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PubMedDate not supplied

Informed consent--wishful thinking?

This article is concerned with the concept of "informed consent" as applied both in biomedical research involving human subjects and in clinical medicine in general. The current crisis over the elaboration and interpretation of the concept will be examined, along with the broader question of whether "informed consent" is any longer meaningful or viable as a criterion for complex bioethical policy-making. Finally, I will attempt to sketch a prognosis for the concept in doctor-patient relations, even if it is only wishful thinking.

Communication↗

PubMed1994

Rhythm in Chinese thinking: a short question for a long tradition.

This paper tries to shed a fresh light on the use of several key terms in traditional Chinese medicine (and philosophy) related to the theory of so-called systematic correspondence. Drawing on some influential works in Chinese science and civilization (e.g., Marcel Granet, Joseph Needham, Nathan Sivin), the paper argues that the idea of rhythm, properly defined, should become an organizing idea in studying the traditions of Chinese thinking and practice in medicine as well as in general. Rhythmicity is not periodicity (though they are inseparable from one another) and the idea of rhythm is more useful (than for example the notion of correspondence) for medical anthropology. The paper is divided into three parts: 1) the idea of rhythm in some key terms of traditional Chinese medicine, 2) the Chinese theory of resonance versus the idea of rhythm, and 3) the relation of resonance, rhythm and ecstatic experiences with respect to medical anthropology. An acquaintance with the arguments of my previous article in these pages will be helpful but not necessary for the present paper.

China↗

PubMed1989

[Plato: forerunner of demographic thinking?].

Since Malthus, several commentators have noted quantitative considerations in Plato's work, regarding him as a forerunner of demographic thinking. But how to explain several demographic contradictions between the Laws and the Republic? This paper brings out the consistency of Plato's thought, which cannot be demonstrated at a purely demographic level. His fascination for mathematics and the influence of the Pythagorean school should 1st be taken into account. However, the City, as an ideal concept and as a concrete social organization is the key to Plato's thought. Confronted with a basic problem of political philosophy, that of [power and justice, Plato proposed to restore the harmony between the City as a political body and the individual citizens. Hence policy measures which we regard unduly as eugenic and demographic, are in fact based on a conception of man quite different from ours.

Demography↗

PubMed1997

Strategic thinking for radiology.

We have now analyzed the use and benefits of four Strategic Thinking Tools for Radiology: the Vision Statement, the High Five, the Two-by-Two, and Real-Win-Worth. Additional tools will be provided during the tutorial. The tools provided above should be considered as examples. They all contain the 10 benefits outlined earlier to varying degrees. It is extremely important that the tools be used in a manner consistent with the Vision Statement of the organization. The specific situation, the effectiveness of the team, and the experience developed with the tools over time will determine the true benefits of the process. It has also been shown that with active use of the types of tools provided above, teams have learned to modify the tools for increased effectiveness and have created additional tools for specific purposes. Once individuals in the organization become committed to improving communication and to using tools/frameworks for solving problems as a team, effectiveness becomes boundless.

Humans↗

PubMed2006

Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children--more common than we think?

A case report in the journal Pediatric Nephrology describes a 15-month-old girl with the syndrome of hypertension and hyponatremia (HH syndrome) due to underlying unilateral renal artery stenosis. This syndrome is typically associated with hypokalemia and severe volume depletion and sometimes proteinuria, all of which, along with hypertension and hyponatremia, are usually corrected by resolution of the underlying renal ischemia. Gross and probably sudden activation of the renin-angiotensin system in response to renal ischemia is central to the pathophysiology although the cardiac atrial and B-type natriuretic peptides probably contribute also. Initial control of the severe hypertension may, in some cases, require careful volume repletion prior to introduction of blockade of the renin-angiotensin system in order to avoid first-dose hypotension, after which correction of the underlying renal ischemia is required. Whereas the syndrome has rarely been reported in children, it is possible that, as in adults, this reflects its lack of recognition by clinicians. The HH syndrome due to unilateral renal ischemia in children may be much more common than we think.

Humans↗

PubMed2006

What obstetrician-gynecologists think of preconception care.

