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PubMed2004

Organizational wisdom.

In recent years, much theoretical and empirical attention has focused on wisdom as a psychological construct. The development of wisdom is viewed as a positive aspect of aging, but also has a complement to more traditionally-studied domains of intelligence. Two studies, involving a total of 327 adults, examined how our understanding of the construct might be furthered by its application into specific, problematic contexts, and by having its utility assessed. This involved: 1) development of an instrument that related the elements of wisdom to the context of work organizations; 2) identification of the primary ways in which wisdom contributes to well-being in work organizations; and 3) identification of types of organizations (organizational cultures) most likely to need and value wise persons of influence in their midst. Results suggest that wisdom is of greatest consequence when it fills an important gap in what is offered by the organization's (or society's) formal structure. Where the culture has developed more formal institutions, structure, and principles to guide its activities and ensure fairness in how people are treated, there may be less need for informal sources of organizational wisdom.

Adolescent↗

PubMed2006

The practice of health care: wisdom as a model.

Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self (professional), other (patient and/or carers and/or colleagues) and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning.

Bioethical Issues↗

PubMed2002

Whither our art? Clinical wisdom and evidence-based medicine.

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise.

Australia↗

PubMed2000

Wisdom. A metaheuristic (pragmatic) to orchestrate mind and virtue toward excellence.

The primary focus of this article is on the presentation of wisdom research conducted under the heading of the Berlin wisdom paradigm. Informed by a cultural-historical analysis, wisdom in this paradigm is defined as an expert knowledge system concerning the fundamental pragmatics of life. These include knowledge and judgment about the meaning and conduct of life and the orchestration of human development toward excellence while attending conjointly to personal and collective well-being. Measurement includes think-aloud protocols concerning various problems of life associated with life planning, life management, and life review. Responses are evaluated with reference to a family of 5 criteria: rich factual and procedural knowledge, lifespan contextualism, relativism of values and life priorities, and recognition and management of uncertainty. A series of studies is reported that aim to describe, explain, and optimize wisdom. The authors conclude with a new theoretical perspective that characterizes wisdom as a cognitive and motivational metaheuristic (pragmatic) that organizes and orchestrates knowledge toward human excellence in mind and virtue, both individually and collectively.

Adult↗

PubMed2000

Toward a culturally inclusive understanding of wisdom: historical roots in the East and West.

To establish a clearer definition of wisdom as a psychological concept, Western and Eastern historical literatures were reviewed and assessed within a general analytical/synthetic framework. In the West, either in an ancient Egyptian, biblical, or philosophical sense, wisdom had been often identified as a form of analytical ability such as an increase in the knowledge database or an increase in information processing efficiency. By contrast, the Eastern understanding of wisdom, primarily derived from the ancient Vedic text, had been more inclusive, with both analytical and synthetic domains regarded as necessary moments to the whole of wisdom. The inclusive account was also discussed with respect to two important Eastern themes of wisdom: "void" and "codependence."

Cross-Cultural Comparison↗

PubMedDate not supplied

[Dental caries and fillings in wisdom teeth as an aid in forensic dentistry for determining chronologic age over 18. Radiologic studies of orthopantomography images of children and adolescents].

UNLABELLED: Dental findings are an important source of information regarding forensic-odontologic determinations of identity and a person's age. A main part of odontologic findings is the judgement of the dental status, including caries and identification of filled teeth. The aim of this study was to answer the question whether fillings of wisdom teeth allow individual age estimation, in particular the age of 18 years or older. MATERIAL AND METHODS: The orthopantomograms of 1053 outpatients were evaluated. The patients were aged 14 to 24 years. For each wisdom tooth the values "decayed", "filled", "decayed and filled", or "not decayed and not filled" were registered. The data were then calculated using tools of descriptive and inferential statistics in order to provide predictive values for the age to be above or below 18 years. RESULTS: The majority of wisdom teeth in this study group showed neither caries nor fillings. However, the correlation between filled wisdom teeth and an age over 18 years was very high, up to 100%. DISCUSSION: This study provides for the first time predictive values for the estimation whether a person is 18 years of age depending on the presence of filled wisdom teeth. This finding is a useful tool for determining the age limit of 18 years. The sanitary condition of teeth is dependent from both social and individual circumstances. Therefore, the calculated values also reflect the culture of the population under study. Further, they are time-dependent and have to be compared to data from other populations.

