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PubMed1996

Evidence of deontic reasoning in 3- and 4-year-old children.

Deontic reasoning is reasoning about what one may, ought, or ought not do in a given set of circumstances. Virtually all of our social institutions and child-rearing practices presume the capacity to reason about deontic concepts, such as what is permitted, obligated, or prohibited. Despite this, very little is known about the development of deontic reasoning. Two experiments were conducted that contrasted children's reasoning performance on deontic and indicative reasoning tasks (i.e., the reduced array selection version of the Wason card selection task). Like adults, children as young as 3 years of age were found to adopt a violation-detecting strategy more often when reasoning about the deontic case than when reasoning about the indicative case. These results indicate that violation detection emerges as an effective deontic reasoning very early in human development.

Child Development↗

PubMed2001

Justifiability, sympathy level, and internal/external locus of the reasons battered women remain in abusive relationships.

Reasons why battered women remain in abusive relationships were rated by college students as to the degree of sympathy the reasons engendered, the degree to which the reasons seemed to justify the woman remaining, and whether the reasons appeared more within the woman's control (internal) or imposed upon her (external). Four clusters of reasons emerged that varied on the sympathy and justifiability ratings: Physical Restraint/Lack of Resources; Maintenance of the Relationship; Personal Deficits; and Loss of Resources. Sympathy for the individual reasons was correlated with viewing these reasons as more justifiable for keeping her in the relationship. Both sympathy and justifiability ratings were higher if the reasons were seen as externally imposed on the woman. The more the participants viewed the battered woman as possessing socially desirable traits, the more they had sympathy for the reasons she stayed and viewed them as justifiable. Gender and ethnicity differences on the ratings were also found. Implications for future research and application of the findings are discussed.

Adolescent↗

PubMed1999

Prostate-specific antigen testing in Ontario: reasons for testing patients without diagnosed prostate cancer.

BACKGROUND: The use of the prostate-specific antigen (PSA) test has been increasing rapidly in Canada since its introduction in 1988. The reasons for using the PSA test in patients without known prostate cancer are unclear. This paper reports on the first study in Canada to use physician records to assess the use of PSA testing. METHODS: A questionnaire was mailed to physicians attending 475 patients without diagnosed prostate cancer. The patients were randomly selected from 2 laboratory databases of PSA test records in the greater Toronto area during 1995. The physicians were asked to consult their patient records to avoid recall bias. Information obtained included physician's specialty, patient's age at time of PSA test and reason(s) for the test. RESULTS: There were 264 responses (56%), of which 240 (91%) were usable. Of these 240, 63% (95% confidence interval [Cl] 58%-70%) indicated that the test was conducted to screen for prostate cancer, 40% (95% Cl 34%-47%) said it was to investigate urinary symptoms, and 33% (95% Cl 27%-40%) responded that it was a follow-up to a medical procedure or drug therapy. More than one reason was permitted. Of 151 responses indicating screening as one reason for testing, 64% (95% Cl 56%-72%) stated that it was initiated by the patient, and 73% (95% Cl 65%-80%) stated that it was part of a routine examination. For 19%, both investigation of symptoms and screening asymptomatic patients were given as reasons for testing, and for another 19% both follow-up of a medical procedure and screening were given as reasons. Screening was recorded as a reason for testing far more commonly for patients seen by family physicians and general practitioners than for patients seen by urologists (67% v. 29%, p < 0.001). In contrast, the use of PSA testing to diagnose urinary symptoms was more common for patients seen by urologists than for those seen by family physicians and general practitioners (52% v. 37%, p = 0.044). No significant difference was found between physician groups in the use of PSA testing as a follow-up of a medical procedure (42% for urologists and 31% for family physicians and general practitioners). About 24% of the PSA test records were for patients younger than 50 and older than 70 years. PSA testing initiated by patients was more common in the practices of family physicians and general practitioners than in the practices of urologists (44% v. 13%, p < 0.001). INTERPRETATION: Screening for prostate cancer was the most common reason for PSA testing in our study group; it occurred most commonly in the family and general practice setting and was usually initiated by the patient. Differences in reasons for testing were identified by practice specialty. Although PSA screening for prostate cancer is sometimes recommended for men between 50 and 70 years of age, it is being conducted in men outside this age group.

