Clinical Reasoning in Physical Therapy: A Concept Analysis

Background Physical Therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. Objective The objective was to conceptualize a broad description of physical therapists’ clinical reasoning grounded in the published literature and to unify our understanding for future work related to teaching, assessment, and research. Design/Methods The design included a systematic concept analysis using Rodgers’ Evolutionary methodology. A concept analysis is a research methodology in which a concept\u27s characteristics and the relationship between features of the concept is clarified. Results Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. Limitations Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature was incomplete or key sources were mistakenly excluded. Conclusions A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to be done to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice

Evidence synthesis on the occurrence, causes, consequences, prevention and management of bullying and harassment behaviours to inform decision making in the NHS

Background Workplace bullying is a persistent problem in the NHS with negative implications for individuals, teams, and organisations. Bullying is a complex phenomenon and there is a lack of evidence on the best approaches to manage the problem. Aims Research questions What is known about the occurrence, causes, consequences and management of bullying and inappropriate behaviour in the workplace? Objectives Summarise the reported prevalence of workplace bullying and inappropriate behaviour. Summarise the empirical evidence on the causes and consequences of workplace bullying and inappropriate behaviour. Describe any theoretical explanations of the causes and consequences of workplace bullying and inappropriate behaviour. Synthesise evidence on the preventative and management interventions that address workplace bullying interventions and inappropriate behaviour. Methods To fulfil a realist synthesis approach the study was designed across four interrelated component parts: Part 1: A narrative review of the prevalence, causes and consequences of workplace bullying Part 2: A systematic literature search and realist review of workplace bullying interventions Part 3: Consultation with international bullying experts and practitioners Part 4: Identification of case studies and examples of good practic

Inter-Coder Agreement for Computational Linguistics

This article is a survey of methods for measuring agreement among corpus annotators. It exposes the mathematics and underlying assumptions of agreement coefficients, covering Krippendorff's alpha as well as Scott's pi and Cohen's kappa; discusses the use of coefficients in several annotation tasks; and argues that weighted, alpha-like coefficients, traditionally less used than kappa-like measures in computational linguistics, may be more appropriate for many corpus annotation tasks—but that their use makes the interpretation of the value of the coefficient even harder. </jats:p

Doctor of Philosophy

dissertationWith the growing national dissemination of the electronic health record (EHR), there are expectations that the public will benefit from biomedical research and discovery enabled by electronic health data. Clinical data are needed for many diseases and conditions to meet the demands of rapidly advancing genomic and proteomic research. Many biomedical research advancements require rapid access to clinical data as well as broad population coverage. A fundamental issue in the secondary use of clinical data for scientific research is the identification of study cohorts of individuals with a disease or medical condition of interest. The problem addressed in this work is the need for generalized, efficient methods to identify cohorts in the EHR for use in biomedical research. To approach this problem, an associative classification framework was designed with the goal of accurate and rapid identification of cases for biomedical research: (1) a set of exemplars for a given medical condition are presented to the framework, (2) a predictive rule set comprised of EHR attributes is generated by the framework, and (3) the rule set is applied to the EHR to identify additional patients that may have the specified condition. iv Based on this functionality, the approach was termed the ‘cohort amplification' framework. The development and evaluation of the cohort amplification framework are the subject of this dissertation. An overview of the framework design is presented. Improvements to some standard associative classification methods are described and validated. A qualitative evaluation of predictive rules to identify diabetes cases and a study of the accuracy of identification of asthma cases in the EHR using frameworkgenerated prediction rules are reported. The framework demonstrated accurate and reliable rules to identify diabetes and asthma cases in the EHR and contributed to methods for identification of biomedical research cohorts

Training methods for facial image comparison: a literature review

This literature review was commissioned to explore the psychological literature relating to facial image comparison with a particular emphasis on whether individuals can be trained to improve performance on this task. Surprisingly few studies have addressed this question directly. As a consequence, this review has been extended to cover training of face recognition and training of different kinds of perceptual comparisons where we are of the opinion that the methodologies or findings of such studies are informative. The majority of studies of face processing have examined face recognition, which relies heavily on memory. This may be memory for a face that was learned recently (e.g. minutes or hours previously) or for a face learned longer ago, perhaps after many exposures (e.g. friends, family members, celebrities). Successful face recognition, irrespective of the type of face, relies on the ability to retrieve the to-berecognised face from long-term memory. This memory is then compared to the physically present image to reach a recognition decision. In contrast, in face matching task two physical representations of a face (live, photographs, movies) are compared and so long-term memory is not involved. Because the comparison is between two present stimuli rather than between a present stimulus and a memory, one might expect that face matching, even if not an easy task, would be easier to do and easier to learn than face recognition. In support of this, there is evidence that judgment tasks where a presented stimulus must be judged by a remembered standard are generally more cognitively demanding than judgments that require comparing two presented stimuli Davies &amp; Parasuraman, 1982; Parasuraman &amp; Davies, 1977; Warm and Dember, 1998). Is there enough overlap between face recognition and matching that it is useful to look at the literature recognition? No study has directly compared face recognition and face matching, so we turn to research in which people decided whether two non-face stimuli were the same or different. In these studies, accuracy of comparison is not always better when the comparator is present than when it is remembered. Further, all perceptual factors that were found to affect comparisons of simultaneously presented objects also affected comparisons of successively presented objects in qualitatively the same way. Those studies involved judgments about colour (Newhall, Burnham &amp; Clark, 1957; Romero, Hita &amp; Del Barco, 1986), and shape (Larsen, McIlhagga &amp; Bundesen, 1999; Lawson, Bülthoff &amp; Dumbell, 2003; Quinlan, 1995). Although one must be cautious in generalising from studies of object processing to studies of face processing (see, e.g., section comparing face processing to object processing), from these kinds of studies there is no evidence to suggest that there are qualitative differences in the perceptual aspects of how recognition and matching are done. As a result, this review will include studies of face recognition skill as well as face matching skill. The distinction between face recognition involving memory and face matching not involving memory is clouded in many recognition studies which require observers to decide which of many presented faces matches a remembered face (e.g., eyewitness studies). And of course there are other forensic face-matching tasks that will require comparison to both presented and remembered comparators (e.g., deciding whether any person in a video showing a crowd is the target person). For this reason, too, we choose to include studies of face recognition as well as face matching in our revie