Adolescent↗

PubMedDate not supplied

[Measuring the distance of the wisdom teeth from the occlusal plane as forensic-odontological method for chronological age determination].

As part of an epidemiological study on tooth eruption it was attempted to define easily accessible criteria for age estimation in living human beings based on the distance of the wisdom teeth from the occlusal plane. 253 cast models of 149 female and 104 male patients were used for evaluation. Due to the great variability observed in the eruption of the wisdom teeth, only a small fraction of the total number of 10,924 cast models was suitable for investigation. Only teeth with the axis being perpendicular to the plane of occlusion during eruption according to radiological and clinical findings were included. After defining these inclusion criteria, the distance of the wisdom teeth from the plane of occlusion was determined and correlated to the age of the subjects. The results confirmed the known large variability concerning wisdom tooth eruption and did not show any reliable relation between age and distance values. Nevertheless, a remarkable finding that may be relevant for forensic odontostomatology was seen in one case where the lower wisdom teeth were taller than the occlusal plane, although the female patient was younger than 14 years. The upper molars were retained and root development was incomplete.

Adolescent↗

PubMedDate not supplied

[Identification of developmental stages of wisdom teeth on orthopantomograms of adolescents and young adults as an aid for forensic-odontological age-estimations: predictive values for the chronological age of 18 years].

UNLABELLED: Dental findings are an important source of information regarding forensic-odontologic determination of identity and age. A main part of dental age assessment is the determination of the wisdom teeth' development. The aim of this study was to answer the question whether the development of wisdom teeth can give information for the task of individual age estimation. Thereby, the investigation could contribute to age estimation efforts that are carried out on persons with an unknown age and where it is of high importance to know as exactly as possible the age of a person, e.g. the age of 18 years or older, for determining the punishment for a criminal offence. MATERIAL AND METHODS: The orthopantomograms of 1053 outpatients were evaluated. The patients were aged 14 to 24 years. The developmental stages of the wisdom teeth were determined according to Demirjian. The data were calculated using statistical tools, like descriptive and inferential statistics in order to provide predictive values for the age to be above or below 18 years. RESULTS: The correlation between the developmental stages of wisdom teeth and the chronological age was high in general. Some values allowed the prediction of an age above 18 years with a probability of more than 70% to 80%, in some instances even more than 90%. The most appropriate developmental stage to determine the age of 18 years was A 1/2 (completed root development, apex open). The positive predictive value of this finding was 94%. DISCUSSION: This study provides for the first time predictive values for the estimation whether or not a person is 18 years of age, based on the evaluation of developmental stages of wisdom teeth on orthopantomograms only. These results should be compared to data from other populations gained by the same method.

Adolescent↗

PubMed2004

Use and perception of hormone therapy following media reports of the Women's Health Initiative: a survey of Australian WISDOM participants.

OBJECTIVES: To investigate the impact of the Women's Health Initiative (WHI) on the use and perception of hormone therapy (HT) in well-informed and altruistic women who had volunteered for a similar long-term study of HT (Women's International Study of long Duration Oestrogen after Menopause, WISDOM). METHODS: A total of 840 South Australian WISDOM participants were sent questionnaires asking about their source of information about the WHI, interpretation of the 2002 WHI findings, perception of HT as a risk factor for breast cancer, attitudes towards doctors and the media and intent to use HT in the future. RESULTS: Altogether, 618 participants (74%) responded. Written and verbal information provided by WISDOM were rated as the most helpful sources of information about the WHI. Participants were aware of the increase in breast cancer and decrease in fractures seen with combined estrogen/progestogen hormone therapy (EPT) but were less convinced about the other major findings, including cardiovascular disease and dementia. HT was rated as an important risk factor for breast cancer. Participants valued medical research and were more likely to question therapies without evidence. After WHI and WISDOM, most were willing to participate in a subsequent trial and most past HT users resumed therapy. CONCLUSIONS: There are sufficient recruits for future long-term HT studies if they are given sufficient quality information and individual counselling. Our study also suggests that women who are appropriately informed may choose to take long-term HT despite a more conservative approach advised by some agencies.

Adult↗

PubMed1995

Variable-frequency stimulation patterns for the optimization of force during muscle fatigue. Muscle wisdom and the catch-like property.

