutional dimension on CR. Numerous databases (n=18) from three relevant fields (healthcare, health law and politics and management) will be searched. Extended search strategies will include the manual search of bibliographies, health-related websites, public registries and journals of interest. Data will be collected and analysed using a thematic chart and content analysis. A systematic multidisciplinary team approach will allow optimal identification of relevant studies, as well as effective and valid content analysis and dissemination of the results. Discussion This scoping study will provide a rigorous, accurate and up-to-date synthesis of existing knowledge regarding: (1) those aspects of the institutional dimension of health professionals’ societal and practice contexts that impact their CR and (2) how these aspects influence health professionals’ CR. Through the synergy of a multidisciplinary research team from a

  9. Technology-based strategies for promoting clinical reasoning skills in nursing education.

    Science.gov (United States)

    Shellenbarger, Teresa; Robb, Meigan

    2015-01-01

    Faculty face the demand of preparing nursing students for the constantly changing health care environment. Effective use of online, classroom, and clinical conferencing opportunities helps to enhance nursing students' clinical reasoning capabilities needed for practice. The growth of technology creates an avenue for faculty to develop engaging learning opportunities. This article presents technology-based strategies such as electronic concept mapping, electronic case histories, and digital storytelling that can be used to facilitate clinical reasoning skills.

  10. Using illness scripts to teach clinical reasoning skills to medical students.

    Science.gov (United States)

    Lee, Anna; Joynt, Gavin M; Lee, Alex K T; Ho, Anthony M H; Groves, Michele; Vlantis, Alexander C; Ma, Ronald C W; Fung, Colman S C; Aun, Cindy S T

    2010-04-01

    Most medical students learn clinical reasoning skills informally during clinical rotations that have varying quality of supervision. We conducted a randomized controlled trial to determine if a workshop that uses "illness scripts" could improve students' clinical reasoning skills when making diagnoses of patients portrayed in written scenarios. In 2007--2008, 53 fourth-year medical students were randomly assigned to either a family medicine (intervention) or psychiatry (control) clerkship at The Chinese University of Hong Kong. Students in the intervention group participated in a 3-hour workshop on clinical reasoning that used illness scripts. The workshop was conducted with small-group teaching using a Web-based set of clinical reasoning problems, individualized feedback, and demonstration of tutors' reasoning aloud. The effectiveness of the intervention was assessed using the Diagnostic Thinking Inventory (DTI) and the measurement of individual students' performance in solving clinical reasoning problems (CRP). The post-intervention overall DTI scores between groups were similar (mean difference 0, 95% confidence interval [CI]= -7.4 to 7.4). However, the total scores on the CRP assessment were 14% (95% CI=8% to 21%) higher in the intervention group than in controls. A workshop on illness scripts may have some benefit for improving diagnostic performance in clinical reasoning problems.

  11. Multigranulation Space and Knowledge Reasoning%多粒度空间与知识推理

    Institute of Scientific and Technical Information of China (English)

    折延宏; 李美丽

    2016-01-01

    This paper aims at establishing a one-to-one correspondence between rough approximation operators in multigranulation space and epistemic operators in knowledge reasoning, and thus providing a more reasonable semantic interpretation for rough approximation operators in multigranulation space. By deeply analyzing the close relationship between the semantic set of a logic formula and that of the formula obtained by adding different epistemic operators, this paper proves that EG, CG, DG are in one-to-one correspondence with rough lower approximation operator in model AIU, rough lower approximation operator in model RU and rough lower approximation operator in model RI, respectively. The obtained results are the generalization of the relationship between modal logic and Pawlak rough set in multi-agent environment.%旨在建立起多粒度空间中粗糙近似算子与知识推理中认知算子之间的一一对应关系,从而给出多粒度空间中粗糙近似算子更为合理的语义解释。对于任意逻辑公式,通过分析其语义集与加了认知算子后的语义集之间的关系,证明了全知算子EG对应于多粒度空间中模型AIU中的下近似算子,公共知识认知算子CG对应于模型RU中的下近似算子,分配知识认知算子DG对应于模型RI中的下近似算子,所得结论是模态逻辑与Pawlak粗糙集之间对应关系在多当事人环境下的推广。

  12. Integration of innovative clinical reasoning pedagogies into a baccalaureate nursing curriculum.

    Science.gov (United States)

    Kuiper, Ruth Anne

    2013-01-01

    The significance of good clinical reasoning skills relates to prevention of adverse patient outcomes from failure to diagnose problems, institute appropriate treatments, and/or manage complications. The clinical reasoning pedagogies described in this article are integrated across a baccalaureate curriculum designed to promote a beginner level of competence in solving patient problems. The faculty adopted the content, structure, and process model for integration that includes professional language and content, the Outcome-Present State Test (OPT) model of clinical reasoning, and reflective journaling. These strategies show promise for attaining higher levels of student thinking, focusing attention on patient problems, and promoting situated cognition. As students realize that situations are complex, faculty guidance can influence best judgments and facilitate clinical reasoning with feedback on assignments to promote student growth and competence in solving clinical problems.

  13. Preferred question types for computer-based assessment of clinical reasoning: a literature study.

    Science.gov (United States)

    van Bruggen, Lisette; Manrique-van Woudenbergh, Margreet; Spierenburg, Emely; Vos, Jacqueline

    2012-11-01

    Clinical reasoning is a core competence of doctors. Therefore, the assessment of clinical reasoning of undergraduate students is an important part of medical education. Three medical universities in the Netherlands wish to develop a shared question database in order to assess clinical reasoning of undergraduate students in Computer-Based Assessments (CBA). To determine suitable question types for this purpose a literature study was carried out. Search of ERIC and PubMed and subsequent cross referencing yielded 30 articles which met the inclusion criteria of a focus on question types suitable to assess clinical reasoning of medical students and providing recommendations for their use. Script Concordance Tests, Extended Matching Questions, Comprehensive Integrative Puzzles, Modified Essay Questions/Short Answer Questions, Long Menu Questions, Multiple Choice Questions, Multiple True/False Questions and Virtual Patients meet the above-mentioned criteria, but for different reasons not all types can be used easily in CBA. A combination of Comprehensive Integrative Puzzles and Extended Matching Questions seems to assess most aspects of clinical reasoning and these question types can be adapted for use in CBA. Regardless of the question type chosen, patient vignettes should be used as a standard stimulus format to assess clinical reasoning. Further research is necessary to ensure that the combination of these question types produces valid assessments and reliable test results.

  14. Examining the Influence of Context and Professional Culture on Clinical Reasoning Through Rhetorical-Narrative Analysis.

    Science.gov (United States)

    Peters, Amanda; Vanstone, Meredith; Monteiro, Sandra; Norman, Geoff; Sherbino, Jonathan; Sibbald, Matthew

    2016-05-23

    According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians' use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians' stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.

  15. A clinical reasoning model focused on clients' behaviour change with reference to physiotherapists: its multiphase development and validation.

    Science.gov (United States)

    Elvén, Maria; Hochwälder, Jacek; Dean, Elizabeth; Söderlund, Anne

    2015-05-01

    A biopsychosocial approach and behaviour change strategies have long been proposed to serve as a basis for addressing current multifaceted health problems. This emphasis has implications for clinical reasoning of health professionals. This study's aim was to develop and validate a conceptual model to guide physiotherapists' clinical reasoning focused on clients' behaviour change. Phase 1 consisted of the exploration of existing research and the research team's experiences and knowledge. Phases 2a and 2b consisted of validation and refinement of the model based on input from physiotherapy students in two focus groups (n = 5 per group) and from experts in behavioural medicine (n = 9). Phase 1 generated theoretical and evidence bases for the first version of a model. Phases 2a and 2b established the validity and value of the model. The final model described clinical reasoning focused on clients' behaviour change as a cognitive, reflective, collaborative and iterative process with multiple interrelated levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour and the selection of strategies for behaviour change. This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

  16. Agile sensor tasking for CoIST using natural language knowledge representation and reasoning

    Science.gov (United States)

    Braines, David; de Mel, Geeth; Gwilliams, Chris; Parizas, Christos; Pizzocaro, Diego; Bergamaschi, Flavio; Preece, Alun

    2014-06-01

    We describe a system architecture aimed at supporting Intelligence, Surveillance, and Reconnaissance (ISR) activities in a Company Intelligence Support Team (CoIST) using natural language-based knowledge representation and reasoning, and semantic matching of mission tasks to ISR assets. We illustrate an application of the architecture using a High Value Target (HVT) surveillance scenario which demonstrates semi-automated matching and assignment of appropriate ISR assets based on information coming in from existing sensors and human patrols operating in an area of interest and encountering a potential HVT vehicle. We highlight a number of key components of the system but focus mainly on the human/machine conversational interaction involving soldiers on the field providing input in natural language via spoken voice to a mobile device, which is then processed to machine-processable Controlled Natural Language (CNL) and confirmed with the soldier. The system also supports CoIST analysts obtaining real-time situation awareness on the unfolding events through fused CNL information via tools available at the Command and Control (C2). The system demonstrates various modes of operation including: automatic task assignment following inference of new high-importance information, as well as semi-automatic processing, providing the CoIST analyst with situation awareness information relevant to the area of operation.

  17. Intelligent technique for knowledge reuse of dental medical records based on case-based reasoning.

    Science.gov (United States)

    Gu, Dong-Xiao; Liang, Chang-Yong; Li, Xing-Guo; Yang, Shan-Lin; Zhang, Pei

    2010-04-01

    With the rapid development of both information technology and the management of modern medical regulation, the generation of medical records tends to be increasingly intelligent. In this paper, Case-Based Reasoning is applied to the process of generating records of dental cases. Based on the analysis of the features of dental records, a case base is constructed. A mixed case retrieval method (FAIES) is proposed for the knowledge reuse of dental records by adopting Fuzzy Mathematics, which improves similarity algorithm based on Euclidian-Lagrangian Distance, and PULL & PUSH weight adjustment strategy. Finally, an intelligent system of dental cases generation (CBR-DENT) is constructed. The effectiveness of the system, the efficiency of the retrieval method, the extent of adaptation and the adaptation efficiency are tested using the constructed case base. It is demonstrated that FAIES is very effective in terms of reducing the time of writing medical records and improving the efficiency and quality. FAIES is also proven to be an effective aid for diagnoses and provides a new idea for the management of medical records and its applications.

  18. Clinical Reasoning in the Assessment and Planning for Intervention for Oppositional Defiant Disorder

    Science.gov (United States)

    Wilcox, Gabrielle; Heudes, Alethea

    2017-01-01

    Clinical reasoning requires thoughtful consideration of a variety of factors that contribute to the conceptualization of a case such as the reason for referral, school information, home environment, assessment outcomes, and behavioural observations made during assessments. The purpose of this article is to provide the reader with insight into the…

  19. Clinical reasoning skills in final-year dental students: A qualitative cross-curricula comparison.

    Science.gov (United States)

    Nafea, E T; Dennick, R

    2017-03-23

    The aim of this research was to explore the perceptions of undergraduate dental students regarding clinical reasoning skills and also discover the influences of different curriculum designs on the acquisition of these skills by students. Eighteen final-year students from three different dental schools with varied curricula and cultures participated in the current research. The research used qualitative methodology. The study took place in 2013-2014. Interviews captured the participants' own understanding of clinical reasoning and its acquisition plus they "talked through" a clinical problem using a "think-aloud" technique. Thematic analysis was used to analyse the transcripts of the recorded interviews. Results obtained were related to curriculum structure. Unfamiliarity with the term clinical reasoning was common in students. Students from different schools used different strategies to reason when discussing clinical vignettes. Clinical reasoning process was dominated by pattern recognition. Students' behaviours seemed to be influenced by cultural factors. This research contributes to a greater understanding of how students learn, understand and apply dental clinical reasoning which will improve educational practices in the future. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2015-01-01

    curricula. Under the broad paradigm of Problem Based Learning (PBL), which is being viewed as the key shift in educations in the last few years, many other models have been proposed. Strategies such as case based teaching, blended learning, co-operative learning, interactive learning, blogging and clinical......Title: Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches Juneja H1, Brekke A F2 1,2 Physical Therapy Education, University College Zealand, Denmark Background: Clinical reasoning (CR) also referred to as “critical thinking” or “decision...... in this area. This has resulted in diverse methods and strategies to transfer reasoning skills effectively to students. Awareness about recommended pedagogical techniques to enhance clinical reasoning skills can significantly influence the educator’s choice of methods within and beyond the classroom teaching...

  1. Case-based knowledge formalization and reasoning method for digital terrain analysis - application to extracting drainage networks

    Science.gov (United States)

    Qin, Cheng-Zhi; Wu, Xue-Wei; Jiang, Jing-Chao; Zhu, A.-Xing

    2016-08-01

    Application of digital terrain analysis (DTA), which is typically a modeling process involving workflow building, relies heavily on DTA domain knowledge of the match between the algorithm (and its parameter settings) and the application context (including the target task, the terrain in the study area, the DEM resolution, etc.), which is referred to as application-context knowledge. However, existing DTA-assisted tools often cannot use application-context knowledge because this type of DTA knowledge has not been formalized to be available for inference in these tools. This situation makes the DTA workflow-building process difficult for users, especially non-expert users. This paper proposes a case-based formalization for DTA application-context knowledge and a corresponding case-based reasoning method. A case in this context consists of a series of indices that formalize the DTA application-context knowledge and the corresponding similarity calculation methods for case-based reasoning. A preliminary experiment to determine the catchment area threshold for extracting drainage networks has been conducted to evaluate the performance of the proposed method. In the experiment, 124 cases of drainage network extraction (50 for evaluation and 74 for reasoning) were prepared from peer-reviewed journal articles. Preliminary evaluation shows that the proposed case-based method is a suitable way to use DTA application-context knowledge to achieve a marked reduction in the modeling burden for users.

  2. Reasons for Not Intensifying Medications: Differentiating “Clinical Inertia” from Appropriate Care

    Science.gov (United States)

    Shewchuk, Richard; Qu, Haiyan; Williams, Jessica H.; Estrada, Carlos A.; Ovalle, Fernando; Allison, Jeroan J.

    2007-01-01

    Background “Clinical inertia” has been defined as inaction by physicians caring for patients with uncontrolled risk factors such as blood pressure. Some have proposed that it accounts for up to 80% of cardiovascular events, potentially an important quality problem. However, reasons for so-called clinical inertia are poorly understood. Objective To derive an empiric conceptual model of clinical inertia as a subset of all clinical inactions from the physician perspective. Methods We used Nominal Group panels of practicing physicians to identify reasons why they do not intensify medications when seeing an established patient with uncontrolled blood pressure. Measurements and Main Results We stopped at 2 groups (N = 6 and 7, respectively) because of the high degree of agreement on reasons for not intensifying, indicating saturation. A third group of clinicians (N = 9) independently sorted the reasons generated by the Nominal Groups. Using multidimensional scaling and hierarchical cluster analysis, we translated the sorting results into a cognitive map that represents an empirically derived model of clinical inaction from the physician’s perspective. The model shows that much inaction may in fact be clinically appropriate care. Conclusions/Recommendations Many reasons offered by physicians for not intensifying medications suggest that low rates of intensification do not necessarily reflect poor quality of care. The empirically derived model of clinical inaction can be used as a guide to construct performance measures for monitoring clinical inertia that better focus on true quality problems. PMID:17957346

  3. The effect of short-term workshop on improving clinical reasoning skill of medical students.

    Science.gov (United States)

    Yousefichaijan, Parsa; Jafari, Farshad; Kahbazi, Manijeh; Rafiei, Mohammad; Pakniyat, AbdolGhader

    2016-01-01

    Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students. This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and "key feature" (KF) test and "clinical reasoning problem" (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held. The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant. Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students.

  4. Knowledge and Behavior Regarding Cosmetics in Koreans Visiting Dermatology Clinics

    OpenAIRE

    Cho, Soyun; Oh, Sohee; Kim, Nack In; Ro, Young Suck; Kim, Joung Soo; Park, Young Min; Park, Chun Wook; Lee, Weon Ju; Kim, Dong Kun; Lee, Dong Won; Lee, Sang Jun

    2017-01-01

    Background Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics. Objective To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics. Methods A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic setti...

  5. NNF and NNPrF—Fuzzy Petri Nets Based on Neural Network for Knowledge Representation,Reasoning and Learning

    Institute of Scientific and Technical Information of China (English)

    周奕; 吴时霖

    1996-01-01

    This paper proposes NNF-a fuzzy Petri Net system based on neural network for proposition logic repesentation,and gives the formal definition of NNF.For the NNF model,forward reasoning algorithm,backward reasoning algorithm and knowledge learning algorithm are discussed based on weight training algorithm of neural network-Back Propagation algorithm.Thus NNF is endowed with the ability of learning a rule.The paper concludes with a discussion on extending NNF to predicate logic,forming NNPrF,and proposing the formal definition and a reasoning algorithm of NNPrF.

  6. Evidence in clinical reasoning: a computational linguistics analysis of 789,712 medical case summaries 1983-2012.

    Science.gov (United States)

    Seidel, Bastian M; Campbell, Steven; Bell, Erica

    2015-03-21

    Better understanding of clinical reasoning could reduce diagnostic error linked to 8% of adverse medical events and 30% of malpractice cases. To a greater extent than the evidence-based movement, the clinical reasoning literature asserts the importance of practitioner intuition—unconscious elements of diagnostic reasoning. The study aimed to analyse the content of case report summaries in ways that explored the importance of an evidence concept, not only in relation to research literature but also intuition. The study sample comprised all 789,712 abstracts in English for case reports contained in the database PUBMED for the period 1 January 1983 to 31 December 2012. It was hypothesised that, if evidence and intuition concepts were viewed by these clinical authors as essential to understanding their case reports, they would be more likely to be found in the abstracts. Computational linguistics software was used in 1) concept mapping of 21,631,481 instances of 201 concepts, and 2) specific concept analyses examining 200 paired co-occurrences for 'evidence' and research 'literature' concepts. 'Evidence' is a fundamentally patient-centred, intuitive concept linked to less common concepts about underlying processes, suspected disease mechanisms and diagnostic hunches. In contrast, the use of research literature in clinical reasoning is linked to more common reasoning concepts about specific knowledge and descriptions or presenting features of cases. 'Literature' is by far the most dominant concept, increasing in relevance since 2003, with an overall relevance of 13% versus 5% for 'evidence' which has remained static. The fact that the least present types of reasoning concepts relate to diagnostic hunches to do with underlying processes, such as what is suspected, raises questions about whether intuitive practitioner evidence-making, found in a constellation of dynamic, process concepts, has become less important. The study adds support to the existing corpus of

  7. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory

    Directory of Open Access Journals (Sweden)

    Thierry Pelaccia

    2011-03-01

    Full Text Available Context. Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward.Purpose. This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years.Discussion. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

  8. Utilization of the Nursing Process to Foster Clinical Reasoning During a Simulation Experience

    Directory of Open Access Journals (Sweden)

    Amanda Lambie

    2015-11-01

    Full Text Available Nursing practice includes complex reasoning and multifaceted decision making with minimal standardized guidance in how to evaluate this phenomenon among nursing students. Learning outcomes related to the clinical reasoning process among novice baccalaureate nursing students during a simulation experience were evaluated. Nursing process records were utilized to evaluate and foster the development of clinical reasoning in a high-fidelity medical-surgical simulation experience. Students were unable to describe and process pertinent patient information appropriately prior to the simulation experience. Students’ ability to identify pertinent patient cues and plan appropriate patient care improved following the simulation. The learning activity afforded a structured opportunity to identify cues, prioritize the proper course of nursing interventions, and engage in collaboration among peers. The simulation experience provides faculty insight into the students’ clinical reasoning processes, while providing students with a clear framework for successfully accomplishing learning outcomes.

  9. Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2015-01-01

    curricula. Under the broad paradigm of Problem Based Learning (PBL), which is being viewed as the key shift in educations in the last few years, many other models have been proposed. Strategies such as case based teaching, blended learning, co-operative learning, interactive learning, blogging and clinical...... in this area. This has resulted in diverse methods and strategies to transfer reasoning skills effectively to students. Awareness about recommended pedagogical techniques to enhance clinical reasoning skills can significantly influence the educator’s choice of methods within and beyond the classroom teaching....... It is imperative that physical therapy educators utilize innovative pedagogical methods to facilitate learning of reasoning skills in students. Purpose: The review is an attempt to highlight and discuss selected pedagogical strategies and approaches to enhance clinical reasoning skills in undergraduate physical...

  10. Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning.

    Science.gov (United States)

    Cheung, Therma W C; Clemson, Lindy; O' Loughlin, Kate; Shuttleworth, Russell

    2017-09-18

    Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. To construct a conceptual representation of how occupational therapists make clinical decisions for such program. Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is

  11. Constructible Authentic Representations: Designing Video Games That Enable Players to Utilize Knowledge Developed In-Game to Reason about Science

    Science.gov (United States)

    Holbert, Nathan R.; Wilensky, Uri

    2014-01-01

    While video games have become a source of excitement for educational designers, creating informal game experiences that players can draw on when thinking and reasoning in non-game contexts has proved challenging. In this paper we present a design principle for creating educational video games that enables players to draw on knowledge resources…

  12. Relationship of neuroimaging to typical sleep times during a clinical reasoning task: a pilot study

    NARCIS (Netherlands)

    Durning, S.J.; Kelly, W.; Costanzo, M.E.; Artino, A.R.; Vleuten, C.P.M. van der; Beckman, T.J.; Roy, M.J.H.M. van; Holmboe, E.S.; Wittich, C.M.; Schuwirth, L.

    2015-01-01

    BACKGROUND: Sleep deprivation and fatigue have been associated with medical errors, clinical performance decrements, and reduced quality of life for both practicing physicians and medical students. Greater understanding of the impact of sleep quantity on clinical reasoning could improve patient care

  13. Specialised Content Knowledge: Evidence of Pre-Service Teachers' Appraisal of Student Errors in Proportional Reasoning

    Science.gov (United States)

    Chinnappan, Mohan; White, Bruce

    2015-01-01

    That the quality of teachers' knowledge has direct impact on students' engagement and learning outcomes in mathematics is now well established. But questions about the nature of this knowledge and how to characterise that knowledge are important for mathematics educators. In the present study, we examine a strand of "Specialised Content…

  14. What's in a Label? Is Diagnosis the Start or the End of Clinical Reasoning?

    Science.gov (United States)

    Ilgen, Jonathan S; Eva, Kevin W; Regehr, Glenn

    2016-04-01

    Diagnostic reasoning has received substantial attention in the literature, yet what we mean by "diagnosis" may vary. Diagnosis can align with assignment of a "label," where a constellation of signs, symptoms, and test results is unified into a solution at a single point in time. This "diagnostic labeling" conceptualization is embodied in our case-based learning curricula, published case reports, and research studies, all of which treat diagnostic accuracy as the primary outcome. However, this conceptualization may oversimplify the richly iterative and evolutionary nature of clinical reasoning in many settings. Diagnosis can also represent a process of guiding one's thoughts by "making meaning" from data that are intrinsically dynamic, experienced idiosyncratically, negotiated among team members, and rich with opportunities for exploration. Thus, there are two complementary constructions of diagnosis: 1) the correct solution resulting from a diagnostic reasoning process, and 2) a dynamic aid to an ongoing clinical reasoning process. This article discusses the importance of recognizing these two conceptualizations of "diagnosis," outlines the unintended consequences of emphasizing diagnostic labeling as the primary goal of clinical reasoning, and suggests how framing diagnosis as an ongoing process of meaning-making might change how we think about teaching and assessing clinical reasoning.

  15. Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study.

    Science.gov (United States)

    Wiese, Jeff; Varosy, Paul; Tierney, Lawrence

    2002-02-15

    The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance. Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability. Mean (+/- SD) presentation times at baseline were similar in the two groups (intervention group: 8 +/- 2 minutes; control group: 8 +/- 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 +/- 2 minutes, but increased by 2 +/- 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P Presentation quality scores at baseline were similar in both groups (intervention group: 17 +/- 8 points; control group: 20 +/- 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 +/- 6 points in

  16. Practical Approach to Knowledge-based Question Answering with Natural Language Understanding and Advanced Reasoning

    CERN Document Server

    Wong, Wilson

    2007-01-01

    This research hypothesized that a practical approach in the form of a solution framework known as Natural Language Understanding and Reasoning for Intelligence (NaLURI), which combines full-discourse natural language understanding, powerful representation formalism capable of exploiting ontological information and reasoning approach with advanced features, will solve the following problems without compromising practicality factors: 1) restriction on the nature of question and response, and 2) limitation to scale across domains and to real-life natural language text.

  17. Teaching practical wisdom in medicine through clinical judgement, goals of care, and ethical reasoning.

    Science.gov (United States)

    Kaldjian, Lauris Christopher

    2010-09-01

    Clinical decision making is a challenging task that requires practical wisdom-the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that 'clinical judgement' will merely express 'the clinician's judgement.'

  18. Can script concordance testing be used in nursing education to accurately assess clinical reasoning skills?

    Science.gov (United States)

    Dawson, Tyia; Comer, Linda; Kossick, Mark A; Neubrander, Judy

    2014-05-01

    The Script Concordance Test (SCT) has been used successfully in medical schools to assess clinical reasoning in medical students, but it has not been widely used in nursing education. The purpose of this study was to provide additional evidence of the validity and reliability of the SCT in evaluating clinical reasoning in nursing students by replicating a previous study. The test was administered to 48 first-year Bachelor of Science in Nursing students. A scoring grid was developed using the aggregate scores method based on the modal responses of 13 panel members. The reliability of the scores was measured by Cronbach's alpha coefficient, and the scores of the students and the panel were compared using a t test. The difference between the panel's and the students' scores was statistically significant, and the reliability of the scores is high. The SCT provides a reliable, standardized, and easy-to-administer method of evaluating clinical reasoning in nursing students. Copyright 2014, SLACK Incorporated.

  19. Bible Knowledge and Moral Judgment: Knowing Scripture and Using Ethical Reasoning

    Science.gov (United States)

    Nelson, Daniel

    2004-01-01

    The relationship between moral judgment and religious knowledge was investigated, with an analysis of the impact of academic skill on both domains. Fifty-six Bible college seniors completed measures of moral judgment (Defining Issues Test), Bible knowledge (Standardized Bible Content Test), and academic skill (Academic Profile). Results indicate…

  20. Children's and Adults' Knowledge and Models of Reasoning about the Ozone Layer and Its Depletion.

    Science.gov (United States)

    Leighton, Jacqueline P.; Bisanz, Gay L.

    2003-01-01

    Examines children's and adults' knowledge of the ozone layer and its depletion, whether this knowledge increases with age, and how the ozone layer and ozone hole might be structured as scientific concepts. Uses a standardized set of questions to interview children and adults in Canada. Discusses implications of the results for health…

  1. Children's and Adults' Knowledge and Models of Reasoning about the Ozone Layer and Its Depletion.

    Science.gov (United States)

    Leighton, Jacqueline P.; Bisanz, Gay L.

    2003-01-01

    Examines children's and adults' knowledge of the ozone layer and its depletion, whether this knowledge increases with age, and how the ozone layer and ozone hole might be structured as scientific concepts. Uses a standardized set of questions to interview children and adults in Canada. Discusses implications of the results for health…

  2. Telesurgery: remote knowledge translation in clinical surgery.

    Science.gov (United States)

    Anvari, Mehran

    2007-08-01

    Dissemination of new surgical knowledge, skills, and techniques across the wide spectrum of practicing surgeons in the community is often difficult and slow. This is even more problematic in countries such as Canada, where geographic distances separate a large portion of community surgeons from the large teaching centers. As an example, the penetration of advanced minimally invasive techniques in Canada has been severely hampered by the inability to provide adequate training opportunities and support for community surgeons, many of whom live in remote regions of the country. In an attempt to overcome the barriers that exist, the Centre for Minimal Access Surgery (CMAS) at McMaster University has been using broadband Internet and telecommunication systems to provide distance training and mentoring to community surgeons living in remote northern communities of Canada. This article describes our experience with telementoring and robot-assisted remote telepresence surgery and assisting, between a teaching hospital in Hamilton and two community hospitals in northern Ontario and Quebec.

  3. Bringing explicit insight into cognitive psychology features during clinical reasoning seminars: a prospective, controlled study.

    Science.gov (United States)

    Nendaz, Mathieu R; Gut, Anne M; Louis-Simonet, Martine; Perrier, Arnaud; Vu, Nu V

    2011-04-01

    Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored. This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning. Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups. Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02). This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.

  4. The cognitive organization of music knowledge: a clinical analysis

    Science.gov (United States)

    Omar, Rohani; Hailstone, Julia C.; Warren, Jane E.; Crutch, Sebastian J.

    2010-01-01

    Despite much recent interest in the clinical neuroscience of music processing, the cognitive organization of music as a domain of non-verbal knowledge has been little studied. Here we addressed this issue systematically in two expert musicians with clinical diagnoses of semantic dementia and Alzheimer’s disease, in comparison with a control group of healthy expert musicians. In a series of neuropsychological experiments, we investigated associative knowledge of musical compositions (musical objects), musical emotions, musical instruments (musical sources) and music notation (musical symbols). These aspects of music knowledge were assessed in relation to musical perceptual abilities and extra-musical neuropsychological functions. The patient with semantic dementia showed relatively preserved recognition of musical compositions and musical symbols despite severely impaired recognition of musical emotions and musical instruments from sound. In contrast, the patient with Alzheimer’s disease showed impaired recognition of compositions, with somewhat better recognition of composer and musical era, and impaired comprehension of musical symbols, but normal recognition of musical emotions and musical instruments from sound. The findings suggest that music knowledge is fractionated, and superordinate musical knowledge is relatively more robust than knowledge of particular music. We propose that music constitutes a distinct domain of non-verbal knowledge but shares certain cognitive organizational features with other brain knowledge systems. Within the domain of music knowledge, dissociable cognitive mechanisms process knowledge derived from physical sources and the knowledge of abstract musical entities. PMID:20142334

  5. The cognitive organization of music knowledge: a clinical analysis.

    Science.gov (United States)

    Omar, Rohani; Hailstone, Julia C; Warren, Jane E; Crutch, Sebastian J; Warren, Jason D

    2010-04-01

    Despite much recent interest in the clinical neuroscience of music processing, the cognitive organization of music as a domain of non-verbal knowledge has been little studied. Here we addressed this issue systematically in two expert musicians with clinical diagnoses of semantic dementia and Alzheimer's disease, in comparison with a control group of healthy expert musicians. In a series of neuropsychological experiments, we investigated associative knowledge of musical compositions (musical objects), musical emotions, musical instruments (musical sources) and music notation (musical symbols). These aspects of music knowledge were assessed in relation to musical perceptual abilities and extra-musical neuropsychological functions. The patient with semantic dementia showed relatively preserved recognition of musical compositions and musical symbols despite severely impaired recognition of musical emotions and musical instruments from sound. In contrast, the patient with Alzheimer's disease showed impaired recognition of compositions, with somewhat better recognition of composer and musical era, and impaired comprehension of musical symbols, but normal recognition of musical emotions and musical instruments from sound. The findings suggest that music knowledge is fractionated, and superordinate musical knowledge is relatively more robust than knowledge of particular music. We propose that music constitutes a distinct domain of non-verbal knowledge but shares certain cognitive organizational features with other brain knowledge systems. Within the domain of music knowledge, dissociable cognitive mechanisms process knowledge derived from physical sources and the knowledge of abstract musical entities.

