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PubMed2002

Anti-tobacco advertisements by Massachusetts and Philip Morris: what teenagers think.

OBJECTIVE: To assess teenagers' receptivity to anti-tobacco television advertisements produced by public health organisations and by tobacco companies. Reactions were examined as a function of the message type as well as the respondents' demographics and smoking status. DESIGN: A 1999 telephone survey of teenagers in households identified during a random digit dial survey of adults conducted during the prior four years. Respondents were asked to describe an ad they had seen in the past 30 days, and then to rate its perceived effectiveness. PARTICIPANTS: Respondents were 733 youth between the ages of 14 and 17 years. INTERVENTION: The most prominent anti-tobacco advertisements broadcast in Massachusetts during the time covered by the survey consisted of those produced by the Massachusetts Tobacco Control Program and those produced by the Philip Morris tobacco company. The ads described by respondents were grouped into four categories based on their sponsor and their approach. MAIN OUTCOME MEASURES: Perceived effectiveness of anti-tobacco advertisements seen during the month before the survey as measured on an 11 point scale. RESULTS: Ads featuring the serious consequences of smoking were seen as significantly more effective by youth than both Massachusetts ads that did not discuss illness (p < 0.001) and Philip Morris "Think, Don't Smoke" ads (p < 0.001). CONCLUSION: Youth prevention programmes should not shy away from anti-tobacco ads that feature the serious consequences of smoking. These types of ads are the ones perceived as most effective by teenagers regardless of their smoking status, age, sex or ethnicity.

Adolescent↗

PubMed2004

Re-thinking acute psychiatric inpatient care.

BACKGROUND: Reports of low staff morale and high levels of patient complaints suggest that acute psychiatric wards are not achieving their full therapeutic potential. AIMS: This paper reviews some of the 'therapeutic milieu' literature to identify ways of construing ward functioning so as to maximise therapeutic and minimise destructive processes within inpatient units. METHOD: Relevant papers are reviewed, providing an understanding that permits the inpatient clinician to consider and apply the pertinent concepts. RESULTS: Five key therapeutic functions of the ward environment are identified containment, support, structure, involvement and validation. Four destructive processes are described, relating to: the isolated patient; group phenomena; the contribution of staff; and structural manifestations in the ward. CONCLUSIONS: The inpatient ward can be construed as a 'whole', embodying a range of therapeutic functions, which may need rapid deployment and dismantling, as dictated by changes in ward conditions. The 'ward-as-a-whole' construct complements individualised models of patient care and the practical implications of such thinking could engender a greater sense of agency and job satisfaction in staff.

Acute Disease↗

PubMed2004

Know when to hold 'em, know when to fold 'em: qualitative thinking outside the university.

Qualitative researchers often face a dilemma. They are asked to apply their knowledge to problems without adequate time or support to conduct projects that meet traditional academic standards of research design and methodology. Should qualitative researchers pitch in and get involved or keep their distance? What can they hope to accomplish, if anything? How do they know whether a particular job can be done? Traditional research training provides few guidelines to answer such questions. In this article, the author explores one way to think about what such guidelines might look like.

Focus Groups↗

PubMed2003

So you are thinking of having a gastrostomy?

In this article Lauren, who is 10 years old, writes a letter to Victoria, a friend who is thinking about having a gastrostomy. Lauren describes why she needed a gastrostomy and about the operation she had. In her letter she talks about how much better she feels since she had her gastrostomy placed. She writes about the advantages of having medicines put down the tube, and tries to reassure other children about gastrostomies. One of Lauren's nurses sets the scene and explains why Lauren wrote the letter in the first place.

Adaptation, Psychological↗

PubMed2006

Think of HIT.

