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PubMed2003

Contribution of the diagnostic test to the physician's diagnostic thinking: new method to evaluate the effect.

RATIONALE AND OBJECTIVES: The purpose of this study was to develop and test a method for evaluating the effect of diagnostic tests on physicians' diagnostic thinking. MATERIALS AND METHODS: The authors applied the method to data obtained in a previous study. The diagnoses of surgeons in the emergency department before and after contrast material-enhanced computed tomography (CT) and their certainty were collected from the cases of 125 adult patients with acute abdominal pain. When the pre- or post-CT diagnosis was not consistent with the final diagnosis, the diagnostic certainty reported by a physician was converted to a negative value (true diagnostic certainty). Change in true diagnostic certainty was calculated by subtracting the values for diagnostic certainty before CT from those after CT. RESULTS: In 118 cases, the change in true diagnostic certainty was positive, which indicates that the CT information was beneficial for the physician's diagnostic thinking. The true diagnostic certainty before CT was 32.9% +/- 57.6 (range: -90% to 100%; 95% confidence interval: 22.7%, 43.1%) and that after CT was 73.4% +/- 37.0 (range: -80% to 100%; 95% confidence interval: 66.8%, 80.0%; P < .0001). Thus, the increase in true diagnostic certainty was 40.5% +/- 58.8 (range: -160% to 170%; 95% confidence interval: 30.1%, 69.2%). CONCLUSION: This method may be useful for estimating the effect of diagnostic tests on physicians' diagnostic thinking in variable conditions.

Abdomen, Acute↗
PubMed1977

Allusive thinking, the Word Halo and verbosity.

The concept of allusive thinking is briefly reviewed and a Pavlovian model of thinking advanced. It is hypothesized that allusive, as compared with non-allusive thinkers, have a broader but less intense attention process associated with weaker inhibition. From this model it was predicted that on word tests which require judgements of similarity of meaning, allusive thinkers would tend to choose more remote or unusual words as similar in meaning. The Word Halo Test and the Word Sorting Test were administered to 63 university students using the Object Sorting Test as a measure of allusive thinking. The prediction that allusive thinkers would choose more unusual words as similar in meaning was supported. A tendency for allusive thinkers to be more verbose than non-allusive thinkers was also noted.

Adolescent↗
PubMed2004

Inverse thinking about double mutants of enzymes.

The quantitative effect of a second damaging mutation on a mutated enzyme may be additive, partially additive, synergistic, antagonistic, or absent, in the double mutant. Each of these five possible types of interactions has its own mechanistic explanation [Mildvan, A. S., Weber, D. J., and Kuliopulos, A. (1992) Arch. Biochem. Biophys. 294, 327-340]. Additive effects indicate independent functioning of the two residues in the process being studied, such as catalysis (k(cat)) or substrate binding (K(S)). Departures from additivity reflect interaction of the two residues. Thus, partial additivity indicates cooperativity, synergy indicates anticooperativity, and antagonism indicates opposing structural effects of the two mutations. No additional effects represent limiting cases of either partial additivity or antagonism. A significant conceptual simplification is achieved by applying inverse thinking, namely, by using the parameters of the double mutant rather than those of the wild-type enzyme as the reference point. To explain partially additive effects on k(cat), inverse thinking starts with the k(cat) of the double mutant. Restoring only one residue increases k(cat) by the factor A. Restoring only the other residue increases k(cat) by the factor B. Restoring both residues is shown to increase k(cat) by a factor greater than A x B, with the excess directly measuring the cooperativity. Similarly, inverse thinking provides simpler and more intuitive explanations of synergistic and antagonistic effects, as illustrated by specific examples.

Amino Acid Substitution↗
PubMed1997

Positive thinking and moral oppression in cancer care.

Anecdotal evidence suggests that many cancer patients experience moral and psychological pressure to 'think positively' about their disease in order to 'fight' cancer. Such pressure seems to be both internally and externally generated. This paper examines some of the psychological literature which supports the connection between positive thinking and recovery but it also looks at the moral implications of these kinds of ideas, particularly when patients have to face deterioration in their health and the prospect of death. In emphasizing the positive, there may be two important consequences. Firstly, negative feelings may be marginalized or simply denied, a phenomenon which carries its own psychological implications and secondly, when faced with a failure to recover, people may interpret this as a moral failure i.e. they did not try hard enough. It is the writer's contention that such ideas can result in a sense of guilt and blame which could be diminished if not eradicated, if health care professionals were more careful to understand what is at stake when inculcating or endorsing an attitude of 'positive thinking'.