  6. Systematic reviews, systematic error and the acquisition of clinical knowledge

    Directory of Open Access Journals (Sweden)

    Mickenautsch Steffen

    2010-06-01

    Full Text Available Abstract Background Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources. Discussion The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge. Conclusions The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.

  7. Systematic reviews, systematic error and the acquisition of clinical knowledge.

    Science.gov (United States)

    Mickenautsch, Steffen

    2010-06-10

    Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources. The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge. The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.

  8. Assisted knowledge discovery for the maintenance of clinical guidelines.

    Directory of Open Access Journals (Sweden)

    Emilie Pasche

    Full Text Available BACKGROUND: Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used. OBJECTIVE: We present the design and the evaluation of a tool (KART that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques. METHODS: KART consists of three main modules 1 a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2 a module to normalize clinical recommendations based on automatic text categorizers; and 3 a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough. RESULTS: KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users. CONCLUSIONS: We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building.

  9. Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

    Science.gov (United States)

    Pasche, Emilie; Ruch, Patrick; Teodoro, Douglas; Huttner, Angela; Harbarth, Stephan; Gobeill, Julien; Wipfli, Rolf; Lovis, Christian

    2013-01-01

    Background Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used. Objective We present the design and the evaluation of a tool (KART) that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques. Methods KART consists of three main modules 1) a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2) a module to normalize clinical recommendations based on automatic text categorizers; and 3) a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough. Results KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users. Conclusions We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building. PMID:23646153

  10. Clinical reasoning process underlying choice of teaching strategies: a framework to improve occupational therapists' transfer skill interventions.

    Science.gov (United States)

    Carrier, Annie; Levasseur, Mélanie; Bédard, Denis; Desrosiers, Johanne

    2012-10-01

    Clinical reasoning, a critical skill influenced by education and practice context, determines how occupational therapists teach transfer skills. Teaching strategies affect intervention efficacy. Although knowledge about the way teaching strategies are chosen could help improve interventions, few studies have considered this aspect. Therefore, the aim of this study was to explore the clinical reasoning process of occupational therapists underlying the choice of strategies to teach older adults transfer skills. A grounded theory study was carried out with eleven community occupational therapists recruited in six Health and Social Services Centres in Québec, Canada. Data were collected through observations of teaching situations (n = 31), in-depth semi-structured interviews (n = 12) and memos, and were analysed using constant comparative methods. Memos were also used to raise codes to conceptual categories, leading to an integrative framework. Rigour was assured by following scientific criteria for qualitative studies. The integrative framework includes the clinical reasoning process, consisting of eight stages, and its factors of influence. These factors are internal (experiences and elements of personal context) and external (type of transfer, clients' and their environment's characteristics and practice context). The clinical reasoning process underlying the choice of strategies to teach transfer skills was conceptualised into an integrative framework. Such a framework supports clinicians' reflective practice, highlights the importance of theory and practice of pedagogy in occupational therapists' education, and encourages consideration and better documentation of the possible influence of practice context on teaching interventions. As such, this integrative framework could improve occupational therapists' transfer skill interventions with older adults. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.

  11. The development of clinical reasoning and interprofessional behaviors: service-learning at a student-run free clinic.

    Science.gov (United States)

    Seif, Gretchen; Coker-Bolt, Patty; Kraft, Sara; Gonsalves, Wanda; Simpson, Kit; Johnson, Emily

    2014-11-01

    This article examines the benefits of a student run free clinic (SRFC) as a service learning experience for students in medicine, pharmacy, occupational therapy, physical therapy and physician assistant programs. We hypothesized that students who participate in an interprofessional service learning course and volunteer at a SRFC would demonstrate significant increases in perceptions and attitudes for working in interprofessional health care teams and clinical reasoning skills compared to students who did not participate. Three assessments were administered to an experimental and control group of pre-clinical students from medical, occupational therapy, physical therapy, pharmacy and physician assistant programs before and after participation in an interprofessional service-learning course and volunteering at the SRFC. The tools were the Interdisciplinary Education Perception Scale (IEPS), Readiness for Interprofessional Learning Scale (RIPLS) and the Self-Assessment of Clinical Reflection and Reasoning (SACRR). Students who completed the course had improvements in interprofessional perceptions and attitudes (p = 0.03) and perceptions of clinical reasoning skills when compared to the control group (p = 0.002). This study is novel as it examined students' perceptions of interprofessional attitudes and clinical reasoning following participation in an interprofessional service-learning course and participation in a SRFC.

  12. Evolution in clinical knowledge management strategy at Intermountain Healthcare.

    Science.gov (United States)

    Hulse, Nathan C; Galland, Joel; Borsato, Emerson P

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

  13. The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course

    Science.gov (United States)

    Elizondo-Omana, Rodrigo E.; Lopez, Santos Guzman

    2008-01-01

    Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives:…

  14. The cognitive organization of music knowledge: a clinical analysis

    OpenAIRE

    Omar, R.; Hailstone, J. C.; Warren, J. E.; Crutch, S J; Warren, J. D.

    2010-01-01

    Despite much recent interest in the clinical neuroscience of music processing, the cognitive organization of music as a domain of non-verbal knowledge has been little studied. Here we addressed this issue systematically in two expert musicians with clinical diagnoses of semantic dementia and Alzheimer’s disease, in comparison with a control group of healthy expert musicians. In a series of neuropsychological experiments, we investigated associative knowledge of musical compositions (musical o...

  15. Prevalence and Reasons for Tooth Loss in a Sample from a Dental Clinic in Brazil

    Directory of Open Access Journals (Sweden)

    Andréia Affonso Barretto Montandon

    2012-01-01

    Full Text Available Purpose. To evaluate the prevalence and reasons for teeth extractions in a sample from a dental clinic in Brazil. Methods. The prevalence of teeth mortality was analyzed by gender, age, tooth type and reasons for extraction on 800 teeth of 439 subjects, whose data was collected in clinical records in a convenience sample. Results. The groups with range from 35 to 44 years, 45 to 54 years and 55 to 64 years revealed significantly greater number of teeth extractions than other age groups (P<0.0001. The anterior teeth loss increased significantly with aging, while the tooth mortality of premolar and molar were higher in younger people. The caries was the more prevalent reason for tooth mortality among young and adults up to 44 years old, while the periodontal disease was the main reason for extractions from 45 years old until range of 81 years (P<0.0001. Conclusions. It can be suggested that some reasons for tooth loss were age-dependent, but the caries and the periodontal diseases were the main reasons for tooth mortality in this Brazilian sample.

  16. [Schizophrenic disorders: current etiologic and clinical knowledge].

    Science.gov (United States)

    Olié, Jean-Pierre; Krebs, Marie-Odile; Lôo, Henri

    2005-05-01

    Brain anomalies associated with schizophrenic disorders may be of a cognitive, neurophysiological or neurological nature [the latter being relatively minor and nonspecific]. Brain imaging has revealed early anomalies such as cortical-subcortical atrophy and abnormal gyration. These anomalies can also be present in relatives free of schizophrenic symptoms. This raises the question of what determines the transition from vulnerability to clinical onset. There is now evidence that schizophrenic disorders are true brain diseases. This is based on neuropathological studies, brain imaging and clinical findings such as "soft" neurological signs (pyramidal and extrapyramidal symptoms, coordination difficulties, etc.). Cognitive dysfunctions such as attention and memory disorders and abnormal verbal fluency have also been described. Oculomotor pursuit and auditive evoked potentials have identified specific neurophysiological disorders such as N300 and P50 wave modifications. Schizophrenic disorders can also be associated with neuronal abnormalities, notably affecting factors involved in synaptic transmission and plasticity. For example, BDNF protein deficit is linked to certain late-onset forms of schizophrenia. Genetic studies are no longer focusing on a possible disease genotype but rather on phenotypic characteristics determined by simpler genotypes (P50 wave modulation, COMT and BDNF genes). The ultimate objective is to identify high-risk subjects, in order to shorten the treatment delay and thereby improve long-term outcome. The benefit of primary prophylaxis remains to be determined, however.

  17. Nutrition knowledge, attitudes and fat intake: application of the theory of reasoned action.

    Science.gov (United States)

    Shepherd, R; Towler, G

    2007-06-01

    Validated questionnaires eliciting information on nutrition knowledge and attitudes, related to fat intake from meat, meat products, dairy products and fried foods, were completed by 538 subjects. There were high correlations (ranging from 0.40 to 0.77) between the sums of belief-evaluations, attitudes, intention and self-reported behaviour, with similar correlations for a subgroup of males aged 35-54 years. Nutrition knowledge, showed some statistically significant (but small) negative correlations with components of attitudes. Females had higher nutrition knowledge scores and more negative views of the foods than did males. Fat intake, measured using 3 day weighed intakes, correlated with self-reported behaviour (r = 0.55, p<0.01) in a subsample of 30 males, aged 35-54 years. Thus, nutrition knowledge seems less clearly related to consumption of these foods than are more specific beliefs and attitudes.

  18. A Study of Qualitative and Geometric Knowledge in Reasoning about Motion. Revision.

    Science.gov (United States)

    1981-02-01

    other always outside the) cannot. The knowledge we use in this situation appcars simpler than formal mechanics, and is based on our experience with... experience with a program caled 1I [Su%.man & Stalman] this program contained a number of scminal ideas. including a "fact gabage collcttor" diat led...Qualitative knowledge must also identify those situations where the equations of motion are no longer applicable. Fr the purpose of description dese

  19. Does Ignorance Matter? The Relative Importance of Civic Knowledge and the Human Tendency to Engage in Motivated Reasoning

    Directory of Open Access Journals (Sweden)

    Aaron Dusso

    2015-03-01

    Full Text Available It has long been understood that political knowledge in the U.S. is very low. For those who care about the quality of American democracy, this is a big problem. In attempting to find a solution, many people often blame education. While increasing civic knowledge is a laudatory goal, increased political sophistication does not necessarily turn individuals into good democratic citizens. Research in cognitive and social psychology paints a picture of people as motivated reasoners. Instead of having an open-minded engagement with issues, individuals typically only seek, see, and understand information in a manner that reinforces what they already believe. Here, we examine motivated reasoning and argue that the strongest partisans and the most committed ideologues will be the most susceptible to holding contradictory policy positions with regard to same-sex marriage and religious freedom.

  20. Reasoning by analogy requires the left frontal pole: lesion-deficit mapping and clinical implications.

    Science.gov (United States)

    Urbanski, Marika; Bréchemier, Marie-Laure; Garcin, Béatrice; Bendetowicz, David; Thiebaut de Schotten, Michel; Foulon, Chris; Rosso, Charlotte; Clarençon, Frédéric; Dupont, Sophie; Pradat-Diehl, Pascale; Labeyrie, Marc-Antoine; Levy, Richard; Volle, Emmanuelle

    2016-06-01

    SEE BURGESS DOI101093/BRAIN/AWW092 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE  : Analogical reasoning is at the core of the generalization and abstraction processes that enable concept formation and creativity. The impact of neurological diseases on analogical reasoning is poorly known, despite its importance in everyday life and in society. Neuroimaging studies of healthy subjects and the few studies that have been performed on patients have highlighted the importance of the prefrontal cortex in analogical reasoning. However, the critical cerebral bases for analogical reasoning deficits remain elusive. In the current study, we examined analogical reasoning abilities in 27 patients with focal damage in the frontal lobes and performed voxel-based lesion-behaviour mapping and tractography analyses to investigate the structures critical for analogical reasoning. The findings revealed that damage to the left rostrolateral prefrontal region (or some of its long-range connections) specifically impaired the ability to reason by analogies. A short version of the analogy task predicted the existence of a left rostrolateral prefrontal lesion with good accuracy. Experimental manipulations of the analogy tasks suggested that this region plays a role in relational matching or integration. The current lesion approach demonstrated that the left rostrolateral prefrontal region is a critical node in the analogy network. Our results also suggested that analogy tasks should be translated to clinical practice to refine the neuropsychological assessment of patients with frontal lobe lesions.

  1. Relationships between Conceptual Knowledge and Reasoning about Systems: Implications for Fostering Systems Thinking in Secondary Science

    Science.gov (United States)

    Lyons, Cheryl

    2014-01-01

    Reasoning about systems is necessary for understanding many modern issues that face society and is important for future scientists and all citizens. Systems thinking may allow students to make connections and identify common themes between seemingly different situations and phenomena, and is relevant to the focus on cross-cutting concepts in…

  2. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Ana Paula Ribeiro Bonilauri Ferreira

    Full Text Available BACKGROUND: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. METHOD: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. RESULTS: FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. DISCUSSION: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  3. Clinical Reasoning in the Assessment and Intervention Planning for Attention-Deficit/Hyperactivity Disorder

    Science.gov (United States)

    Climie, Emma A.; Mah, Janet W. T.; Chase, Cheryl Y.

    2017-01-01

    The purpose of this article is to provide the reader with insight into the clinical reasoning involved in the assessment and intervention planning for a child with Attention-Deficit/Hyperactivity Disorder. The reader will be guided through the authors' conceptualization of this case, and suggestions for intervention in the classroom will be…

  4. Clinical Reasoning in the Assessment and Intervention Planning for a Reading Disability

    Science.gov (United States)

    Sotelo-Dynega, Marlene

    2017-01-01

    The purpose of this article is to provide the reader with insight into the clinical reasoning process involved in the assessment and intervention planning for a child with a reading disability. A Cattell-Horn-Carroll (CHC) theoretical/neuropsychological approach shall serve as the foundational theoretical framework for this case study, and…

  5. Conveying clinical reasoning based on visual observation via eye-movement modelling examples

    NARCIS (Netherlands)

    Jarodzka, Halszka; Balslev, Thomas; Holmqvist, Kenneth; Nyström, Marcus; Scheiter, Katharina; Gerjets, Peter; Eika, Berit

    2012-01-01

    Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2012). Conveying clinical reasoning based on visual observation via eye-movement modelling examples. Instructional Science, 40(5), 813-827. doi:10.1007/s11251-012-9218-5

  6. Conveying clinical reasoning based on visual observation via eye-movement modelling examples

    NARCIS (Netherlands)

    Jarodzka, Halszka; Balslev, Thomas; Holmqvist, Kenneth; Nyström, Marcus; Scheiter, Katharina; Gerjets, Peter; Eika, Berit

    2012-01-01

    Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2012). Conveying clinical reasoning based on visual observation via eye-movement modelling examples. Instructional Science, 40(5), 813-827. doi:10.1007/s11251-012-9218-5

  7. Using Hermeneutic Phenomenology to Investigate How Experienced Practitioners Learn to Communicate Clinical Reasoning

    Science.gov (United States)

    Ajjawi, Rola; Higgs, Joy

    2007-01-01

    This paper is primarily targeted at doctoral students and other researchers considering using hermeneutic phenomenology as a research strategy. We present interpretive paradigm research designed to investigate how experienced practitioners learn to communicate their clinical reasoning in professional practice. Twelve experienced physiotherapy…

  8. What Comes before Report Writing? Attending to Clinical Reasoning and Thinking Errors in School Psychology

    Science.gov (United States)

    Wilcox, Gabrielle; Schroeder, Meadow

    2015-01-01

    Psychoeducational assessment involves collecting, organizing, and interpreting a large amount of data from various sources. Drawing upon psychological and medical literature, we review two main approaches to clinical reasoning (deductive and inductive) and how they synergistically guide diagnostic decision-making. In addition, we discuss how the…

  9. Clinical Reasoning in the Assessment and Intervention Planning for Attention-Deficit/Hyperactivity Disorder

    Science.gov (United States)

    Climie, Emma A.; Mah, Janet W. T.; Chase, Cheryl Y.

    2017-01-01

    The purpose of this article is to provide the reader with insight into the clinical reasoning involved in the assessment and intervention planning for a child with Attention-Deficit/Hyperactivity Disorder. The reader will be guided through the authors' conceptualization of this case, and suggestions for intervention in the classroom will be…

  10. Core Components of Communication of Clinical Reasoning: A Qualitative Study with Experienced Australian Physiotherapists

    Science.gov (United States)

    Ajjawi, Rola; Higgs, Joy

    2012-01-01

    Communication is an important area in health professional education curricula, however it has been dealt with as discrete skills that can be learned and taught separate to the underlying thinking. Communication of clinical reasoning is a phenomenon that has largely been ignored in the literature. This research sought to examine how experienced…

  11. What Comes before Report Writing? Attending to Clinical Reasoning and Thinking Errors in School Psychology

    Science.gov (United States)

    Wilcox, Gabrielle; Schroeder, Meadow

    2015-01-01

    Psychoeducational assessment involves collecting, organizing, and interpreting a large amount of data from various sources. Drawing upon psychological and medical literature, we review two main approaches to clinical reasoning (deductive and inductive) and how they synergistically guide diagnostic decision-making. In addition, we discuss how the…

  12. Generic Reflective Feedback: An Effective Approach to Developing Clinical Reasoning Skills

    Science.gov (United States)

    Wojcikowski, K.; Brownie, S.

    2013-01-01

    Problem-based learning can be an effective tool to develop clinical reasoning skills. However, it traditionally takes place in tutorial groups, giving students little flexibility in how and when they learn. This pilot study compared the effectiveness of generic reflective feedback (GRF) with tutorial-based reflective feedback on the development of…

  13. Using Blogging to Promote Clinical Reasoning and Metacognition in Undergraduate Physiotherapy Fieldwork Programs

    Science.gov (United States)

    Tan, Shuyan Melissa; Ladyshewsky, Richard K.; Gardner, Peter

    2010-01-01

    This qualitative study investigated the impact of using blogs on the clinical reasoning and meta-cognitive skills of undergraduate physiotherapy students in a fieldwork education program. A blog is a web based document that enables individuals to enter comments and read each others' comments in a dynamic and interactive manner. In this study,…

  14. Knowledge Representation and Reasoning in Personalized Web-Based e-Learning Applications

    DEFF Research Database (Denmark)

    Dolog, Peter

    2006-01-01

    Adaptation that is so natural for teaching by humans is a challenging issue for electronic learning tools. Adaptation in classic teaching is based on observations made about students during teaching. Similar idea was employed in user-adapted (personalized) eLearning applications. Knowledge about...... a user inferred from user interactions with the eLeanrning systems is used to adapt o®ered learning resources and guide a learner through them. This keynote gives an overview about knowledge and rules taken into account in current adaptive eLearning prototypes when adapting learning instructions....... Adaptation is usually based on knowledge about learning esources and users. Rules are used for heuristics to match the learning resources with learners and infer adaptation decisions....

  15. Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices

    OpenAIRE

    Adam Burke; Nahin, Richard L.; Stussman, Barbara J.

    2015-01-01

    Background Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at wh...

  16. Knowledge Representation and Reasoning in Personalized Web-Based e-Learning Applications

    DEFF Research Database (Denmark)

    Dolog, Peter

    2006-01-01

    Adaptation that is so natural for teaching by humans is a challenging issue for electronic learning tools. Adaptation in classic teaching is based on observations made about students during teaching. Similar idea was employed in user-adapted (personalized) eLearning applications. Knowledge about...

  17. Midwives’ Clinical Reasons for Performing Episiotomies in the Kurdistan Region; Are they evidence-based?

    Directory of Open Access Journals (Sweden)

    Hamdia M. Ahmed

    2014-08-01

    Full Text Available Objectives: An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives’ reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. Methods: This cross-sectional study was conducted between 1st July and 30th September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53. Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives’ demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. Results: The main clinical reasons reported by midwives for performing an episiotomy were: macrosomia/large fetus (38, 71.7%, breech delivery (31, 58.5%, shoulder dystocia (29, 54.7%, anticipated perineal tear (27, 50.9% and fetal distress (27, 50.9%. There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education. Conclusion: Most of the reasons given by the midwives for performing episiotomies were not evidencebased. Age, years of experience, specialties and level of education also had an effect on midwives’ reasons for performing episiotomies.

  18. Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2015-01-01

    -deduction and the pattern recognition skills in physical therapy students, focused teaching methods and strategies need to be emphasized and adopted by academicians, clinical educators and of course students. It is also of utmost importance that evaluation systems of physical therapy programs are introspected for inclusion...... in this area. This has resulted in diverse methods and strategies to transfer reasoning skills effectively to students. Awareness about recommended pedagogical techniques to enhance clinical reasoning skills can significantly influence the educator’s choice of methods within and beyond the classroom teaching...... curricula. Under the broad paradigm of Problem Based Learning (PBL), which is being viewed as the key shift in educations in the last few years, many other models have been proposed. Strategies such as case based teaching, blended learning, co-operative learning, interactive learning, blogging and clinical...

  19. Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR?

    Directory of Open Access Journals (Sweden)

    Harimanana Aina

    2013-02-01

    Full Text Available Abstract Background The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE and access to epilepsy care. In a national survey we assessed: 1 the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2 patient attendance at health facilities. Methods We conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009. Results Overall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5% recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9% was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20% health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%. A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low. Conclusions The low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.

  20. A brief simulation intervention increasing basic science and clinical knowledge

    OpenAIRE

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background: The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application.Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant d...

  1. Influencing public policies: Two (very good) reasons to look toward scientific knowledge in public policy.

    Science.gov (United States)

    Gagnon, François; Bellefleur, Olivier

    2014-07-11

    The healthy public policy movement rests on the belief that a range of public policies should be at least partly informed by evidence demonstrating the positive effects of these policies on population health, health inequalities and their determinants. In order to address certain difficulties that the movement faces, knowledge produced in various scientific disciplines regarding public policies may provide some valuable guidance. In this short commentary, we examine how knowledge from the scientific disciplines investigating public policies makes it possible to address two difficulties in the development of healthy public policies: 1) adequately anticipating the effects of public policies, and 2) assessing the political viability of the policies being promoted. Since urban traffic policies are of interest to most of the other contributors to this supplement, we use examples from this field to illustrate some of our points.

  2. Social Work Students’ Use of Knowledge in Direct Practice – Reasons, Strategies and Effects

    Directory of Open Access Journals (Sweden)

    2007-08-01

    Full Text Available This article describes a study of Swedish social work students’ use of knowledge during their field practice. Data was collected by using short written narratives, where the students reflect on situations from practice, situations they experienced as critical or problematic. The narratives were analysed with a method inspired by the interpretation theory of Paul Ricoeur. The article starts with a discussion adhering to the present trend of evidence-based social work practice. This is followed by a study of 144 narratives from social work students containing critical or problematic events. A quantitative description of the material as well as qualitative model of two type-strategies, that social work students use, is presented. The results show, among other things, that students use several forms of knowledge, where facts/evidence is one of several. The study also shows that there is a strong adaptation to varying critical situations. A conclusion is that it is difficult to a priori define the types and proportions of knowledge to use in social work practice.

  3. Knowledge and vision engines: a new generation of image understanding systems combining computational intelligence methods and model-based knowledge representation and reasoning

    Science.gov (United States)

    Kuvychko, Igor

    2000-10-01

    Vision is a part of a larger informational system that converts visual information into knowledge structures. These structures drive vision process, resolving ambiguity and uncertainty via feedback, and provide image understanding, that is an interpretation of visual information in terms of such knowledge models. The solution to Image Understanding problems is suggested in form of active multilevel hierarchical networks represented dually as discrete and continuous structures. Computational intelligence methods transform images into model-based knowledge representation. Certainty Dimension converts attractors in neural networks into fuzzy sets, preserving input-output relationships. Symbols naturally emerge in such networks. Symbolic Space is a dual structure that combines closed distributed space split by the set of fuzzy regions, and discrete set of symbols equivalent to the cores of regions represented as points in the Certainty dimension. Model Space carries knowledge in form of links and relations between the symbols, and supports graph, diagrammatic and topological operations. Composition of spaces works similar to M. Minsky frames and agents, Gerard Edelman's maps of maps, etc., combining machine learning, classification and analogy together with induction, deduction and other methods of higher level model-based reasoning. Based on such principles, an Image Understanding system can convert images into knowledge models, effectively resolving uncertainty and ambiguity via feedback projections and does not require supercomputers.

  4. Do medical students’ scores using different assessment instruments predict their scores in clinical reasoning using a computer-based simulation?

    Directory of Open Access Journals (Sweden)

    Fida M

    2015-02-01

    Full Text Available Mariam Fida,1 Salah Eldin Kassab2 1Department of Molecular Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 2Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Purpose: The development of clinical problem-solving skills evolves over time and requires structured training and background knowledge. Computer-based case simulations (CCS have been used for teaching and assessment of clinical reasoning skills. However, previous studies examining the psychometric properties of CCS as an assessment tool have been controversial. Furthermore, studies reporting the integration of CCS into problem-based medical curricula have been limited. Methods: This study examined the psychometric properties of using CCS software (DxR Clinician for assessment of medical students (n=130 studying in a problem-based, integrated multisystem module (Unit IX during the academic year 2011–2012. Internal consistency reliability of CCS scores was calculated using Cronbach's alpha statistics. The relationships between students' scores in CCS components (clinical reasoning, diagnostic performance, and patient management and their scores in other examination tools at the end of the unit including multiple-choice questions, short-answer questions, objective structured clinical examination (OSCE, and real patient encounters were analyzed using stepwise hierarchical linear regression. Results: Internal consistency reliability of CCS scores was high (α=0.862. Inter-item correlations between students' scores in different CCS components and their scores in CCS and other test items were statistically significant. Regression analysis indicated that OSCE scores predicted 32.7% and 35.1% of the variance in clinical reasoning and patient management scores, respectively (P<0.01. Multiple-choice question scores, however, predicted only 15.4% of the variance in diagnostic performance scores (P<0.01, while

  5. [Tobacco: knowledge, reasoning and opinion of high school students in Doubs. Reflections on prevention].

    Science.gov (United States)

    Michaud, C; Saraiva, I; Henry, Y; Dodane, M

    2003-03-01

    The prevalence of smoking has increased among young people aged 14 to 18 between 1993 and 1999, and most notably among girls within the same period. These observations illustrate the necessity for significant changes in mass media campaigns and education programmes related to the prevention of smoking among youth. The objective of this survey, initiated by the city of Besançon and the French National Mutual Insurance of Doubs, was to describe and analyse the knowledge and rationale of high school students on tobacco and their opinions in terms of prevention. Twelve public and private high schools in Besançon and Morteau (Doubs-France) participated in the survey; the group also represented a mix of general and professional schools. The questionnaire was filled out by 970 students selected at random. 96% of the students indicated cancer as being the main illness linked to tobacco and 94% stated that second-hand smoke constitutes a health risk. 61% admitted to seeking out the psychoactive effects of smoking. The students responses confirm that the types of messages relayed in a smoking prevention campaign which have an impact on them are: evoking fear of death (74%) and the use of humor (16%). One-third of high school students find that it is unacceptable to forbid smoking on school premises. The knowledge of the dangers related to smoking is not sufficient to keep young people from smoking and confirms that an educational approach based solely on knowledge and facts will not be sufficient to decrease their tobacco consumption. It is important to take into account the image that young people have of tobacco as a means to combat stress in future prevention strategies and campaigns.

  6. Clinical reasoning of medical students in a public university in Brazil

    Directory of Open Access Journals (Sweden)

    Célia Cristina Fornaziero

    Full Text Available The aim of this research was to understand the reasoning developed by medical students in a public university in Brazil. This research on education included semi-structured interviews and film recordings of interns discussing 10 clinical cases. A sample of 16 interns analyzed cases presented on a notebook computer with a webcam. They were instructed to verbalize all their thoughts on the procedures they would use. The film recordings and transcripts of the interviews were analyzed. Quantitative data was evaluated using Yates' chi-squared test and speech analysis was used to evaluate the transcripts. The theme worked on in the practice of reasoning was: the student's perceptions of their clinical practice. Of the 160 diagnoses, 57% were done with analytical reasoning and 43% with non-analytical reasoning. The hypothetical deductive method was employed by 31% of the interns and the inductive method was employed by 69%. The diagnostic accuracy was 81% correct for easy cases and 85% correct for difficult cases. We observed two empirical categories: the cognitive universe of the student and the patient's context.

  7. Medical education and cognitive continuum theory: an alternative perspective on medical problem solving and clinical reasoning.

    Science.gov (United States)

    Custers, Eugène J F M

    2013-08-01

    Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: "System 1," the unconscious, intuitive, or nonanalytic system, and "System 2," the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems.This article outlines the difficulties of this "two-system view" and presents an alternative, developed by K.R. Hammond and colleagues, called cognitive continuum theory (CCT). CCT is featured by three key assumptions. First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called "quasirationality." Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning.

  8. VHA Blueprints: redefining the way clinical knowledge is transferred.

    Science.gov (United States)

    Kosel, Keith C; Clark, Teresa; Haywood, Trent T; Lonappan, Margaret

    2012-01-01

    Despite a growing interest in health care quality improvement, little has changed regarding how clinicians acquire, assimilate, and transfer knowledge concerning leading practices. Working with hospitals with recognized leading clinical practices, VHA Inc developed an innovative methodology for generating and transferring knowledge using a visual story format that incorporates structural, process, and contextual elements into a comprehensive knowledge transfer vehicle called a VHA Leading Practice Blueprint. The authors describe a validation study comparing the effectiveness of the Blueprint methodology as a knowledge transfer vehicle to 2 commonly used sources of performance improvement knowledge: traditional case study and peer-reviewed journal article. Six dimensions-display, content, transferability, recall, diffusion, and actionable-were evaluated. Analysis of data indicates that the Blueprint methodology was judged superior to case studies and peer-reviewed articles on all 6 dimensions. The Blueprint methodology appears to hold promise as a new medium for conveying leading practices in health care.

  9. Cognitive Maps and the Structure of Observed Learning Outcome Assessment of Physiotherapy Students' Ethical Reasoning Knowledge

    Science.gov (United States)

    Jones, Mark; van Kessel, Gisela; Swisher, Laura; Beckstead, Jason; Edwards, Ian

    2014-01-01

    Assessment of student learning in complex areas is challenging, particularly when there is interest in students' deeper understanding and connectivity of concepts. Assessment of ethics learning has been limited by lack of consensus regarding what is effective and an overfocus on quantification at the expense of clinical or ethical relevance.…

  10. Young People's Experiences of Participation in Clinical Trials : Reasons for Taking Part

    NARCIS (Netherlands)

    Luchtenberg, Malou; Maeckelberghe, Els; Locock, Louise; Powell, Lesley; Verhagen, A. A. Eduard

    2015-01-01

    Given the lack of knowledge about safety and efficacy of many treatments for children, pediatric clinical trials are important, but recruitment for pediatric research is difficult. Little is known about children's perspective on participating in trials. The purpose of this study was to understand th

  11. Understanding reasons for treatment interruption amongst patients on antiretroviral therapy – A qualitative study at the Lighthouse Clinic, Lilongwe, Malawi

    Directory of Open Access Journals (Sweden)

    Julia Tabatabai

    2014-09-01

    Full Text Available Background: In recent years, scaling up of antiretroviral therapy (ART in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI can inform strategies for improving drug adherence and retention in care. Objective: To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART. Design: This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients’ knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach. Results: A total of 347 patients (58.2% female, average age 35.1±11.3 years with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147, which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients’ health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma. Conclusions

  12. Increased student self-confidence in clinical reasoning skills associated with case-based learning (CBL).

    Science.gov (United States)

    Patterson, Jon S

    2006-01-01

    Second-year veterinary students were surveyed at the beginning and end of a 15-week semester regarding their confidence in performing three clinical reasoning skills: (1) making Problem Lists; (2) making Rule-Out Lists; and (3) selecting appropriate diagnostic tests. Each week during the semester, these skills were practiced in small-group case discussions. Changes in self-confidence were analyzed and studied in light of faculty assessments of student competence in performance of the three skills. The purpose of the study was to determine if students' self-confidence in performing three clinical reasoning skills increased with practice. On the first and last days of class, students rated their confidence in each of the three skills on a scale of 0 to 10. Mean confidence scores for the whole class both for time points and for each of the three skills were analyzed. There were significant increases in students' self-confidence in all three clinical reasoning skills over the semester each year. A greater percentage of students expressed improved confidence in selecting appropriate diagnostic tests than in the other two skills in three of the four years studied. Students' self-confidence in performing three clinical reasoning skills improved over the course of a semester in which they practiced the skills in a CBL format. Subjective faculty assessment of students' competence in these skills generally indicated improvement. However, no meaningful conclusions about the correlation of skill competence and student confidence could be drawn because of inadequacies in the measurement of student performance.

