Method, Judgement, and Clinical Reasoning

1999 ◽  
Vol 16 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Tony Ward
Keyword(s):  
Cognitive Skills ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Cognitive Tasks ◽  
Sources Of Knowledge ◽  
Wide Range ◽  
Gut Feelings ◽  
Cognitive Continuum ◽  
The One

AbstractResearchers have tended to take one of two mutually exclusive positions concerning the nature and status of clinical decision-making. On the one hand, clinicians are urged to be more rigorous and analytical when assessing a client, to disregard their intuitions and instead utilise explicit rules and algorithms. On the other hand, they are counselled to regard their “gut feelings” as valuable sources of knowledge about clients. As a way of reconciling these two perspectives, it is important to acknowledge that clinical psychologists are confronted with a wide range of assessment and clinical tasks that vary in their degree of structure. Therefore, in order to effectively manage the diverse tasks they face during a typical assessment, they need to possess a wide range of cognitive skills. These skills, and their associated cognitive tasks, will span the cognitive continuum from the intuitive to the analytical poles (Hammond, 1996).

scholarly journals GPs’ use of gut feelings when assessing cancer risk in primary care: A qualitative study

2020 ◽  
pp. bjgp21X714269
Author(s):  
Claire Friedemann Smith ◽  
Benedikte Moller Kristensen ◽  
Rikke Sand Andersen ◽  
FD Richard Hobbs ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Cancer Risk ◽  
Clinical Decision Making ◽  
Good Clinical Practice ◽  
Clinical Decision ◽  
Careful Examination ◽  
Qualitative Interview Study ◽  
Gut Feelings ◽  
The One

Background: The use of gut feelings to guide clinical decision-making in primary care has been frequently described but is not considered a legitimate reason for cancer referral. Aim: To explore the role that gut feelings play in clinical decision-making in primary care. Design and Setting: Qualitative interview study with 19 General Practitioners (GPs) in Oxfordshire, UK. Methods: GPs who had referred patients to a cancer pathway allowing the use of gut feeling as a referral criterion were invited to participate. Interview transcripts were analysed using the One Sheet of Paper method. Results: Gut feeling was seen as an essential part of decision-making that facilitated appropriate and timely care. GPs distanced their gut feelings from descriptions that could be seen as unscientific, describing successful use as reliant on experience and clinical knowledge. This was especially true for patients who fell within a ‘grey-area’ where clinical guidelines did not match the GP’s assessment of cancer risk, either because the guidance inadequately represented the patient’s presentation, or the patient’s presentation was missing. GPs sought to legitimise their gut feelings by gathering objective clinical evidence, careful examination of referral procedures, and consultation with colleagues. Conclusion: The GPs described their gut feelings as important to decision-making in primary care and a necessary addition to clinical guidance. The steps taken to legitimise their gut feelings matched what would be expected in good clinical practice.

scholarly journals Introduction

2021 ◽  
Vol 25 (1) ◽  
pp. 9-12
Author(s):  
Janusz Smołucha
Keyword(s):  
Cultural Heritage ◽  
Coming Out ◽  
Religious Studies ◽  
The Other ◽  
Research Center ◽  
Editorial Team ◽  
Sources Of Knowledge ◽  
Wide Range ◽  
The One

Dear Readers,After a long break caused, on the one hand, by staff changes in the Editorial Board and, on the other, by the lingering coronavirus pandemic, another issue of the Ignatianum Philosophical Yearbook is coming out. The new editorial team has decided to expand the journal’s formula to include texts from the general humanities; thus, there will be articles not only on philosophy, but also on history, cultural and religious studies, and theology, on top of Polish and foreign literature. The journal is also open to a wide range of issues that take into account the mission of the Jesuit University Ignatianum as a Catholic research center. An important element of this approach is the issue of the Mediterranean civilizational tradition and cultural heritage, which in our understanding are the most important sources of knowledge and inspiration for the study of contemporary problems of individual people, societies and states as well.

From Fieldwork to Research Theory on an Indian Pilgrimage

2005 ◽  
Vol 1 (2) ◽  
pp. 105-121 ◽  
Author(s):  
Rémy Delage
Keyword(s):  
Social Sciences ◽  
Random Sampling ◽  
South India ◽  
Scientific Discourse ◽  
The Other ◽  
Critical Reading ◽  
Major Research ◽  
Research Hypothesis ◽  
Sources Of Knowledge ◽  
The One

Using as the example of the pilgrimage to Sabarimala (Kerala, South India), I propose here to explore the links existing between sources, research hypothesis and research theory in social sciences. The choice of research materials in the process of investigation, sources of knowledge about the studied object, is not mere random sampling; it is processed in accordance with the questions of the researcher. It inevitably assumes a selective dimension. After a critical reading of the sources used by Indian studies, I will highlight on the connections between the sources and the methodological tools on the one hand, and the major research hypothesis about pilgrimage on the other. The links between the data taken from the field and the legitimacy of scientific discourse on India will be examined at the end before providing some keys for the interpretation of Sabarimala phenomenon in South India during the contemporary period.

