Osteopathic clinical reasoning: an ethnographic study of perceptual diagnostic judgments, metacognition, and reflective practice

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateThis thesis explores the use of reflective practice in osteopathic medicine and uses the method to narrate my work as an osteopathic practitioner. It explores the development of perceptual diagnostic judgments, and the role of metacognition, intuition and palpation in osteopathic clinical reasoning. A qualitative interpretive approach was used with a novel narrative method as an organising structure. This was broadly based around reflective practice models of Gibbs, (1988), Kolb, (1984) and Carper (1978) and the ideas of Schön (1983). Descriptive texts were constructed from notes taken of my thoughts whilst in the presence of patients. This allowed access, as closely as possible, to my decision making process. Finally, the descriptive texts were expanded into narratives through dialogue with the existing literature and peer review. The narratives were then analysed using thematic analysis to derive an understanding of concepts arising from the data. This thesis argues that osteopathic clinical reasoning involves multisensory perceptual diagnostic judgments that begin as soon as the patient enters the clinic, and arise as a result of the use of mental and visual imagery and embodied senses. The multisensory information that is detected by a practitioner activates pattern recognition, analytic reasoning and provides explicit feedback used in decision making. Diagnosis occurs as a result of piecing together and interpreting the multisensory information whilst maintaining awareness of other diagnostic possibilities. The findings also suggest that osteopathic clinical reasoning involves the supervision of cognition by the metacognitive processes of meta-knowledge (MK), meta-experiences (ME), and meta-skills (MS). The latter are used to plan, monitor, analyse, predict, evaluate and revise the consultation and patient management as suggested by Pesut and Herman (1992). ME is demonstrated by the presence of judgments of learning used to ensure sufficient information has been gathered, and feelings of rightness that are used to perceive the correctness of information arriving and decisions made. The use of reflective practice in this research has developed the understanding of osteopathic clinical reasoning, and demonstrated that it provides a powerful conduit for change in practice. As a result, it enables the provision of better patient-centred osteopathic healthcare incorporating the biopsychosocial model of healthcare. Although rooted in my own osteopathic practice style and strategies, it should have resonance for those within the discipline of osteopathy and has implications for osteopathic education, training and research

Affective neuroscience, emotional regulation, and international relations

International relations (IR) has witnessed an emerging interest in neuroscience, particularly for its relevance to a now widespread scholarship on emotions. Contributing to this scholarship, this article draws on the subfields of affective neuroscience and neuropsychology, which remain largely unexplored in IR. Firstly, the article draws on affective neuroscience in illuminating affect's defining role in consciousness and omnipresence in social behavior, challenging the continuing elision of emotions in mainstream approaches. Secondly, it applies theories of depth neuropsychology, which suggest a neural predisposition originating in the brain's higher cortical regions to attenuate emotional arousal and limit affective consciousness. This predisposition works to preserve individuals' self-coherence, countering implicit assumptions about rationality and motivation within IR theory. Thirdly, it outlines three key implications for IR theory. It argues that affective neuroscience and neuropsychology offer a route towards deep theorizing of ontologies and motivations. It also leads to a reassessment of the social regulation of emotions, particularly as observed in institutions, including the state. It also suggests a productive engagement with constructivist and poststructuralist approaches by addressing the agency of the body in social relations. The article concludes by sketching the potential for a therapeutically-attuned approach to IR

What Makes Delusions Pathological?

Bortolotti argues that we cannot distinguish delusions from other irrational beliefs in virtue of their epistemic features alone. Although her arguments are convincing, her analysis leaves an important question unanswered: What makes delusions pathological? In this paper I set out to answer this question by arguing that the pathological character of delusions arises from an executive dysfunction in a subject’s ability to detect relevance in the environment. I further suggest that this dysfunction derives from an underlying emotional imbalance—one that leads delusional subjects to regard some contextual elements as deeply puzzling or highly significant

RGN-Net: A Global Contextual and Multiscale Information Association Network for Medical Image Segmentation

Segmentation of medical images is a necessity for the development of healthcare systems, particularly for illness diagnosis and treatment planning. Recently, convolutional neural networks (CNNs) have gained amazing success in automatically segmenting medical images to identify organs or lesions. However, the majority of these approaches are incapable of segmenting objects of varying sizes and training on tiny, skewed datasets, both of which are typical in biomedical applications. Existing solutions use multi-scale fusion strategies to handle the difficulties posed by varying sizes, but they often employ complicated models more suited to broad semantic segmentation computer vision issues. In this research, we present an end-to-end dual-branch split architecture RGN-Net that takes the benefits of the two networks into greater account. Our technique may successfully create long-term functional relationships and collect global context data. Experiments on Lung, MoNuSeg, and DRIVE reveal that our technique reaches state-of-the-art benchmarks in order to evaluate the performance of RGN-Net

Exploring parental experiences and decision-making processes following a fetal anomaly diagnosis

Often the first indication that something may be wrong in a seemingly normal pregnancy occurs during the first detailed ultrasound appointment between 16 and 20 weeks gestation. Even the most tentative suspicions of fetal anomalies is jarring. Parent’s default reality of a normal pregnancy and a ‘perfect child’ changes to one of risk factors and the possibility of an ‘unhealthy child’. This study begins with the realization of this first loss in a series of losses that follow for parents as they grapple with diagnostic information to be able to make informed medical decisions regarding their fetus and pregnancy. The study aims to explore the gap between clinical/ professional knowledge and the private worldviews of parents when they return home to process the information and make decisions. This study was situated within a Canadian healthcare context that provides prenatal screening and medical care within a socialized medicine system. Using Grounded Theory methodology, this study bridges the disciplinary boundaries of Thanatology, Psychology, Bioethics and Reproductive medicine to explore the lived experience and the processes of personal/emotional decision making of parents, as well as a needs assessment of services. The process of inquiry and the results will be discussed with relevance to scholars and clinicians on the context of end-of-life decision making that occurs within the prenatal context. Theoretical lens also examines the multiple death related and non-death losses as well as the reframed identity of parents and their unborn babies following a diagnosis of fetal anomalies

Complexity and integration. A philosophical analysis of how cancer complexity can be faced in the era of precision medicine

Complexity and integration are longstanding widely debated issues in philosophy of science and recent contributions have largely focused on biology and biomedicine. This paper specifically considers some methodological novelties in cancer research, motivated by various features of tumours as complex diseases, and shows how they encourage some rethinking of philosophical discourses on those topics. In particular, we discuss the integrative cluster approach, and analyse its potential in the epistemology of cancer. We suggest that, far from being the solution to tame cancer complexity, this approach offers a philosophically interesting new manner of considering integration, and show how it can help addressing the apparent contrast between a pluralistic and a unitary account