  13. A Serious Game for Teaching Nursing Students Clinical Reasoning and Decision-Making Skills.

    Science.gov (United States)

    Johnsen, Hege Mari; Fossum, Mariann; Vivekananda-Schmidt, Pirashanthie; Fruhling, Ann; Slettebø, Åshild

    2016-01-01

    The aim of this study was to design and pilot-test a serious game for teaching nursing students clinical reasoning and decision-making skills in caring for patients with chronic obstructive pulmonary disease. A video-based serious game prototype was developed. A purposeful sample of six participants tested and evaluated the prototype. Usability issues were identified regarding functionality and user-computer interface. However, overall the serious game was perceived to be useful, usable and likable to use.

  14. Reasons patients leave their nearest healthcare service to attend Karen Park Clinic, Pretoria North

    Directory of Open Access Journals (Sweden)

    Agnes T. Masango- Makgobela

    2013-01-01

    Full Text Available Background: Many patients move from one healthcare provider or facility to another, disturbing the continuity that enhances holistic patient care.Objectives: To investigate the reasons given by patients for attending Karen Park Clinic rather than the clinic nearest to their homes.Methods: A cross-sectional descriptive study was conducted during 2010. Three hundred and fifty patients attending Karen Park Clinic were given questionnaires to complete, with the following variables: place of residence; previous attendance at the clinic nearest their home; services available at their nearest clinic; and their willingness to attend their nearest clinic in future.Results: Respondents were from Soshanguve (153; 43.7%, Mabopane (92; 26.3%, Garankuwa (29; 8.3% and Hebron (20; 5.7% and most were women (271; 77.4% aged 26–45 (177; 50.6%. Eighty per cent (281 of the patients had visited their nearest clinic previously and 54 of these (19.2% said they would not return. The reasons for this were: long waiting time (88; 25.1%; long queues (84; 24%; rude staff (60; 17%; and no medication (39; 11.1%.Conclusion: The majority of patients who had attended their nearest clinic were adamant that they would not return. It is necessary to reduce waiting times, thus reducing long queues. This can be achieved by having adequate, satisfied healthcare providers to render a quality service and by organising training for management. Patients can thus be redirected to their nearest clinic and the health centre’s capacity can be increased by procuring adequate drugs. There is a need to follow up on patients’ complaints about staff attitudes.

  15. Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

    Science.gov (United States)

    Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

    2014-09-01

    This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

  16. Teaching clinical reasoning is more like detective work than you might imagine.

    Science.gov (United States)

    Audétat, Marie-Claude; Rieder, Arabelle; Sommer, Johanna

    When supervising a medical student or a doctor in training, it is useful to know the different stages of clinical reasoning in order to identify at what stage the learner encounters a difficulty in making the right decision. Is he having trouble characterizing the clinical problem ? Is he generating the right hypotheses that are adapted to the data collection ? Is it a problem of verification of assumptions ? Of interpreting the data ? Of presumptive diagnosis or a poor choice of an intervention plan ? By making a pedagogical diagnosis, the supervisor will be more effective in adapting his recommendations in a more targeted way to the specific difficulties of the student or young colleague.

  17. The cradle of social knowledge: Infants' reasoning about caregiving and affiliation.

    Science.gov (United States)

    Spokes, Annie C; Spelke, Elizabeth S

    2017-02-01

    Considerable research has examined infants' understanding and evaluations of social agents, but two questions remain unanswered: First, do infants organize observed social relations into larger structures, inferring the relationship between two social beings based on their relations to a third party? Second, how do infants reason about a type of social relation prominent in all societies: the caregiving relation between parents and their babies? In a series of experiments using animated events, we ask whether 15- to 18-month-old infants infer that two babies who were comforted by the same adult, or two adults who comforted the same baby, will affiliate with one another. We find that infants make both of these inferences, but they make no comparable inferences when presented with the same visible events with voices that specify a peer context, in which one adult responds to another laughing adult. Thus, infants are sensitive to at least one aspect of caregiving and organize relations between infants and adults into larger social structures. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Implementation of Case-Based Reasoning System for Knowledge Management of Power Plant Construction Projects in a Korean Company

    Science.gov (United States)

    Jang, Gil-Sang

    Recently, plant construction industries are enjoying a favorable business climate centering around developing countries and oil producing countries rich in oil money. This paper proposes a methodology of implementing corporation-wide case-based reasoning (CBR) system for effectively managing lessons learned knowledge like experiences and know-how obtained in performing power plant construction projects. Our methodology is consisted of 10 steps: user requirement analysis, information modeling, case modeling, case base design, similarity function design, user interface design, case base building, CBR module development, user interface development, integration test. Also, to illustrate the usability of proposed methodology, the practical CBR system is implemented for the plant construction business division of ’H’ company which has international competitiveness in the field of plant construction industry. At present, our CBR system is successfully utilizing as storing, sharing, and reusing the knowledge which is accumulated in performing power plant construction projects in the target enterprise.

  19. The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills.

    Science.gov (United States)

    Hoffman, Kerry; Dempsey, Jennifer; Levett-Jones, Tracy; Noble, Danielle; Hickey, Noelene; Jeong, Sarah; Hunter, Sharyn; Norton, Carol

    2011-08-01

    This paper describes the conceptual design and testing of an Interactive Computerised Decision Support Framework (ICDSF) which was constructed to enable student nurses to "think like a nurse." The ICDSF was based on a model of clinical reasoning. Teaching student nurses to reason clinically is important as poor clinical reasoning skills can lead to "failure-to rescue" of deteriorating patients. The framework of the ICDSF was based on nursing concepts to encourage deep learning and transferability of knowledge. The principles of active student participation, situated cognition to solve problems, authenticity, and cognitive rehearsal were used to develop the ICDSF. The ICDSF was designed in such a way that students moved through it in a step-wise fashion and were required to achieve competency at each step before proceeding to the next. The quality of the ICDSF was evaluated using a questionairre survey, students' written comments and student assessment measures on a pilot and the ICDSF. Overall students were highly satisfied with the clinical scenarios of the ICDSF and believed they were an interesting and useful way to engage in authentic clinical learning. They also believed the ICDSF was useful in developing cognitive skills such as clinical reasoning, problem-solving and decision-making. Some reported issues were the need for good technical support and the lack of face to face contact when using e-learning. Some students also believed the ICDSF was less useful than actual clinical placements. Copyright © 2010 Elsevier Ltd. All rights reserved.

  20. CLINICAL PSYCHOLOGY AFTER THE PGS (GENERAL HEALTHCARE PSYCHOLOGY IN SPAIN: A REASONED PROPOSAL

    Directory of Open Access Journals (Sweden)

    César González-Blanch

    2015-01-01

    Full Text Available From now on, for the independent practice of psychology in the field of health in Spain, the psychologist must complete the newly created Master’s degree in General Healthcare Psychology. However, this mandatory university course is not required for access to the specialised healthcare training that provides the title of “clinical psychologist” (the PIR, an internship in Clinical Psychology. In this paper we argue in favour of changing the access to the specialised training program in clinical psychology so as to ensure that the knowledge and skills specifically related to healthcare offered by the university are included in the curricula of future clinical psychologists. Finally, the risks to the entire profession of impoverishing the university studies of clinical psychologists are discussed.

  1. Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

    Science.gov (United States)

    Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

    2003-09-01

    Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

  2. WAYS TO EVALUATE THE QUANTITY AND QUALITY OF KNOWLEDGE IN THE STUDY OF CLINICAL MEDICI

    Directory of Open Access Journals (Sweden)

    F. F. Tetenev

    2014-01-01

    Full Text Available Analysis of the current literature showed that in publications, in our opinion, there is no master: a scientific analysis of the reasons behind the decline in the quality of knowledge of the doctor, as well as the scientific basis of modern pedagogical technologies introduced in the process of training future doctors to address this problem. Objective and subjective factors are having a negative effect on the quality of the doctor's knowledge. The generally accepted methods of assessing the quality of knowledge – testing and rating system – have their limitations. Testing reflects the level of knowledge about the thinking style of the originator of test tasks. Ranking system for assessing knowledge increasingly characterized by diligence in studying medicine. It is proposed to upgrade the quality of medical knowledge in the teaching of the theory of integration of diagnostics. Amount of knowledge to evaluate the content of educational narrative history of the disease. The quality of the knowledge to assess the content of professional clinical picture comment in the history of the disease.

  3. Clinical Decision Support Knowledge Management: Strategies for Success.

    Science.gov (United States)

    Khalifa, Mohamed; Alswailem, Osama

    2015-01-01

    Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.

  4. Knowledge and Attitude of clinical level dental students concerning ...

    African Journals Online (AJOL)

    Knowledge and Attitude of clinical level dental students concerning HIV/AIDS. ... high- risk groups, common oral manifestations and prevention of HIV/AIDS. ... that they did not have any reservations dealing with patients with HIV/AIDS while 55 ...

  5. Knowledge and Behavior Regarding Cosmetics in Koreans Visiting Dermatology Clinics.

    Science.gov (United States)

    Cho, Soyun; Oh, Sohee; Kim, Nack In; Ro, Young Suck; Kim, Joung Soo; Park, Young Min; Park, Chun Wook; Lee, Weon Ju; Kim, Dong Kun; Lee, Dong Won; Lee, Sang Jun

    2017-04-01

    Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics. To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics. A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic settings. In total 1,015 subjects (73.2% females, mean age 32.5 years) completed the survey. Education level was college or higher in 72.8%. Thirty-one percent had been diagnosed with a skin disorder, atopic dermatitis and seborrheic dermatitis being the most frequent diagnoses (33.7% and 16.8%, respectively). The frequency of makeup/sunscreen/functional cosmetics use, amount of sunscreen use, recognition of functional cosmetics, and knowledge of shelf life were significantly correlated with level of education. Among "functional cosmetics," whitening products were used most frequently (29.2%). Regardless of education level, 79.2% purchased cosmetics without checking ingredients, and 85.7% were unaware of the all-ingredient-labelling regulations, and yet subjects considered ingredient the most important factor when purchasing a product. Outpatient subjects in their twenties and thirties are the most knowledgeable about cosmetics in Korea.

  6. Enhancement of cognitive and neural functions through complex reasoning training: evidence from normal and clinical populations.

    Science.gov (United States)

    Chapman, Sandra B; Mudar, Raksha A

    2014-01-01

    Public awareness of cognitive health is fairly recent compared to physical health. Growing evidence suggests that cognitive training offers promise in augmenting cognitive brain performance in normal and clinical populations. Targeting higher-order cognitive functions, such as reasoning in particular, may promote generalized cognitive changes necessary for supporting the complexities of daily life. This data-driven perspective highlights cognitive and brain changes measured in randomized clinical trials that trained gist reasoning strategies in populations ranging from teenagers to healthy older adults, individuals with brain injury to those at-risk for Alzheimer's disease. The evidence presented across studies support the potential for Gist reasoning training to strengthen cognitive performance in trained and untrained domains and to engage more efficient communication across widespread neural networks that support higher-order cognition. The meaningful benefits of Gist training provide compelling motivation to examine optimal dose for sustained benefits as well as to explore additive benefits of meditation, physical exercise, and/or improved sleep in future studies.

  7. Enhancement of Cognitive and Neural Functions through Complex Reasoning Training: Evidence from Normal and Clinical Populations

    Directory of Open Access Journals (Sweden)

    Sandra Bond Chapman

    2014-04-01

    Full Text Available Public awareness of cognitive health is fairly recent compared to physical health. Growing evidence suggests that cognitive training offers promise in augmenting cognitive brain performance in normal and clinical populations. Targeting higher-order cognitive functions, such as reasoning in particular, may promote generalized cognitive changes necessary for supporting the complexities of daily life. This data-driven perspective highlights cognitive and brain changes measured in randomized clinical trials that trained gist reasoning strategies in populations ranging from teenagers to healthy older adults, individuals with brain injury to those at-risk for Alzheimer’s disease. The evidence presented across studies support the potential for Gist reasoning training to strengthen cognitive performance in trained and untrained domains and to engage more efficient communication across widespread neural networks that support higher-order cognition. The meaningful benefits of Gist training provide compelling motivation to examine optimal dose for sustained benefits as well as to explore additive benefits of meditation, physical exercise, and/or improved sleep in future studies.

  8. Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study.

    Science.gov (United States)

    Haring, Catharina M; Cools, Bernadette M; van Gurp, Petra J M; van der Meer, Jos W M; Postma, Cornelis T

    2017-08-29

    During their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students' clinical reasoning abilities, especially during history taking. A grounded theory approach was used to analyze what expert physicians apply as indicators in their assessment of medical students' diagnostic reasoning abilities during history taking. Twelve randomly selected clinical encounter recordings of students at the end of the internal medicine clerkships were observed by six expert assessors, who were prompted to formulate their assessment criteria in a think-aloud procedure. These formulations were then analyzed to identify the common denominators and leading principles. The main indicators of clinical reasoning ability were abstracted from students' observable acts during history taking in the encounter. These were: taking control, recognizing and responding to relevant information, specifying symptoms, asking specific questions that point to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language. In addition, patients' acts and the course, result and efficiency of the conversation were identified as indicators of clinical reasoning, whereas context, using self as a reference, and emotion/feelings were identified by the clinicians as variables in their assessment of clinical reasoning. In observing and assessing clinical reasoning during history taking by medical students, general and specific phenomena to be used as indicators for this process could be identified. These phenomena can be traced back to theories on the development and the process of clinical reasoning.

  9. Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences.

    Science.gov (United States)

    Okubo, Yumiko; Ishiguro, Naoko; Suganuma, Taiyo; Nishikawa, Toshio; Takubo, Toshio; Kojimahara, Noriko; Yago, Rie; Nunoda, Shinichi; Sugihara, Shigetaka; Yoshioka, Toshimasa

    2012-01-01

    Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4(th) year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in 2005, 2006, and 2007 (non-TBL students). Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure.

  10. WAIS-III Matrix Reasoning test performance in a mixed clinical sample.

    Science.gov (United States)

    Dugbartey, A T; Sanchez, P N; Rosenbaum, J G; Mahurin, R K; Davis, J M; Townes, B D

    1999-11-01

    This study examined the relationship between the Matrix Reasoning subtest (MRT) of the WAIS-III and a selected number of neuropsychological tests in a heterogeneous clinical sample of English-speaking American (n = 41), and non-English-speaking immigrant (n = 14) adults. A moderate association between the Halstead Category Test and the MRT (-.58) was found in the English-speaking sample. Multiple regression analysis revealed a significant association between measures of verbal abstract reasoning and verbal fluency, and performance on the MRT. Among the immigrant sample, the MRT was also found to be significantly associated with verbal fluency task performance, as well as with the Comprehensive Test of Nonverbal Intelligence. Correlational analyses therefore suggest a strong verbal mediation element in the MRT, and that labeling it a nonverbal task may be misleading.

  11. Case-based reasoning using electronic health records efficiently identifies eligible patients for clinical trials.

    Science.gov (United States)

    Miotto, Riccardo; Weng, Chunhua

    2015-04-01

    To develop a cost-effective, case-based reasoning framework for clinical research eligibility screening by only reusing the electronic health records (EHRs) of minimal enrolled participants to represent the target patient for each trial under consideration. The EHR data--specifically diagnosis, medications, laboratory results, and clinical notes--of known clinical trial participants were aggregated to profile the "target patient" for a trial, which was used to discover new eligible patients for that trial. The EHR data of unseen patients were matched to this "target patient" to determine their relevance to the trial; the higher the relevance, the more likely the patient was eligible. Relevance scores were a weighted linear combination of cosine similarities computed over individual EHR data types. For evaluation, we identified 262 participants of 13 diversified clinical trials conducted at Columbia University as our gold standard. We ran a 2-fold cross validation with half of the participants used for training and the other half used for testing along with other 30 000 patients selected at random from our clinical database. We performed binary classification and ranking experiments. The overall area under the ROC curve for classification was 0.95, enabling the highlight of eligible patients with good precision. Ranking showed satisfactory results especially at the top of the recommended list, with each trial having at least one eligible patient in the top five positions. This relevance-based method can potentially be used to identify eligible patients for clinical trials by processing patient EHR data alone without parsing free-text eligibility criteria, and shows promise of efficient "case-based reasoning" modeled only on minimal trial participants. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  12. Faculty as simulated patients (FSPs) in assessing medical students' clinical reasoning skills.

    Science.gov (United States)

    Abdelkhalek, Nahed M; Hussein, Amal M; Sulaiman, Nabil; Hamdy, Hossam

    2009-12-01

    At the University of Sharjah College of Medicine in the United Arab Emirates, clinical faculty are used as simulated patients (FSP) to assess students' communication, history taking and reasoning skills on summative Objective Structured Clinical Examinations (OSCEs). The aim of this study is to evaluate student and faculty perceptions of using a faculty member simultaneously as both the simulated patient and the assessor in OSCEs. Two structured questionnaires were developed. The questionnaires measured, on a five-point Likert scale, the students' and faculty's agreement with statements related to the ability of the FSPs to convince students that they were real patients, to respond to students' questions, and to evaluate students' skills in questioning, communication and clinical reasoning. Responses to items were collapsed into three-point scales (3=Agree/Strongly Agree, 2=Neutral/Uncertain, 1=Disagree/Strongly Disagree). Students' and faculty's responses to the questionnaires' items were summarized and presented in frequencies, percentages and mean scores. A total of 412 students and 28 FSPs responded to the questionnaires with response rates of 98% and 93%, respectively. The encounter with a FSP was generally found not to be stressful by students and faculty. Students were able to think of the FSP as a real patient and faculty generally felt they were able to assess the students' reasoning processes, communication skills and history taking. The percentage of students who agreed or strongly agreed with the various positively-worded questionnaire items ranged from a lowest of 52% (mean = 2.32) to a highest of 78% (mean = 2.66) and among faculty ranged from a lowest of 61% (mean = 2.54) to a highest of 100% (mean=3.0). Student and faculty perceptions about the simultaneous use of faculty as simulated patients and assessors were generally positive. The results of this study encouraged the program to continue using FSPs on formative and summative OSCE assessments

  13. Construction of a clinical decision support system for undergoing surgery based on domain ontology and rules reasoning.

    Science.gov (United States)

    Bau, Cho-Tsan; Chen, Rung-Ching; Huang, Chung-Yi

    2014-05-01

    To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé-Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia.

  14. A Duty To Warn Relatives in Clinical Genetics: Arguably 'Fair just and reasonable' in English Law?

    Science.gov (United States)

    Mitchell, C; Ploem, M C; Hennekam, R C M; Kaye, J

    2016-07-01

    The use of 'next-generation' genetic sequencing technology that allows the sequencing of large parts, or even the entirety, of a patient's genome is advancing rapidly in the UK and around the world. This is set to greatly increase the level of health information that will be of relevance to relatives and the latest medical guidance advises that there is a professional duty to consider warning a patient's relatives of a serious genetic risk in limited circumstances. However, the High Court in ABC v St George's Healthcare NHS Trust [2015] EWHC 1394 (QB), recently found that a legal duty on the part of doctors to warn a patient's daughter of a genetic risk of Huntington's Disease without the patient's consent, was not even 'reasonably arguable' and would not be 'fair, just and reasonable'. This article considers the courts' approach to a duty of care towards 'third parties' in this context and concludes that some form of a duty of care to genetic relatives in clinical genetics is at very least arguably 'fair, just and reasonable'.

  15. Drop-out from a drug treatment clinic and associated reasons.

    Science.gov (United States)

    Hoseinie, Leila; Gholami, Zhaleh; Shadloo, Behrang; Mokri, Azarakhsh; Amin-Esmaeili, Masoumeh; Rahimi-Movaghar, Afarin

    2017-05-01

    The aim of this study was to assess drop-out rates and associated reasons among patients at the Iranian National Center for Addiction Studies (INCAS) clinic. In a one-year period (April 2014 to March 2015), all patients with drug dependence who had been referred for treatment and attended for a first assessment were included in this study (N=242). Those who received treatment were followed until March 2016. Survival analysis showed that 70.2% had dropped out from treatment. Log rank test showed that treatment drop-out rates differed between the different approaches used (P Drop-out rates within the first three months was 62% (SE= 0.05) and 82.4% (SE=0.03) for opioids and stimulants dependence, respectively. Analyses were performed using SPSS (Version 21.0) and STATA software, (version 13.0). From the patients' perspective, motivational inconsistencies were considered as the main reason for not starting or leaving treatment. The findings of this study could give service providers a better grasp of drop-out rates and the associated reasons.

  16. Acquiring, encoding, and re-using clinical knowledge in PRODIGY

    Directory of Open Access Journals (Sweden)

    Richard Hall

    2002-11-01

    Full Text Available The development, implementation and maintenance of computer-executable clinical guidelines encompass a series of complex processes. As they are often performed by more than one organisation, this introduces further complexity. Within the PRODIGY project we attempt to control as many aspects of the process as possible, in order to increase the likelihood of achieving success. To illustrate the complexity of the process and many of the inherent problems and solutions, this paper describes the evolution of the PRODIGY knowledge base, describing the steps from acquiring knowledge, through encoding, to the execution of guidelines, and 'closing the loop' by discussing an approach to knowledge re-use. We will also consider some of the wider implications of our work and propose directions for future research and development activities.

  17. Pre-clinical patient contacts and the application of biomedical and clinical knowledge

    NARCIS (Netherlands)

    Diemers, Agnes D.; van de Wiel, Margje W. J.; Scherpbier, Albert J. J. A.; Heineman, Erik; Dolmans, Diana H. J. M.

    2011-01-01

    Context Real-patient contacts in problem-based undergraduate medical education are promoted as a good way to introduce biomedical and (in)formal clinical knowledge early in the curriculum and thereby to foster the development of coherent and integrated knowledge networks. There are concerns, however

  18. Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

    Science.gov (United States)

    Wan, S H

    2015-10-01

    The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment.

  19. Scientific reasons for including persons with disabilities in clinical and translational diabetes research.

    Science.gov (United States)

    Moore, Shirley M

    2012-03-01

    Despite disparities in health problems and outcomes, people with disabilities are underrepresented in diabetes research. This results in a lack of evidence-based knowledge regarding best approaches in caring for this population. This article addresses the need for research that includes people with disabilities and describes the common reasons persons with disabilities are not included in research, including scientists' concerns regarding threats to a study's internal validity and cost. Arguments are provided as to how involving people with disabilities in research will improve our science and reduce disparities in this population. In addition to the ethical reasons for including persons with disabilities in research, the ability to generalize study findings to this population and thus speed our development and translation of this knowledge for use by clinicians is discussed. The bias in study conclusions that arise from study samples that do not include persons with disabilities and its possible effect on care delivery are presented. Two strategies that researchers can use to increase the inclusion of persons with disabilities in research are described: (1) Universal Design of Research and (2) intervention optimization study designs. Universal Design of Research includes research design processes such as the use of multisensory formats for recruiting participants, approaches to designing and presenting research instruments and interventions, and methods of data collection to promote the inclusion of participants with a wide range of abilities in research studies. Intervention optimization study designs offer an efficient way for scientists to rapidly build the most potent interventions for a wide range of people, including those with disabilities participating in mainstream research.

  20. Reasons for students’ poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme

    Directory of Open Access Journals (Sweden)

    Ann Müller

    2010-03-01

    Full Text Available ‘No member of [health] staff should undertake tasks unless they are competent to do so’ is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001document. In South Africa, primary clinical nurses (PCNs, traditionally known as primary health care nurses (PHCNs, function as ‘frontline providers’ of clinical primary health care (PHC services within public PHC facilities, which is their extended role. This extended role of registered nurses(set out in section 38A of the Nursing Act 50 of 1978, as amended demands high clinical competency training by nursing schools and universities.

    The objectives of the study were to explore and describe the perceptions of both clinical instructors and students, in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students’ poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University.

    Opsomming

    Die primêre kliniese verpleegkundiges, tradisioneel bekend as primêre gesondheidsorg verpleegkundiges, funksioneer in Suid-Afrika as eerste-linie verskaffers van kliniese primêre gesondheidsorg (PGS dienste binne die publieke PGS fasiliteite. Dit is hulle uitgebreide rol. Hierdie uitgebreide rol van die verpleegkundige (soos deur Wet op Verpleging,No 50 van 1978, artikel 38A voorgeskryf, vereis opleiding in kliniese vaardighede van hoë gehalte deur verpleegskole en universiteite.

    Die doelwitte van die navorsing was om die persepsies van beide kliniese dosente en leerders,met betrekking tot die redes vir swak kliniese vaardighede, repektiewelik te verken en te beskryf.Twee temas is deur die resultate as uitdagings (hoof redes vir die swak vaardighede van leerders aangetoon, naamlik uitdagings in die PGS kliniese praktyk en die uitdagings in die leerprogram (universiteit

  1. Optimizing clinical environments for knowledge translation: strategies for nursing leaders.

    Science.gov (United States)

    Scott, Shannon D; VandenBeld, Brenda; Cummings, Greta G

    2011-10-01

    Using findings from our recent study that found that a context of uncertainty in the work environment hindered nurses' research utilization, we suggest strategies for nurse managers and leaders to optimize clinical environments and support efforts to put research into clinical practice (knowledge translation). Two important sources of uncertainty were the complexity of teamwork and inconsistency in management and leadership styles. To reduce the uncertainty arising from teamwork, we propose (a) clarifying nurses' scopes of practice, (b) increasing knowledge sharing through supporting journal clubs and enhanced computer access and (c) creating safe venues for multidisciplinary dialogue. To reduce uncertainty arising from variations in management and leadership, we propose (a) developing policies that enhance the consistency of leadership and clarify the strategic direction of the management team, (b) clearly communicating those policies to nurses and (c) providing explicit rationales for treatment changes. Small, incremental steps can be taken to realize substantive changes in clinical environments in order to optimize nursing work environments for knowledge translation.

  2. Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?

    Science.gov (United States)

    Giuliano, Karen K

    2003-04-01

    The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.

  3. Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses' clinical reasoning.

    Science.gov (United States)

    Greenwood, J; Sullivan, J; Spence, K; McDonald, M

    2000-05-01

    During 1995-1997 a study was undertaken to explore the extent to which theoretical knowledge acquired through a distance education programme in neonatal nursing was brought to bear in the real-world clinical reasoning of course participants. The study utilized a think aloud technique and included both concurrent (on-the-job) and retrospective verbal reports at 0, 6 and 12 months into the programme. Participants (n=4) were also interviewed individually on completion of the study. Results indicated that important inconsistencies existed between participants' theoretical knowledge and their practice; they also pointed to some organizational influences on these theory-practice inconsistencies. Script (or schema) theory provided a useful explanatory framework for these results. The paper includes a brief description of data collection and analysis techniques; its main emphasis, however, is on these theory-practice inconsistencies and their explanation in terms of the nature and acquisition of nursing practice scripts. The implications of nursing scripts for the promotion of critical thinking and evidence-based practice are discussed.

  4. Use of the script concordance approach to evaluate clinical reasoning in food-ruminant practitioners.

    Science.gov (United States)

    Dufour, Simon; Latour, Sylvie; Chicoine, Yvan; Fecteau, Gilles; Forget, Sylvain; Moreau, Jean; Trépanier, André

    2012-01-01

    A script concordance test (SCT) was developed measuring clinical reasoning of food-ruminant practitioners for whom potential clinical competence difficulties were identified by their provincial professional organization. The SCT was designed to be used as part of a broader evaluation procedure. A scoring key was developed based on answers from a reference panel of 12 experts and using the modified aggregate method commonly used for SCTs. A convenient sample of 29 food-ruminant practitioners was constituted to assess the reliability and precision of the SCT and to determine a fair threshold value for success. Cronbach's α coefficients were computed to evaluate internal reliability. To evaluate SCT precision, a test-retest methodology was used and measures of agreement beyond chance were computed at question and test levels. After optimization, the 36-question SCT yielded acceptable internal reliability (Cronbach's α=0.70). Precision of the SCT at question level was excellent with 33 questions (92%) yielding moderate to almost perfect agreement between administrations. At test level, fair agreement (concordance correlation coefficient=0.32) was observed between administrations. A slight SCT score improvement (M=+2.8 points) on the second administration was in part responsible for some of the disagreement and was potentially a result of an adaptation to the SCT format. Scores distribution was used to determine a fair threshold value for success, while considering the underlying objectives of the examination. The data suggest that the developed SCT can be used as a reliable and precise measurement of clinical reasoning of food-ruminant practitioners.

  5. The interrater reliability of an objective structured practical examination in measuring the clinical reasoning ability of chiropractic students.

    Science.gov (United States)

    Rose, Kevin A; Babajanian, Jesika

    2016-10-01

    The objective structured practical examination (OSPE) is a case-based assessment that can be used to assess the clinical reasoning ability of students. The reliability of using an OSPE for this purpose has not been reported in the literature. The objective of this study was to determine the interrater reliability of the OSPE in measuring the clinical reasoning ability of chiropractic students. Two examiners tested each student simultaneously when enough were available as a check for interrater reliability. The scores for students over 4 exam administrations were compiled, and we calculated an intraclass correlation coefficient (ICC) using 1-way random single measures. Paired scores were available for 133 students. The ICC was .685, showing a fair-to-good level of agreement for faculty in assessing the clinical reasoning ability of chiropractic students using an OSPE. The OSPE can be a valuable tool for testing clinical reasoning abilities because it can simulate the decision-making process that needs to be implemented in clinical practice. Faculty members at our chiropractic college were able to achieve an acceptable level of reliability in measuring the clinical reasoning abilities of students using an OSPE. Other health professional programs may consider using this tool for assessing the clinical reasoning skills of their students.

  6. Feasibility of Self-Reflection as a Tool to Balance Clinical Reasoning Strategies

    Science.gov (United States)

    Sibbald, Matthew; de Bruin, Anique B. H.