OBJECTIVES: To describe obstetrician-gynecologists' opinions of preconception care (PCC) and ascertain patient uptake for this service. METHODS: A questionnaire was mailed to 1105 ACOG members in August 2004. RESULTS: There was a 60% response rate. Most physicians think PCC is important (87%) and almost always recommend it to women planning a pregnancy (94%); 54% do so with women who are sexually active. Around a third (34%) thought their patients usually do not plan their pregnancies and 49% said very few pregnant patients came in for PCC. Of those who obtain PCC, they were believed to do so more likely to assure a healthy pregnancy (83%) than because of an elevated risk for birth defects (20%). Of 11 issues presented, cigarette smoking and folic acid supplementation were rated the most important for PCC counseling; exercise and environmental concerns were the least important. CONCLUSIONS: Physicians are willing to provide PCC but few patients are accessing such services.

Adult↗

PubMed2026

Content validity, face validity and comprehensiveness of generic quality-of-life measures in adults and children with rare genetic conditions and their carers: a think aloud qualitative study.

PURPOSE: This study aims to assess the content validity, face validity and comprehensiveness of the: (a) EQ-5D-5L, EQ-HWB, and ASCOT SCT4, for adults with rare genetic conditions; (b) the EQ-5D-5L, EQ-HWB, and ASCOT-carer for carers of adults or children with rare genetic conditions; and (c) the EQ-5D-Y-5L carer proxy-complete for children with rare genetic conditions. METHODS: In total, 60 qualitative think-aloud interviews were conducted in Australia and England to understand individuals' thought process during the completion of the QoL measures. Participants were subsequently led through a semi-structured discussion. Transcripts were analysed for whether participants demonstrated understanding of the measures and thematic analysis was conducted on responses to the semi-structured discussion. RESULTS: The majority of participants showed good understanding and supported the validity of the measures for people experiencing rare conditions. For carers, however, a broader evaluative space than health-related QoL was preferred. Several non-health domains were identified as important to both patients and carers, including treatment availability, impact on employment and finance, information and uncertainty, medication and carer burden, impact of passing on a condition, relationships and social connection, and experience with the healthcare system. CONCLUSION: This study provides some support for the face validity and comprehensiveness of the measures for people experiencing rare conditions. However, several participants felt that the narrow health domains were inadequate to capture the breadth of their lived experience. Future research should explore the extent to which the measures capture differences and changes in the QoL domains identified as important to patients and carers.

Humans↗

PubMed2001

Getting scientists to think about what they are doing.

Research scientists are trained to produce specialised bricks of knowledge, but not to look at the whole building. Increasing public concern about the social role of science is forcing science students to think about what they are actually learning to do. What sort of knowledge will they be producing, and how will it be used? Science education now requires serious consideration of these philosophical and ethical questions. But the many different forms of knowledge produced by modern science cannot be covered by any single philosophical principle. Sociology and cognitive psychology are also needed to understand what the sciences have in common and the significance of what they generate. Again traditional modes of ethical analysis cannot deal adequately with the values, norms and interests activated by present-day technoscience without reference to its sociological, political and economic dimensions. What science education now requires is 'metascience', a discipline that extends beyond conventional philosophy and ethics to include the social and humanistic aspects of the scientific enterprise. For example, students need to learn about the practices, institutions, career choices, and societal responsibilities of research scientists, and to rehearse in advance some of the moral dilemmas that they are likely to meet. They need also to realise that science is changing rapidly, not only in its research techniques and organisational structures but also in its relationships with society at large.

Education↗

PubMed2004

What does the public think of placebo use? The Canadian experience.

Part of the National Placebo Initiative in Canada included public consultations, based on the belief that the views of the public should inform Canadian policy development on what constitutes appropriate placebo use. Public consultations took place nationally in 2003. A deliberative dialogue approach was used, or a structured discussion format designed to facilitate the consideration of complex issues and build consensus. The placebo debate was characterized as having 3 distinct approaches and each were explored. The first approach "Maximize Patient Protection" identified the need for experts to determine appropriate placebo use and that placebos should only be allowed under very restricted conditions. The second approach "Maximize Medical Knowledge" identified that placebos give essential information about the safety and efficacy of new drugs, and are appropriate when the rights, safety and well-being of research participants are ensured. The third approach "Maximize Patient Autonomy" identified that the current system of regulating placebo use is paternalistic and that patients should be able to define what is in their best interests and have more leeway to determine for themselves if they wish to participate in a placebo-controlled trial. Advantages and disadvantages of each approach were considered and feedback on what constitutes appropriate placebo use was sought. The major findings were that: PCTs were considered a valuable and acceptable part of advancing medical knowledge, research using placebos must be valid and justifiable; a patient-centred approach needs to be fostered; patient autonomy (choice) should be a first consideration and take clear precedence in trials of low to medium risk, patient protection (or health) may need to "trump" patient autonomy at higher levels of risk and/or patient vulnerability; placebos are not a violation of the duty of care as duty of care is best met by identifying a choice for patients, whenever a choice is available. These consultations clearly were not designed to produce conclusive evidence, but rather to provide some useful insights into what the public may think about placebo use; additional studies are indicated.