Adult↗

PubMed2004

Comparison of clinical reasoning skills in occupational therapy students in the USA and Scotland.

Problem-based learning (PBL) in occupational therapy (OT) education has become increasingly important. However, the efficacy in identifying clinical reasoning skills has not been well researched. The purpose of this study was to evaluate the utilization of clinical reasoning by students in the USA and Scotland. Thirty OT students were videotaped during a PBL case. Responses were transcribed and compiled into 122 statements. The two primary investigators independently coded each of the responses into one of five categories: Procedural, Interactive, Conditional reasoning, N/A, or Other. Intraclass correlation coefficients reflected strong reliability between the two raters (ICC = 0.914). Results of this study indicated that the predominant form of clinical reasoning was procedural in nature (61%) followed by conditional reasoning (27%) and interactive reasoning (12%). Students in Scotland tended to use interactive reasoning more than the students in the USA. Further research is needed to explore educational models to foster clinical reasoning skills in occupational therapy students.

Adult↗

PubMed1996

Reasons for rejection of food items in Swedish families with children aged 2-17.

The aims of the study were to investigate family members' reasons for rejection of foods served in the family, the reasons for not serving specific foods, children's reasons for liking/disliking foods and the use of parental mealtime practices to encourage child eating. Also, the relationships between child/parental neophobia and (1) the reasons for not serving specific foods and (2) the use of mealtime practices were studied. A group of randomly selected families (n = 370) with children aged 2-17 years from two Swedish towns (stratified, 185 from each) were invited and 57 participated. The results are based on an ad hoc food-frequency questionnaire, a mealtime-practices questionnaire, the Food and Neophobia Scale (Pliner & Hobden, 1992), parental ratings of child food neophobia and on a child interview. The main reason for family members rejecting the foods and the main reason for children's dislikes was "distaste". The most frequent reason for children's likings was "good taste". The most frequent reasons for not serving the specific foods were "distaste", the "food did not occur to me", "seasonal/availability" and "habit". The mothers' total Food Neophobia score was significantly correlated with "did not occur to me". Parental ratings of child food neophobia were significantly correlated with mealtime-practice factors "postpone meals" and "child decides portion".

Adolescent↗

PubMed2000

Dissociation of mechanisms underlying syllogistic reasoning.

A key question for cognitive theories of reasoning is whether logical reasoning is inherently a sentential linguistic process or a process requiring spatial manipulation and search. We addressed this question in an event-related fMRI study of syllogistic reasoning, using sentences with and without semantic content. Our findings indicate involvement of two dissociable networks in deductive reasoning. During content-based reasoning a left hemisphere temporal system was recruited. By contrast, a formally identical reasoning task, which lacked semantic content, activated a parietal system. The two systems share common components in bilateral basal ganglia nuclei, right cerebellum, bilateral fusiform gyri, and left prefrontal cortex. We conclude that syllogistic reasoning is implemented in two distinct systems whose engagement is primarily a function of the presence or absence of semantic content. Furthermore, when a logical argument results in a belief-logic conflict, the nature of the reasoning process is changed by recruitment of the right prefrontal cortex.

Basal Ganglia↗

PubMed2004

Left internal mammary artery to the left anterior descending artery: effect on morbidity and mortality and reasons for nonusage.