    2012-01-01

    Clinicians are believed to use two predominant reasoning strategies: system 1 based pattern recognition, and system 2 based analytical reasoning. Balancing these cognitive reasoning strategies is widely believed to reduce diagnostic error. However, clinicians approach different problems with different reasoning strategies. This study explores…

  7. [Clinical practice guidelines and knowledge management in healthcare].

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

  8. Guideline Formalization and Knowledge Representation for Clinical Decision Support

    Directory of Open Access Journals (Sweden)

    Tiago OLIVEIRA

    2012-09-01

    Full Text Available Normal 0 21 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-US;} The prevalence of situations of medical error and defensive medicine in healthcare institutions is a great concern of the medical community. Clinical Practice Guidelines are regarded by most researchers as a way to mitigate theseoccurrences; however, there is a need to make them interactive, easier to update and to deploy. This paper provides a model for Computer-Interpretable Guidelines based on the generic tasks of the clinical process, devised to be included in the framework of a Clinical Decision Support System. Aiming to represent medical recommendations in a simple and intuitive way. Hence, this work proposes a knowledge representation formalism that uses an Extension to Logic Programming to handle incomplete information. This model is used to represent different cases of missing, conflicting and inexact information with the aid of a method to quantify its quality. The integration of the guideline model with the knowledge representation formalism yields a clinical decision model that relies on the development of multiple information scenarios and the exploration of different clinical hypotheses.

  9. Developing students' clinical reasoning skills: correlates of perceived relevance of two teaching and learning approaches.

    Science.gov (United States)

    Postma, T C; White, J G

    2017-02-01

    'Relevance' is a key concept in adult learning. Hence, this study sought to examine students' perceptions of relevance of the teaching and learning in relation to different instructional designs employed in a Comprehensive Patient Care (CPC) course that aims to develop integrated clinical reasoning skills. Third to fifth year students (2009-2011) were asked to anonymously rate the relevance of the instructional design (RELID) they participated in by means of visual analogue scales at the School of Dentistry, University of Pretoria. They were also asked to rate their perceptions of the alignment between teaching and learning and outcomes (ATLO), assessments' contribution to learning (ACL), course organisation (CO) and teacher competence (TC). RELID served as the outcome measure in stepwise linear regression analyses. ATLO, ACL, CO, TC and the instructional design (case-based learning (CBL = 1) and the combination of discipline-based and lecture-based teaching in CPC (DB-LBT = 0)) served as the co-variables for each of the years of study. The analyses showed positive correlations between RELID and ATLO and between RELID and ACL for all the years of study. RELID was associated with TC in year three and four and CO was associated with RELID in year four and five. CBL outperformed DB-LBT in terms of perceived relevance of the teaching and learning. The results suggest that students' perceptions of the relevance of the instructional design may be enhanced when outcomes, teaching, learning and assessment are constructively aligned during the development of clinical reasoning skills. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Extraction of the human cerebral ventricular system from MRI: inclusion of anatomical knowledge and clinical perspective

    Science.gov (United States)

    Aziz, Aamer; Hu, Qingmao; Nowinski, Wieslaw L.

    2004-04-01

    The human cerebral ventricular system is a complex structure that is essential for the well being and changes in which reflect disease. It is clinically imperative that the ventricular system be studied in details. For this reason computer assisted algorithms are essential to be developed. We have developed a novel (patent pending) and robust anatomical knowledge-driven algorithm for automatic extraction of the cerebral ventricular system from MRI. The algorithm is not only unique in its image processing aspect but also incorporates knowledge of neuroanatomy, radiological properties, and variability of the ventricular system. The ventricular system is divided into six 3D regions based on the anatomy and its variability. Within each ventricular region a 2D region of interest (ROI) is defined and is then further subdivided into sub-regions. Various strict conditions that detect and prevent leakage into the extra-ventricular space are specified for each sub-region based on anatomical knowledge. Each ROI is processed to calculate its local statistics, local intensity ranges of cerebrospinal fluid and grey and white matters, set a seed point within the ROI, grow region directionally in 3D, check anti-leakage conditions and correct growing if leakage occurs and connects all unconnected regions grown by relaxing growing conditions. The algorithm was tested qualitatively and quantitatively on normal and pathological MRI cases and worked well. In this paper we discuss in more detail inclusion of anatomical knowledge in the algorithm and usefulness of our approach from clinical perspective.

  11. Designing m-learning for junior registrars--activation of a theoretical model of clinical knowledge.

    Science.gov (United States)

    Kanstrup, Anne Marie; Boye, Niels; Nøhr, Christian

    2007-01-01

    The MINI-project aims at supporting junior registrars in the learning process of how to utilize their theoretical knowledge from Medical School in everyday clinical reasoning and practice. Due to the nature of the work--concurrent moving, learning and producing--we designed an m-learning application. This paper introduces the possibilities and challenges for design of the m-learning application based on a) analytical findings on learning and mobility as derived from the design case--an emergency medical ward b) theoretical perspectives on medical knowledge, and c) presentation of the design of an m-learning application. The design process was based on user-driven innovation and the paper discusses considerations on how to combine user-drive and generic models.

  12. The hypothesis-oriented pediatric focused algorithm: a framework for clinical reasoning in pediatric physical therapist practice.

    Science.gov (United States)

    Kenyon, Lisa K

    2013-03-01

    Pediatric physical therapist practice presents unique challenges to the clinical reasoning processes of novice clinicians and physical therapist students. The purpose of this article is to present the Hypothesis-Oriented Pediatric Focused Algorithm (HOP-FA), a clinical framework designed to guide the clinical reasoning process in pediatric physical therapist practice. The HOP-FA provides a systematic, stepwise guide to the patient/client management process wherein the therapist is asked to consider various factors and issues that may affect the clinical reasoning process for a particular child and family. The framework provided by the HOP-FA is not built upon a specific therapeutic philosophy and may be useful as a tool in clinical education, in the classroom, and for clinicians who are new to or re-entering pediatric practice.

  13. Nausea: current knowledge of mechanisms, measurement and clinical impact.

    Science.gov (United States)

    Kenward, Hannah; Pelligand, Ludovic; Savary-Bataille, Karine; Elliott, Jonathan

    2015-01-01

    Nausea is a subjective sensation, which often acts as a signal that emesis is imminent. It is a widespread problem that occurs as a clinical sign of disease or as an adverse effect of a drug therapy or surgical procedure. The mechanisms of nausea are complex and the neural pathways are currently poorly understood. This review summarises the current knowledge of nausea mechanisms, the available animal models for nausea research and the anti-nausea properties of commercially available anti-emetic drugs. The review also presents subjective assessment and scoring of nausea. A better understanding of the underlying mechanisms of nausea might reveal potential clinically useful biomarkers for objective measurement of nausea in species of veterinary interest.

  14. The Social Value of Knowledge and International Clinical Research.

    Science.gov (United States)

    Wenner, Danielle M

    2015-08-01

    In light of the growth in the conduct of international clinical research in developing populations, this paper seeks to explore what is owed to developing world communities who host international clinical research. Although existing paradigms for assigning and assessing benefits to host communities offer valuable insight, I criticize their failure to distinguish between those benefits which can justify the conduct of research in a developing world setting and those which cannot. I argue that the justification for human subjects research is fundamentally grounded in the social value of knowledge, and that this value is context-dependent in a manner which should inform our ethical evaluation of the conduct of research in specific settings. I propose a new framework for the assessment of research benefits assigned to developing world host communities, a natural implication of which is to limit the types of research projects which may permissibly be conducted in developing world settings. © 2013 John Wiley & Sons Ltd.

  15. The effectiveness of using human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students: a systematic review.

    Science.gov (United States)

    Lapkin, Samuel; Fernandez, Ritin; Levett-Jones, Tracy; Bellchambers, Helen

    2010-01-01

    Human patient simulation manikins are being used extensively both nationally (in Australia) and internationally in the education of health professionals. There is evidence suggesting that these types of technologies are effective in teaching psychomotor skills. Furthermore student satisfaction with simulation approaches is generally high. However, the extent to which human patient simulation manikins are effective in the teaching of clinical reasoning skills to undergraduate nursing students is less clear. The aim of this systematic review was to identify the best available evidence for the effectiveness of using whole-body high-fidelity human patient simulation manikins to teach clinical reasoning skills to undergraduate nursing students. The review included all randomised controlled trials that assessed the effectiveness of high fidelity human patient manikins in educating undergraduate nursing students. Studies that included health professionals were excluded unless data for nursing students were analysed separately. The primary outcome measure was clinical reasoning. Other outcome measures included critical thinking, student satisfaction, knowledge acquisition, confidence levels, and skill performance as assessed by methods such as objective structured clinical examinations, and questionnaires. Using a systematic search strategy designed for each database, the following electronic sources were searched for the period 1999 -2009: AMED, CINAHL, Cochrane Database, Dissertation and Theses, EMBASE, ERIC, Journals@Ovid, MEDLINE, Proquest Nursing Journals, PsycINFO. Hand searching of the reference lists of included studies and conference proceedings was undertaken to identify further studies. Two independent reviewers assessed the methodological quality of each study selected for retrieval prior to inclusion using a critical appraisal tool from the Joanna Briggs Institute. Data were extracted from studies using the standardised data extraction tool from the Joanna

  16. A brief simulation intervention increasing basic science and clinical knowledge

    Directory of Open Access Journals (Sweden)

    Maria L. Sheakley

    2016-04-01

    Full Text Available Background: The United States Medical Licensing Examination (USMLE is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods: This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l=515 and the intervention group received lecture plus a simulation exercise (nl+s=1,066. Assessment included summative exam questions (n=4 that were scored as pass/fail (≥75%. USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results: Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003. Discussion: Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

  17. A brief simulation intervention increasing basic science and clinical knowledge

    Science.gov (United States)

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (nl=515) and the intervention group received lecture plus a simulation exercise (nl+s=1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). Discussion Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum. PMID:27060102

  18. From college to clinic: reasoning over memorization is key for understanding anatomy.

    Science.gov (United States)

    Miller, Sue Ann; Perrotti, William; Silverthorn, Dee U; Dalley, Arthur F; Rarey, Kyle E

    2002-04-15

    Anatomy and physiology are taught in community colleges, liberal arts colleges, universities, and medical schools. The goals of the students vary, but educators in these diverse settings agree that success hinges on learning concepts rather than memorizing facts. In this article, educators from across the postsecondary educational spectrum expand on several points: (1) There is a problem with student perception that anatomy is endless memorization, whereas the ability to manage information and use reasoning to solve problems are ways that professionals work. This misperception causes students to approach the subject with the wrong attitude. (2) The process of learning to use information is as important as the concepts themselves. Using understanding to explain and make connections is a more useful long-term lesson than is memorization. Anatomy should be presented and learned as a dynamic basis for problem solving and for application in the practice and delivery of quality health care. (3) Integration of form and function must be explicit and universal across all systems. (4) Using only models, images, audiovisuals, or computers cannot lead students to the requisite reasoning that comes from investigative dissection of real tissue. (5) Some undergraduate courses require students to memorize excessive musculoskeletal detail. (6) Learning tissue biology is a particular struggle for medical students who have no background from an undergraduate course. (7) Medical professors and students see benefits when students have taken undergraduate courses in anatomy, histology, and physiology. If medical schools suggest these electives to applicants, medical students might arrive better prepared and, thus, be able to learn clinical correlations more efficiently in the limited allocated time of medical school curricula.

  19. Enhancing the Clinical Reasoning Skills of Postgraduate Students in Internal Medicine Through Medical Nonfiction and Nonmedical Fiction Extracurricular Books.

    Science.gov (United States)

    Kiran, H S; Chacko, Thomas V; Murthy, K A Sudharshana; Gowdappa, H Basavana

    2016-12-01

    To improve the clinical reasoning skills of postgraduate students in internal medicine through 2 kinds of extracurricular books: medical nonfiction and nonmedical fiction. Clinical reasoning is difficult to define, understand, observe, teach, and measure. This is an educational innovation under an experimental framework based on a cognitive intervention grounded in constructivist and cognitivist theories. This study was conducted from June 1, 2014, through May 31, 2015. It was a pre-post, randomized, controlled, prospective, mixed-methods, small-group study. The intervention was through medical nonfiction and nonmedical fiction books. The process was structured to ensure that the students would read the material in phases and reflect on them. Clinical reasoning (pretests and posttests) was quantitatively assessed using the Diagnostic Thinking Inventory (DTI) and clinical reasoning exercises (CREs) and their assessment using a rubric. A qualitative design was used, and face-to-face semistructured interviews were conducted. Posttest total scores (DTI=188.92; CREs=53.92) were higher for the study group after the intervention compared with its own pretest scores (DTI=165.25; CREs=41.17) and with the pretest (DTI=159.27; CRE=40.73) and posttest (DTI=166.91; CREs=41.18) scores of the control group. Interviews with the study group confirmed that the intervention was acceptable and useful in daily practice. We introduced, evaluated, and proved an approach to teaching-learning clinical reasoning based on the assumption that the clinical reasoning skills of postgraduate students in internal medicine can be enhanced through 2 kinds of extracurricular books and that fun as well as interest will enhance learning. This study is not only about teaching-learning clinical reasoning but also about the humanities in medical education. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  20. Risk-Taking and Reasons for Living in Non-Clinical Italian University Students

    Science.gov (United States)

    Pompili, Maurizio; Lester, David; Innamorati, Marco; Narciso, Valentina; Vento, Alessandro; De Pisa, Eleonora; Tatarelli, Roberto; Girardi, Paolo

    2007-01-01

    The associations between risk-taking, hopelessness, and reasons for living were explored in a sample of 312 Italian students. Respondents completed the Physical Risk Assessment Inventory, the Physical Risk-Taking Behavior Inventory, the Beck Hopelessness Scale, and the Reasons for Living Inventory. Students with lower scores on the Reasons for…

  1. Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years.

    Science.gov (United States)

    Hren, Darko; Marušić, Matko; Marušić, Ana

    2011-03-30

    Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning. We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education. In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3(rd) year medical students scored higher on Postconventional schema score than all other study years (pregressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum. Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.

  2. Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students.

    Science.gov (United States)

    Coker, Patty

    2010-01-01

    This study examined the effects of participation in a 1-week, experiential, hands-on learning program on the critical thinking and clinical reasoning skills of occupational therapy students. A quasi-experimental, nonrandomized pre- and post-test design was used with a sample of 25 students. The students had completed three semesters of didactic lecture coursework in a master's level OT educational program prior to participation in a hands-on therapy program for children with hemiplegic cerebral palsy. Changes in critical thinking and clinical reasoning skills were evaluated using the following dependent measures: Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the California Critical Thinking Skills Test (CCTST). Changes in pretest and posttest scores on the SACRR and the CCTST were statistically significant (p>0.05) following completion of the experiential learning program. This study supports the use of hands-on learning to develop clinical reasoning and critical thinking skills in healthcare students, who face ever more diverse patient populations upon entry-level practice. Further qualitative and quantitative investigations are needed to support the results of this study and determine which components of experiential learning programs are essential for developing clinical reasoning and critical thinking skills in future allied health professionals.

  3. Factors impacting on nurses' transference of theoretical knowledge of holistic care into clinical practice.

    Science.gov (United States)

    Henderson, Saras

    2002-12-01

    Since nurse education moved to universities, a reoccurring concern of health consumers, health administrators, and some practising nurses is that nurses are not able to transfer the theoretical knowledge of holistic care into practice. Much has been written about this concern usually under the heading of the theory-practice gap. A common reason that has been highlighted as the cause of this gap is that the theoretical knowledge that nurses learn in academia is predicated on concepts such as humanism and holistic caring. In contrast, the bureaucratic organisation where nurses provide care tends to be based on management concepts where cost containment and outcome measures are more acceptable. Hence nurses' learned values of holistic caring are pitted against the reality of the practice setting. So what is this practice reality? This paper attempts to provide an insider view of why the theoretical knowledge of holistic care may be difficult to enact in the clinical setting. In-depth taped interviews with nurses and participant observation were conducted in acute care hospitals in Western Australia. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings indicated that utilitarian nursing and role models had impacted on the transference of theoretical knowledge of holistic care into practice. The paper outlines some measures that nurses themselves can undertake to ensure the narrowing of the theory-practice gap in this area.

  4. Proportional reasoning

    DEFF Research Database (Denmark)

    Dole, Shelley; Hilton, Annette; Hilton, Geoff

    2015-01-01

    Proportional reasoning is widely acknowledged as a key to success in school mathematics, yet students’ continual difficulties with proportion-related tasks are well documented. This paper draws on a large research study that aimed to support 4th to 9th grade teachers to design and implement tasks...... to foster students’ proportional reasoning. Classroom data revealed limited initial teacher knowledge and awareness of the pervasive nature of proportional reasoning required in the mathematics curriculum. Teacher capacity to seize teachable moments for building students’ proportional reasoning skills...... increased throughout the project. From this background, this paper presents an analysis of the proportional reasoning demands and opportunities of topics within the school mathematics curriculum in Australia. Implications for the study of whole number arithmetic (WNA) and other topics to promote...

  5. Proportional reasoning

    DEFF Research Database (Denmark)

    Dole, Shelley; Hilton, Annette; Hilton, Geoff

    2015-01-01

    to foster students’ proportional reasoning. Classroom data revealed limited initial teacher knowledge and awareness of the pervasive nature of proportional reasoning required in the mathematics curriculum. Teacher capacity to seize teachable moments for building students’ proportional reasoning skills......Proportional reasoning is widely acknowledged as a key to success in school mathematics, yet students’ continual difficulties with proportion-related tasks are well documented. This paper draws on a large research study that aimed to support 4th to 9th grade teachers to design and implement tasks...... increased throughout the project. From this background, this paper presents an analysis of the proportional reasoning demands and opportunities of topics within the school mathematics curriculum in Australia. Implications for the study of whole number arithmetic (WNA) and other topics to promote...

  6. Exploring the Reasons for Using Electric Books and Technologic Pedagogical and Content Knowledge of Taiwanese Elementary Mathematics and Science Teachers

    Science.gov (United States)

    Chen, Ho-Yuan; Jang, Syh-Jong

    2013-01-01

    This study highlights trends and features of E-books and their versatility of this tool in elementary educational settings. There has been little quantitative research employed to examine teachers' reasons for using or not using E-books. The purpose of this study was to examine elementary school mathematics and science teachers' reasons for using…

  7. An exploratory study using a statistical approach as a platform for clinical reasoning in canine epilepsy.

    Science.gov (United States)

    Armaşu, M; Packer, R M A; Cook, S; Solcan, G; Volk, H A

    2014-11-01

    Links between deficits identified on neurological examination, age of seizure onset and the presence of structural forebrain disease have often been postulated in dogs presenting with a history of seizures. The purpose of this study was to assess the influence of such factors on the likelihood of structural or functional brain disease, via a thorough history taking process and interictal neurological examination. Four hundred and four dogs with seizures due to intracranial causes were included. Data including age, sex, neuter status, time until diagnosis, age of seizure onset in years, type of seizure, seizure symmetry, seizure severity, interictal neurological deficits, MRI changes and side effects associated with antiepileptic drugs were extracted from medical files. Two hundred and fifty-eight dogs were diagnosed with epilepsy of unknown origin (EUO), 11 with symmetrical structural lesions and 135 with asymmetrical structural lesions. Multinomial analysis demonstrated that dogs that were older at seizure onset were significantly more likely to have an asymmetrical structural lesion than EUO (OR 95% CI: 1.4-1.8). Dogs that had single seizures rather than cluster seizures were less likely to have asymmetrical structural lesions than dogs with EUO (OR 95% CI: 0.2-0.7). Dogs with abnormal neurological examinations were 16.5 times more likely to have asymmetrical structural lesions (OR 95% CI: 8.5-32.1) and 12.5 times more likely to have symmetrical structural lesions (OR 95% CI: 3.0-52.3) than EUO. These findings support the importance of considering interictal neurological deficits and seizure history in clinical reasoning.

  8. The reasons for triple therapy in stable COPD patients in Japanese clinical practice

    Directory of Open Access Journals (Sweden)

    Miyazaki M

    2015-06-01

    Full Text Available Masaki Miyazaki,1 Hidetoshi Nakamura,1,2 Saeko Takahashi,1 Shotaro Chubachi,1 Mamoru Sasaki,1 Mizuha Haraguchi,1 Hideki Terai,1 Makoto Ishii,1 Koichi Fukunaga,1 Sadatomo Tasaka,1 Kenzo Soejima,1 Koichiro Asano,3 Tomoko Betsuyaku1 On behalf of the Keio COPD Comorbidity Research (K-CCR group 1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 2Department of Respiratory Medicine, Saitama Medical University, Saitama, 3Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan Background: Triple combination therapy involving long-acting muscarinic antagonists long-acting β2 agonists, and inhaled corticosteroids has recently become an option for maintenance treatment of COPD. Some add-on clinical trials have reported the benefits of these combinations. However, the process to step up to triple therapy varies for individual cases.Methods: Keio University and affiliated hospitals conducted an observational COPD cohort study, recruiting patients diagnosed as having COPD by pulmonary physicians and those referred for investigation of possible COPD. Their prescription history and clinical course were retrospectively analyzed based on the physicians’ medical records and patient questionnaires. This study was registered with UMIN (UMIN000003470, April 10, 2010.Results: A total of 95 of the 445 COPD patients (21% were treated with inhaled corticosteroids/long-acting β2 agonists/long-acting muscarinic antagonists as maintenance therapy, including 12 in COPD Grade I, 31 in Grade II, 38 in Grade III, and 14 in Grade IV, based on the Global Initiative for Chronic Obstructive Lung Disease spirometric grading. For more than half of the patients on triple therapy, the treatment had been intensified due to unsatisfactory improvement of symptoms, and 32% were treated with triple therapy due to comorbid asthma. In contrast, there were COPD patients whose therapy was

  9. Altruistic reasoning in adolescent-parent dyads considering participation in a hypothetical sexual health clinical trial for adolescents.

    Science.gov (United States)

    Chávez, Noé Rubén; Williams, Camille Y; Ipp, Lisa S; Catallozzi, Marina; Rosenthal, Susan L; Breitkopf, Carmen Radecki

    2016-04-01

    Altruism is a well-established reason underlying research participation. Less is known about altruism in adolescent-parent decision-making about clinical trials enrolling healthy adolescents. This qualitative investigation focused on identifying spontaneous statements of altruism within adolescent-parent (dyadic) discussions of participation in a hypothetical phase I clinical trial related to adolescent sexual health. Content analysis revealed several response patterns to each other's altruistic reasoning. Across 70 adolescent-parent dyads in which adolescents were 14-17 years of age and 91% of their parents were mothers, a majority (61%) of dyadic discussions included a statement reflecting altruism. Parents responded to adolescents' statements of altruism more frequently than adolescents responded to parents' statements. Responses included: expresses concern, reiterates altruistic reasoning, agrees with altruistic reasoning, and adds to/expands altruistic reasoning. Since an altruistic perspective was often balanced with concerns about risk or study procedures, researchers cannot assume that altruism will directly lead to study participation. Optimizing the informed consent process for early phase clinical trials involving healthy adolescents may include supporting parents to have conversations with their adolescents which will enhance their capacity to consider all aspects of trial participation.

  10. The Research of Field Expert Knowledge Base Based on Nonmonotony Reasoning%基于非单调推理的领域专家知识库的研究

    Institute of Scientific and Technical Information of China (English)

    夏幼明; 夏幼安; 徐天伟; 赵景秀

    2001-01-01

    At first,this paper introduces the last results of knowledge presenting and reasoning,basic conception and research methods of nonmonotony. Then,we enlarge ability to express knowledge in semantic network language,and put forward knowledge presenting way of modal logic. Finally,we provide arithmetic of modal logic reason.

  11. Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

    Science.gov (United States)

    Stansfield, R Brent; Diponio, Lisa; Craig, Cliff; Zeller, John; Chadd, Edmund; Miller, Joshua; Monrad, Seetha

    2016-10-14

    Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students' ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson's correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a

  12. The Impact of Humanities-Based Teaching and Learning Strategies on Critical Thinking and Clinical Reasoning Development among BSN Students

    Science.gov (United States)

    Brodhead, Josette

    2016-01-01

    The ability to function effectively in a dynamic, culturally diverse healthcare environment requires both critical thinking and clinical reasoning skills. The American Association of Colleges of Nursing (AACN, 2008) recognizes the importance of humanities in the baccalaureate nursing curriculum. This quasi-experimental, nonrandomized…

  13. Do Expert Clinical Teachers Have a Shared Understanding of What Constitutes a Competent Reasoning Performance in Case-Based Teaching?

    Science.gov (United States)

    Gauthier, Geneviève; Lajoie, Susanne P.

    2014-01-01

    To explore the assessment challenge related to case based learning we study how experienced clinical teachers--i.e., those who regularly teach and assess case-based learning--conceptualize the notion of competent reasoning performance for specific teaching cases. Through an in-depth qualitative case study of five expert teachers, we investigate…

  14. Pre-clerkship clinical skills and clinical reasoning course performance: Explaining the variance in clerkship performance : Pre-clerkship predictors of clerkship variance.

    Science.gov (United States)

    LaRochelle, Jeffrey S; Dong, Ting; Durning, Steven J

    2016-08-01

    Evidence suggests that pre-clerkship courses in clinical skills and clinical reasoning positively impact student performance on the clerkship. Given the increasing emphasis on reducing diagnostic reasoning errors, it is very important to develop this critical area of medical education. An integrated approach between clinical skills and clinical reasoning courses may better predict struggling learners, and better allocate scarce resources to remediate these learners before the clerkship. Pre-clerkship and clerkship outcome measures from 514 medical students graduating between 2009 and 2011were analyzed in a multiple linear regression model. Learners with poor performances on integrated pre-clerkship outcome measures had a relative risk of 6.96 and 5.85 for poor performance on National Board of Medical Examiners (NBME) subject exams and clerkship performance, respectively, and explained 22 % of the variance in clerkship NBME subject exam scores and 20.2 % of the variance in clerkship grades. Pre-clerkship outcome measures from clinical skills and clinical reasoning courses explained a significant amount of clerkship performance beyond baseline academic ability. These courses provide valuable information regarding student abilities, and may serve as an early indicator for students requiring remediation. Integrating pre-clerkship outcome measures may be an important aspect of ensuring the validity of this information as the pre-clerkship curriculum becomes compressed, and may serve as the basis for identifying students in need of clinical skills remediation.

  15. PARTAKE survey of public knowledge and perceptions of clinical research in India.

    Directory of Open Access Journals (Sweden)

    Tal Burt

    Full Text Available BACKGROUND: A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE - Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program. OBJECTIVE: To study public knowledge and perceptions of clinical research. METHODS: A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India. RESULTS: Interviewees were 18-84 old (mean: 39.6, SD ± 16.6, 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware: 'research benefits society' (94.1%/3.5%/2.3%, 'the government protects against unethical clinical research' (56.7%/26.3%/16.9%, 'research hospitals provide better care' (67.2%/8.7%/23.9%, 'confidentiality is adequately protected' (54.1%/12.3%/33.5%, 'participation in research is voluntary' (85.3%/5.8%/8.7%; 'participants treated like 'guinea pigs'' (20.7%/53.2%/26.0%, and 'compensation for participation is adequate' (24.7%/12.9%/62.3%. CONCLUSIONS: Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation, and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross

  16. The biomedical disciplines and the structure of biomedical and clinical knowledge.

    Science.gov (United States)

    Nederbragt, H

    2000-11-01

    The relation between biomedical knowledge and clinical knowledge is discussed by comparing their respective structures. The knowledge of a disease as a biological phenomenon is constructed by the interaction of facts and theories from the main biomedical disciplines: epidemiology, diagnostics, clinical trial, therapy development and pathogenesis. Although these facts and theories are based on probabilities and extrapolations, the interaction provides a reliable and coherent structure, comparable to a Kuhnian paradigma. In the structure of clinical knowledge, i.e. knowledge of the patient with the disease, not only biomedical knowledge contributes to the structure but also economic and social relations, ethics and personal experience. However, the interaction between each of the participating "knowledges" in clinical knowledge is not based on mutual dependency and accumulation of different arguments from each, as in biomedical knowledge, but on competition and partial exclusion. Therefore, the structure of biomedical knowledge is different from that of clinical knowledge. This difference is used as the basis for a discussion in which the place of technology, evidence-based medicine and the gap between scientific and clinical knowledge are evaluated.

  17. Survey of reasons for discontinuation from in vitro fertilization treatment among couples attending infertility clinic

    Directory of Open Access Journals (Sweden)

    Grishma Kulkarni

    2014-01-01

    Full Text Available Background: With the increase in infertility burden, more and more couples are opting for in vitro fertilization (IVF. Despite the availability of various treatment options, the major concern that needs to be addressed is the reasons why such couples, initially motivated so strongly, drop out in fairly high numbers from IVF cycles. With this point of view the study was designed. AIM: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Settings and Design: This retrospective study was carried out among couples in the age group of 20-40 years who opted for IVF at Tertiary care hospital and a private infertility center. Materials and Methods: Medical records for 3 years (2009-2012 were taken out and included in the study for analysis. Socio-demographic details along with indication for IVF and reasons for drop-separate IVF therapy were recorded on case record form and were analyzed. Results: Twenty-one percent of the patients had tubal pathology, thus making it the commonest female related factor for indication of IVF. Oligoasthenospermia (13% was the commonest cause of male related infertility factor. Financial burden was the primary cause for terminating treatment in majority of the IVF cases. Conclusions: Financial burden (62.5% was the commonest reason for drop out among couples from IVF cycle.

  18. 基于知识发现的范例推理系统%Case-Based Reasoning System Based on Knowledge Discovery

    Institute of Scientific and Technical Information of China (English)

    倪志伟; 蔡庆生

    2003-01-01

    Nowadays the research and exploitation of the case-based system are getting more and more attention.Case-Based Reasoning (CBR) is a strategy for solving the object cases based on the source cases that are prompted bythe object ones. CBR is not only a psychological theory for human knowledge, but will be a new cornerstone of theintelligent computer system technology. The case-based system is adopted in more and more application fields in orderto obtain better results, especially in the fields with ill-defined and no expert knowledge. But there is a lot of knowl-edge required in CBR, and we are also faced with the same knowledge acquisition bottleneck as in the expert systems.Data Mining (DM) and Knowledge Discovery in Database (KDD) are just the most useful means to solve this kind ofproblem in order to make the knowledge acquisition more automated . In this paper, we discuss the data mining tech-nology in CBR, especially we raise knowledge discovery in case base (KDC) and discuss this concept in detail. Final-ly, the structure of CBR based on DM is put forward.

  19. Effects of a supplementary final year curriculum on students' clinical reasoning skills as assessed by key-feature examination.

    Science.gov (United States)

    Nikendei, C; Mennin, S; Weyrich, P; Kraus, B; Zipfel, S; Schrauth, M; Jünger, J

    2009-09-01

    The final year of medical education is considered crucial in making students 'fit for purpose'. Studies have shown that many students leave medical school without having experienced sufficient preparation for their upcoming professional life. The aim of this study was to examine the effectiveness of a supplementary internal medicine final year curriculum on clinical reasoning skills. Final year internal medicine students from two universities participated in the study which was based on a static-group design. The experimental group (n = 49) took part in a final year student curriculum with interactive case-based seminars and skills training sessions. The comparison group (n = 25) did not receive any additional training beyond working on the ward. Clinical reasoning skills were assessed using a key-feature pre-post test. Prior to their clinical rotation, the two groups did not differ in the key-feature examination (p skills training sessions are effective and significantly improve the clinical reasoning skills of final year students in internal medicine. Further study is warranted and should look to examine the effectiveness of a final year student curriculum on other performance measures.

