The Effect of Case Presentation on Student Physical Therapists\u27 Clinical Reasoning Hypotheses

Purpose: Clinical reasoning is an essential skill for Physical Therapists to develop for making sound decisions regarding patient care. Case-method teaching is an instructional strategy commonly implemented in physical therapy professional education programs for facilitating clinical reasoning skill acquisition. One advantage of case-method teaching is the various ways cases can be portrayed. The purpose of this study was to identify how a case is portrayed effects student thinking and their subsequent clinical decision making. Method: Third-year student physical therapists (n = 14) working in dyads clinically reasoned through a hypothetical musculoskeletal case presented via written case study or simulated patient experience. Talk aloud methodology via concurrent reports was implemented for data collection. Mann-Whitney U-tests followed by manual calculations of effect sizes were conducted for comparing hypothesis category generation between groups. Results: A total of 14 hypothesis categories were generated by the student dyads during the problem-solving sessions. Specifically, students generated more ideas regarding health condition, and contextual factors when thinking through a written case study whereas significantly more thoughts regarding symptom characteristics, client perspectives, and minimizing reasoning errors were generated during simulated patient experiences. Conclusion: When implementing case-method teaching, physical therapy academic educators need to be aware that the manner a case is portrayed affects the clinical judgements students generate and their learning of clinical reasoning. Future research should continue to investigate these effects and how they ultimately impact clinical practice

Examining Elementary Students\u27 Purposeful and Ancillary Prior Knowledge Activation When Reading Grade Level Texts

Prior knowledge activation is a crucial component of reading comprehension. Previous studies have examined students’ prompted (or solicited) purposeful knowledge activation, which occurs when the explicit goal is to activate knowledge, as well as ancillary knowledge activation, which is when students indirectly use their prior knowledge to fill in gaps in the text, form an opinion, or question the author. However, little is known regarding elementary students’ unprompted (or unsolicited) purposeful and ancillary activation of prior knowledge while reading grade level texts. The purpose of the current study was to (a) examine differences between third and fifth grade students on their use of purposeful and ancillary prior knowledge activation when reading grade level social studies and science texts; and (b) determine how students’ prior knowledge activation relates to their reading outcomes and reader profiles. Participants included 25 third grade and 27 fifth grade students from an urban school system in the southeastern United States. Participants were asked to think aloud as they read grade level texts. Utterances were transcribed and coded according to the type of knowledge activation. Although repeated measures ANOVA revealed no significant differences in purposeful or ancillary activation across texts or between grade levels, the way in which students utilized these two types of prior knowledge activation (i.e., purposeful and ancillary) differed as a function of their reader profile. To uncover these differences, we took a case study approach to further explicate the complex relations between prior knowledge activation, other reading behaviors, and reading outcomes

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Toward a Dynamic, Multidimensional Research Framework for Strategic Processing

While the empirical literature on strategic processing is vast, understanding how and why certain strategies work for certain learners is far from clear. The purpose of this review is to systematically examine the theoretical and empirical literature on strategic process to parse out current conceptual and methodological progress to inform new conceptual and methodological approaches to investigating strategic processing. From a PsycINFO search from 2011 to 2016, a pool of 134 studies was tabled with regard to key conceptual and methodological characteristics along with salient findings. These conceptual and methodological findings were then synthesized to examine how development, three aspects of strategic processing, and personal and environmental factors explained the relation between strategic processing and performance in academic domains. Three major findings emerged: less is known empirically about the developmental nature of strategic processing; quality and conditional use explain performance more consistently than simply frequency of strategy use; and, numerous person and environmental factors shape the degree to which certain strategies are effective for certain learners. A framework for future research based on these three findings is presented

Examining the ontological and epistemic assumptions of research on metacognition, self-regulation and self-regulated learning

While research on metacognition, self-regulation and self-regulated learning is quite mature, these studies have been carried out with varying methodologies and with mixed results. This paper explores the ontological and epistemological assumptions of theories, models and methods used to investigate these three constructs to examine the underlying assumptions of all three. Using oft-cited theories and models of the three constructs along with highly cited studies identified in a previous review of these constructs, this paper examined facets of two popular frameworks: Cartesian-split-mechanistic tradition (CSMT) and the relational tradition specifically looking at the role of intra-individual development, the inclusiveness of categories and notions of causality in these theories, models and methods. While the theories and methods contained elements of both traditions, methods to investigate these constructs relied almost exclusively on assumptions from CSMT. Future directions for research include incorporating more studies examining intra-individual change and multiple notions of causality. Future directions for practice include better contextualisation of research results to strengthen the link between theory and practice

Strategic processing in education

While there are certainly numerous influences on individuals\u27 learning and performance, cognitive strategies are the processes most directly related to making meaningful progress on a learning task or problem. Written by a leading expert on strategic processing, this book situates the topic within the broader context of educational psychology research and theory and brings it to a wider audience. With chapters on the fundamentals of domain-general and domain-specific strategies, connections to other constructs, and advice for instructing students, this concise volume is designed for anyeducation course that includes learning or study strategies in the curriculum. It will be indispensable for student researchers and both pre- and in-service teachers

Levels of Strategies and Strategic Processing

The influence of levels of processing on performance has seen increasing attention in the research literature over the past few decades. Although there are theories that certain types of processing or strategies should lead to better performance, such as deeper-level processing over surface-level processing, this is not always the case. Instead, there may be environmental or individual differences which lead to changes in the efficacy of specific strategies (whether surface or deep level) for specific purposes. This chapter employs a review of reviews to provide a roadmap to how levels of processing have been considered in past research as well as the current scholarship on the topic. Evidence from the reviews indicates that the relation between levels of processing and performance is not simple and is not direct. Many other individual and contextual factors, as well as facets of the strategies themselves, play an important role in whether certain types and levels of strategies help performance

The Model of Domain Learning: Understanding the Development of Expertise

The Model of Domain Learning is the first edited volume to provide a comprehensive overview of the Model of Domain Learning (MDL). Unique in its emphasis on development, this model examines both the cognitive and motivational forces behind expertise in academic domains. Chapters written by a variety of scholars, including those responsible for the model\u27s evolution, are tied together by commentaries that synthesize these varied perspectives. With dedicated sections focused on the foundations, current applications, and future potential of the MDL, this book is indispensable as an introduction to the theory and research associated with this topic and as a cutting-edge resource for established scholars