BACKGROUND: The left internal mammary artery to the left anterior descending artery is recognized as the gold standard for revascularization. Several studies have shown the benefits of the left internal mammary artery. However, a substantial portion of patients undergoing coronary artery bypass grafting does not receive this conduit. We sought to identify reasons for nonusage of the left internal mammary artery to the left anterior descending artery, while evaluating short- and medium-term outcomes. METHODS: Between April 1997 and September 2001 a total of 4406 consecutive patients underwent coronary artery bypass grafting with revascularization to the left anterior descending artery. All data were collected prospectively except reasons for nonusage of the left internal mammary artery. Logistic regression and Cox proportional hazards analyses were used to adjust in-hospital and medium-term outcomes, respectively. Selection bias was controlled by constructing a propensity score. A case note review was carried out to determine reasons for nonusage. RESULTS: A total of 4047 patients (91.8%) received the left internal mammary artery to the left anterior descending artery leaving 359 patients (8.2%) who did not. We found no difference in hospital mortality or morbidity, however, patients receiving the left internal mammary artery had a survival advantage at 4 years. Reasons for not using the left internal mammary artery were damage to the conduit (n = 44), poor flow (n = 43), poor lung function (n = 45), unstable symptoms (n = 24), vascular problems (n = 12), and 19 patients with "other" reasons (previous radiotherapy, chest wall deformity, and obese patients). Case notes had no reason stated for 146 patients and reasons for 26 patients were unobtainable. CONCLUSIONS: Left internal mammary artery usage is not associated with any increase in hospital mortality and morbidity, but these patients have better medium-term survival. Injury on harvesting, poor flow, and poor lung function were the most common reasons for not using this conduit.

Aged↗

PubMed2006

Reasons for wanting to lose weight: different strokes for different folks.

We assessed whether treatment seeking overweight and obese people citing differing reasons for wanting to lose weight also differed in psychosocial characteristics thought to impact on weight loss. Dieting motives, self-esteem, body image, number of dieting attempts in the past two years, and the primary reason for wanting to lose weight were assessed in 106 treatment seeking overweight and obese volunteers (mean (SD) body mass index 35.5 (5.7)kg/m2; age 41.9 (10.8)y). Reasons for wanting to lose weight fell into three broad categories, with 35%, 50%, and 15% of the participants citing appearance, health, and mood, respectively. Participants citing health reasons were happier with their appearance than people citing mood or appearance reasons. Participants citing mood reasons had poorer self-image and self-esteem, a greater preoccupation with being overweight, and had attempted to diet more often than people citing appearance or health. The primary reason for overweight people seeking weight loss may reflect psychosocial differences that impact on successful weight loss. Identifying a person's reasons and motives for weight loss may help in tailoring dietary and psychological components of a weight loss program to the individual.

Adult↗

PubMed2005

Reasons for participation in and needs for continuing professional education among health workers in Ghana.

The reasons for participation in continuing professional education (CPE) programs among health workers importantly determine the level of post-CPE application in daily servicing practice and finally the quality of health services. To categorize and distinguish type of reasons in an evidence-based manner, background factors associated with reasons were identified through conducting a census targeting the health workers in three regions of Ghana (N=6696). The total number of subjects where health workers found CPE needs produced significantly positive odds ratios (OR>1) with three reasons ("to maintain and improve professional knowledge and skills", "to interact and exchange views with colleagues", and "to obtain a higher job status") of four employed for this study. That implies that health workers with those reasons have more quantities of CPE needs. Conversely, the total number of subjects where health workers found CPE needs produced significantly negative odds ratio with "to gain relief from routine" indicating it is an extrinsic reason. Therefore, whether "to gain relief from routine" is chosen as a reason for participation could be criterion of differentiating between the types of reason.

Adult↗

PubMed2006

Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study.

BACKGROUND: Nurses' clinical reasoning is of great importance for the delivery of safe and efficient care. Pressure ulcer prevention allows a variety of aspects within nursing to be viewed. OBJECTIVE: The aim of this study was to describe both the process and the content of nurses' reasoning during care planning at different nursing homes, using pressure ulcer prevention as an example. DESIGN: A qualitative research design was chosen. SETTINGS: Seven different nursing homes within one community were included. PARTICIPANTS: Eleven registered nurses were interviewed. METHOD: The methods used were think-aloud technique, protocol analysis and qualitative content analysis. Client simulation illustrating transition was used. The case used for care planning was in three parts covering the transition from hospital until 3 weeks in the nursing home. RESULT: Most nurses in this study conducted direct and indirect reasoning in a wide range of areas in connection with pressure ulcer prevention. The reasoning focused different parts of the nursing process depending on part of the case. Complex assertations as well as strategies aiming to reduce cognitive strain were rare. Nurses involved in direct nursing care held a broader reasoning than consultant nurses. Both explanations and actions based on older ideas and traditions occurred. CONCLUSIONS: Reasoning concerning pressure ulcer prevention while care planning was dominated by routine thinking. Knowing the person over a period of time made a more complex reasoning possible. The nurses' experience, knowledge together with how close to the elderly the nurses work seem to be important factors that affect the content of reasoning.