  20. Medical Teachers Conceptualize a Distinctive Form of Clinical Knowledge

    Science.gov (United States)

    Barrett, J.; Yates, L.; McColl, G.

    2015-01-01

    For over four decades, there have been efforts to specify the types of knowledge that medical students need, how that knowledge is acquired and how its constituent parts are related. It is one of the areas of continuing concern underlying medical education reform. Despite their importance to medical students' learning and development, the…

  1. The Relationship between Matrons' Knowledge, Attitude, and Performance in Clinical Governance Domain and Mashhad Hospitals Fulfillment of Clinical Governance: 2013

    Directory of Open Access Journals (Sweden)

    Rozita Davoodi

    2014-07-01

    Full Text Available Introduction: Clinical Governance (CG is a systematic approach to the maintaining and improving the quality of provided services for patients in the health system. With regards to the implementation of clinical governance in hospitals affiliated to Mashhad University of Medical Sciences and the role of matrons in ensuring quality care, little is known about the relationship between matrons’ participation in this plan and hospital success in clinical governance fulfillment. Materials and Methods:This cross-sectional, analytic-descriptive study was conducted to investigate the relationship between matrons’ knowledge, attitude, and performance in clinical governance and Mashhad hospitals' fulfillment of clinical governance. A researcher-made questionnaire was used for data collection on matrons’ knowledge, attitude, and performance. The standard checklist of the health ministry and observation were used to assess hospital clinical governance fulfillment. Data was analyzed at the hospital level by SPSS16. Results: The mean scores of matrons' knowledge, attitude, and performance were above average. Matrons' attitude towards clinical governance achieved the highest mark (4.46. There was no significant correlation between matrons' knowledge/attitude/performance and hospital scores for clinical governance fulfillment (P>0.05. Conclusion: While the levels of matrons' knowledge, attitude, and performance were satisfactory, there is still a need for improving matrons' knowledge. Absence of any statistically significant relationship between matrons' knowledge, attitude, performance and hospitals scores for clinical governance fulfillment may be due to the study small sample size.

  2. 采煤机概念设计的知识表示与知识推理%Knowledge representation and reasoning of shearer conceptual design

    Institute of Scientific and Technical Information of China (English)

    丁华; 杨兆建; 姚晶

    2011-01-01

    为实现采煤机概念设计知识和经验的重用,针对采煤机设计领域知识的可分解性、多样性和模糊性等特点,提出了以面向对象为主、产生式规则为辅的知识表示方法,建立了采煤机概念设计实例库和规则库,并将基于实例和规则推理的集成推理机制应用于采煤机概念设计知识推理中.最后以UG为平台开发了采煤机概念设计系统,实现了知识驱动的采煤机概念设计自动化,积累了设计经验和知识,缩短了产品设计周期.通过工程应用实例验证了该方法的有效性与可靠性.%For reusing of design knowledge and experience of shearer conceptual design,aiming at the decomposability,diversity and fuzziness of knowledge in the field of shearer design,knowledge representation is proposed in it which is mainly the knowledge representation for object-oriented,production rules as complement, then case base and nde base for shearer conceptual design are establishead, and an integrated mechanism based on cases and rules reasoning is applied to knowledge reasoning of shearer conceptual design. With Unigraphics as the platform,shear conceptual design system was developed,which automation of knowledge-driven conceptual design is achieved,design experience and knowledge is accumulated, and the design cycle is shortened.The method is verified with high effectiveness and credibility through engineering application.

  3. Search Using N-gram Technique Based Statistical Analysis for Knowledge Extraction in Case Based Reasoning Systems

    OpenAIRE

    Karthik, M. N.; Davis, Moshe

    2004-01-01

    Searching techniques for Case Based Reasoning systems involve extensive methods of elimination. In this paper, we look at a new method of arriving at the right solution by performing a series of transformations upon the data. These involve N-gram based comparison and deduction of the input data with the case data, using Morphemes and Phonemes as the deciding parameters. A similar technique for eliminating possible errors using a noise removal function is performed. The error tracking and elim...

  4. Relationship between cannabis and psychosis: Reasons for use and associated clinical variables.

    Science.gov (United States)

    Mané, Anna; Fernández-Expósito, Miguel; Bergé, Daniel; Gómez-Pérez, Laura; Sabaté, Agnés; Toll, Alba; Diaz, Laura; Diez-Aja, Cristobal; Perez, Victor

    2015-09-30

    The mechanism underneath the relationship between cannabis and psychosis remains controversial, for which several hypotheses have been proposed, including cannabis as self-medication and cannabis as a risk for the development of psychosis. The aim of this work was to study the relationship between cannabis and psychosis in first-episode psychosis cannabis users and non-users, and non-psychotic cannabis users. The age at the first psychotic episode, duration of untreated psychosis, psychopathology and reasons for cannabis use were assessed. First-episode psychosis cannabis users showed an earlier age at psychosis onset than non-user patients. No significant differences in symptomatology were found. The distinguishing reasons to use cannabis for patients with first-episode psychosis with respect to non-psychotic users were to arrange their thoughts and deal with hallucinations and suspiciousness. These findings are in agreement with both hypotheses: self-medication and secondary psychosis hypothesis. However, longitudinal prospective cohort studies assessing reasons for cannabis use are needed to investigate both hypotheses and their complementarity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. AN INTERVENTION-BASED CLINICAL REASONING FRAMEWORK TO GUIDE THE MANAGEMENT OF THORACIC PAIN IN A DANCER: A CASE REPORT

    Science.gov (United States)

    Kirker, Kaitlin; Collins, Cristiana Kahl; Hanney, William; Liu, Xinliang

    2016-01-01

    Background and Purpose As a result of the anatomical proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine can influence pain, mobility, and stability across these areas. Currently, a paucity of evidence exists addressing treatment of individuals with primary thoracic pain, especially in young, athletic patients. Furthermore, current research discussing clinical reasoning frameworks focus on the differential diagnostic process. The purpose of this case report was to present a framework that describes the clinical reasoning process for the implementation and sequencing of procedural interventions for the management of a dancer with thoracic pain. Case Description A 21-year-old female dancer presented to physical therapy with a medical diagnosis of thoracic pain. The patient reported exacerbation of left thoracic pain with prolonged sitting, twisting/arching her back during dance, and lifting >15 lbs overhead. Examination revealed hypomobility with positive pain provocation during mobility testing of T1-T3 and the sternocostal junction of ribs 2-4, with associated muscle guarding palpated in the left iliocostalis thoracis and levator scapulae. Outcomes Following 10 visits, the patient had no pain, no functional deficits, and a Global Rating of Change (GROC) of + 6. She returned to full competition, and a 3-month follow-up revealed continued success with dancing and a GROC of +7. Discussion This case report described the successful management of a dancer with primary thoracic pain using a clinical reasoning framework for the sequencing of procedural interventions, while incorporating Olson's impairment-based classification system. A combination of manual therapy techniques and neuromuscular control exercises were incorporated to address mobility, stability, mobility on stability, and skill level impairments, which allowed the patient to return to dance activities safely. Future studies should consider the

  6. Scaffolding Student Learning in the Discipline-Specific Knowledge through Contemporary Science Practices: Developing High-School Students' Epidemiologic Reasoning through Data Analysis

    Science.gov (United States)

    Oura, Hiroki

    Science is a disciplined practice about knowing puzzling observations and unknown phenomena. Scientific knowledge of the product is applied to develop technological artifacts and solve complex problems in society. Scientific practices are undeniably relevant to our economy, civic activity, and personal lives, and thus public education should help children acquire scientific knowledge and recognize the values in relation to their own lives and civil society. Likewise, developing scientific thinking skills is valuable not only for becoming a scientist, but also for becoming a citizen who is able to critically evaluate everyday information, select and apply only the trustworthy, and make wise judgments in their personal and cultural goals as well as for obtaining jobs that require complex problem solving and creative working in the current knowledge-based economy and rapid-changing world. To develop students' scientific thinking, science instruction should focus not only on scientific knowledge and inquiry processes, but also on its epistemological aspects including the forms of causal explanations and methodological choices along with epistemic aims and values under the social circumstances in focal practices. In this perspective, disciplinary knowledge involves heterogeneous elements including material, cognitive, social, and cultural ones and the formation differs across practices. Without developing such discipline-specific knowledge, students cannot enough deeply engage in scientific "practices" and understand the true values of scientific enterprises. In this interest, this dissertation explores instructional approaches to make student engagement in scientific investigations more authentic or disciplinary. The present dissertation work is comprised of three research questions as stand-alone studies written for separate publication. All of the studies discuss different theoretical aspects related to disciplinary engagement in epidemiologic inquiry and student

  7. Teaching clinical reasoning and problem-solving skills using human patient simulation.

    Science.gov (United States)

    Vyas, Deepti; Ottis, Erica J; Caligiuri, Frank J

    2011-11-10

    This paper discusses using human patient simulation (HPS) to expose students to complex dynamic patient cases that require clinical judgment, problem-solving skills, and teamwork skills for success. An example of an HPS exercise used to teach multifaceted clinical concepts in a therapeutics course also is provided.

  8. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    Science.gov (United States)

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  9. Fair inclusion of pregnant women in clinical research : a systematic review of reported reasons for exclusion

    NARCIS (Netherlands)

    van der Zande, ISE; Verhave, R; Browne, JL; van Delden, Johannes

    2016-01-01

    This empirical chapter provides a systematic review of literature relevant to the inclusion of pregnant women in clinical trials. In particular, it addresses barriers to fair inclusion identified within the literature. The 31 articles reviewed discuss the exclusion of pregnant women from clinical tr

  10. Do adults show a curse of knowledge in false-belief reasoning? A robust estimate of the true effect size.

    Science.gov (United States)

    Ryskin, Rachel A; Brown-Schmidt, Sarah

    2014-01-01

    Seven experiments use large sample sizes to robustly estimate the effect size of a previous finding that adults are more likely to commit egocentric errors in a false-belief task when the egocentric response is plausible in light of their prior knowledge. We estimate the true effect size to be less than half of that reported in the original findings. Even though we found effects in the same direction as the original, they were substantively smaller; the original study would have had less than 33% power to detect an effect of this magnitude. The influence of plausibility on the curse of knowledge in adults appears to be small enough that its impact on real-life perspective-taking may need to be reevaluated.

  11. Do adults show a curse of knowledge in false-belief reasoning? A robust estimate of the true effect size.

    Directory of Open Access Journals (Sweden)

    Rachel A Ryskin

    Full Text Available Seven experiments use large sample sizes to robustly estimate the effect size of a previous finding that adults are more likely to commit egocentric errors in a false-belief task when the egocentric response is plausible in light of their prior knowledge. We estimate the true effect size to be less than half of that reported in the original findings. Even though we found effects in the same direction as the original, they were substantively smaller; the original study would have had less than 33% power to detect an effect of this magnitude. The influence of plausibility on the curse of knowledge in adults appears to be small enough that its impact on real-life perspective-taking may need to be reevaluated.

  12. Validity and reliability of a novel written examination to assess knowledge and clinical decision making skills of medical students on the surgery clerkship.

    Science.gov (United States)

    Reinert, Anna; Berlin, Ana; Swan-Sein, Aubrie; Nowygrod, Roman; Fingeret, Abbey

    2014-02-01

    The Surgery Clerkship Clinical Skills Examination (CSE) is a novel written examination developed to assess the surgical knowledge, clinical decision making, communication skills, and professionalism of medical students on the surgery clerkship. This study was undertaken to determine its validity. Data were prospectively collected from July 2011 through February 2013. Multivariate linear and logistic regression analyses were used to assess score trend; convergent validity with National Board of Medical Examiners surgery and medicine subject scores, United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge scores, and evaluation of clinical reasoning and fund of knowledge; and the effect of clerkship order. Exam reliability was assessed using a modified Cronbach's α statistic. During the study period, 262 students completed the CSE, with a normal distribution of performance. United States Medical Licensing Examination Step 2 Clinical Knowledge score and end-of-clerkship evaluations of fund of knowledge and clinical reasoning predicted CSE score. Performance on the CSE was independent of clerkship order or prior clerkships. The modified Cronbach's α value for the exam was .67. The CSE is an objective, valid, reliable instrument for assessing students on the surgery clerkship, independent of clerkship order. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Introduction to the special issue on advances in clinical and health-care knowledge management.

    Science.gov (United States)

    Bali, Rajeev K; Feng, David Dagan; Burstein, Frada; Dwivedi, Ashish N

    2005-06-01

    Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

  14. From Idea to Product--Translating Knowledge between the Lab and the Clinic

    Science.gov (United States)

    Ali, Ayfer Habib

    2012-01-01

    This dissertation is composed of three essays looking at innovation at Academic Medical Centers. It tries to empirically explore the problem of translating knowledge from the laboratory bench to the clinic and from the clinic to the bench. Chapter 1, co-authored with Iain Cockburn, establishes the importance of in-house complementary knowledge in…

  15. A qualitative study of the reasons why PTB patients at clinics in the ...

    African Journals Online (AJOL)

    Background: Tuberculosis (TB) remains the leading infectious cause of adult ... family and friends, as well as the length of the treatment period, all contribute to the ... pressure, poor self-esteem, distance from clinic and lack of continuity of care.

  16. Teaching clinical reasoning and problem-solving skills using human patient simulation

    National Research Council Canada - National Science Library

    Vyas, Deepti; Ottis, Erica J; Caligiuri, Frank J

    2011-01-01

    This paper discusses using human patient simulation (HPS) to expose students to complex dynamic patient cases that require clinical judgment, problem-solving skills, and teamwork skills for success...

  17. What are the reasons for clinical network success? A qualitative study

    OpenAIRE

    McInnes, Elizabeth; Haines, Mary; Dominello, Amanda; Kalucy, Deanna; Jammali-Blasi, Asmara; Middleton, Sandy; Klineberg, Emily

    2015-01-01

    Background Clinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success. Method...

  18. Representing clinical communication knowledge through database management system integration.

    Science.gov (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang

    2012-01-01

    Clinical communication failures are considered the leading cause of medical errors [1]. The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches [2]. Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository.

  19. Inductive reasoning.

    Science.gov (United States)

    Hayes, Brett K; Heit, Evan; Swendsen, Haruka

    2010-03-01

    Inductive reasoning entails using existing knowledge or observations to make predictions about novel cases. We review recent findings in research on category-based induction as well as theoretical models of these results, including similarity-based models, connectionist networks, an account based on relevance theory, Bayesian models, and other mathematical models. A number of touchstone empirical phenomena that involve taxonomic similarity are described. We also examine phenomena involving more complex background knowledge about premises and conclusions of inductive arguments and the properties referenced. Earlier models are shown to give a good account of similarity-based phenomena but not knowledge-based phenomena. Recent models that aim to account for both similarity-based and knowledge-based phenomena are reviewed and evaluated. Among the most important new directions in induction research are a focus on induction with uncertain premise categories, the modeling of the relationship between inductive and deductive reasoning, and examination of the neural substrates of induction. A common theme in both the well-established and emerging lines of induction research is the need to develop well-articulated and empirically testable formal models of induction. Copyright © 2010 John Wiley & Sons, Ltd. For further resources related to this article, please visit the WIREs website.

  20. Negotiating clinical knowledge: a field study of psychiatric nurses' everyday communication

    DEFF Research Database (Denmark)

    Buus, Niels

    2008-01-01

    Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced b...... knowledge influenced processes of clinical decision-making among the nurses as the game added to a distorted widening of a 'fictional distance' between patients and the representations produced by the nurses.......Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced...... by the particular social relations on hospital wards. Empirical data stemming from an extended fieldwork at two Danish psychiatric hospital wards were interpreted using interactionistic theory and the metaphor: 'the game of clinical knowledge'. The results indicated that the nurses' production of clinical knowledge...

  1. [Knowledge discovery in database and its application in clinical diagnosis].

    Science.gov (United States)

    Lui, Hui; Qiu, Tianshuang

    2004-08-01

    Nowadays the tremendous amount of data has far exceeded our human ability for comprehension, and this has been particularly true for the medical database. However, traditional statistical techniques are no longer adequate for analyzing this vast collection of data. Knowledge discovery in database and data mining play an important role in analyzing data and uncovering important data patterns. This paper briefly presents the concepts of knowledge discovery in database and data mining, then describes the rough set theory, and gives some examples based on rough set.

  2. Reliability of a viva assessment of clinical reasoning in an Australian pre-professional osteopathy program assessed using generalizability theory.

    Science.gov (United States)

    Vaughan, Brett; Orrock, Paul; Grace, Sandra

    2017-01-01

    Clinical reasoning is situation-dependent and case-specific; therefore, assessments incorporating different patient presentations are warranted. The present study aimed to determine the reliability of a multi-station case-based viva assessment of clinical reasoning in an Australian pre-registration osteopathy program using generalizability theory. Students (from years 4 and 5) and examiners were recruited from the osteopathy program at Southern Cross University, Lismore, Australia. The study took place on a single day in the student teaching clinic. Examiners were trained before the examination. Students were allocated to 1 of 3 rounds consisting of 5 10-minute stations in an objective structured clinical examination-style. Generalizability analysis was used to explore the reliability of the examination. Fifteen students and 5 faculty members participated in the study. The examination produced a generalizability coefficient of 0.53, with 18 stations required to achieve a generalizability coefficient of 0.80. The reliability estimations were acceptable and the psychometric findings related to the marking rubric and overall scores were acceptable; however, further work is required in examiner training and ensuring consistent case difficulty to improve the reliability of the examination.

  3. Reliability of a viva assessment of clinical reasoning in an Australian pre-professional osteopathy program assessed using generalizability theory

    Science.gov (United States)

    2017-01-01

    Clinical reasoning is situation-dependent and case-specific; therefore, assessments incorporating different patient presentations are warranted. The present study aimed to determine the reliability of a multi-station case-based viva assessment of clinical reasoning in an Australian pre-registration osteopathy program using generalizability theory. Students (from years 4 and 5) and examiners were recruited from the osteopathy program at Southern Cross University, Lismore, Australia. The study took place on a single day in the student teaching clinic. Examiners were trained before the examination. Students were allocated to 1 of 3 rounds consisting of 5 10-minute stations in an objective structured clinical examination-style. Generalizability analysis was used to explore the reliability of the examination. Fifteen students and 5 faculty members participated in the study. The examination produced a generalizability coefficient of 0.53, with 18 stations required to achieve a generalizability coefficient of 0.80. The reliability estimations were acceptable and the psychometric findings related to the marking rubric and overall scores were acceptable; however, further work is required in examiner training and ensuring consistent case difficulty to improve the reliability of the examination. PMID:28104901

  4. Do Adults Show a Curse of Knowledge in False-Belief Reasoning? A Robust Estimate of the True Effect Size

    OpenAIRE

    Ryskin, Rachel A.; Sarah Brown-Schmidt

    2014-01-01

    Seven experiments use large sample sizes to robustly estimate the effect size of a previous finding that adults are more likely to commit egocentric errors in a false-belief task when the egocentric response is plausible in light of their prior knowledge. We estimate the true effect size to be less than half of that reported in the original findings. Even though we found effects in the same direction as the original, they were substantively smaller; the original study would have had less than...

  5. Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: a qualitative study.

    Science.gov (United States)

    May, Stephen; Withers, Sarah; Reeve, Sarah; Greasley, Alison

    2010-06-01

    The aim of this study was to explore the clinical reasoning process used by novice physical therapists in specific patient problems. Nine physical therapists in the UK with limited experience of managing musculoskeletal problems were included. Semi-structured interviews were conducted on how novice physical therapists would assess and manage a patient with a shoulder problem; interviews were transcribed and analyzed using framework analysis. To be included as a final theme at least 50% of participants had to mention that theme. A large number of items (n = 93) were excluded as fewer than 50% of participants referred to each item. Included items related to seven main themes: history (16), physical exam (13), investigations (1), diagnostic reasoning (1), clinical reasoning process (diagnostic pathway) (3), clinical reasoning process (management pathway) (5) and treatment options (1). Items mostly related to information gathering, although there was some use of hypothetico-deductive clinical reasoning there appeared to be limited understanding of the clinical implications of data gathered, and clinical reasoning through use of pattern recognition was minimal. Major weaknesses were apparent in the clinical reasoning skills of these novice therapists compared to previous reports of expert clinical reasoning, indicating areas for development in the education of student and junior physical therapists.

  6. [The development of clinical reasoning skills and leadership: personal factors and organizational factors].

    Science.gov (United States)

    Larue, Caroline; Dubois, Sylvie; Girard, Francine; Goudreau, Johanne; Dumont, Katia

    2013-03-01

    Continuing education of newly graduated nurses (NGN) depends on several factors related to the characteristics of skills to be developed, the target population and the organizational context. Few studies describe both how nurses develop their skills and how institutions promote this development. The objectives of this manuscript are to (1) describe the behaviors that the NGN use to develop their reasoning skills and leadership and (2) document the organizational elements that facilitate this development. Method. Individual interviews were conducted with nurses (n = 34) using a grid of semistructured interviews and two group interviews were conducted with nurses (n = 7) and managers (n = 19) in two teaching hospitals in eastern Canada. The results show that nurses develop mainly by reflecting on their professional practice in their workplace. However, the lack of time for reflection in the workspace is a considerable obstacle while managerial leadership is an important asset.

  7. Analysis and reasoning of knowledge based on ontology of colleges and universities%基于本体的高校知识分析和推理

    Institute of Scientific and Technical Information of China (English)

    袁小艳

    2014-01-01

    以高校知识为研究和应用背景,研究基于本体理论的高校知识本体结构化表示和描述,并采用protege 4.0建立了高校知识本体。同时从高校知识中提取出基本公理、类内公理和类间公理,建立公理库,并采用protege的PAL推理引擎对高校知识进行一致性分析和推理。解决了高校知识语义层次上的信息共享和交互的问题,为高校知识的管理提供语义支撑。%With knowledge of colleges and universities as the research and application background,the university knowl-edge ontology structuring representation and description based on the theory of the ontology are studied. Protege4.0 is adopted to establish the university knowledge ontology. The axiom library was established by extracting the basic axioms,class axiom and axioms between classes from university knowledge. The PAL inference engine of Protege is used to do consistency analysis and reasoning of university knowledge. The information sharing and interaction in the semantic level of knowledge in colleges and uni-versities was realized. It provided a semantic support for knowledge management of colleges and universities.

  8. Clinical Reasoning in the Assessment and Intervention Planning for Writing Disorder

    Science.gov (United States)

    Harrison, Gina L.; McManus, Kelly L.

    2017-01-01

    The incidence of writing disorder is as common as reading disorder, but it is frequently under-identified and rarely targeted for intervention. Increasing clinical understanding on various subtypes of writing disorder through assessment guided by data-driven decision making may alleviate this disparity for students with writing disorders. The…

  9. Integration of Rule Based Expert Systems and Case Based Reasoning in an Acute Bacterial Meningitis Clinical Decision Support System

    CERN Document Server

    Cabrera, Mariana Maceiras

    2010-01-01

    This article presents the results of the research carried out on the development of a medical diagnostic system applied to the Acute Bacterial Meningitis, using the Case Based Reasoning methodology. The research was focused on the implementation of the adaptation stage, from the integration of Case Based Reasoning and Rule Based Expert Systems. In this adaptation stage we use a higher level RBC that stores and allows reutilizing change experiences, combined with a classic rule-based inference engine. In order to take into account the most evident clinical situation, a pre-diagnosis stage is implemented using a rule engine that, given an evident situation, emits the corresponding diagnosis and avoids the complete process.

  10. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

    Science.gov (United States)

    Johnson, Alisha M; Smith, Sheree M S

    2016-09-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  11. Political Competences and Political Participation: On The Role of “Objective” Political Knowledge, Political Reasoning, and Subjective Political Competence in Early Adulthood

    Directory of Open Access Journals (Sweden)

    Frank Reichert

    2010-12-01

    Full Text Available This article deals with the relation of objective political competences and the subjective assessment of one’s own political competence. The theoretical frame states that at least in early adulthood, only the subjective competence but not political knowledge is an autonomous and important determinant for (socio-political participation, mediating the influence of objective political competences (or political knowledge, respectively. To test the role of subjective political competence and the (remaining effect of political knowledge in early adulthood, empirical evidence using a sample of university students is presented. Cross-sectional analyses show that political knowledge has at least, if anything, an impact on voting, while fully mediated by subjective political competence relating non-electoral legal political activities. In contrast, the more profound competence of political reasoning has clear and stable positive effects on the intention to engage in non-electoral legal political actions – here subjective competence seems to be less important. Eventually, after a short excursus on school participation the findings are summarised and discussed by relating them back to framework and hypothesis. A concluding section proposes two opposing developmental-psychological considerations about the findings, raising further questions and giving an outlook into future research.

  12. The Application of Case-based Reasoning Technology in Knowledge Management%基于事例推理技术在知识管理中的应用

    Institute of Scientific and Technical Information of China (English)

    冯秋红

    2001-01-01

    Based on an analysis of the connotation of knowledge system and knowledge management,this paper clarifies that historical experience is an important content of the study of the organization.It also describes the concept and characteristics of Case-Based Reasoning Technology,and the process framework of empirical knowledge management of an enterprise.

  13. Knowledge of cancer symptoms among patients attending one-stop breast and rectal bleeding clinics.

    Science.gov (United States)

    Pullyblank, A M; Cawthorn, S J; Dixon, A R

    2002-08-01

    The aim of this questionnaire study was to identify knowledge of breast and colorectal cancer symptoms among 100 patients attending one-stop breast clinics and rectal bleeding clinics and to determine the source of the information. Seventy-five breast clinic (mean age 46 years, all female) and 78 colorectal clinic patients (mean age 59 years, 51% male) responded. Knowledge of breast was significantly greater than bowel cancer in both groups (Pknowledge of symptoms of breast cancer or bowel cancer between patients attending either clinic. There was a positive association between cancer knowledge, family history and female gender but no association with age. Knowledge of Bowel Cancer Awareness Week was positively associated with colorectal cancer knowledge. Knowledge of colorectal cancer is much less than breast cancer in clinic attenders. Seventy-five per cent of women attending breast clinic could name a breast cancer symptom whereas only 37% of patients attending colorectal clinic could name a bowel cancer symptom. These findings have implications when considering patients' anxiety, expectations of a cancer diagnosis and breaking bad news.

  14. Heuristic reasoning

    CERN Document Server

    2015-01-01

    How can we advance knowledge? Which methods do we need in order to make new discoveries? How can we rationally evaluate, reconstruct and offer discoveries as a means of improving the ‘method’ of discovery itself? And how can we use findings about scientific discovery to boost funding policies, thus fostering a deeper impact of scientific discovery itself? The respective chapters in this book provide readers with answers to these questions. They focus on a set of issues that are essential to the development of types of reasoning for advancing knowledge, such as models for both revolutionary findings and paradigm shifts; ways of rationally addressing scientific disagreement, e.g. when a revolutionary discovery sparks considerable disagreement inside the scientific community; frameworks for both discovery and inference methods; and heuristics for economics and the social sciences.

  15. Knowledge Creation in Clinical Product Development Management Research

    DEFF Research Database (Denmark)

    Karlsson, Christer; Sköld, Martin

    2012-01-01

    This paper explores the clinical approach to management research and positions it in relation to other similar approaches. It achieves this by pointing out the most important historical milestones in the development of such approaches. The literature on the approach is mapped, including that on t......This paper explores the clinical approach to management research and positions it in relation to other similar approaches. It achieves this by pointing out the most important historical milestones in the development of such approaches. The literature on the approach is mapped, including...... that on the most adjacent approaches, in order to characterize and position the different approaches. Field or application data are used to identify how the approach has been used and developed in publications in major journals in the field. After the introduction, which presents the brief characteristics...

  16. Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727

    Directory of Open Access Journals (Sweden)

    Law Mary

    2006-07-01

    Full Text Available Abstract Background A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning related to health outcome measures. Method/Design Physical and occupational therapists (n = 144 will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1 Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS, and 2 Online Problem-Based course (e-PBL. SHIPS will consist of face-to-face problem-based learning (PBL for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT

  17. Clinical reasoning and advanced practice privileges enable physical therapist point-of-care decisions in the military health care system: 3 clinical cases.

    Science.gov (United States)

    Rhon, Daniel I; Deyle, Gail D; Gill, Norman W

    2013-09-01

    Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making. Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain. Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions. Physical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.

  18. Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game.

    Science.gov (United States)

    Johnsen, Hege Mari; Fossum, Mariann; Vivekananda-Schmidt, Pirashanthie; Fruhling, Ann; Slettebø, Åshild

    2016-10-01

    Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom's taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user-computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and

  19. Formalizing Default Reasoning

    Institute of Scientific and Technical Information of China (English)

    1990-01-01

    Fuzzy set systems can be used to solve the problem with uncertain knowledge,and default logic can be used to solve the problem with incomplete knowledge,in some sense.In this paper,based on interval-valued fuzzy sets we introduce a method of inference which combines approximate reasoning an default ogic,and give the procedure of transforming monotonic reasoning into default reasoning.

  20. CLINICAL AND PHARMACOECONOMIC REASONABILITY OF USING PROBIOTIC ENTEROCOCCUS STRAIN FOR THE COMPLEX DEVELOPMENTAL CARE PROGRAM FOR PREMATURE INFANTS

    Directory of Open Access Journals (Sweden)

    N. V. Gonchar

    2015-01-01

    Full Text Available Introduction. Possibilities of using probiotic enterococci in premature neonates undergoing inpatient antibacterial therapy remains understudied. The article is aimed at analyzing clinical and pharmacoeconomic reasonability of using probiotic Enterococcus faecium L3 strain in premature infants with very low body weight in the framework of complex inpatient developmental care. Patients and methods. 55 children randomized into 2 groups were observed: the control group (n = 26 was undergoing standard developmental care program, the primary group (n = 29 was introduced liquid probiotic Enterococcus faecium L3 strain (titer — 108 CFU/ml or more (0.5 ml TID for 14 days after attaining the enteral feeding volume of 5.0 ml. Results. Analysis of the clinical symptoms characteristic of non-smooth course of developmental care over premature infants helped to reveal higher frequency of infectious complications in the control group children than in the primary group (14 [53.8%] vs. 6 [20.7%]; p < 0.05. Acute food intolerance was observed less frequently in the primary group than in the control group (6 [20.7%] vs. 10 [38.5%], p > 0.05. The primary group's children featured significant decrease in the frequency of monocytosis, positive changes of intestinal microbiotic composition (increase in the amount of bifidum bacteria, lactobacilli, enterococci, decrease in the amount of Clostridium difficile and antibiotic-resistant clinical Klebsiella pneumoniae strains. Conclusion. Favorable outcome of developmental care over premature infants (absence of infectious complications was less expensive in the primary group's children.