Attitude to Health↗
PubMed2000

'Science', 'critical thinking' and 'competence' for tomorrow's doctors. A review of terms and concepts.

CONTEXT: The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare? AIM AND OBJECTIVES: This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement. COMMENT: Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.

Clinical Competence↗
PubMed1998

Kolff's credo: new ways of thinking!

Dr. Willem J. Kolff's imaginative venturesomeness in adopting "new ways of thinking" has served as an encouraging model for this author's research career. In appreciation of his leadership and beginning with the favorable results that attended the initial use of the Brigham-Kolff artificial kidney at a renal center in the Korean war, this presentation summarizes four experiences to illustrate how "new ways of thinking" produced new results and new research, namely, the concept and use of prophylactic daily hemodialysis; the use of a model of acute renal failure in rats to examine mechanisms of pathogenesis and means of prevention; the recognition of patients' uremic illness as an encephalopathy that can be quantified by appropriate measures; and the use of daily peritoneal dialysis and quantified EEGs in rats to explore relationships between dialysis-induced concentrations of potentially toxic solutes, quantified indices of symptomatic uremic encephalopathy, and concurrent, localized metabolic abnormalities in the brain. The results of these "new ways of thinking" suggest that we may ultimately come to understand the clinical uremic illness and its response to dialysis.

Acute Kidney Injury↗
PubMedDate not supplied

Negative thinking mediates the effect of self-esteem on depressive symptoms in college women.

BACKGROUND: One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES: To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS: A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS: Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION: The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.

Adult↗
PubMedDate not supplied

Peer review through clinical rounds. A collaborative critical thinking strategy.

Facilitating the development of critical thinking in beginning nursing students is challenging and exciting. Peer review through student-led clinical rounds can be an effective way to promote students' critical thinking in communicating assessment data and identifying client strengths and problems. Nineteen beginning baccalaureate nursing students participated in a peer review clinical round experience and were then asked to describe their critical thinking. Strengths of using the peer-led rounds include promotion of active student learning and encouragement of collaboration among peers.

Humans↗
PubMed2006

The Edwin Smith Papyrus: the birth of analytical thinking in medicine and otolaryngology.

The Edwin Smith Papyrus, discovered in 1862 outside of Luxor, Egypt, is the oldest known surgical text in the history of civilization. The surviving scroll, a copy of an earlier text from around 3,000 B.C., gives us remarkable insight into the medical practice of ancient Egyptians in the Nile River bed during the dawn of civilization. The Papyrus is divided into 48 cases, most of which describe traumatic injuries. The text instructs the physician to examine the patient and look for revealing physical signs that may indicate the outcome of the injury. Although in modern medicine we take for granted that the use of physical examination and rational thinking lead to an accurate conclusion, 5,000 years ago, this was extraordinary. The Edwin Smith Papyrus cast aside the prevailing magic and mysticism of that time in favor of logic and deductive reasoning. As Egyptian civilization declined during the next millennium, the teachings of the Papyrus would be lost. It would not be until 300 B.C. when Hippocrates and his disciples in ancient Greece would once again revive logic in medical thinking and teaching. It is believed that the ancient Greeks had knowledge of the contents of the Edwin Smith Papyrus and its teachings and used them as the basis for their writings. As Europe entered the Dark Ages, so did medicine yet again, reverting to spells and prayers instead of judgment and reason. Although Hippocrates teachings were recognized by some scholars during the Middle Ages, they did not make up the basis for mainstream medical knowledge. With the dawn of the Renaissance, medicine would finally purge itself of its past supernatural foundation. Hippocratic teachings were used to form the basis of modern medicine, and medical pioneers in the 17 century studied the ancient Greek texts as the origin for their ideas. Many of the concepts physicians and patients today take as common knowledge originated in the Edwin Smith Papyrus. The authors attempt to uncover some of these fundamental ideas and trace them through time until their incorporation in our modern medical knowledge base. It is the rational, logical, and advanced thinking exhibited in the Edwin Smith Papyrus that mandates its respect from modern otolaryngologists and all physicians alike.