Heparin-induced thrombocytopenia, or HIT, can present in many ways, ranging from common-isolated thrombocytopenia, venous thromboembolism, acute limb ischemia-to less common but specific presentations-necrotizing skin lesions at heparin injection sites, post-bolus acute systemic reactions, and adrenal hemorrhagic necrosis (secondary to adrenal vein thrombosis). Many patients with HIT have mild or moderate thrombocytopenia: the median platelet count nadir is 60 x 10(9)/L, and ranges from 15 to 150 x 10(9)/L in 90% of patients, most of whom evince a 50% or greater fall in the platelet count. HIT that begins after stopping heparin ("delayed-onset HIT") is increasingly recognized. Factors influencing risk of HIT include type of heparin (unfractionated heparin > low-molecular-weight heparin), type of patient (surgical > medical), and gender (female > male). Since timely diagnosis and treatment of HIT may reduce the risk of adverse outcomes, this review focuses on those clinical circumstances that should prompt the clinician to "think of HIT." Coumarin anticoagulants such as warfarin are ineffective in acute HIT and can even be deleterious by predisposing to micro-thrombosis via protein C depletion (venous limb gangrene and skin necrosis syndromes). Thus, it is important to avoid or postpone coumarin while managing HIT hypercoagulability, focusing on agents that inhibit thrombin directly (lepirudin, argatroban) or that inhibit its generation (danaparoid, fondaparinux). Post-marketing experience suggests that standard dosing of lepirudin is too high; current recommendations are to avoid the initial lepirudin bolus and to begin with lower infusion rates, even in patients without overt renal dysfunction.

Contraindications↗

PubMed2005

General practitioners' reasoning when considering the diagnosis heart failure: a think-aloud study.

BACKGROUND: Diagnosing chronic heart failure is difficult, especially in mild cases or early in the course of the disease, and guidelines are not easily implemented in everyday practice. The aim of this study was to investigate general practitioners' diagnostic reasoning about patients with suspected chronic heart failure in comparison with recommendations in European guidelines. METHODS: Think-aloud technique was used. Fifteen general practitioners reasoned about six case vignettes, representing authentic patients with suspected chronic heart failure. Information about each case was added successively in five steps. The general practitioners said their thoughts aloud while reasoning about the probability of the patient having chronic heart failure, and tried to decide about the diagnosis. Arguments for and against chronic heart failure were analysed and compared to recommendations in guidelines. RESULTS: Information about ejection fraction was the most frequent diagnostic argument, followed by information about cardiac enlargement or pulmonary congestion on chest X-ray. However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning. Only three of the 15 doctors used information about a normal electrocardiography as an argument against chronic heart failure. Information about other cardio-vascular diseases was frequently used as a diagnostic argument. CONCLUSIONS: The clinical information was not utilized to the extent recommended in guidelines. Some implications of our study are that 1) general practitioners need more information about how to utilize echocardiography when diagnosing chronic heart failure, 2) guidelines ought to give more importance to information about other cardio-vascular diseases in the diagnostic reasoning, and 3) guidelines ought to treat the topic of diastolic heart failure in a clearer way.

Cognition↗

PubMed2006

Implementing chlamydia screening: what do women think? A systematic review of the literature.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. ELIGIBILITY CRITERIA: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Attitude to Health↗

PubMed2004

GPs' decisions on drug treatment for patients with high cholesterol values: a think-aloud study.

BACKGROUND: The purpose was to examine how General Practitioners (GPs) use clinical information and rules from guidelines in their decisions on drug treatment for high cholesterol values. METHODS: Twenty GPs were presented with six case vignettes and were instructed to think aloud while successively more information about a case was presented, and finally to decide if a drug should be prescribed or not. The statements were coded for the clinical information to which they referred and for favouring or not favouring prescription. RESULTS: The evaluation of clinical information was compatible with decision-making as a search for reasons or arguments. Lifestyle-related information like smoking and overweight seemed to be evaluated from different perspectives. A patient's smoking favoured treatment for some GPs and disfavoured treatment for others. CONCLUSIONS: The method promised to be useful for understanding why doctors differ in their decisions on the same patient descriptions and why rules from the guidelines are not followed strictly.

Adult↗

PubMed2004

Relational databases: a transparent framework for encouraging biology students to think informatically.