Religion and Medicine

2020 ◽  
Author(s):  
Jeff Levin ◽  
Stephen G. Post
Keyword(s):  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Religion And Medicine ◽  
Physical And Mental Health ◽  
Faith Based ◽  
Baylor University ◽  
Wide Range ◽  
History Of ◽  
The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

Prognostic Factors for Persistent Symptoms in Adults With Mild Traumatic Brain Injury: an Overview of Systematic Reviews

2021 ◽  
Author(s):  
Julien Déry ◽  
Béatrice Ouellet ◽  
Élaine de Guise ◽  
Ève-Line Bussières ◽  
Marie-Eve Lamontagne
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Persistent Symptoms ◽  
Wide Range ◽  
Overview Of Systematic Reviews

Abstract Background: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide prevention of persistent symptoms following mTBI. Prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope.Methods: We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms.Results: From the 3857 references retrieved in database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews.Conclusion: We highlighted the need of a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decision and research related to prevention and intervention regarding persistent post-concussion symptoms.Systematic review registration: PROSPERO CRD42020176676

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Opisy interiekcji w wybranych XIX-wiecznych słownikach języka polskiego

LingVaria ◽  
2021 ◽  
Vol 31 (1) ◽  
pp. 11-24
Author(s):  
Marek Kaszewski
Keyword(s):  
19Th Century ◽  
The Other ◽  
Functional Variants ◽  
Wide Range ◽  
The One ◽  
The 19Th Century ◽  
Linguistic Units

Descriptions of Interjections in Selected Polish Dictionaries from 19th Century The author of the text analyses interjections present in three Polish dictionaries from the 19th century: the dictionaries by S.B. Linde, J.S. Bandtkie and A. Osiński, which are a part of a larger linguistic collection created in order to study and describe historical Polish interjections. The article takes into account the internal diversity of the historical class of interjections in the light of the lexicographers’ attempts to describe such units. Our attention is drawn to the lack of graphical normalization of interjections in the dictionaries, as well as the inconsistency of their marking and definition on the one hand, and the wide range of functional variants on the other. Differences in the manner of presentation of interjections in these dictionaries are also taken into account. Moreover, the author emphasizes the fact that they include a large number of animal-related (hunting) interjections. The study of the dictionary materials confirmed that their authors did not work out a method of a lexicographical description of these linguistic units.

scholarly journals The Fully Conscious Ape

2018 ◽  
Vol 31 ◽  
Author(s):  
Sue Savage-Rumbaugh ◽  
Itai Roffman ◽  
Sabatien Lingomo ◽  
Elizabeth Pugh
Keyword(s):  
Comparative Studies ◽  
Cognitive Skills ◽  
Nonhuman Primates ◽  
The Self ◽  
The Other ◽  
Human Language ◽  
Wide Range ◽  
Transfer Index ◽  
Modern Era ◽  
Current Experience

Duane Rumbaugh was one of the first primatologists of the modern era (which began after WWII), to engage in comparative studies of the cognitive capacities of nonhuman primates. In fact, it was Rumbaugh who drew the world's attention to the Order Primates and who helped initiate the International Primatological Society, IPS, the first academic society to be organized around an Order rather than a discipline. His work eventually led in two directions, first the development of the Transfer Index, a was completely new way of looking at learning. The TI seperated monkeys from apes as completely as did Gallup's mirror task. From this arose the Primate Test Battery, a video based system to test cognitive skills across a wide range of tasks from memory to numerical skils in primates. The other direction was to look at language and its effect on cognition. Only Apes succeeded in the laguage tasks. With Lana's success arose a raft of critiques that - in the light of more recent findings about the structure of human language, are now rendered invalid. Rumbaugh's initial findings in all domains has remained sound. This includes fundamental differences between monkeys and apes in their capacity to spontaneously begin control their attention, to consciously monitor their own behavior, and then to alter it deliberately, or by their own choice. It is the ape's conscious capacity to control its attention and to conciously monitor outcomes in a cause/effect manner, that allows for the acquisition of langauge. This also allows for the creation of "personal self", as a being that exists apart from the current experience of the self. Language greatly assists the emergence of this ability in apes, as does early rearing in which the ape is carried but not seperated from its mother. This allows pointing and joint reference to appear far ahead of schedule and for the spontaneouls development of human language in cross-species co-reared apes. The presence of a wild-reared mother (not present in other captive environments)also allows for the emergence of a nonhuman form of vocal language. The implications of this work for future investigations of apes are discussed.

scholarly journals Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

2020 ◽  
Vol 9 (7) ◽  
pp. 2237
Author(s):  
Nicola Galea ◽  
Francesco Bandera ◽  
Chiara Lauri ◽  
Camillo Autore ◽  
Andrea Laghi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Electronic Device ◽  
Multimodality Imaging ◽  
Nuclear Imaging ◽  
Clinical Decision ◽  
Cardiac Device ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios ◽  
Wide Range

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

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