Egypt, Ancient↗
PubMed1992

Outcomes evaluation: measuring critical thinking.

Nursing education, along with higher education in general, is increasingly focusing on educational outcomes; critical thinking is one of these outcomes. This study examined the impact of a baccalaureate registered nurse programme on the critical thinking skills of students. Students were tested upon entry and exit of the programme and a significant (0.05) difference was found. Subtest gains were significant (0.05) on Recognition of Assumptions, and Deductions. A significant relationship (0.05) between the nursing grade point average (GPA) and the post-test total score existed, accounting for a variance of 4%. No relationship was found between the post-test total score and the general education GPA. The two GPA correlation coefficients were significantly different from one another (0.05). Since one goal of professional nursing education is to prepare nurses who engage in complex problem solving and critical thinking, both the curriculum and teaching strategies need to enhance these skills.

Curriculum↗
PubMed2005

Read, Think, Do!: a method for fitting research evidence into practice.

AIM: This paper discusses a process for research utilization that overcomes well-known barriers in order to influence clinical decision-making and practice change. Read, Think, Do! is a problem-solving approach to research utilization and practice development which has the potential to overcome barriers to research utilization. BACKGROUND: Any process for research utilization at the practice level needs to overcome numerous barriers in order to influence clinical decision-making and practice change. Access to research-based knowledge is an obvious first step in the evidence-based approach to care delivery, but is clearly inadequate alone in influencing the improvement of practice. DISCUSSION: Read, Think, Do! acknowledges the complexity of problem-solving processes from the outset by looking for (1) the evidence, (2) assessing the value to practice, and (3) addressing the social and cultural milieu of the practice setting to ascertain the best strategies for initiating and sustaining practice change. This approach draws distal forms of empirical knowledge that have the capacity to improve patient outcomes into the proximal knowledge base of the clinical nurse. This is achieved by collaboration, planning and evaluation involving all levels of staff and a specialist facilitator, the Clinical Nurse Consultant in evidence-based practice. CONCLUSION: Read, Think, Do! is a method of research utilization and practice development that has the potential to overcome barriers to research utilization and avoid the "misplaced concreteness" that can occur when trying to fit empiricism into practice. By addressing the breadth and diversity of issues surrounding research utilization in a systematic manner it presents a sustainable method for practice change informed by evidence.

Decision Making↗
PubMed2004

Concerning technology: thinking with Heidegger.

In human lives, technology holds sway in mundane and extraordinary ways, such as in the ways we work, entertain, transport, and feed ourselves, and importantly in the ways we encounter and manage health, disease, illness, and death. A significant area of Heidegger's later work is questioning technology. Unlike many current inquiries that centre on contemporary technology's function, utility, and positive transformations, Heidegger offers a radical way of thinking about technology through developing an inquiry that uncovers technology's essence of revealing. In this article, Heidegger's thinking about technological modes of revealing in regard to bodies, health, and illness is explored. In Heidegger's view, the ordered revealing of modern technology has overshadowed other modes of revealing. This article highlights how remembering concealment and unconcealment in its many modes can be relevant to nurses and others involved in health care. Through tracing Heidegger's thinking about technology, a more critical approach to the effects and outcomes of modern technologies within health care systems can be generated.

Biomedical Technology↗
PubMed2004

Negative thinking and the mental health of low-income single mothers.

PURPOSE: To test a conceptual model of predictors of depressive symptoms in low-income single mothers with children from 2 to 6 years of age. DESIGN: Data were collected from September 2000 to October 2002 as part of the baseline data collection for a larger study in the eastern part of the United States. A volunteer sample of 205 women who were at risk for depression was recruited. METHODS: Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, the Crandall Cognitions Inventory, and the Everyday Stressors Index. FINDINGS: More than 75% of the participants scored at least in the mild depressive range on the Beck Depression Inventory or in the high depressive range on the CES-D. Negative thinking mediated the relationship between self-esteem and depressive symptoms and partially mediated the relationship between chronic stressors and depressive symptoms. CONCLUSIONS: These findings are consistent with earlier research by this team. Negative thinking is an important factor in the development of depressive symptoms in at-risk women. As a symptom, negative thinking might be more amenable to nursing intervention than to interventions focused on reducing chronic stress.