We discuss how relational databases constitute an ideal framework for representing and analyzing large-scale genomic data sets in biology. As a case study, we describe a Drosophila splice-site database that we recently developed at Wesleyan University for use in research and teaching. The database stores data about splice sites computed by a custom algorithm using Drosophila cDNA transcripts and genomic DNA and supports a set of procedures for analyzing splice-site sequence space. A generic Web interface permits the execution of the procedures with a variety of parameter settings and also supports custom structured query language queries. Moreover, new analytical procedures can be added by updating special metatables in the database without altering the Web interface. The database provides a powerful setting for students to develop informatic thinking skills.

Algorithms↗

PubMed1982

Sex differences in primary process thinking and flexibility in problem-solving in children.

The relationship between primary process thinking and flexibility in problem-solving was investigated. Specifically, it was hypothesized from psychodynamic theory that primary process integration on the Rorschach (Holt's scoring system) would be positively related to the capacity to shift problem-solving strategies on the Luchins' water-jar test. The Rorschach and water-jar test were individually administered to 47 third grade children. The hypothesis was confirmed for boys in that the Adaptive Regression score on the Rorschach was significantly related to performance on Luchins' water-jar test (r = .64, df = 16, p < .01). This relationship remained significant when IQ was partialed out (r = .59, df = 16, p < .01). There was no relationship between primary process integration and flexibility in problem solving for girls (r = .02, df = 26, NS). These results and sex differences were replicated with a second sample of children. Consistent sex differences also were found in the amount of primary process material expressed. Girls showed a significantly smaller percentage of primary process material than boys. Primary process integration was also related to Iowa test achievement scores, independent of IQ. This finding is consistent with previous studies.

Journal Article↗

PubMed1997

Rorschach interpretation with high-ability adolescent females: psychopathology or creative thinking?

Highly intelligent and creative persons have long posed interpretation difficulties for users of the Rorschach Inkblot Test. This study examined Exner's (1993) Schizophrenia, Depression, and Coping Deficit indices as adjustment measures in a sample of 43 female adolescents enrolled in an early college entrance program and a comparison group of 19 girls enrolled in public high school gifted programs. Contrary to conventional interpretation, higher scores on the Rorschach Schizophrenia Index among the accelerants were correlated with healthy emotional adjustment on both the California Psychological Inventory and the Self-Perception Profile for Adolescents (SPPA). Further analyses offered support for the hypothesis that among accelerants, elevated scores on the Rorschach constellations did not indicate psychopathology, but rather their creative thinking style.

Adaptation, Psychological↗

PubMed2001

Oncology thinking cap: scaffolded use of a simulation to learn clinical trial design.

BACKGROUND: Physicians often are called on to participate in and interpret clinical trials, but their training in this area may not provide them with the inquiry skills that are needed. Simulations have the potential to be a promising tool for helping medical students learn the skills involved in clinical trial design. However, simulations may be complex and require additional scaffolding to support learning. DESCRIPTION: The goal of this study was to teach aspects of cancer clinical trial design through the scaffolded use of a simulation, the Oncology Thinking Cap. The software-based scaffolding provided guidance in designing the trial. Subsequently, the simulation allowed students to run the designed trial, which produces detailed patient histories. This feedback then could be used to redesign the trial. EVALUATION: Twenty-four 4th-year medical students were asked to design a clinical trial in advance, on paper, to test a new anticancer drug. Student groups then designed and simulated running the clinical trial assisted by the software environment. Instructional effectiveness was measured using a pretest-posttest design that included having students (a) write a group research proposal and (b) individually critique a flawed proposal. At the group level (N = 6 groups), students demonstrated a 34% increase in the number of elements of a clinical trial that they included in their research proposals. At the individual level (N = 24), students improved by 48% in their critiques of flawed proposals. CONCLUSIONS: Scaffolding embedded in the simulator is a promising approach to helping students learn about clinical trial design.

Antineoplastic Agents↗

PubMed1997

Social problem solving in hyperactive-aggressive children: how and what they think in conditions of automatic and controlled processing.