Muscle wisdom is the process whereby the activation rates of motor units are modulated by the central nervous system to optimize the force during sustained voluntary contractions. During maximal voluntary contractions the activation rates decline as the muscle fatigues. No similar decline has been observed during submaximal contractions. Subsequent chapters explore the potential mechanisms for muscle wisdom. In this chapter, a historical background on the development of ideas on muscle wisdom is first presented. Next, artificial wisdom, the procedure used to optimize force during an electrically imposed tetanus by progressively reducing the stimulation frequency as the muscle fatigues, is discussed. Finally, recent studies are described in which fatigue was delayed and reduced by the use of variable-frequency stimulus trains that elicit the catch-like property of muscle.

Evoked Potentials↗

PubMed2001

[Forensic evaluation of injuries to nerves and jaw bone after wisdom tooth extraction from the viewpoint of current jurisprudence].

The removal of lower wisdom teeth is one of the most frequent operations in oral surgery. Iatrogenic lesions of the lingual and inferior alveolar nerve and fractures of the lower jaw are rare, but can lead to actions for damage and compensation for personal suffering. The aim of our investigation was to elaborate recommendations for the oral surgeon from the legal point of view. Therefore we investigated in two data banks all court decisions concerning wisdom teeth and analysed them in regard to the obligation to provide information, documentation and the minimum requirements of the surgical treatment. In 57% of all court decisions the obligation to provide information was omitted by the surgeon. Surprisingly, regarding injuries of the lingual nerve we found different opinions from various law courts. In some former decisions only the fact of the damage was equivalent to a lack of care, while recently other courts had the opinion that an injury of the lingual nerve could also be caused in spite of careful treatment. With regard to lower jaw fracture all courts emphasized that the patient must be informed about the risk by the surgeon. Moreover, minimum requirements for the removal of wisdom teeth were given. In conclusion, the recent court decisions restrict the liability for complications but demand the observance of minimum requirements for the surgical treatment. Additionally, all courts stress that informed consent about the risk of nerve damage of jaw fracture must be obtained before the removal of wisdom teeth.

Germany↗

PubMed1994

Beyond reflection: practical wisdom and the practical syllogism.

The relationship between the way nurses think and the actions they perform is one of the key debates within the nursing profession. It has been assumed that the thinking that precedes and follows nursing actions has been described within the reflective practitioner doctrine. It is suggested that this is not so, as the reflective doctrine has not only failed to explicate the link between theory and practice but some reflective theorists have perpetuated the theory-practice gap by separating thought and action. Instead it is argued that Aristotle's conceptions of Practical Wisdom and the Practical Syllogism provide a framework in which the link between thinking and doing are described. Practical wisdom is a form of knowledge that can be claimed by those who purport to deal with human good. Unlike theoretical knowledge, practical wisdom ends not in an intellectual conclusion but in the actual performing of some action designed to produce good for fellow humans. These actions are taken only after the practically wise person decides, consciously or unconsciously, the most effective and morally right option. The practical syllogism is that particular feature of critical thinking that links theory and practice in practice professions. The practical syllogism describes the means-end considerations that underpin all actions undertaken by nurses. It is not suggested that all the deliberations of those with practical wisdom is syllogistic in nature but that this is a central feature of the way in which nurses approach the care they deliver.

Humans↗

PubMed1994

Symptoms from impacted wisdom teeth.

A study of patients referred for wisdom teeth removal was carried out, to investigate symptoms prior to consultation and during the period on the waiting list for surgery. The reasons for treatment of asymptomatic wisdom teeth were investigated. Pain was the main indication for surgery in 73.7% of patients waiting for consultation. 168 patients waiting for consultation consumed a total of 271 courses of antibiotics, averaging 1.6 courses of antibiotics per patient. The antibiotic consumption increased to an average of 2.5 courses per patient in 94 patients waiting for operation. 67 out of 423 patients had an average of three lost working days due to symptoms from wisdom teeth. The long waiting list for consultation and treatment added further to the discomfort. The extent of symptoms from wisdom teeth may be underestimated.

Absenteeism↗

PubMed2005

A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves.