  1. Using clinical and computer simulations to reason about the impact of context on system safety and technology-induced error.

    Science.gov (United States)

    Kushniruk, Andre W; Borycki, Elizabeth M; Anderson, James; Anderson, Marilyn; Nicoll, James; Kannry, Joseph

    2013-01-01

    This paper describes how simulations can be used to reason about the impact of user interface design features in exploring the effect of different contexts of use on the occurrence of technology-induced errors. The paper describes our approach in several phases, using an example from the analysis of technology-induced errors in medication administration. In the initial phase a clinical simulation is conducted to gather baseline data on the occurrence of technology-induced error using the technology under study. In this phase of the study, data arising from the clinical simulation are collected and then analyzed using qualitative and quantitative approaches to assess the relationship between aspects of interface design (i.e. usability problems) and rates of technology-induced error. In the next phase, the base rates for error associated with specific types of usability problems (from the initial phase) form the input into computer-based mathematical simulations. This approach links clinical simulations with computer-based simulations and demonstrates the potential impact of aspects of interface design and contextual factors upon medical error along with the implications for correcting interface design issues.

  2. Using the theory of reasoned action (TRA) to understand the decision to use condoms in an STD clinic population.

    Science.gov (United States)

    Baker, S A; Morrison, D M; Carter, W B; Verdon, M S

    1996-11-01

    The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individual's prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.

  3. The illogicality of stock-brokers: psychological experiments on the effects of prior knowledge and belief biases on logical reasoning in stock trading.

    Directory of Open Access Journals (Sweden)

    Markus Knauff

    Full Text Available BACKGROUND: Explanations for the current worldwide financial crisis are primarily provided by economists and politicians. However, in the present work we focus on the psychological-cognitive factors that most likely affect the thinking of people on the economic stage and thus might also have had an effect on the progression of the crises. One of these factors might be the effect of prior beliefs on reasoning and decision-making. So far, this question has been explored only to a limited extent. METHODS: We report two experiments on logical reasoning competences of nineteen stock-brokers with long-lasting vocational experiences at the stock market. The premises of reasoning problems concerned stock trading and the experiments varied whether or not their conclusions--a proposition which is reached after considering the premises--agreed with the brokers' prior beliefs. Half of the problems had a conclusion that was highly plausible for stock-brokers while the other half had a highly implausible conclusion. RESULTS: The data show a strong belief bias. Stock-brokers were strongly biased by their prior knowledge. Lowest performance was found for inferences in which the problems caused a conflict between logical validity and the experts' belief. In these cases, the stock-brokers tended to make logically invalid inferences rather than give up their existing beliefs. CONCLUSIONS: Our findings support the thesis that cognitive factors have an effect on the decision-making on the financial market. In the present study, stock-brokers were guided more by past experience and existing beliefs than by logical thinking and rational decision-making. They had difficulties to disengage themselves from vastly anchored thinking patterns. However, we believe, that it is wrong to accuse the brokers for their "malfunctions", because such hard-wired cognitive principles are difficult to suppress even if the person is aware of them.

  4. The illogicality of stock-brokers: psychological experiments on the effects of prior knowledge and belief biases on logical reasoning in stock trading.

    Science.gov (United States)

    Knauff, Markus; Budeck, Claudia; Wolf, Ann G; Hamburger, Kai

    2010-10-18

    Explanations for the current worldwide financial crisis are primarily provided by economists and politicians. However, in the present work we focus on the psychological-cognitive factors that most likely affect the thinking of people on the economic stage and thus might also have had an effect on the progression of the crises. One of these factors might be the effect of prior beliefs on reasoning and decision-making. So far, this question has been explored only to a limited extent. We report two experiments on logical reasoning competences of nineteen stock-brokers with long-lasting vocational experiences at the stock market. The premises of reasoning problems concerned stock trading and the experiments varied whether or not their conclusions--a proposition which is reached after considering the premises--agreed with the brokers' prior beliefs. Half of the problems had a conclusion that was highly plausible for stock-brokers while the other half had a highly implausible conclusion. The data show a strong belief bias. Stock-brokers were strongly biased by their prior knowledge. Lowest performance was found for inferences in which the problems caused a conflict between logical validity and the experts' belief. In these cases, the stock-brokers tended to make logically invalid inferences rather than give up their existing beliefs. Our findings support the thesis that cognitive factors have an effect on the decision-making on the financial market. In the present study, stock-brokers were guided more by past experience and existing beliefs than by logical thinking and rational decision-making. They had difficulties to disengage themselves from vastly anchored thinking patterns. However, we believe, that it is wrong to accuse the brokers for their "malfunctions", because such hard-wired cognitive principles are difficult to suppress even if the person is aware of them.

  5. Clinical instructors' knowledge and perceptions about nursing care of older people: a pilot study.

    Science.gov (United States)

    Baumbusch, Jennifer; Dahlke, Sherry; Phinney, Alison

    2014-08-01

    With an aging population, the majority of nurses will spend their careers working with older people. Currently, there is scant research about clinical instructors' knowledge and perceptions about nursing care of older people despite their instrumental role in preparing nurses for practice. The purpose of this study was to explore clinical instructors' knowledge and perceptions about nursing care of older people. A mixed methods approach was used. Fifteen clinical instructors and 15 nurse educators employed on specialized units for older people completed questionnaires. Independent t-tests were administered. Five of the clinical instructors also participated in semi-structured interviews, which were analyzed using thematic analysis. Findings indicated that clinical instructors had significantly lower scores on knowledge and perceptions about nursing care of older people than practice-based nurse educators. Further, clinical instructors found it difficult to integrate specialized knowledge about nursing care of older people along with other aspects of their teaching. They also reported that it was challenging to support learning about best practices for older people within the current clinical context, which was complex and fast-paced. This study reinforces the need for professional development opportunities for clinical instructors to support their instrumental role in preparing students for practice with older people.

  6. Improving Adjunct Nursing Instructors' Knowledge of Student Assessment in Clinical Courses

    Science.gov (United States)

    Johnson, Kelly Vowell

    2014-01-01

    Utilization of adjunct nursing instructors to teach clinical courses is a common occurrence in nursing programs. Adjunct clinical instructors are often expert clinicians, but they have limited experience in teaching and lack the expertise needed to be successful in the educator role, such as knowledge of student assessment. Faculty development…

  7. Familiarity knowledge in student nurses' clinical studies: exemplified by student nurses in palliative care.

    Science.gov (United States)

    Haugan, Grethe; Hanssen, Ingrid

    2012-01-01

    In this article based on a literary study, the form of knowledge named familiarity knowledge is examined. Although rooted in the philosophical tradition of Wittgenstein and Polanyi, the development of familiarity knowledge is tied in with clinical practice and particular patients and contexts while paying attention to the framework factors influencing the setting as a whole as well as with theoretical knowledge relevant to the situation at hand. Palliative care makes a backdrop for some of the discussion. Familiarity knowledge can never be context free and attends to that which is unique in every nurse-patient relationship. Both assertive and familiarity knowledge are needed to care for dying patients in a competent, sensitive, and truly caring manner. Mentors need to help students synthesize assertive knowledge and familiarity knowledge during their clinical studies to enrich both kinds of knowledge and deepen their understanding. Student nurses expertly mentored and tutored while caring for dying patients living at home become, for instance, less apprehensive about facing dying patients than students not so mentored. Nurses need to understand the complexity of nursing care to be able to see the uniqueness of the situation and approach the individual patient on the bases of experience and insight.

  8. Conceptual Knowledge Representation and Reasoning

    DEFF Research Database (Denmark)

    Oldager, Steen Nikolaj

    2003-01-01

    , in particular the works of Gottlob Frege and Rudolf Carnap, we start by defining when a logical formalism is intensional. We then examine whether the current formalizations of concepts are intensional. The result is negative in the sense that none of the prevalent formalizations are intensional. This motivates...... udgangspunkt i hovedbidragene til intensionalitet, der stammer fra Gottlob Frege og Rudolf Carnap, starter vi med at definere, hvornår en logisk formalisme er intensionel. Derefter undersøger vi, hvorvidt de nuværende formaliseringer af begrebsviden er intensionelle. Resultatet er negativt, idet ingen af de...

  9. Constructing Clinical Decision Support Systems for Adverse Drug Event Prevention: A Knowledge-based Approach.

    Science.gov (United States)

    Koutkias, Vassilis; Kilintzis, Vassilis; Stalidis, George; Lazou, Katerina; Collyda, Chrysa; Chazard, Emmanuel; McNair, Peter; Beuscart, Regis; Maglaveras, Nicos

    2010-11-13

    A knowledge-based approach is proposed that is employed for the construction of a framework suitable for the management and effective use of knowledge on Adverse Drug Event (ADE) prevention. The framework has as its core part a Knowledge Base (KB) comprised of rule-based knowledge sources, that is accompanied by the necessary inference and query mechanisms to provide healthcare professionals and patients with decision support services in clinical practice, in terms of alerts and recommendations on preventable ADEs. The relevant Knowledge Based System (KBS) is developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication). In the current paper, we present the foundations of the framework, its knowledge model and KB structure, as well as recent progress as regards the population of the KB, the implementation of the KBS, and results on the KBS verification in decision support operation.

  10. Using a Clinical Knowledge Base to Assess Comorbidity Interrelatedness Among Patients with Multiple Chronic Conditions

    Science.gov (United States)

    Zulman, Donna M.; Martins, Susana B.; Liu, Yan; Tu, Samson W.; Hoffman, Brian B.; Asch, Steven M.; Goldstein, Mary K.

    2015-01-01

    Decision support tools increasingly integrate clinical knowledge such as medication indications and contraindications with electronic health record (EHR) data to support clinical care and patient safety. The availability of this encoded information and patient data provides an opportunity to develop measures of clinical decision complexity that may be of value for quality improvement and research efforts. We investigated the feasibility of using encoded clinical knowledge and EHR data to develop a measure of comorbidity interrelatedness (the degree to which patients’ co-occurring conditions interact to generate clinical complexity). Using a common clinical scenario—decisions about blood pressure medications in patients with hypertension—we quantified comorbidity interrelatedness by calculating the number of indications and contraindications to blood pressure medications that are generated by patients’ comorbidities (e.g., diabetes, gout, depression). We examined properties of comorbidity interrelatedness using data from a decision support system for hypertension in the Veterans Affairs Health Care System. PMID:26958279

  11. Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

    Science.gov (United States)

    Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

    2016-07-01

    To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine.

  12. [Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice].

    Science.gov (United States)

    Chen, Kee-Hsin; Kao, Ching-Chiu; Chen, Chiehfeng

    2016-12-01

    In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.

  13. [Medical practice and clinical research: keys to generate knowledge and improve care].

    Science.gov (United States)

    Martínez Castuera-Gómez, Carla; Talavera, Juan O

    2013-01-01

    The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.

  14. Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study.

    Science.gov (United States)

    Kumar, Koshila; Greenhill, Jennene

    2016-02-18

    In order to consolidate their educational knowledge and skills and develop their educational role, many clinicians undertake professional development in clinical education and supervision. It is well established that these educationally-focussed professional development activities have a positive impact. However, it is less clear what factors within the clinical workplace can shape how health professionals may use and apply their educational knowledge and skills and undertake their educational role. Looking through the lens of workplace affordances, this paper draws attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role. Data were gathered via a survey of 387 clinical educators and semi-structured interviews with 12 clinical educators and 6 workplace managers. In this paper, we focus on analysing and reporting the qualitative data gathered in this study. This qualitative data were subject to a thematic analysis and guided by theoretical constructs related to workplace affordances. Three key themes were identified including contextual, personal and interactional factors. Contextual elements referred to organisational structures and systems that impact on participants' educational role, how participants' clinical education role was articulated and configured within the organisation, and how the organisation shaped the educational opportunities available to clinicians. Personal factors encompassed clinicians' personal motivations and goals to teach and be involved in education, develop their own educational skills and function as a role model for students. Interactional factors referred to the professional interactions and networks through which clinicians shared their educational knowledge and skills and further consolidated their profile as educational advocates in their workplace. There are a number of

  15. PSYCHIATRIC CLINICAL PLACEMENT UPON NURSING STUDENTS PERCEIVED KNOWLEDGE IN CARING FOR MENTALLY ILL

    Directory of Open Access Journals (Sweden)

    Herry Prasetyo

    2012-08-01

    Full Text Available Background: The implementation of a psychiatric clinical placement has been an integral component in Indonesia Nursing Academies. Purpose: The research was to investigate how nursing students’ perceived knowledge in caring for mentally ill patients as a result of their psychiatric clinical placement. Method: A descriptive survey design commonly called non-experimental design was used in this research. Students, who had completed two weeks in a psychiatric clinical placement as a component of mental health nursing subject, were invited to participate. Then, a questionnaire was distributed to nursing students (N=40, giving an overall responses rate of 85 %. Result: The finding revealed that as a result of clinical placement, the majority of nursing students had better perceived knowledge regarding the concept of mental health and mental illness, nursing care plan, medication and providing education towards patient and people in community about mental health. Conclusion: The findings provide evidence for the benefits of such a clinical placement in relation to students’ perceived knowledge in caring for psychiatric patients. Key words: Clinical placement, nursing students, knowledge, mentally ill

  16. Clinical and basic science teachers' opinions about the required depth of biomedical knowledge for medical students.

    Science.gov (United States)

    Koens, Franciska; Custers, Eugène J F M; ten Cate, Olle T J

    2006-05-01

    The aim of the present study was to investigate whether basic scientists and physicians agree on the required depth of biomedical knowledge of medical students at graduation. A selection of basic science and clinical teachers rated the relevance of biomedical topics for students at graduation, illustrated by 80 example items. The items were derived from ten organ systems and designed at four levels: clinical, organ, cellular and molecular. Respondents were asked to identify for each item to what extent recently graduated medical students should have knowledge about it. In addition, they were asked to indicate whether the content of the item should be included in the medical curriculum. Analysis showed that basic scientists and physicians do not diverge at the clinical level. At the organ, cellular and molecular levels however, basic scientists judge that medical students should have more active knowledge. As expected, basic scientists also indicate that more deep level content should be included. Explanations for this phenomenon will be discussed.

  17. Newly Graduated Nurses' use of Knowledge Sources in Clinical Decision Making

    DEFF Research Database (Denmark)

    Lygum Voldbjerg, Siri

    of clinical decisions, based on transparent, articulate and reflective use of knowledge sources. Furthermore, it is implied that nurses are able to retrieve, asses, implement and evaluate research evidence. To meet these requirements, nursing educations around the world have organised curricula to educate...... graduated nurses do not work within a framework of evidence-based practice. The overall aim of this thesis was to explore which knowledge sources newly graduated nurses’ use in their clinical decision-making and why they use them in order to understand why newly graduated nurses use research and components...... within evidence-based practice to a limited extent. The thesis is based on a synthesis of findings from two studies. The aim of the first study was to explore which knowledge sources newly graduated nurses use in clinical decision making as reported within international qualitative research. The purpose...

  18. Developing genomic knowledge bases and databases to support clinical management: current perspectives.

    Science.gov (United States)

    Huser, Vojtech; Sincan, Murat; Cimino, James J

    2014-01-01

    Personalized medicine, the ability to tailor diagnostic and treatment decisions for individual patients, is seen as the evolution of modern medicine. We characterize here the informatics resources available today or envisioned in the near future that can support clinical interpretation of genomic test results. We assume a clinical sequencing scenario (germline whole-exome sequencing) in which a clinical specialist, such as an endocrinologist, needs to tailor patient management decisions within his or her specialty (targeted findings) but relies on a genetic counselor to interpret off-target incidental findings. We characterize the genomic input data and list various types of knowledge bases that provide genomic knowledge for generating clinical decision support. We highlight the need for patient-level databases with detailed lifelong phenotype content in addition to genotype data and provide a list of recommendations for personalized medicine knowledge bases and databases. We conclude that no single knowledge base can currently support all aspects of personalized recommendations and that consolidation of several current resources into larger, more dynamic and collaborative knowledge bases may offer a future path forward.

  19. Knowledges

    DEFF Research Database (Denmark)

    Berling, Trine Villumsen

    2012-01-01

    and reflectivism. Bourdieu, on the contrary, lets the challenge to the theory/reality distinction spill over into a challenge to the theory/practice distinction by thrusting the scientist in the foreground as not just a factor (discourse/genre) but as an actor. In this way, studies of IR need to include a focus......Scientific knowledge in international relations has generally focused on an epistemological distinction between rationalism and reflectivism over the last 25 years. This chapter argues that this distinction has created a double distinction between theory/reality and theory/practice, which works...... as a ghost distinction structuring IR research. While reflectivist studies have emphasised the impossibility of detached, objective knowledge production through a dissolution of the theory/reality distinction, the theory/practice distinction has been left largely untouched by both rationalism...

  20. A New Clinical Pain Knowledge Test for Nurses: Development and Psychometric Evaluation.

    Science.gov (United States)

    Bernhofer, Esther I; St Marie, Barbara; Bena, James F

    2017-08-01

    All nurses care for patients with pain, and pain management knowledge and attitude surveys for nurses have been around since 1987. However, no validated knowledge test exists to measure postlicensure clinicians' knowledge of the core competencies of pain management in current complex patient populations. To develop and test the psychometric properties of an instrument designed to measure pain management knowledge of postlicensure nurses. Psychometric instrument validation. Four large Midwestern U.S. hospitals. Registered nurses employed full time and part time August 2015 to April 2016, aged M = 43.25 years; time as RN, M = 16.13 years. Prospective survey design using e-mail to invite nurses to take an electronic multiple choice pain knowledge test. Content validity of initial 36-item test "very good" (95.1% agreement). Completed tests that met analysis criteria, N = 747. Mean initial test score, 69.4% correct (range 27.8-97.2). After revision/removal of 13 unacceptable questions, mean test score was 50.4% correct (range 8.7-82.6). Initial test item percent difficulty range was 15.2%-98.1%; discrimination values range, 0.03-0.50; final test item percent difficulty range, 17.6%-91.1%, discrimination values range, -0.04 to 1.04. Split-half reliability final test was 0.66. A high decision consistency reliability was identified, with test cut-score of 75%. The final 23-item Clinical Pain Knowledge Test has acceptable discrimination, difficulty, decision consistency, reliability, and validity in the general clinical inpatient nurse population. This instrument will be useful in assessing pain management knowledge of clinical nurses to determine gaps in education, evaluate knowledge after pain management education, and measure research outcomes. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  1. Assessing the Knowledge and Attitudes of Medical Students and Graduates about Clinical Governance

    Directory of Open Access Journals (Sweden)

    Rana Gholamzadeh nikjoo

    2015-08-01

    Full Text Available Background and Objectives : In order to implement clinical governance successfully, it should be perceived positively and there must be a positive attitude towards it. The current policy of the Ministry of Health and Medical Education about clinical governance requires assessing the knowledge and attitudes of medical students to identify their educational needs and the necessary steps needed to be taken in educational planning, designing and modification of the courses. This study aimed to evaluate the knowledge and attitudes of medical students and graduates about clinical governance in 1391. Materials and Methods : This is a descriptive–analytic study. This research was conducted on 159 students from different medical fields simple random sampling method. For data collecting, a researcher-made questionnaire was used which its validity was confirmed by using content validity and construct validity. To determine the reliability of the questionnaire, internal consistency and Cronbach's Alpha were used for field of knowledge (0.78 and attitude (0.68. For data analysis, SPSS version 11.5 software was applied using exploratory factor analysis method. Results : 64% of the participants were female and 36% were male. 71% of the participants were in the health care management field and 29% from other medical fields. Mean and standard deviation of knowledge and attitude scores were 64.2 ± 5.8 and 13.06 ± 3.02 respectively. Comparing the students' and graduates’ knowledge and attitudes with their educational level showed no significant correlation. (P> 0.05 Although, there was a significant correlation between educational level and attitude (P = 0.001. In higher levels of education, students' attitude towards clinical governance reduced. Conclusion : The knowledge of medical students and graduates was estimated average to high about clinical governance but their attitude was very poor. This reflects negative views of medical students despite the

  2. Investigating nurses' knowledge, attitudes, and skills patterns towards clinical management system: results of a cluster analysis.

    Science.gov (United States)

    Chan, M F

    2006-09-01

    To determine whether definable subtypes exist within a cohort of Hong Kong nurses as related to the clinical management system use in their clinical practices based on their knowledge, attitudes, skills, and background factors. Data were collected using a structured questionnaire. The sample of 242 registered nurses was recruited from three hospitals in Hong Kong. The study employs personal and demographic variables, knowledge, attitudes, and skills scale. A cluster analysis yielded two clusters. Each cluster represents a different profile of Hong Kong nurses on the clinical management system use in their clinical practices. The first group (Cluster 1) was labeled 'lower attitudes, less skilful and average knowledge' group, and represented 55.4% of the total respondents. The second group (Cluster 2) was labeled as 'positive attitudes, good knowledge but less skilful'. They comprised almost 44.6% of this nursing sample. Cluster 2 had more older nurses, the majority were educated to the baccalaureate or above level, with more than 10 years working experience, and they held a more senior ranking then Cluster 1. A clear profile of Hong Kong nurses may benefit healthcare professionals in making appropriate education or assistance to prompt the use of the clinical management system by nurses an officially recognized profession. The findings were useful in determining nurse-users' specific needs and their preferences for modification of the clinical management system. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' knowledge, attitudes, and skills toward such system.

  3. A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

    Science.gov (United States)

    Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

    2011-01-01

    The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

  4. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    Science.gov (United States)

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  5. Newly graduated nurses use of knowledge sources in clinical decison-making - a qualitative study

    DEFF Research Database (Denmark)

    Voldbjerg, Siri

    into a clinical setting influences the use of knowledge sources among newly graduated nurses. In study 1, meta-ethnography as described by Noblit and Hare was applied as method of synthesis of international qualitative research. Based on iterative literature search in the databases CINAHL, PubMed, SCOPUS...

  6. Data-mining to build a knowledge representation store for clinical decision support. Studies on curation and validation based on machine performance in multiple choice medical licensing examinations.

    Science.gov (United States)

    Robson, Barry; Boray, Srinidhi

    2016-06-01

    Extracting medical knowledge by structured data mining of many medical records and from unstructured data mining of natural language source text on the Internet will become increasingly important for clinical decision support. Output from these sources can be transformed into large numbers of elements of knowledge in a Knowledge Representation Store (KRS), here using the notation and to some extent the algebraic principles of the Q-UEL Web-based universal exchange and inference language described previously, rooted in Dirac notation from quantum mechanics and linguistic theory. In a KRS, semantic structures or statements about the world of interest to medicine are analogous to natural language sentences seen as formed from noun phrases separated by verbs, prepositions and other descriptions of relationships. A convenient method of testing and better curating these elements of knowledge is by having the computer use them to take the test of a multiple choice medical licensing examination. It is a venture which perhaps tells us almost as much about the reasoning of students and examiners as it does about the requirements for Artificial Intelligence as employed in clinical decision making. It emphasizes the role of context and of contextual probabilities as opposed to the more familiar intrinsic probabilities, and of a preliminary form of logic that we call presyllogistic reasoning. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. 法律知识的因果表达和非单调推理模型%Causal Knowledge Representation and Nonmonotonic Reasoning Models in Law Consultant Systems

    Institute of Scientific and Technical Information of China (English)

    干红华; 潘云鹤

    2001-01-01

    Causal reasoning is the most important feature in law consultant systems. This paper analy-ses the structure of law clauses,proposes a representation model for law knowledge in terms of causal relationships and nonmonotonic reasoning models based on it. These models are successfully applied in the implementation of NBU-CALA+ ,a law expert consultant system for case analysis and interpreta-tion.

  8. Teaching to Reason

    Science.gov (United States)

    Riveros Rotge, Hector G.

    2014-01-01

    The objective of Physics courses is that the students learn how to use what they know to solve problems in the real world (competencies), but no one learns to do that seeing as the professor think in the blackboard. The program of a course uses topics as examples of reasoning. Reasoning involves the ability to use their knowledge. If we precisely…

  9. Knowledge translation in audiology: promoting the clinical application of best evidence.

    Science.gov (United States)

    Moodie, Sheila T; Kothari, Anita; Bagatto, Marlene P; Seewald, Richard; Miller, Linda T; Scollie, Susan D

    2011-01-01

    The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced.

  10. Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.

    Science.gov (United States)

    Weng, Chunhua; Payne, Philip R O; Velez, Mark; Johnson, Stephen B; Bakken, Suzanne

    2014-01-01

    The successful adoption by clinicians of evidence-based clinical practice guidelines (CPGs) contained in clinical information systems requires efficient translation of free-text guidelines into computable formats. Natural language processing (NLP) has the potential to improve the efficiency of such translation. However, it is laborious to develop NLP to structure free-text CPGs using existing formal knowledge representations (KR). In response to this challenge, this vision paper discusses the value and feasibility of supporting symbiosis in text-based knowledge acquisition (KA) and KR. We compare two ontologies: (1) an ontology manually created by domain experts for CPG eligibility criteria and (2) an upper-level ontology derived from a semantic pattern-based approach for automatic KA from CPG eligibility criteria text. Then we discuss the strengths and limitations of interweaving KA and NLP for KR purposes and important considerations for achieving the symbiosis of KR and NLP for structuring CPGs to achieve evidence-based clinical practice.

  11. Newly graduated nurses' use of knowledge sources in clinical decision-making

    DEFF Research Database (Denmark)

    Voldbjerg, Siri Lygum; Grønkjaer, Mette; Wiechula, Rick;

    2016-01-01

    could be used. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Although there is a complexity and variety to knowledge sources used there is an imbalance with the experienced nurse playing a key role, functioning both as predominant source and a role-model as to which sources are valued and used......AIMS AND OBJECTIVES: To explore which knowledge sources newly graduated nurses' use in clinical decision-making and why and how they are used. BACKGROUND: In spite of an increased educational focus on skills and competencies within evidence based practice newly graduated nurses' ability to use...... approaches to strengthen the knowledgebase used in clinical decision-making. DESIGN AND METHODS: Ethnographic study using participant-observation and individual semi-structured interviews of nine Danish newly graduated nurses in medical and surgical hospital settings. RESULTS: Newly graduates use...

  12. Eating disorders in the context of preconception care: fertility specialists' knowledge, attitudes, and clinical practices.

    Science.gov (United States)

    Rodino, Iolanda S; Byrne, Susan M; Sanders, Katherine A

    2017-02-01

    To gauge fertility specialists' knowledge, clinical practices, and training needs in regard to eating disorders. Cross-sectional study. Fertility clinics. Eighty Australian and New Zealand fertility specialists who were members of the Fertility Society of Australia. None. Responses to an anonymously completed online questionnaire. Approximately 54% of doctors correctly identified the body mass index relevant to anorexia nervosa, and 30% identified menstrual disturbances for anorexia, while 63.8% of doctors incorrectly nominated maladaptive weight control behaviors as a characteristic of binge eating disorder. While clinicians (83.7%) agreed it was important to screen for eating disorders during preconception assessments, 35% routinely screened for eating disorders and 8.8% indicated that their clinics had clinical practice guidelines for management of eating disorders. A minority of participants (13.8%) felt satisfied with their level of university training in eating disorders, 37.5% of doctors felt confident in their ability to recognize symptoms of an eating disorder, and 96.2% indicated a need for further education and clinical guidelines. On most items examined, knowledge and clinical practices regarding eating disorders did not differ according to doctor gender or years of clinical experience working as a fertility specialist. Knowledge about eating disorders in the context of fertility treatment is important. This study highlights the uncertainty among fertility specialists in detecting features of eating disorders. The findings point to the importance of further education and training, including the development of clinical guidelines specific to fertility health care providers. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Forms of Knowledge Incorporated in Clinical Decision-making among Newly-Graduated Nurses: A Metasynthesis

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Elgaard Sørensen, Erik; Grønkjær, Mette

    2013-01-01

    the knowledge that informs clinical decision-making among newly-graduated nurses. Qualitative studies were retrieved from CINAHL, PubMed, SCOPE, ERIC and GOOGLE-Scholar and subsequently selected by pre-defined inclusion criteria and critically appraised using CASP. Metaphors identified in the analytical process......Clinical-decision-making is of decisive importance to how evidence-based practice is put into practice. Schools of Nursing have a responsibility to teach and train nursing students to make clinical decisions within a frame of evidence-based practice. Clinical decision-making among nurses has been...... explored from numerous angles using a diversity of methodologies. Existing research has mainly focused on promoting and inhibiting factors for implementation of evidence-based practice and incorporation of research evidence in the clinical-decision. Little attention has been given to the nurses' behavior...

  14. Integration of preclinical and clinical knowledge to predict intravenous PK in human: bilastine case study.

    Science.gov (United States)

    Vozmediano, Valvanera; Ortega, Ignacio; Lukas, John C; Gonzalo, Ana; Rodriguez, Monica; Lucero, Maria Luisa

    2014-03-01

    Modern pharmacometrics can integrate and leverage all prior proprietary and public knowledge. Such methods can be used to scale across species or comparators, perform clinical trial simulation across alternative designs, confirm hypothesis and potentially reduce development burden, time and costs. Crucial yet typically lacking in integration is the pre-clinical stage. Prediction of PK in man, using in vitro and in vivo studies in different animal species, is increasingly well theorized but could still find wider application in drug development. The aim of the present work was to explore methods for bridging pharmacokinetic knowledge from animal species (i.v. and p.o.) and man (p.o.) into i.v. in man using the antihistamine drug bilastine as example. A model, predictive of i.v. PK in man, was developed on data from two pre-clinical species (rat and dog) and p.o. in man bilastine trials performed earlier. In the knowledge application stage, two different approaches were used to predict human plasma concentration after i.v. of bilastine: allometry (several scaling methods) and a semi-physiological method. Both approaches led to successful predictions of key i.v. PK parameters of bilastine in man. The predictive i.v. PK model was validated using later data from a clinical study of i.v. bilastine. Introduction of such knowledge in development permits proper leveraging of all emergent knowledge as well as quantification-based exploration of PK scenario, e.g. in special populations (pediatrics, renal insufficiency, comedication). In addition, the methods permit reduction or elimination and certainly optimization of learning trials, particularly those concerning alternative off-label administration routes.

  15. Integrating complex business processes for knowledge-driven clinical decision support systems.

    Science.gov (United States)

    Kamaleswaran, Rishikesan; McGregor, Carolyn

    2012-01-01

    This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS.

  16. Impact of educational intervention on knowledge, attitude and awareness of good clinical practice among health care providers

    Directory of Open Access Journals (Sweden)

    Divya Goel

    2017-01-01

    Conclusion: A day's training program on GCP guidelines may help to increase the knowledge as well as awareness about principles and techniques of clinical research, which will increase the credibility of clinical research in the country.

  17. Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambaréné, Gabon

    NARCIS (Netherlands)

    N.G. Schwarz; M. Gysels; C. Pell; J. Gabor; M. Schlie; S. Issifou; B. Lell; P.G. Kremsner; M.P. Grobusch; R. Pool

    2009-01-01

    The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem a

  18. Preferential reasoning for modal logics

    CSIR Research Space (South Africa)

    Britz, K

    2011-11-01

    Full Text Available Modal logic is the foundation for a versatile and well-established class of knowledge representation formalisms in artificial intelligence. Enriching modal logics with non-monotonic reasoning capabilities such as preferential reasoning as developed...