Examined how and what children think under conditions of automatic and controlled processing within the context of social problem solving. In a condition that elicited automatic processing, hyperactive-aggressive children did not differ in being able to identify the components of a problem or in the number of solutions generated to solve a problem, but were more aggressive in the types of solutions generated, as compared to nonhyperactive-nonaggressive children. Furthermore, in a condition eliciting controlled processing, hyperactive-aggressive children did not differ in identifying problem components, generating solutions, or in anticipating outcomes for solutions, but were less able to anticipate consequences, and were more aggressive in choosing a best solution to solve a problem, as compared to nonhyperactive-nonaggressive children. The study demonstrated a relation between problem-solving codes that discriminated between groups, and overall child adjustment. Implications for social problem-solving interventions are discussed.

Adult↗

PubMed2003

Retrograde Gbb signaling through the Bmp type 2 receptor wishful thinking regulates systemic FMRFa expression in Drosophila.

Amidated neuropeptides of the FMRFamide class regulate numerous physiological processes including synaptic efficacy at the Drosophila neuromuscular junction (NMJ). We demonstrate here that mutations in wishful thinking (wit) a gene encoding a Drosophila Bmp type 2 receptor that is required for proper neurotransmitter release at the neuromuscular junction, also eliminates expression of FMRFa in that subset of neuroendocrine cells (Tv neurons) which provide the systemic supply of FMRFa peptides. We show that Gbb, a Bmp ligand expressed in the neurohemal organ provides a retrograde signal that helps specify the peptidergic phenotype of the Tv neurons. Finally, we show that supplying FMRFa in neurosecretory cells partially rescues the wit lethal phenotype without rescuing the primary morphological or electrophysiological defects of wit mutants. We propose that Wit and Gbb globally regulate NMJ function by controlling both the growth and transmitter release properties of the synapse as well as the expression of systemic modulators of NMJ synaptic activity.

Animals↗

PubMed2006

Reflective testing: what do patients think?

INTRODUCTION: Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice. METHODS: We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations. RESULTS: In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why. CONCLUSION: Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest.

Clinical Chemistry Tests↗

PubMed2003

"At risk" women who think that they have no chance of getting HIV: self-assessed perceived risks.

During the past two decades, a fair amount of inconclusive research has been conducted to examine the relationship between perceived risk of contracting HIV and actual HIV risk behavior practices. The present study examines HIV risk perceptions among a sample of 250 urban, economically-disadvantaged, primarily minority women. In particular, we focus on differences between those saying that they have no chance whatsoever of contracting HIV and those who indicated at least some possibility of becoming HIV-infected. Three research questions are addressed: (1) Are there differences between these groups attributable to their risk behavior practices? (2) To what extent do women who think that they are not at risk for HIV engage in risky behaviors that could expose them to HIV? (3) What are the most salient predictors of the women's perceived risk classification? Results showed that women perceiving themselves to have at least some HIV risk engaged in higher rates of risky behaviors than their counterparts who perceived themselves to have no possibility of contracting HIV. Despite this finding, more than one-half of the "no perceived risk of HIV" sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors. Age, childhood maltreatment experiences, self-esteem, number of HIV risk behaviors practiced, amount of illegal drug use reported, and number of times having sex were significant predictors of women's perception of having some HIV risk versus having no HIV risk.

Attitude to Health↗

PubMed1994

Physician addiction and impairment--current thinking: a review.

This is a review of the most current thinking on physician impairment with regard to definitions, prevalence, etiology, diagnosis, detection, intervention, treatment, treatment outcomes and prevention. The impaired physicians movement needs to be concerned with what is effective.

Alcoholism↗

PubMed2003

Thinking about gender types: cognitive organization of female and male types.

We examined the content and dimensional structure of a large and representative sample of gender types. In Study 1, using an open-ended procedure, participants generated 306 different labels for female types (e.g. housewife, feminist, femme fatale, secretary, slob) and 310 for male types (e.g. workaholic, family man, sissy, womanizer, labourer). In Study 2A, a multidimensional configuration of 229 of these male and female types was derived from a free sorting task among a new set of participants. In Study 2B, a subset of types was judged on several dimensions of meaning, which were then fitted into the configuration of types. The most important dimensions in describing the structure of gender types were: young-old, masculine-feminine and traditional-modern. The masculine-feminine dimension showed that the male and female types were largely separated from each other; within each gender category, the types were ordered by their position on the masculine-feminine dimension. Several other aspects of current thinking about men and women are discussed.

Adult↗