This randomised prospective study aimed at evaluating possible differences in the post-operative complication rate following lower wisdom tooth surgery performed with either sterile or clean surgical gloves. The microbiological profiles of the tooth sockets and glove surfaces were also evaluated and compared. A total of 275 ASA I, non-smoking and non-drinking patients consented to be randomly assigned into two groups for lower wisdom tooth surgery, performed by operators wearing either sterile or clean gloves. All the patients returned for a post-operative assessment visit one week later. An additional 40 patients were recruited and randomised into the sterile glove group (n = 20) or the clean glove group (n = 20) for the microbiology study. Specimens were taken from the glove surfaces and the post-operative socket wounds during wisdom tooth surgery. This clinical trial showed no significant difference between the sterile and clean glove groups in the incidence of acute inflammation, acute infection and dry sockets in the wounds. No single peri-operative factor had a statistically significant effect on post-operative pain intensity. Most of the bacterial isolates from the clean gloves were Gram-positive cocci or spore-forming bacilli. The total number of colony forming units and the variety of bacterial isolates from the socket wounds in the sterile and clean glove groups were similar. The study concluded that there was no advantage in using sterile surgical gloves rather than clean gloves to minimize post-operative complications in wisdom tooth surgery. There was also no apparent relationship between the bacteria contaminating the clean glove surfaces and those isolated from the socket wounds.

Adolescent↗

PubMed1994

Occupational settings facilitating wisdom-related knowledge: the sample case of clinical psychologists.

Wisdom can be defined as expert knowledge in the fundamental pragmatics of life. Examined here is whether clinical practice may facilitate access to and acquisition of such knowledge. Spontaneous think-aloud responses to 2 wisdom-related dilemmas from young (M = 32 years) and older (M = 70 years) clinicians were compared with responses obtained from other professionals. Raters judged clinicians' responses as higher on 5 criteria of wisdom: factual knowledge, procedural knowledge, life-span contextualism, value relativism, and management of uncertainty. Contrary to most studies of cognitive aging, young and older adults did not differ. Rather, each age-cohort group received highest ratings when responding to a life dilemma matched to their own life phase. Discussed is the application of a wisdom framework to assessing therapeutic treatment goals and therapist interventions as well as global changes in client's beliefs during therapy.

Adult↗

PubMed1992

Wisdom-related knowledge in a life review task: age differences and the role of professional specialization.

The study adopts life review as an avenue to access wisdom-related knowledge and examines the contribution of age and type of professional specialization to individual differences in wisdom-related knowledge. Women from 2 age groups/cohorts (young, M = 32 years; old, M = 71 years) and different professional specializations (human services vs. nonhuman services) were asked to think aloud about the life review of a fictitious woman who was either young or old. Verbal protocols were scored on 5 wisdom-related criteria: factual and procedural knowledge about life, life-span contextualism, relativism of values, recognition, and management of uncertainty. Three major findings emerged. First, human-services professionals outperformed the control group. Second, old adults performed as well as young adults. Third, for older adults wisdom-related performance was enhanced by the match between their own age and the age of the fictitious character.

Adaptation, Psychological↗

PubMed1982

Wisdom and intelligence: the nature and function of knowledge in the later years.

Intelligence can be defined as the ability to think logically, to conceptualize and abstract from reality. Wisdom can be defined as the ability to grasp human nature, which is paradoxical, contradictory, and subject to continual change. These two constructs hold potential for highlighting positive and adaptive features of development in the later years. both are considered to increase with age, and both provide for life-long acquisition of knowledge. Despite these phenotypic similarities, this paper attempts to illustrate that the nature of wisdom and its function in the developmental process differs sufficiently from cognitive ability to warrant separate scrutiny. These two constructs are compared with respect to the domains of behavior they represent, the operational tasks used to assess them, and the relationship of logic and time in their development. The function of intelligence is characterized as focusing on questions of how to do and accomplish necessary life-supporting tasks; the function of wisdom Is characterized as provoking the individual to consider the consequences of his actions both to self and their effects on others. Wisdom, therefore, evokes questions of should one pursue a particular course of action.

Aged↗

PubMed1999

On defining wisdom.

Many gerontologists propose definitions of wisdom. Usually these are "empirical," as opposed to a-priori or "real" definitions. In this article we defend an a-priori definition of wisdom. We briefly explain a-priori and empirical definitions, and how they relate to each other in research. After rejecting two classical a-priori definitions of wisdom, we present and defend our own, and examine its ability to predict key findings of recent empirical studies. Finally, we describe some implications of our approach for future empirical studies of wisdom.

Humans↗