  19. Improved knowledge retention among clinical pharmacy students using an anthropology classroom assessment technique.

    Science.gov (United States)

    Whitley, Heather P; Parton, Jason M

    2014-09-15

    To adapt a classroom assessment technique (CAT) from an anthropology course to a diabetes module in a clinical pharmacy skills laboratory and to determine student knowledge retention from baseline. Diabetes item stems, focused on module objectives, replaced anthropology terms. Answer choices, coded to Bloom's Taxonomy, were expanded to include higher-order thinking. Students completed the online 5-item probe 4 times: prelaboratory lecture, postlaboratory, and at 6 months and 12 months after laboratory. Statistical analyses utilized a single factor, repeated measures design using rank transformations of means with a Mann-Whitney-Wilcoxon test. The CAT revealed a significant increase in knowledge from prelaboratory compared to all postlaboratory measurements (panthropology assessment tool was effectively adapted using Bloom's Taxonomy as a guide and, when used repeatedly, demonstrated knowledge retention. Minimal time was devoted to application of the probe making it an easily adaptable CAT.

  20. A scalable architecture for incremental specification and maintenance of procedural and declarative clinical decision-support knowledge.

    Science.gov (United States)

    Hatsek, Avner; Shahar, Yuval; Taieb-Maimon, Meirav; Shalom, Erez; Klimov, Denis; Lunenfeld, Eitan

    2010-01-01

    Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians' assessment was significantly lower than the assessment of the knowledge engineers.

  1. Transition to clinical training : influence of pre-clinical knowledge and skills, and consequences for clinical performance

    NARCIS (Netherlands)

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transi

  2. Transition to clinical training : influence of pre-clinical knowledge and skills, and consequences for clinical performance

    NARCIS (Netherlands)

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transi

  3. Medical and psychology students' knowledge of and attitudes towards mindfulness as a clinical intervention.

    Science.gov (United States)

    McKenzie, Stephen P; Hassed, Craig S; Gear, Jacqui L

    2012-01-01

    Mindfulness is a technique for training people to pay full attention and to fully accept the reality of what they are paying attention to. The clinical efficacy of mindfulness has been increasingly demonstrated during the last two decades. Very little research, however, has been undertaken on health professionals' and students of health professions' knowledge of and attitudes towards mindfulness. These may affect the current and future level of use of a technique that offers important clinical advantages. We aimed to compare knowledge of and attitudes towards mindfulness of medical students without exposure to it in their training with psychology students without exposure and with medical students with exposure to mindfulness in their training. A total of 91 medical students from Monash University, 49 medical students from Deakin University, and 31 psychology students from Deakin University were given a questionnaire that elicited quantitative and qualitative responses about level of knowledge of mindfulness and willingness to administer or recommend it to their future patients. Psychology students without exposure to mindfulness in their training have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure to it in their training. Medical students with exposure to mindfulness in their course have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure. Knowledge of mindfulness is positively correlated with students' willingness to use or recommend it. Possible implications of the findings of this study are that if future doctors are routinely instructed in mindfulness as a clinical intervention they may be more likely to form a more positive attitude towards it, that is more consistent with that of nonmedical health professions such as psychologists, and that they therefore may be more likely to administer it or refer its use. The

  4. Development of Category-Based Reasoning in 4- to 7-Year-Old Children: The Influence of Label Co-Occurrence and Kinship Knowledge

    Science.gov (United States)

    Godwin, Karrie E.; Matlen, Bryan J.; Fisher, Anna V.

    2013-01-01

    Category-based reasoning is central to mature cognition; however, the developmental course of this ability remains contested. One strong indicator of category-based reasoning is the propensity to make inferences based on semantically similar labels. Recent evidence indicates that in preschool-age children the effects of semantically similar labels…

  5. Knowledge and Perception about Clinical Research Shapes Behavior: Face to Face Survey in Korean General Public.

    Science.gov (United States)

    Choi, Yun Jung; Beck, Sung-Ho; Kang, Woon Yong; Yoo, Soyoung; Kim, Seong-Yoon; Lee, Ji Sung; Burt, Tal; Kim, Tae Won

    2016-05-01

    Considering general public as potential patients, identifying factors that hinder public participation poses great importance, especially in a research environment where demands for clinical trial participants outpace the supply. Hence, the aim of this study was to evaluate knowledge and perception about clinical research in general public. A total of 400 Seoul residents with no previous experience of clinical trial participation were selected, as representative of population in Seoul in terms of age and sex. To minimize selection bias, every fifth passer-by was invited to interview, and if in a cluster, person on the very right side was asked. To ensure the uniform use of survey, written instructions have been added to the questionnaire. Followed by pilot test in 40 subjects, the survey was administered face-to-face in December 2014. To investigate how perception shapes behavior, we compared perception scores in those who expressed willingness to participate and those who did not. Remarkably higher percentage of responders stated that they have heard of clinical research, and knew someone who participated (both, P perceptions and lack of knowledge will be effective in enhancing public engaged in clinical research.

  6. A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills.

    Science.gov (United States)

    Supiano, Mark A; Fitzgerald, James T; Hall, Karen E; Halter, Jeffrey B

    2007-10-01

    The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.

  7. Development, validation and clinical assessment of a short questionnaire to assess disease-related knowledge in inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    Keegan, Denise

    2013-02-01

    Only two inflammatory bowel disease (IBD) knowledge scales are available, both primarily aimed at evaluating the effectiveness of clinical education programs. The aim of this study was to develop and validate a short knowledge questionnaire for clinical and academic research purposes.

  8. Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014.

    Science.gov (United States)

    Adam, Jessica K; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L; Han, George; Sharp, Tyler M; Waterman, Stephen H; Tomashek, Kay M

    2017-03-01

    AbstractDengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.

  9. Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features

    Science.gov (United States)

    Chen, Huaidong; Chen, Wei; Liu, Chenglin; Zhang, Le; Su, Jing; Zhou, Xiaobo

    2016-07-01

    Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. “Full feature spectrum” knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis, and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center’s electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient’s cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features, and clinical decisions. The discovered “ER module”, which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.

  10. Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features.

    Science.gov (United States)

    Chen, Huaidong; Chen, Wei; Liu, Chenglin; Zhang, Le; Su, Jing; Zhou, Xiaobo

    2016-07-18

    Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. "Full feature spectrum" knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis, and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center's electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient's cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features, and clinical decisions. The discovered "ER module", which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.

  11. Artificial neural network modeling using clinical and knowledge independent variables predicts salt intake reduction behavior.

    Science.gov (United States)

    Isma'eel, Hussain A; Sakr, George E; Almedawar, Mohamad M; Fathallah, Jihan; Garabedian, Torkom; Eddine, Savo Bou Zein; Nasreddine, Lara; Elhajj, Imad H

    2015-06-01

    High dietary salt intake is directly linked to hypertension and cardiovascular diseases (CVDs). Predicting behaviors regarding salt intake habits is vital to guide interventions and increase their effectiveness. We aim to compare the accuracy of an artificial neural network (ANN) based tool that predicts behavior from key knowledge questions along with clinical data in a high cardiovascular risk cohort relative to the least square models (LSM) method. We collected knowledge, attitude and behavior data on 115 patients. A behavior score was calculated to classify patients' behavior towards reducing salt intake. Accuracy comparison between ANN and regression analysis was calculated using the bootstrap technique with 200 iterations. Starting from a 69-item questionnaire, a reduced model was developed and included eight knowledge items found to result in the highest accuracy of 62% CI (58-67%). The best prediction accuracy in the full and reduced models was attained by ANN at 66% and 62%, respectively, compared to full and reduced LSM at 40% and 34%, respectively. The average relative increase in accuracy over all in the full and reduced models is 82% and 102%, respectively. Using ANN modeling, we can predict salt reduction behaviors with 66% accuracy. The statistical model has been implemented in an online calculator and can be used in clinics to estimate the patient's behavior. This will help implementation in future research to further prove clinical utility of this tool to guide therapeutic salt reduction interventions in high cardiovascular risk individuals.

  12. National survey of China's oncologists' knowledge, attitudes, and clinical practice patterns on complementary and alternative medicine.

    Science.gov (United States)

    Yang, Geliang; Lee, Richard; Zhang, Huiqing; Gu, Wei; Yang, Peiying; Ling, Changquan

    2017-02-21

    It is common for cancer patients to use complementary and alternative medicine (CAM). This study was designed to explore China's oncologists' knowledge, attitudes and clinical practices regarding CAM use by their patients. An online survey was conducted of China's oncologists. Among 11,270 participants who completed the online survey, 6,007 (53.3%) were identified as oncologists. Most were men (75.2%), with a mean age of 33.4 (standard deviation: 6.5) years. The 6,007 oncologists discussed with 36.5% of their patients about CAM. Most of them (75.6%) did not want to initiate discussions due to lack of knowledge on CAM. Oncologists estimated that 40.0% of their patients used CAM treatments. Oncologists reported that 28.7% of their patients underwent anticancer therapy with the concurrent use of CAM. Four out of five of the responding oncologists self-reported inadequate knowledge and only 22.0% reported receiving professional education on CAM. Nearly half (44.9%) of the oncologists believed CAM treatment was effective for symptoms and treatment of cancer. Physician factors associated with initiating discussions with patients about CAM use included sex, age (≥ 33 years), medical license for traditional Chinese medicine, enough knowledge and professional education experience. China's oncologists infrequently discussed with their patients about CAM due to lack of knowledge. Most of the oncologists did not encourage CAM use.

  13. A cluster analysis to investigating nurses' knowledge, attitudes, and skills regarding the clinical management system.

    Science.gov (United States)

    Chan, M F

    2007-01-01

    Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.

  14. Mathematical knowledge and drug dosage calculation: Necessary clinical skills for the nurse

    Directory of Open Access Journals (Sweden)

    Athanasakis Efstratios

    2013-01-01

    Full Text Available When nurses perform their tasks, they manage situations where maths knowledge is required. Such a situation is the calculation of medication dosage. Aim: The literature review of papers relevant with the mathematical knowledge and drug calculation skills of nurses and nursing students. Material-Method: A search of published research and review articles from January 1989 until March 2012, has been conducted in Pubmed database. The search terms used were: nurses, mathematics skills, numeracy skills and medication dosology calculation skills. Results: Literature review showed that many studies focus in the mathematical knowledge and drug dosage calculation competency of nursing students. Results from these studies revealed that nursing students had poor mathematical knowledge and drug dosage calculation skills. In contrast with students, professional nurses are more likely to have sufficient skills in drug calculations. Apart from the papers analyzing calculation skills' assessment, several studies examined educational interventions in the context of calculation skills enhancement. Accuracy and proficiency in the dosage calculation of medications is a preventive factor of errors made at medication preparation and administration. Conclusion: Mathematical knowledge and drug dosage calculation abilities are interrelated concepts and essential clinical skills for the nurse. The fact that nursing students do not have adequate skills for calculating medications' dosage, might be an issue that schools of nursing education should focus in. Further research of the drug dosage calculation skills is considered essential.

  15. Virtual patients design and its effect on clinical reasoning and student experience: a protocol for a randomised factorial multi-centre study

    Directory of Open Access Journals (Sweden)

    Bateman James

    2012-08-01

    Full Text Available Abstract Background Virtual Patients (VPs are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent and structured clinical reasoning feedback (present or absent. Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent, and structured clinical reasoning feedback (present or absent.The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for

  16. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences.

    Science.gov (United States)

    Tilson, Julie K; Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T

    2016-04-01

    Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127).

  17. Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

    Directory of Open Access Journals (Sweden)

    Bello AI

    2011-08-01

    Full Text Available Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores ≥70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal–Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P < 0.05Results: Overall mean percentage score of the participants on ICSQ was 65.4 ± 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ± 1.19, and 61.31 ± 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P > 0.05 between course of study and knowledge of

  18. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement.

    Science.gov (United States)

    Thornton, Tim

    2006-03-17

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values.

  19. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

    Directory of Open Access Journals (Sweden)

    Ash Joan S

    2012-02-01

    Full Text Available Abstract Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS development and implementation and for knowledge management (KM processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1 workflow; 2 knowledge management; 3 data as a foundation for CDS; 4 user computer interaction; 5 measurement and metrics; 6 governance; 7 translation for collaboration; 8 the meaning of CDS; 9 roles of special, essential people; and 10 communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

  20. Clinical study on the reasons for and location of failures of metal-ceramic restorations and survival of repairs

    NARCIS (Netherlands)

    Ozcan, M; Niedermeier, W

    2002-01-01

    Purpose: A recently introduced technique, the Cojet system, using SiOx (Al2O3 coated with silisic acid), provides ultrafine mechanical retention by sandblasting, as well as a chemicophysical bond between the metal/ceramic and the composite resin. This study determined the reasons for and locations o

  1. Clinical study on the reasons for and location of failures of metal-ceramic restorations and survival of repairs

    NARCIS (Netherlands)

    Ozcan, M; Niedermeier, W

    2002-01-01

    Purpose: A recently introduced technique, the Cojet system, using SiOx (Al2O3 coated with silisic acid), provides ultrafine mechanical retention by sandblasting, as well as a chemicophysical bond between the metal/ceramic and the composite resin. This study determined the reasons for and locations

  2. The illogicality of stock-brokers: psychological experiments on the effects of prior knowledge and belief biases on logical reasoning in stock trading

    National Research Council Canada - National Science Library

    Knauff, Markus; Budeck, Claudia; Wolf, Ann G; Hamburger, Kai

    2010-01-01

    .... So far, this question has been explored only to a limited extent. We report two experiments on logical reasoning competences of nineteen stock-brokers with long-lasting vocational experiences at the stock market...

  3. The Illogicality of Stock-Brokers: Psychological Experiments on the Effects of Prior Knowledge and Belief Biases on Logical Reasoning in Stock Trading: e13483

    National Research Council Canada - National Science Library

    Markus Knauff; Claudia Budeck; Ann G Wolf; Kai Hamburger

    2010-01-01

    .... So far, this question has been explored only to a limited extent. Methods We report two experiments on logical reasoning competences of nineteen stock-brokers with long-lasting vocational experiences at the stock market...

  4. Pertinent reasoning

    CSIR Research Space (South Africa)

    Britz, K

    2010-05-01

    Full Text Available In this paper the authors venture beyond one of the fundamental assumptions in the non-monotonic reasoning community, namely that non-monotonic entailment is supra-classical. They investigate reasoning which uses an infra-classical entailment...

  5. A study of the effects of English language proficiency and scientific reasoning skills on the acquisition of science content knowledge of Hispanic English language learners and native English language-speaking students participating in grade 10 science classes

    Science.gov (United States)

    Torres, Hector Neftali, Sr.

    2000-11-01

    The purpose of this study was to examine the effects of English language proficiency and levels of scientific reasoning skills of Hispanic English language learners and native English language speaking students on their acquisition of science content knowledge as measured by a state-wide standardized science test. The researcher studied a group of high school Hispanic English language learners and native English language speaking students participating in Grade 10 science classes. The language proficiency of the students was to be measured through the use of the Test of English as a Foreign Language (TOEFL) instrument. A Classroom Test of Scientific Reasoning developed by Lawson (1978) was administered in either English or Spanish to the group of Hispanic English language learners and in English to the group of native English language-speaking students in order to determine their levels of scientific reasoning skills. The students' acquisition of science content knowledge was measured through the use of statewide-standardized science test developed by the State's Department of Education. This study suggests that the levels of English language proficiency appear to influence the acquisition of science content knowledge of Hispanic English language learners in the study. The results of the study also suggest that with regards to scientific reasoning skills, students that showed high levels or reflective reasoning skills for the most part performed better on the statewide-standardized science test than students with intuitive or transitional reasoning skills. This assertion was supported by the studies conducted by Lawson and his colleagues, which showed that high levels of reasoning or reflective reasoning skills are prerequisite for most high school science courses. The findings in this study imply that high order English language proficiency combined with high levels of reasoning skills enhances students' abilities to learn science content subject matter. This

  6. Genetic counselors' (GC) knowledge, awareness, understanding of clinical next-generation sequencing (NGS) genomic testing.

    Science.gov (United States)

    Boland, P M; Ruth, K; Matro, J M; Rainey, K L; Fang, C Y; Wong, Y N; Daly, M B; Hall, M J

    2015-12-01

    Genomic tests are increasingly complex, less expensive, and more widely available with the advent of next-generation sequencing (NGS). We assessed knowledge and perceptions among genetic counselors pertaining to NGS genomic testing via an online survey. Associations between selected characteristics and perceptions were examined. Recent education on NGS testing was common, but practical experience limited. Perceived understanding of clinical NGS was modest, specifically concerning tumor testing. Greater perceived understanding of clinical NGS testing correlated with more time spent in cancer-related counseling, exposure to NGS testing, and NGS-focused education. Substantial disagreement about the role of counseling for tumor-based testing was seen. Finally, a majority of counselors agreed with the need for more education about clinical NGS testing, supporting this approach to optimizing implementation.

  7. Assessing clinical reasoning skills in scenarios of uncertainty: convergent validity for a Script Concordance Test in an emergency medicine clerkship and residency.

    Science.gov (United States)

    Humbert, Aloysius J; Besinger, Bart; Miech, Edward J

    2011-06-01

    The Script Concordance Test (SCT) is a new method of assessing clinical reasoning in the face of uncertainty. An SCT item consists of a short clinical vignette followed by an additional piece of information and asks how this new information affects the learner's decision regarding a possible diagnosis, investigational study, or therapy. Scoring is based on the item responses of a panel of experts in the field. This study attempts to provide additional validity evidence in the realm of emergency medicine (EM). This observational study examined the performance of medical students, EM residents, and expert emergency physicians (EPs) on an SCT in the area of general EM (SCT-EM) at one of the largest medical schools in the United States. The 59-item SCT-EM was developed for a fourth-year required clerkship in EM. The results on the SCT-EM were compared between different levels of clinical experience. Results were also compared to performance on other measures to evaluate convergent validity. The SCT-EM was given to 314 fourth-year medical students (MS4), 40 EM residents, and 13 EPs during the study period. Mean differences between the three different groups of test takers was statistically significant (p reasoning skills in the face of uncertainty. Future research will compare performance on the SCT to other measures of clinical reasoning abilities. © 2011 by the Society for Academic Emergency Medicine.

  8. Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania

    Directory of Open Access Journals (Sweden)

    Mfinanga Godfrey S

    2008-12-01

    Full Text Available Abstract Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis

  9. Clinical significance of knowledge about the structure, function, and impairments of working memory.

    Science.gov (United States)

    Brodziak, Andrzej; Brewczyński, Adam; Bajor, Grzegorz

    2013-05-03

    A review of contemporary research on the working memory system (WMS) is important, both due to the need to focus the discussion on further necessary investigations on the structure and function of this key part of the human brain, as well as to share this knowledge with clinicians. In our introduction we try to clarify the actual terminology and provide an intuitively understandable model for 3 basic cognitive operations: perception, recognition, imagery, and manipulation of recalled mental images. We emphasize the importance of knowledge of the structure and function of the WMS for the possibility to demonstrate the links between genetic polymorphisms and the prevalence to some mental disorders. We also review current knowledge of working memory dysfunction in the most common diseases and specific clinical situations such as maturation and aging. Finally, we briefly discuss methods for assessment of WMS capacity. This article establishes a kind of compendium of knowledge for clinicians who are not familiar with the structure and operation of the WMS.

  10. Developing clinical knowledge through a narrative-based method of interpretation.

    Science.gov (United States)

    Ekman, Inger; Skott, Carola

    2005-09-01

    The results of research using a narrative analysis provide new clinical knowledge, but the methods used are unknown to many readers. In this paper we present an example of how an analysis may be performed in practice. The purpose of the interpretation of this specific story was to develop clinical knowledge of how it is to live with chronic heart failure from a daily life perspective. The steps in the interpretation process, within the framework of Paul Ricoeur's Interpretation theory, were: (1) general or naïve reading, (2) distancing, (3) examination of discourse, (4) conjectures and questions, and (5) reflection over the whole. The demonstrated interpretation of the interview resulted in a theme called: "Struggling to comprehend medical information". This systematic way of working with narratives makes implicit assumptions about the relationship between meaning and language explicit. These themes can be used in everyday practice as clinical tools. Because of the interpretative nature of human understanding the experienced health professional will be capable of integrating evidence-based research findings and individual illness experience.

  11. Clinical tolerance in large field radiotherapy--the knowledge gained over the last ten years.

    Science.gov (United States)

    Gocheva, Lilia B

    2010-01-01

    Malignant disorders are still far from being successfully managed in spite of the apparent progress achieved by surgical treatment, high energy radiotherapy (RT) and chemotherapy (CHT). They keep being the second most frequent cause of lethal outcomes both in Bulgaria and in most countries of the world. One of the promising approaches to increasing the efficaciousness of treatment is development and use of methods that are in full accord with the modern requirements of a complex therapy. Over the last fifty years, large field radiation techniques, applied as systemic therapy in oncology, have been investigated and established. These techniques show the transition in oncology to using actively various variants of large field radiotherapy (LFR), the "heavy artillery" of oncoradiologic practice, as an alternative or adjunct therapy to chemotherapy (CHT). In the present paper we review the current knowledge in the field and present the clinical experience accumulated over the last ten years with respect to clinical tolerance in the major large-field radiotherapy techniques--total body irradiation, half body irradiation, whole abdominal irradiation, total and partial lymphoid irradiation. Described in detail are the contemporary knowledge about clinical and hematologic tolerance in total body irradiation as part of the myelo- and nonmyeloablative conditioning regimens as well as in half body irradiation as a systemic therapy in oncology. We also present the amassed experience in clinical tolerance in partial body irradiation in the form of whole abdominal and total or partial lymphoid irradiation. Another point worth noting based again on the experience gained over the last ten years is that for LFR we need to develop a radiotherapy technique that is designed carefully to achieve an optimal therapeutic effect that should include the disease control, good clinical tolerance and reduction of post-radiotherapy sequelae.

  12. Effects of high-fidelity patient simulation led clinical reasoning course: Focused on nursing core competencies, problem solving, and academic self-efficacy.

    Science.gov (United States)

    Lee, JuHee; Lee, Yoonju; Lee, Senah; Bae, Juyeon

    2016-01-01

    To examine the effects of high-fidelity patient simulation (HFPS) led clinical reasoning course among undergraduate nursing students. A quasi-experimental study of non-equivalent control group pretest-post test design was applied. A total of 49 senior nursing students participated in this study. The experimental group consisted of the students who took the "clinical reasoning" course (n = 23) while the control group consisted of students who did not (n = 26). Self-administered scales including the nursing core competencies, problem solving, academic self-efficacy, and Kolb learning style inventory were analyzed quantitatively using SPSS version 20.0. Data analysis was conducted using one-way ancova due to a significant difference in nursing core competencies between the experimental group and control group. There was a significant improvement in nursing core competencies in the experimental group (F = 7.747, P = 0.008). The scores of problem solving and academic self-efficacy were higher in the experimental group after the HFPS led clinical reasoning course without statistical difference. There is a need for the development of effective instructional methods to improve learning outcomes in nursing education. Future research is needed related to simulation education as well as management strategies so that learning outcomes can be achieved within different students' learning style. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  13. Clinical and subclinical mastitis in smallholder dairy farms in Tanzania: risk, intervention and knowledge transfer.

    Science.gov (United States)

    Karimuribo, E D; Fitzpatrick, J L; Bell, C E; Swai, E S; Kambarage, D M; Ogden, N H; Bryant, M J; French, N P

    2006-04-17

    In a cross-sectional study of 400 randomly selected smallholder dairy farms in the Tanga and Iringa regions of Tanzania, 14.2% (95% confidence interval (CI)=11.6-17.3) of cows had developed clinical mastitis during the previous year. The point prevalence of subclinical mastitis, defined as a quarter positive by the California Mastitis Test (CMT) or by bacteriological culture, was 46.2% (95% CI=43.6-48.8) and 24.3% (95% CI=22.2-26.6), respectively. In a longitudinal disease study in Iringa, the incidence of clinical mastitis was 31.7 cases per 100 cow-years. A randomised intervention trial indicated that intramammary antibiotics significantly reduced the proportion of bacteriologically positive quarters in the short-term (14 days post-infusion) but teat dipping had no detectable effect on bacteriological infection and CMT positive quarters. Other risk and protective factors were identified from both the cross-sectional and longitudinal included animals with Boran breeding (odds ratio (OR)=3.40, 95% CI=1.00-11.57, Pmastitis, and OR=3.51, 95% CI=1.29-9.55, PCMT positive quarter), while the practice of residual calf suckling was protective for a bacteriologically positive quarter (OR=0.63, 95% CI=0.48-0.81, PCMT positive quarter (OR=0.69, 95% CI=0.63-0.75, Pmastitis training course for farmers and extension officers was held, and the knowledge gained and use of different methods of dissemination were assessed over time. In a subsequent randomised controlled trial, there were strong associations between knowledge gained and both the individual question asked and the combination of dissemination methods (village meeting, video and handout) used. This study demonstrated that both clinical and subclinical mastitis is common in smallholder dairying in Tanzania, and that some of the risk and protective factors for mastitis can be addressed by practical management of dairy cows following effective knowledge transfer.

  14. Combining knowledge- and data-driven methods for de-identification of clinical narratives.

    Science.gov (United States)

    Dehghan, Azad; Kovacevic, Aleksandar; Karystianis, George; Keane, John A; Nenadic, Goran

    2015-12-01

    A recent promise to access unstructured clinical data from electronic health records on large-scale has revitalized the interest in automated de-identification of clinical notes, which includes the identification of mentions of Protected Health Information (PHI). We describe the methods developed and evaluated as part of the i2b2/UTHealth 2014 challenge to identify PHI defined by 25 entity types in longitudinal clinical narratives. Our approach combines knowledge-driven (dictionaries and rules) and data-driven (machine learning) methods with a large range of features to address de-identification of specific named entities. In addition, we have devised a two-pass recognition approach that creates a patient-specific run-time dictionary from the PHI entities identified in the first step with high confidence, which is then used in the second pass to identify mentions that lack specific clues. The proposed method achieved the overall micro F1-measures of 91% on strict and 95% on token-level evaluation on the test dataset (514 narratives). Whilst most PHI entities can be reliably identified, particularly challenging were mentions of Organizations and Professions. Still, the overall results suggest that automated text mining methods can be used to reliably process clinical notes to identify personal information and thus providing a crucial step in large-scale de-identification of unstructured data for further clinical and epidemiological studies.

  15. Particular Reasons

    OpenAIRE

    Berker, Selim

    2007-01-01

    Moral particularists argue that because reasons for action are irreducibly context-dependent, the traditional quest in ethics for true and exceptionless moral principles is hopelessly misguided. In making this claim, particularists assume a general framework according to which reasons are the ground floor normative units undergirding all other normative properties and relations. They then argue that there is no cashing out in finite terms either (i) when a given non-normative feature gives ri...

  16. EXACKTE2: Exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol

    Directory of Open Access Journals (Sweden)

    Ouimet Mathieu

    2009-03-01

    Full Text Available Abstract Background While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE2 (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment, this study proposes to assess how patients and physicians influence each other in consultations. Methods We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE2 model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM: definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE2 model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations. Discussion Our proposed model, EXACKTE2, is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE

  17. [Possibilities for the improvement of the quality of knowledge and their evaluation in the course of studying clinical medicine].

    Science.gov (United States)

    Tetenev, F F; Bodrova, T N; Ageeva, T S; Karzilov, A I; Kalinina, O V

    2014-01-01

    The authors consider objective and subjective factors exerting negative influence on the quality of knowledge of physicians. The generally accepted methods for its evaluation (testing and rating-systems) have limitations. Testing reflects the level of knowledge with respect to the mode of thinking of its designer while rating mostly characterizes diligence of the trainee. It is proposed to improve the quality of knowledge by teaching the theory of diagnostics and to evaluate the amount of knowledge from the contents of the descriptive part of the medical history. The quality of knowledge can be assessed based on the contents of professional comments on the clinical picture described in the model case history.

  18. Combined clinical and home rehabilitation: case report of an integrated knowledge-to-action study in a Dutch rehabilitation stroke unit.

    Science.gov (United States)

    Nanninga, Christa S; Postema, Klaas; Schönherr, Marleen C; van Twillert, Sacha; Lettinga, Ant T

    2015-04-01

    There is growing awareness that the poor uptake of evidence in health care is not a knowledge-transfer problem but rather one of knowledge production. This issue calls for re-examination of the evidence produced and assumptions that underpin existing knowledge-to-action (KTA) activities. Accordingly, it has been advocated that KTA studies should treat research knowledge and local practical knowledge with analytical impartiality. The purpose of this case report is to illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting. A participatory action approach was used to co-create knowledge and engage local therapists in a 2-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, as the setting met the criteria articulated in stroke unit reviews. Evidence on early supported discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. Early supported discharge was tailored to the needs of patients severely affected by stroke admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR). Local therapists welcomed CCHR because it helped them make their task-specific training truly context specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures. Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change. © 2015 American Physical Therapy Association.

  19. Knowledge translation of the HELPinKIDS clinical practice guideline for managing childhood vaccination pain: usability and knowledge uptake of educational materials directed to new parents

    Directory of Open Access Journals (Sweden)

    Taddio Anna

    2013-02-01

    Full Text Available Abstract Background Although numerous evidence-based and feasible interventions are available to treat pain from childhood vaccine injections, evidence indicates that children are not benefitting from this knowledge. Unrelieved vaccination pain puts children at risk for significant long-term harms including the development of needle fears and subsequent health care avoidance behaviours. Parents report that while they want to mitigate vaccination pain in their children, they lack knowledge about how to do so. An evidence-based clinical practice guideline for managing vaccination pain was recently developed in order to address this knowledge-to-care gap. Educational tools (pamphlet and video for parents were included to facilitate knowledge transfer at the point of care. The objectives of this study were to evaluate usability and effectiveness in terms of knowledge acquisition from the pamphlet and video in parents of newly born infants. Methods Mixed methods design. Following heuristic usability evaluation of the pamphlet and video, parents of newborn infants reviewed revised versions of both tools and participated in individual and group interviews and individual knowledge testing. The knowledge test comprised of 10 true/false questions about the effectiveness of various pain management interventions, and was administered at three time points: at baseline, after review of the pamphlet, and after review of the video. Results Three overarching themes were identified from the interviews regarding usability of these educational tools: receptivity to learning, accessibility to information, and validity of information. Parents’ performance on the knowledge test improved (p≤0.001 from the baseline phase to after review of the pamphlet, and again from the pamphlet review phase to after review of the video. Conclusions Using a robust testing process, we demonstrated usability and conceptual knowledge acquisition from a parent-directed educational

  20. Identifying best practices for clinical decision support and knowledge management in the field.

    Science.gov (United States)

    Ash, Joan S; Sittig, Dean F; Dykstra, Richard; Wright, Adam; McMullen, Carmit; Richardson, Joshua; Middleton, Blackford

    2010-01-01

    To investigate best practices for implementing and managing clinical decision support (CDS) in community hospitals and ambulatory settings, we carried out a series of ethnographic studies to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, we conducted surveys, interviews, and observations over a period of two years in eight different geographic regions of the U.S.A. We first utilized a template organizing method for an expedited analysis of the data, followed by a deeper and more time consuming interpretive approach. We identified five major categories of best practices that require careful consideration while carrying out the planning, implementation, and knowledge management processes related to CDS. As more health care organizations implement clinical systems such as computerized provider order entry with CDS, descriptions of lessons learned by CDS pioneers can provide valuable guidance so that CDS can have optimal impact on health care quality.