A critical analysis of COA research.

Five experts respected for their significant contributions to the scientific literature on children of alcoholics (COA's) offer their perspectives in a panel discussion format. The panel members reflect on the historical roots of COA research and comment on its current status and future direction. Enriched by the panelists' variety of backgrounds, research interests, and approaches, the discussion emphasizes the need to consider multiple variables that influence the risk for alcoholism among COA's

Psychologists\u27 Skepticism and Knowledge about Dissociative Identity Disorders in Adolescents

Professional skepticism about DID and lack of knowledge about DID has been documented in the adult literature on dissociative pathology (Hayes and Mitchell, 1994). Although 100% of adult DID cases are thought to have originated in childhood as sequelae of trauma, to date no studies about professional skepticism of and knowledge about DID have been done with psychologists who specialize in assessing children and adolescents. This study was designed to investigate the beliefs about DID and knowledge of DID that has been garnered by psychologists who specialize in assessing and treating adolescents. This study consisted of a convenience sample of 34 participants recruited from the American Psychological Association\u27s Division 53 and from participants surveyed via the Internet. This research replicates the study done by Hayes and Mitchell (1994) utilizing the Skepticism and Knowledge Scale designed by them. The abysmal response rate of 2.7% allowed for descriptive analysis but reduced power in calculating correlations between variables. Results indicated an inverse correlation between the Skepticism and the Knowledge variables. Unlike similar studies in the adult literature about dissociative pathology, participants lacked skepticism about DID and were knowledgeable about DID. Yet only 17.6% of the sample accurately diagnosed the DID vignette. The findings of this study reinforce other research findings (Putnam, 1991) that DID, the paradigmatic Dissociative Disorder, is seldom diagnosed in childhood and adolescence. The limitations of this study suggest that findings should be regarded as exploratory rather than conclusive as those who chose not to participate may have done so because of extreme skepticism as well as lack of knowledge about DID

CUE RECOGNITION DEVELOPMENT AMONG UNDERGRADUATE NURSING STUDENTS

Clinical judgment among nurses is imperative to assure quality, safe healthcare to all. The licensure exam for registered nurses has been criticized for not adequately measuring the clinical judgment needed by entry-level nurses. The National Board of State Boards of Nursing (NCSBN) responded to this criticism by developing a new Clinical Judgment Measurement Model (CJMM) with measurable cognitive processes, including cue recognition, to be used as a framework for item development on the new licensure exam. Nursing programs must evaluate current teaching and evaluation modalities for alignment with the new CJMM measurable cognitive processes to prepare entry-level nurses for successful completion of the licensure exam and practice. A concept analysis of cue recognition determined the defining attributes, antecedents, and consequences most commonly depicted medical, nursing, occupational therapy, and physical therapy literature. Cue recognition was more clearly defined resulting in an operational definition of cue recognition. The operational definition of cue recognition informs nurse educator of specific measurable criteria to include on student evaluations in areas such as clinical and simulation. In addition, question items on exams can be created on cue recognition using cue recognition defining attributes, antecedents, and consequences. The second paper investigated the effect of using classroom quizzing on the short and long-term cue recognition retrieval of previously learned client cues. Classroom quizzing, a retrieval-based learning strategy, was given to baccalaureate nursing students prior to watching a simulated patient scenario. The posttest scores of the group receiving the classroom quizzing scored lower than the group whom did not receive the classroom quizzing. There was no significant difference in long-term cue recognition ability as measure by retention questions one week after the intervention. The final study examined nurse educators’ knowledge of cue recognition and factors that affect the knowledge of cue recognition. The results revealed a knowledge deficit among nurse educators. Factors that affected the cue recognition knowledge level included years in the educator role, age, and confidence in using cue recognition as a teaching strategy

Consensus on nomenclature for clinical staging models in bipolar disorder : a narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Objectives: Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. Methods: Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. Results: Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed. Conclusion: The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light

Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.Siirretty Doriast