PubMed Health⌕ Search

Biomedical subjects

A Angell

Publications and source records attributed to A Angell.

4 recordsLinked to original sources
PubMed2001

Evidence-based medicine, clinical uncertainty, and learning to doctor.

For the past two decades, evidence-based medicine (EBM), or the reliance on current scientific evidence to reach medical decisions, has been embraced as a new paradigm to standardize clinical care. Drawing from in-depth interviews with seventeen pediatric residents in two residency programs, we evaluate the extent to which the medical sociology scholarship on uncertainty analytically elucidates the recent influx of EBM during residency training. Our findings suggest that residents interpret EBM in varying ways to match their work practices: "Librarians" consult the literature while "researchers" evaluate it critically. For both groups, EBM might generate new uncertainties due to the increased reliance on information technologies and epidemiology. Whether EBM reduces uncertainty depends upon the residents' understanding of standardized knowledge and consequent incorporation of EBM in their clinical practice. Contrary to the predictions of some sociologists, EBM does not lead to a diminishment of humanitarian values in medical care. Nor does EBM lead to a science-based meritocracy on the patient ward, as claimed by some EBM advocates. Our conceptual updating of uncertainty emphasizes the continuous management of uncertainty during the medical socialization process. We argue that managing uncertainty develops along with what we term evidence-based clinical judgment.

Clinical Competence↗
PubMed1991

An ERP-based, control-question lie detector analog: algorithms for discriminating effects within individuals' average waveforms.

Two experimental, P3-based analog control question tests were run. In both, guilty subjects were presented with a set of seven phrases describing antisocial acts of which they were innocent, plus one phrase describing a guilty act (the analog relevant question), and one act to which a "yes" response (yes-target stimulus) was required to assure attention. Innocent subjects (run only in Experiment 1) saw all innocent acts plus the yes-target act. Thus nine acts were seen by guilty and innocent subjects. In both experiments, all subjects had to selectively review their guilty acts privately. Also in both experiments, all subjects were especially questioned about four acts of which guilty subjects were known to be innocent of all but one, and of which innocent subjects were known to be innocent of all. (These falsely accused acts were regarded as control question analogs.) In Experiment 1, the private review and rehearsal took place on the same day as the main test. In Experiment 2, one subgroup (delay-only) of guilty subjects was run as in Experiment 1, except that the private review-rehearsal was separated from the main run by 7-14 days. Another subgroup (delay-rehearsal) of guilty subjects was run just as was the subgroup delay-only, except that the delay-rehearsal subgroup additionally received a non-selective additional interrogation/rehearsal on the delayed main run day. Parietally maximal P3 responses were obtained to yes-target items in all groups. In Experiment 1, only in the guilty group was the relevant-minus-control P3 amplitude difference significant. In Experiment 2, the difference was significant only in the delay-rehearsal subgroup. A four-step algorithm (involving relevant-control amplitude differences and relevant target vs. control-target cross-correlations) was used to assess effects within individuals. In Experiment 1, 12 of 13 guilty subjects and 13 of 15 innocent subjects were correctly diagnosed. In Experiment 2, 3 of 8 delay-only subjects and 7 of 8 delay-rehearsal subjects were correctly diagnosed. In Experiment 2, the relevant-minus-control group P3 amplitude difference was significant in the delay-rehearsal but not in the delay-only subgroup. The results suggest that temporally proximal, non-selective rehearsal procedures are sufficient to activate personal knowledge of a salient (oddball), P3-generating stimulus phrase, and that even selective rehearsal of guilty acts is not sufficient without temporal proximity.

Adolescent↗
PubMed1983

Synthesis and release of Hageman factor (Factor XII) by the isolated perfused rat liver.

The site of synthesis of Hageman factor (HF, Factor XII) has not been previously demonstrated with certainty. We have studied the production and release of HF in the isolated perfused rat liver and have compared rates of synthesis in this system with absolute rates of degradation measured in vivo. Rat livers, perfused for 5 h with a recycling fluid consisting of a perfluorochemical emulsion (Fluosol 43), were used to demonstrate a cumulative increase of HF in the perfusate as measured by a specific and sensitive radioimmunoassay. The rate of increase in the perfusate pool of HF during the final 4 h of perfusion yielded a mean synthetic rate of 3.5 micrograms/h per 100 g body wt, which was approximately 0.2% of the synthetic rate of albumin in the same system. The cumulative appearance of albumin and transferrin was linear after 1 h and calculated rates of synthesis were 2,012 micrograms/h per 100 g and 263 micrograms/h per 100 g body wt, respectively. De novo synthesis of HF was confirmed by demonstrating incorporation of [14C]lysine into specific immunoprecipitates of HF, and by the observations that both specific incorporation of labeled amino acid and net release of immunoassayable HF were inhibited by the administration of cycloheximide. Finally, it was evident that the rates of synthesis observed in the isolated perfused liver agreed closely with absolute rates of degradation of HF measured in vivo with 125I-rat HF (4.0 micrograms/h per 100 g). From these data we conclude that the liver is the principal site of synthesis of HF.

Animals↗