Adaptation, Psychological↗
PubMedDate not supplied

Mathematical thinking in second-grade children with different forms of LD.

Based on their performance on a standardized achievement test, second-grade children (N = 49) were classified as having mathematics difficulties with normal reading achievement (MD only), both mathematics and reading difficulties (MD/RD), reading difficulties with normal mathematics achievement (RD only) and normal mathematics and reading achievement (NA). Each child was given a series of tasks so that we might assess their thinking across four areas of mathematics: number facts, story problems, place value, and written calculation. Children with MD/RD performed significantly worse than NA children in most areas of mathematical thinking, whereas children with MD only performed worse than NA children only on complex story problems. The MD-only group outperformed the MD/RD group on story problems and written calculation. No significant differences were found between the RD-only and NA groups on any of the tasks. The results suggested that among children with mathematics difficulties, the MD/RD subgroup is distinct from the MD-only subgroup, with the former being characterized by pervasive deficiencies in mathematical thinking and the latter by more specific deficits in problem solving.

Aptitude Tests↗
PubMed2000

"Thinking aloud": data collection in the natural setting.

Knowledge of how nurses make decisions is a desirable outcome of research. However, there currently exists an inadequacy in the techniques used to examine such decision making. In this article, the authors describe the techniques used in two studies incorporating "thinking aloud" to successfully examine the decision making of expert critical care practitioners in the natural setting. Both techniques of thinking aloud were found to provide useful information regarding decision making in the natural setting. No ethical implications were experienced in conducting these studies in the natural setting. In conclusion, the use of thinking aloud in the natural setting is an effective means of data collection.

Australia↗
PubMed2002

The Psychological Inventory of Criminal Thinking Styles (PICTS): a review and meta-analysis.

The Psychological Inventory of Criminal Thinking Styles (PICTS) is an 80-item self-report measure designed to assess crime-supporting cognitive patterns. Data from men (N = 450) and women (N = 227) offenders indicate that the PICTS thinking, validity, and content scales possess moderate to moderately high internal consistency and test-retest stability. Meta-analyses of studies in which the PICTS has been administered reveal that besides correlating with measures of past criminality, several of the PICTS thinking and content scales are capable of predicting future adjustment/release outcome at a low but statistically significant level, and two scales (En, CUR) are sensitive to program-assisted change beyond what control subjects achieve spontaneously. The factor structure of the PICTS is then examined with the aid of exploratory and confirmatory factor analysis, the results of which denote the presence of two major and two minor factors.

Cognition↗
PubMed2005

Do orthologous gene phylogenies really support tree-thinking?

BACKGROUND: Since Darwin's Origin of Species, reconstructing the Tree of Life has been a goal of evolutionists, and tree-thinking has become a major concept of evolutionary biology. Practically, building the Tree of Life has proven to be tedious. Too few morphological characters are useful for conducting conclusive phylogenetic analyses at the highest taxonomic level. Consequently, molecular sequences (genes, proteins, and genomes) likely constitute the only useful characters for constructing a phylogeny of all life. For this reason, tree-makers expect a lot from gene comparisons. The simultaneous study of the largest number of molecular markers possible is sometimes considered to be one of the best solutions in reconstructing the genealogy of organisms. This conclusion is a direct consequence of tree-thinking: if gene inheritance conforms to a tree-like model of evolution, sampling more of these molecules will provide enough phylogenetic signal to build the Tree of Life. The selection of congruent markers is thus a fundamental step in simultaneous analysis of many genes. RESULTS: Heat map analyses were used to investigate the congruence of orthologues in four datasets (archaeal, bacterial, eukaryotic and alpha-proteobacterial). We conclude that we simply cannot determine if a large portion of the genes have a common history. In addition, none of these datasets can be considered free of lateral gene transfer. CONCLUSION: Our phylogenetic analyses do not support tree-thinking. These results have important conceptual and practical implications. We argue that representations other than a tree should be investigated in this case because a non-critical concatenation of markers could be highly misleading.

Algorithms↗