  1. Studying children's religious knowledge: contributions of ethnography and the clinical-critical method.

    Science.gov (United States)

    García Palacios, Mariana; Castorina, José Antonio

    2014-12-01

    We analyze different methodological and conceptual contributions of anthropology and psychogenetic theory to the research of children's religious knowledge. We argue that for the study of children's points of view it is possible to build an approach that links aspects studied by both disciplinary fields. With this aim, we revise some of their basic theoretical assumptions and recent reviews as well as their methodological proposals. Then we review the core characteristics of ethnography and the clinical-critical method-proposed by Piaget's psychogenetic theory-with the goal of stressing their potentialities as well as their limitations in research. We argue that within an ethnographic approach, we must establish certain restrictions on the clinical-critical method following basic premises of social anthropology. This approach lets us demonstrate the importance of understanding children's constructions by placing them within social relations that children produce and update in everyday interactions.

  2. [Historical evolution of some clinical and epidemiological knowledge of coccidioidomycosis in the Americas].

    Science.gov (United States)

    Negroni, R

    2008-01-01

    Coccidioidomycosis is a systemic endemic mycosis caused by two dimorphic fungi of the Coccidioides genus: Coccidioides immitis and Coccidioides posadasii. This fungal infection is only endemic in the American Continent. The majority of the epidemiological, pathogenic, clinical, mycological and therapeutical findings were obtained in the U.S.A. Coccidioidomycosis was discovered in Argentina, at the end of the XIXth century by Alejandro Posadas. In the last two decades, a new endemic zone was found in the northeast of Brazil. Several countries of the region such as Mexico, Guatemala, Honduras, Venezuela and Argentina have performed epidemiological studies which allowed a better knowledge of the endemic areas and of the clinical characteristics of this mycosis.

  3. Moral Reasoning among HEC Members: An Empirical Evaluation of the Relationship of Theory and Practice in Clinical Ethics Consultation.

    Science.gov (United States)

    Wasserman, Jason Adam; Stevenson, Shannon Lindsey; Claxton, Cassandra; Krug, Ernest F

    2015-01-01

    In light of the ongoing development and implementation of core competencies in bioethics, it is important to proceed with a clear sense of how bioethics knowledge is utilized in the functioning of hospital ethics committees (HECs). Without such an understanding, we risk building a costly edifice on a foundation that is ambiguous at best. This article examines the empirical relationship between traditional paradigms of bioethics theory and actual decision making by HEC members using survey data from HEC members. The assumption underlying the standardization of qualifications and corresponding call for increased education of HEC members is that they will base imminent case decisions on inculcated knowledge. Our data suggest, however, that HEC members first decide intuitively and then look for justification, thereby highlighting the need to re-examine the pedagogical processes of ethics education in the process of standardizing and improving competencies.

  4. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions.

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.

  5. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  6. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions.

    Directory of Open Access Journals (Sweden)

    France Légaré

    Full Text Available Knowledge translation (KT interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties.We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing.We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153 published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC and Consumers and Communication.We retrieved 2473 unique trials of which we retained only 28 (1%. Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1 and educational outreach (n = 1. Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15, communication of DNA-based disease risk estimates (n = 7, personalized risk communication (n = 3 and mobile phone messaging (n = 1. Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective.More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.

  7. Reasons of absence from clinical foundation classes from the viewpoints of medical students of Semnan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    abedin vakili

    2013-06-01

    Full Text Available Introduction : Absence of students from classes can reduce the quality of education and increase the failure rate. The present study aims to assess the reasons of absence from classes in basic sciences from the viewpoints of medical students of Semnan University of Medical Sciences in 2011. Methods: This cross-sectional study was performed using a questionnaire with the participation of medical students who undertook basic sciences' course and BSc. students who studied in year two of the course. A questionnaire containing demographic data and factors influencing on students' absence including teacher, student, educational processing and physical conditions of classrooms was designed. Students completed the questionnaire before starting of lectures in classrooms. Results: The results showed that 39% of students were absent two hours and 22.4% were absent for four hours per course credit and 38.6% said they were not aim to be absent except in emergency situation. at all.   Inappropriate teaching was identified as the main reason for absence (3.53 / 4±1.1 followed by inadequate sleep the night before the class (3.45 / 4±1.33 lack of scholarship in teaching (3.43 / 4±1.21 and lack of self-interest to the field (1.76 / 4±1.13. Conclusion: Education planners should consider factors influencing on absence of students. In faculty recruitment, academic proficiency and scholarship of teaching should also be considered. Moreover, emotional status of students should be noticed.

  8. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints.

    Science.gov (United States)

    Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang

    2015-01-01

    The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS.

  9. Knowledge in schizophrenia: The Portuguese version of KAST (Knowledge About Schizophrenia Test) and analysis of social-demographic and clinical factors' influence.

    Science.gov (United States)

    Daltio, C S; Attux, C; Ferraz, M B

    2015-10-01

    Schizophrenia is a complex disorder, and the knowledge about it can have a positive impact. The purpose of this study was to make the translation and cultural adaptation of the Knowledge About Schizophrenia Test (KAST) into Portuguese and determine the influence of clinical and socio-demographic factors on knowledge. The test was applied to 189 caregivers of patients enrolled in Schizophrenia Program of the Federal University of São Paulo, 30 caregivers of clinical patients of the General Outpatient Clinic of the same University, and 30 health professionals. The face and content validity of the test was established. The mean value (SD) obtained with the application of the final version to caregivers of schizophrenic patients was 12.96 (2.45) - maximum 17. Level of knowledge increased considering the following order: caregivers of clinical patients, caregivers of patients with schizophrenia and mental health professionals. The intraclass correlation coefficient (0.592) obtained in the test-retest was statistically significant. An influence of social class, race, gender and education of the caregiver on the test was observed, and the last two factors were more relevant. The KAST translated and adapted into Portuguese is a valid instrument and can be used as an evaluation tool on psychoeducational interventions. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation.

    Science.gov (United States)

    Levac, Danielle; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia A; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana

    2016-10-06

    Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19(th) percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported

  11. Differences in trial knowledge and motives for participation among cancer patients in phase 3 clinical trials.

    Science.gov (United States)

    Godskesen, T M; Kihlbom, U; Nordin, K; Silén, M; Nygren, P

    2016-05-01

    While participants in clinical oncology trials are essential for the advancement of cancer therapies, factors decisive for patient participation have been described but need further investigation, particularly in the case of phase 3 studies. The aim of this study was to investigate differences in trial knowledge and motives for participation in phase 3 clinical cancer trials in relation to gender, age, education levels and former trial experience. The results of a questionnaire returned from 88 of 96 patients (92%) were analysed using the Mann-Whitney U-test. There were small, barely relevant differences in trial knowledge among patients when stratified by gender, age or education. Participants with former trial experience were less aware about the right to withdraw. Male participants and those aged ≥65 years were significantly more motivated by a feeling of duty, or by the opinions of close ones. Men seem more motivated than women by external factors. With the awareness that elderly and single male participants might be a vulnerable group and participants with former trial experience are less likely to be sufficiently informed, the information consent process should focus more on these patients. We conclude that the informed consent process seems to work well, with good results within most subgroups.

  12. The Immunology of Neuromyelitis Optica—Current Knowledge, Clinical Implications, Controversies and Future Perspectives

    Science.gov (United States)

    Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

    2016-01-01

    Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%–25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients. PMID:26950113

  13. The Immunology of Neuromyelitis Optica-Current Knowledge, Clinical Implications, Controversies and Future Perspectives.

    Science.gov (United States)

    Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

    2016-03-02

    Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%-25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

  14. The Immunology of Neuromyelitis Optica—Current Knowledge, Clinical Implications, Controversies and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Michalina Jasiak-Zatonska

    2016-03-01

    Full Text Available Neuromyelitis optica (NMO is an autoimmune, demyelinating disorder of the central nervous system (CNS with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS, it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%–25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs. This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

  15. Sufficient reason and reason enough

    CERN Document Server

    Romero, Gustavo E

    2014-01-01

    I offer an analysis of the Principle of Sufficient Reason and its relevancy for the scientific endeavour. I submit that the world is not, and cannot be, rational - only some brained beings are. The Principle of Sufficient Reason is not a necessary truth nor a physical law. It is just a guiding metanomological hypothesis justified a posteriori by its success in helping us to unveil the mechanisms that operate in Nature.

  16. [Physician knowledge and attitudes on the clinical evaluation and treatment of resistant hypertension: The RESIST study].

    Science.gov (United States)

    Coca, A

    Resistant hypertension (RH) is associated with a high risk of cardiovascular and renal complications. The purpose of this study was to assess the knowledge and attitudes of Primary Care physicians, general medicine doctors, and clinical cardiologists on the management of this condition. A multicentre, descriptive, observational study based on an ad hoc questionnaire distributed to Primary Care physicians (n=1017) and general medicine physicians/clinical cardiologists (n=457). To establish the diagnosis of resistant hypertension, 69.1% of physicians confirm that systolic/diastolic blood pressure is above 140/90 mmHg, despite treatment. Furthermore, 64.9% only consider this diagnosis if the patient is treated with at least 3 medications, and 50.3% also requires that one of them is a thiazide diuretic (56.7% among specialists, P=.0004). To establish a definite diagnosis of true RH, 89.6% perform 24-h ambulatory blood pressure monitoring (93.3% of specialists, P=.0017), looking specifically for «white-coat» effect in 70.2% of cases. In addition, 79.3% verify that adherence to treatment is adequate. Between 87 and 95% of physicians indicate examinations to exclude causes of secondary hypertension. Up to 54.3% of physicians (71.3% specialists, P<.0001) consider adding a fourth drug and insisting on lifestyle interventions as a priority therapeutic measure. These data show that physician knowledge regarding the management of patients with RH is good. Interestingly, this knowledge is somewhat higher among specialists than among Primary Care physicians. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Evolution of the clinical and epidemiological knowledge about Chagas disease 90 years after its discovery

    Directory of Open Access Journals (Sweden)

    Prata Aluízio

    1999-01-01

    Full Text Available Three different periods may be considered in the evolution of knowledge about the clinical and epidemiological aspects of Chagas disease since its discovery: (a early period concerning the studies carried out by Carlos Chagas in Lassance with the collaboration of other investigators of the Manguinhos School. At that time the disease was described and the parasite, transmitters and reservoirs were studied. The coexistence of endemic goiter in the same region generated some confusion about the clinical forms of the disease; (b second period involving uncertainty and the description of isolated cases, which lasted until the 1940 decade. Many acute cases were described during this period and the disease was recognized in many Latin American countries. Particularly important were the studies of the Argentine Mission of Regional Pathology Studies, which culminated with the description of the Romaña sign in the 1930 decade, facilitating the diagnosis of the early phase of the disease. However, the chronic phase, which was the most important, continued to be difficult to recognize; (c period of consolidation of knowledge and recognition of the importance of Chagas disease. Studies conducted by Laranja, Dias and Nóbrega in Bambuí updated the description of Chagas heart disease made by Carlos Chagas and Eurico Villela. From then on, the disease was more easily recognized, especially with the emphasis on the use of a serologic diagnosis; (d period of enlargement of knowledges on the disease. The studies on denervation conducted in Ribeirão Preto by Fritz Köberle starting in the 1950 decade led to a better understanding of the relations between Chagas disease and megaesophagus and other visceral megas detected in endemic areas.

  18. Nutritional knowledge of medical students studying in clinical courses of Shahid Sadoughi University of Medical Sciences in 2012

    OpenAIRE

    H Mozaffari-Khosravi; Vaziri, N; A. Mohammadimanesh; Z. Naderi; H. Daneshbodi

    2013-01-01

    Introduction: Nutrition is one of the important components of health promotion and disease prevention. However, nutrition literacy of medical students is unclear. This study aims to determine nutritional knowledge of medical students studying in clinical course of Shahid Sadoughi University of Medical Sciences in 2012. Methods: In this cross-sectional study, 114 medical students in clinical course of Shahid Sadoughi hospital were randomly selected. Nutritional knowledge questionnaire was comp...

  19. Reasoning with Geometric Shapes

    Science.gov (United States)

    Seah, Rebecca

    2015-01-01

    Geometry belongs to branches of mathematics that develop students' visualisation, intuition, critical thinking, problem solving, deductive reasoning, logical argument and proof (Jones, 2002). It provides the basis for the development of spatial sense and plays an important role in acquiring advanced knowledge in science, technology, engineering,…

  20. An Exploration of School Counselors' Knowledge Sharing Practices Using Diffusion of Innovation Theory, Social Exchange Theory, and Theory of Reasoned Action

    Science.gov (United States)

    Shipp, Adria E.

    2010-01-01

    School counselors are expected to be advocates, collaborators, consultants, and leaders in their work with students, families, administrators, school staff, and community based stakeholders (ASCA, 2005; Shoffner & Briggs, 2001; Rowley, 2000). Underlying these expectations is the belief that school counselors are knowledgeable in the areas that…

  1. Verbal Reasoning

    Science.gov (United States)

    1992-08-31

    Psicologia , 4(3), 183-198. 94 Guyote, M.J. and Sternberg, R.J. (1981). A transitive-chain theory of syllogistic reasoning. Cognitive Psychology, 13(4), 461...personal connections. Journal of Social Psychology, 20, 39-59. Newell, A. (1990). Unified Theories of Cognition. Cambridge, Massachusetts: Harvard

  2. Lexical patterns, features and knowledge resources for coreference resolution in clinical notes.

    Science.gov (United States)

    Gooch, Phil; Roudsari, Abdul

    2012-10-01

    Generation of entity coreference chains provides a means to extract linked narrative events from clinical notes, but despite being a well-researched topic in natural language processing, general-purpose coreference tools perform poorly on clinical texts. This paper presents a knowledge-centric and pattern-based approach to resolving coreference across a wide variety of clinical records from two corpora (Ontology Development and Information Extraction (ODIE) and i2b2/VA), and describes a method for generating coreference chains using progressively pruned linked lists that reduces the search space and facilitates evaluation by a number of metrics. Independent evaluation results give an F-measure for each corpus of 79.2% and 87.5%, respectively. A baseline of blind coreference of mentions of the same class gives F-measures of 65.3% and 51.9% respectively. For the ODIE corpus, recall is significantly improved over the baseline (p0.05). For the i2b2/VA corpus, recall, precision, and F-measure are significantly improved over the baseline (papproach offers performance at least as good as human annotators and greatly increased performance over general-purpose tools. The system uses a number of open-source components that are available to download. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Cervical Cancer Screening Knowledge and Behavior among Women Attending an Urban HIV Clinic in Western Kenya.

    Science.gov (United States)

    Rosser, Joelle I; Njoroge, Betty; Huchko, Megan J

    2015-09-01

    Cervical cancer is a highly preventable disease that disproportionately affects women in developing countries and women with HIV. As integrated HIV and cervical cancer screening programs in Sub-Saharan Africa mature, we have an opportunity to measure the impact of outreach and education efforts and identify areas for future improvement. We conducted a cross-sectional survey of 106 women enrolled in care at an integrated HIV clinic in the Nyanza Province of Kenya 5 years after the start of a cervical cancer screening program. Female clinic attendees who met clinic criteria for cervical cancer screening were asked to complete an oral questionnaire assessing their cervical cancer knowledge, attitudes, and screening history. Ninety-nine percent of women had heard of screening, 70 % felt at risk, and 84 % had been screened. Increased duration of HIV diagnosis was associated with feeling at risk and with a screening history. Nearly half (48 %) of women said they would not get screened if they had to pay for it.

  4. Reasons for reoperation after epilepsy surgery: a review based on a complex clinical case with three operations

    Directory of Open Access Journals (Sweden)

    José F Téllez-Zenteno

    2010-07-01

    Full Text Available José F Téllez-Zenteno1, Farzad Moien-Afshari1, Lizbeth Hernández-Ronquillo1, Robert Griebel2, Venkat Sadanand21Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Canada; 2Department of Surgery, Division of Neurosurgery, University of Saskatchewan, Saskatoon, CanadaAbstract: The results of surgical treatment of epileptic seizures have gradually improved in the past decade, approaching 60% to 90% seizure-free outcome in temporal lobe epilepsy and 45% to 66% in extratemporal lobe epilepsy. Unfortunately some patients continue with seizures after epilepsy surgery and the studies have shown that approximately the 3% to 15% of patients with a previous failed surgical procedure are reoperated. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. In patients with intractable partial epilepsy there are many possible factors, alone or in combination, that could be related to the failure of resection. Some of the factors could be genetic or acquired predisposition to epileptogenicity. In this article we report a case with intractable epilepsy that required three interventions to render seizure free. We analyzed our specific case in the light of previous reports on reoperation and enumerate the potential reasons or reoperation that could apply to all patients with failure of an initial procedure.Keywords: intractable epilepsy, reoperation, epilepsy surgery, surgical failure

  5. Rethinking moral reasoning theory.

    Science.gov (United States)

    Nokes, K M

    1989-01-01

    Many nursing studies on moral reasoning and ethics have used Kohlberg's theory of moral development. The body of knowledge that resulted from these studies indicated that nurses and nursing students had consistently lower than expected levels of moral reasoning. Educational offerings were developed to assist nurses to improve their moral reasoning. This article explores the cognitive-developmental theory of moral development as one way of determining the moral development of nurses. Since this theory of moral reasoning focuses on the rational thought of the individual and does not consider the impact of the environment, it is of limited applicability in nursing. A new theory of morality needs to be developed--a more holistic one that will include both universal principles and contextual tissues.

  6. Management of Holding and Evaluating Comprehensive System of Electronic Clinical Reasoning Exams (Sajab in the Sixth Nationwide Medical Sciences Students Olympiad

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    Manouchehr Khoshbaten

    2015-12-01

    Full Text Available Introduction: The Nationwide Medical Sciences Students purpose of the Olympiad is to discover student’s talents and encourage them to study. It seems that holding regional Olympiad exams to select students for the National Olympiad can help us to maintain fairness. The aim of this study is Management of Holding and Evaluating Clinical Reasoning Exams Using a Comprehensive System of Electronic Clinical Reasoning Exams. Methods: Study was carried out in 2013 at the University of Medical Sciences on 750 students, 250 question designers, 37 responsibles. The nationwide universities held regional exams for the Student Olympiad in the area of clinical reasoning on specific dates and times. A quality review of the exams was done to study the strengths and weaknesses and to eliminate shortcomings and problems. Therefore, a researcher created a questionnaire with a reliability of R= 0.86 and validity was confirmed by experts, which was then loaded into the system. The collected data were analyzed using SPSS and descriptive statistics (Percent, Average, standard deviation. Results: The multimedia educational quality of the system, with an average of 69.36 ±22.79, the students and faculty members evaluated as good, with averages of 64.30 ±23.48 and 67.28 ± 22.43, respectively. The quality of the exam was evaluated as excellent by faculty members, with an average of 94.63 ±16.60 and 59.52 ±27.46, by the students. Conclusion: Evaluating the quality of the system’s performance and its ability to assess students will lead to a clarification of its strengths and weaknesses. Finally, result in the creation of a high quality evaluation system.

  7. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

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    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies.

  8. Challenging the epistemological foundations of EBM: what kind of knowledge does clinical practice require?

    Science.gov (United States)

    Hutchison, Katrina J; Rogers, Wendy A

    2012-10-01

    This paper raises questions about the epistemological foundations of evidence-based medicine (EBM). We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. © 2012 Blackwell Publishing Ltd.

  9. Knowledge discovery in clinical decision support systems for pain management: a systematic review.

    Science.gov (United States)

    Pombo, Nuno; Araújo, Pedro; Viana, Joaquim

    2014-01-01

    The occurrence of pain accounts for billions of dollars in annual medical expenditures; loss of quality of life and decreased worker productivity contribute to indirect costs. As pain is highly subjective, clinical decision support systems (CDSSs) can be critical for improving the accuracy of pain assessment and offering better support for clinical decision-making. This review is focused on computer technologies for pain management that allow CDSSs to obtain knowledge from the clinical data produced by either patients or health care professionals. A comprehensive literature search was conducted in several electronic databases to identify relevant articles focused on computerised systems that constituted CDSSs and include data or results related to pain symptoms from patients with acute or chronic pain, published between 1992 and 2011 in the English language. In total, thirty-nine studies were analysed; thirty-two were selected from 1245 citations, and seven were obtained from reference tracking. The results highlighted the following clusters of computer technologies: rule-based algorithms, artificial neural networks, nonstandard set theory, and statistical learning algorithms. In addition, several methodologies were found for content processing such as terminologies, questionnaires, and scores. The median accuracy ranged from 53% to 87.5%. Computer technologies that have been applied in CDSSs are important but not determinant in improving the systems' accuracy and the clinical practice, as evidenced by the moderate correlation among the studies. However, these systems play an important role in the design of computerised systems oriented to a patient's symptoms as is required for pain management. Several limitations related to CDSSs were observed: the lack of integration with mobile devices, the reduced use of web-based interfaces, and scarce capabilities for data to be inserted by patients. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Formative evaluation of a patient-specific clinical knowledge summarization tool.

    Science.gov (United States)

    Del Fiol, Guilherme; Mostafa, Javed; Pu, Dongqiuye; Medlin, Richard; Slager, Stacey; Jonnalagadda, Siddhartha R; Weir, Charlene R

    2016-02-01

    To iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians' perceived decision quality compared with standard search of UpToDate and PubMed. Mixed-methods observations of the interactions of 10 physicians with the CKS prototype vs. standard search in an effort to solve clinical problems posed as case vignettes. The CKS tool automatically summarizes patient-specific and actionable clinical recommendations from PubMed (high quality randomized controlled trials and systematic reviews) and UpToDate. Two thirds of the study participants completed 15 out of 17 usability tasks. The median time to task completion was less than 10s for 12 of the 17 tasks. The difference in search time between the CKS and standard search was not significant (median=4.9 vs. 4.5m in). Physician's perceived decision quality was significantly higher with the CKS than with manual search (mean=16.6 vs. 14.4; p=0.036). The CKS prototype was well-accepted by physicians both in terms of usability and usefulness. Physicians perceived better decision quality with the CKS prototype compared to standard search of PubMed and UpToDate within a similar search time. Due to the formative nature of this study and a small sample size, conclusions regarding efficiency and efficacy are exploratory. Published by Elsevier Ireland Ltd.

  11. Exploration of knowledge, attitudes and percepions regarding sexually transmitted infections among patients attending a primary health care clinic in Gauteng--part 1.

    Science.gov (United States)

    Molapo, T J; Maja, T M M; Wright, S C D

    2007-12-01

    Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for two main reasons. Firstly, the long-term consequences of these infections are a major cause of loss of health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. The control and prevention of sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing number of persons daily seeking treatment for sexually transmitted infections. The purpose of the study was therefore to investigate the knowledge, attitudes and perceptions of people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older) who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.

  12. Exploration of knowledge, attitudes and percepions regarding sexually transmitted infections among patients attending a primary health care clinic in Gauteng - Part 1

    Directory of Open Access Journals (Sweden)

    T.J. Molapo

    2007-09-01

    Full Text Available Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for two main reasons. Firstly, the long-term consequences of these infections are a major cause of loss of health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS epidemic. The control and prevention of sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing number of persons daily seeking treatment for sexually transmitted infections. The purpose of the study was therefore to investigate the knowledge, attitudes and perceptions of people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.

  13. Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users.

    Science.gov (United States)

    Shorofi, Seyed Afshin; Arbon, Paul

    2017-05-01

    This study was intended to examine CAM among Australian hospital-based nurses, identifying their knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users. Nurses holding a qualification in nursing and working in surgical wards were included using a convenience sampling technique. A self-complete questionnaire was developed to achieve the aims of the study. Descriptive and non-parametric statistics were calculated to describe and analyse data. Overall, 95.7% and 49.7% of nurses reported personal and professional use of CAM, respectively. The most popular CAM/CAM domain personally and professionally used by nurses was massage therapy and mind-body therapies. The primary reason for personal use of CAM was "[it] fits into my way of life/philosophy". Furthermore, massage therapists were the most commonly recommended CAM practitioners to patients. Only 15.8% of nurses would always ask patients about use of herbal medicines as part of nursing history taking. Over one-fifth (22.4%) of nurses rated their attitude as having a very positive, and 60.3% rated themselves as having very little or no knowledge of CAM. A positive correlation was also found between knowledge and attitude about CAM. Positive attitude and higher knowledge about CAM were positively correlated to CAM referrals. Several socio-demographic factors predicted personal and professional use of CAM. This study revealed that nurses generally believe not to have sufficient knowledge of CAM but are open to use CAM with patients. Nurses' positive attitude toward and personal use of CAM could be an indication that they are poised for further integration of evidence-based CAM into nursing practice to treat whole person. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. On line clinical reasoning assessment with Script Concordance test in urology: results of a French pilot study

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    Hellot Marie-France

    2006-08-01

    Full Text Available Abstract Background The Script Concordance test (SC test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists. Methods A 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a The first one for the reference panel to elaborate the scoring system; b The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient. Results The on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students. No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123. The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants. Conclusion Feasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop

  15. Lo que todo profesor necesita saber sobre el razonamiento clínico What every teacher needs to know about clinical reasoning

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    Eva Kevin W.

    2005-06-01

    reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e., conscious/controlled versus non-analytic (i.e., unconscious/automatic reasoning strategies as an orienting framework. Discussion: Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implication are drawn from this overview for clinical teachers.

  16. MANAGEMENT OF A GUILLAIN BARRE SYNDROME PATIENT THROUGH THREE TRACK REASONING: A CASE STUDY

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    Shamima Islam Nipa

    2015-12-01

    Full Text Available Background: Clinical reasoning is a thinking and decision making process which occur in clinical practice. It helps the health care providers to solve the clinical problem by using their reasoning process in an effective and efficient manner. Three track reasoning in one of the clinical reasoning process which includes the procedural, interactive and conditional reasoning to diagnose as well as ensure proper rehabilitation service according to patient and patient’s family members’ needs. Methods: A single case based study through the three track reasoning process. The purpose of this study was to explore the management strategies of a Gullian Barrie Syndrome (GBS patient through three track reasoning. We have tried to show how the basic idea behind the reasoning process helped to determine the reasoning process and diagnosis. However it has performed through theory and observation. We have also showed how we used the reasoning process through with the common sense reasoning. However it was the part of procedural reasoning in three track clinical reasoning. In three track reasoning, there is also interactive and procedural reasoning part through which we told patient story about his condition, identified his and his family members expectations and to establish hypothesis as GBS. So three track reasoning also supported us to do reasoning process rather than selecting another reasoning process. Results: After analyzing the reasoning process it was identified that to be strict in a single reasoning process is very difficult. Clinical reasoning is the clinician’s ability through which they can consider the interpretation of different clinical findings. An expert clinician must have critical thinking skill rather than ignoring any symptoms or overemphasize the symptoms. In addition, patient’s knowledge, believes and reasoning was found an important part of clinical reasoning process in this study. Conclusion: We have been practicing clinical

  17. A versatile knowledge-based clinical imaging annotation system for breast cancer screening

    Science.gov (United States)

    Gemo, Monica; Gouze, Annabelle; Debande, Benoît; Grivegnée, André; Mazy, Gilbert; Macq, Benoît

    2007-03-01

    Medical information is evolving towards more complex multimedia data representation, as new imaging modalities are made available by sophisticated devices. Features such as segmented lesions can now be extracted through analysis techniques and need to be integrated into clinical patient data. The management of structured information extracted from multimedia has been addressed in knowledge based annotation systems providing methods to attach interpretative semantics to multimedia content. Building on these methods, we develop a new clinical imaging annotation system for computer aided breast cancer screening. The proposed system aims at more consistent, efficient and standardised data mark-up of digital and digitalised radiology images. The objective is to provide detailed characterisation of abnormalities as an aid in the diagnostic task through integrated annotation management. The system combines imaging analysis results and radiologist diagnostic information about suspicious findings by mapping well-established visual and low-level descriptors into pathology specific profiles. The versatile characterisation allows differentiating annotation descriptors for different types of findings. Our approach of semi-automatic integrated annotations supports increased quality assurance in screening practice. This is achieved through detailed and objective patient imaging information while providing user-friendly means for their manipulation that is oriented to relieving the radiologist's workload.

  18. The Developmental Brain Disorders Database (DBDB): a curated neurogenetics knowledge base with clinical and research applications.

    Science.gov (United States)

    Mirzaa, Ghayda M; Millen, Kathleen J; Barkovich, A James; Dobyns, William B; Paciorkowski, Alex R

    2014-06-01

    The number of single genes associated with neurodevelopmental disorders has increased dramatically over the past decade. The identification of causative genes for these disorders is important to clinical outcome as it allows for accurate assessment of prognosis, genetic counseling, delineation of natural history, inclusion in clinical trials, and in some cases determines therapy. Clinicians face the challenge of correctly identifying neurodevelopmental phenotypes, recognizing syndromes, and prioritizing the best candidate genes for testing. However, there is no central repository of definitions for many phenotypes, leading to errors of diagnosis. Additionally, there is no system of levels of evidence linking genes to phenotypes, making it difficult for clinicians to know which genes are most strongly associated with a given condition. We have developed the Developmental Brain Disorders Database (DBDB: https://www.dbdb.urmc.rochester.edu/home), a publicly available, online-curated repository of genes, phenotypes, and syndromes associated with neurodevelopmental disorders. DBDB contains the first referenced ontology of developmental brain phenotypes, and uses a novel system of levels of evidence for gene-phenotype associations. It is intended to assist clinicians in arriving at the correct diagnosis, select the most appropriate genetic test for that phenotype, and improve the care of patients with developmental brain disorders. For researchers interested in the discovery of novel genes for developmental brain disorders, DBDB provides a well-curated source of important genes against which research sequencing results can be compared. Finally, DBDB allows novel observations about the landscape of the neurogenetics knowledge base.

  19. Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine.

    Science.gov (United States)

    Hartling, Lisa; Scott-Findlay, Shannon; Johnson, David; Osmond, Martin; Plint, Amy; Grimshaw, Jeremy; Klassen, Terry P

    2007-11-01

    In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.

  20. Diagrammatic Reasoning

    DEFF Research Database (Denmark)

    Tylén, Kristian; Fusaroli, Riccardo; Stege Bjørndahl, Johanne

    2015-01-01

    of representational artifacts for purposes of thinking and communicating is discussed in relation to C.S. Peirce’s notion of diagrammatical reasoning. We propose to extend Peirce’s original ideas and sketch a conceptual framework that delineates different kinds of diagram manipulation: Sometimes diagrams...... are manipulated in order to profile known information in an optimal fashion. At other times diagrams are explored in order to gain new insights, solve problems or discover hidden meaning potentials. The latter cases often entail manipulations that either generate additional information or extract information...