Adolescent↗

PubMed1995

Think before you prep: defining the terms of change in American healthcare.

United States physicians are grappling with a fundamental reorganization of the healthcare system. Although many remain skeptical of governmental efforts at reform, they seem to take as given an industrial efficiency model of change, including large and integrated managed care arrangements and performance measurement based on outcomes such as quality. This uncharacteristic acquiescence seems to derive in part from a confounding of concepts. This article makes three distinctions: among knowledge about practice, knowledge about quality, and outcomes research; between outcomes research and the outcomes movement; and between the outcomes movement and other options for healthcare reform. The suggestion that statistical measurement of specific variables ought not to have a priori precedence over other ways of thinking--and doing something--about healthcare is made.

Efficiency, Organizational↗

PubMed1996

Accelerated versus traditional nursing students: a comparison of stress, critical thinking ability and performance.

A high demand for graduate nurses and a dwindling pool of nursing school applicants have led several collegiate nursing programs to adopt innovative programs to increase the number of eligible applicants. One option is the development of accelerated nursing program. Because of the relative newness of these programs, the need to ascertain data about accelerated students and their success in these programs is vital. This prospective study examines the differences in stress levels, critical thinking ability, and performance of traditional and accelerated nursing students. A voluntary convenient sample (n = 94) was used from nursing students enrolled in the Associate Degree Nursing (ADN) program. The State-Trait Anxiety Inventory and the Scale of Judgmental Abilities were used to measure the two independent variables. The grade point average in nursing courses and the National Council Licensure Exam scores were employed to measure performance of students. Results revealed that accelerated students showed consistently higher stress levels than those of the traditional students. Moreover, the accelerated group had significantly higher grade averages in nursing courses than traditional students. Implications for nurse educators and recommendations for further studies were made.

Achievement↗

PubMed1994

Dynamic activities of the frontal association cortex in calculating and thinking.

We found 5-7 Hz magnetic theta waves in the frontal association cortex of adult human subjects during calculation and musical imagination by using 37-channel SQUID gradiometers. Simultaneous recording from the left and right cerebral hemispheres with two sets of 37-channel gradiometers revealed that the theta activity appeared in a waxing and waning manner in the frontal cortices of both hemispheres during the mental exercises. Electrical current dipoles for the theta waves were estimated to occur repeatedly and scatteringly in various parts of the frontal lobes of both hemispheres during continuous and intense mental exercises for 2 min. The results suggest a dynamic mode of activities in the frontal association cortex during mental effort such as calculating and thinking.

Adult↗

PubMed1992

M.V. Volkenstein, evolutionary thinking and the structure of fitness landscapes.

High dimensional fitness landscapes are robustly dominated by saddle points, not isolated peaks. We present an argument to this effect that is reminiscent of May's complexity stability analysis and trace out the significance for the dynamics of speciation, the connection between the neutral and punctuated aspects of evolution and evolution on moving landscapes. The paper is written in honor of M.V. Volkenstein (October 23rd, 1912-February 18th, 1992), who devoted his last papers to uniting dynamics with evolutionary thinking.

Biological Evolution↗

PubMedDate not supplied

What do pediatric primary care providers think are important research questions? A perspective from PROS providers.

OBJECTIVE: To describe what pediatric primary care providers involved in the Pediatric Research in Office Settings (PROS) research network think are important yet inadequately addressed questions in pediatric primary care research. METHODS: A total of 1785 pediatric primary care providers in the PROS network were asked what they thought were important yet inadequately addressed areas of primary care research. We used a single, open-ended question in a mail survey. Written answers to this question were analyzed by qualitative methods to determine the main themes of interest to pediatric primary care providers. RESULTS: Overall survey response rate was 48.7%; the open-ended question yielded 1109 individual answers. Six lines of inquiry were identified as being important to these providers: (1) effective counseling techniques to use in anticipatory guidance; (2) strategies to prevent and treat obesity; (3) the effectiveness of well-child care; (4) ongoing management of patients with attention-deficit/hyperactivity disorder; (5) the role of the primary care provider in caring for children with mental health needs; and (6) optimal organization of office practices. CONCLUSIONS: The translation of research into practice may be improved by a better understanding of the needs and interests of those who see pediatric patients in the primary care setting.

Adult↗

PubMed2005

Understanding text after severe closed-head injury: assessing inferences and memory operations with a think-aloud procedure.

A think-aloud method was used to examine the content of information available to working memory during narrative comprehension in a CHI population. Twenty severe CHI participants (>1 year post-injury) and 20 controls talked aloud after they read each sentence of story narratives. Trabasso and Magliano's (1996a) verbal protocol analysis was then used to code for the production of inferential and non-inferential clauses and the memory operations that supported inferential clause production. We found that CHI and control groups produced a comparable number of clauses, that inferences dominated narrative comprehension, and that both groups produced more explanatory inferences than predictive or associative inferences. Despite these qualitative similarities, the CHI group demonstrated poorer comprehension, generated proportionately fewer inferences, relied less on retrieval as a memory source for explanatory inferences, and produced more non-inferential clauses and associative inferences.

Adult↗

PubMed2005

Only spontaneous counterfactual thinking is impaired in patients with prefrontal cortex lesions.

Counterfactual thoughts (CFT) are mental simulations of what might have been if another behavior had been executed. They are pervasive in everyday life, help people learn from experience, modulate their emotional state, and contribute to decision-making and social functioning. To test the hypothesis that the prefrontal cortex (PFC) is involved in the generation, content, and use of CFT, we studied 18 patients with strictly prefrontal cortex lesions. Our results indicated that the PFC is crucial only for self-generated counterfactual reflections. We did not detect CFT generation differences based on lesion location within the PFC. CFT performance correlated positively with measures of attention, creativity, verbal skills, conscientiousness, and self-esteem and negatively with depression and dysexecutive symptoms. An impairment in counterfactual thinking may contribute to the lack of regret and insight often observed in patients with frontal lobe lesions.

Adult↗

PubMed2005

What does Batman think about SpongeBob? children's understanding of the fantasy/fantasy distinction.

Young children reliably distinguish reality from fantasy; they know that their friends are real and that Batman is not. But it is an open question whether they appreciate, as adults do, that there are multiple fantasy worlds. We test this by asking children and adults about fictional characters' beliefs about other characters who exist either within the same world (e.g., Batman and Robin) or in different worlds (e.g., Batman and SpongeBob). Study 1 found that although both adults and young children distinguish between within-world and across-world types of character relationships, the children make an unexpected mistake: they often claim that Batman thinks that Robin is make believe. Study 2 used a less explicit task, exploring intuitions about the actions of characters-whom they could see, touch, and talk to--and found that children show a mature appreciation of the ontology of fictional worlds.

Adolescent↗

PubMed2005

Meta-perception for pathological personality traits: do we know when others think that we are difficult?

The self allows us to reflect on our own behavior and to imagine what others think of us. Clinical experience suggests that these abilities may be impaired in people with personality disorders. They do not recognize the impact that their behavior has on others, and they have difficulty understanding how they are seen by others. We collected information regarding pathological personality traits--using both self and peer report measures--from groups of people who knew each other well (at the end of basic military training). In previous papers, we have reported that agreement between self-report and peer-report is only modest. In this paper, we address the question: Do people know that others disagree with their own perceptions of themselves? We found that expected peer scores predicted variability in peer report over and above self-report for all 10 diagnostic traits. People do have some incremental knowledge of how they are viewed by others, but they do not tell you about it unless you ask them to do so; the knowledge is not reflected in ordinary self-report data. Among participants who expect their peers to describe them as narcissistic, those who agree with this assessment are viewed as being less narcissistic by their peers than those who deny being narcissistic. It therefore appears that insight into how one is viewed by others can moderate negative impressions fostered by PD traits.

Adult↗