Aged↗

PubMed2002

Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study.

PURPOSE: The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance. SUBJECTS AND METHODS: Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability. RESULTS: Mean (+/- SD) presentation times at baseline were similar in the two groups (intervention group: 8 +/- 2 minutes; control group: 8 +/- 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 +/- 2 minutes, but increased by 2 +/- 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P <0.001). Presentation quality scores at baseline were similar in both groups (intervention group: 17 +/- 8 points; control group: 20 +/- 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 +/- 6 points in the quality of their presentations, while control students had an improvement of 2 +/- 7 points (on a scale of 4-36). The difference in the changes between the groups was statistically significant (mean difference = 4 points; 95% CI: 1 to 7 points; P = 0.04). CONCLUSION: A clinical reasoning curriculum, in combination with video-based individual instruction, improves the efficiency and quality of oral presentations, and may augment clinical performance.

Adult↗

PubMed2003

Reasoning and working memory: common and distinct neuronal processes.

The neuronal processes underlying reasoning and the related working memory subsystems were examined with functional magnetic resonance imaging (fMRI). Twelve volunteers solved relational reasoning problems which either supported a single (determinate) or several alternative solutions (indeterminate). In a second condition, participants maintained the identical premises of these problems in working memory without making inferences. Although problems were presented in auditory format, activity was detected for both reasoning and maintenance in a network comprising bilaterally the secondary visual cortex, the posterior cingulate cortex, and the medial anterior frontal cortex. In direct comparisons, reasoning was associated with stronger dorsolateral and medial prefrontal activation than maintenance, whereas maintenance led to stronger lateral parietal activation than reasoning. Participants' visuo-spatial abilities ("Block Design" score) covaried positively with behavioral performance and negatively with activity of the precuneus for reasoning, but not for maintenance. These results support the notion that relational reasoning is based on visuo-spatial mental models, and they help to distinguish the neuronal processes related to reasoning itself versus to the maintenance of problem information in working memory.

Adult↗

PubMed2001

Social reasoning: a source of influence on aggression.

Aggressive children show deficits and biases in their social information processing. Cognitions based on early experience and social schemas are also related to development and maintenance of aggressive behavior. Social reasoning can be linked to these aspects of social cognition, impacting on the situational cues individuals encode, their interpretations of events, and influencing response decisions. Past experience also influences development of social reasoning and social schema. Despite this, current discussion of the links between cognition and aggression rarely involves consideration of the influence of social reasoning. In this review, domain theory (E. Turiel, 1978, 1983) underpins an examination of links between social reasoning and aggression using empirical evidence drawn from research on the social reasoning of normal and aggressive children. Children as young as 3 appear to use consistent patterns of social reasoning when making judgments about transgressions and other social events, and these patterns are linked to social reasoning domains. We propose that aggressive children access information from the underlying social reasoning domains differently than their prosocial peers. This in turn affects their decision making and subsequent behavior in social situations. Our review explores developmental and clinical implications of the proposal and provides directions for future research.

Aggression↗

PubMed2001

The relationship between pharmacists' tenure in community setting and moral reasoning.

OBJECTIVE: To explore the relationship between pharmacists' tenure in the community setting and their moral reasoning abilities. DESIGN: Systematic random sample design. SETTING: A large southeastern city in the United States. PARTICIPANTS: 450 independent and chain community pharmacists identified from the state board of pharmacy list of licensed community pharmacists. INTERVENTIONS: A mailed questionnaire that included a well-known moral reasoning instrument and collected demographic information. MAIN OUTCOME MEASURES: Moral Reasoning abilities and tenure of community pharmacists. RESULTS: As a group, community pharmacists with greater years of tenure in community practice scored significantly lower on moral reasoning than those pharmacists with fewer years of tenure (p=0.016). CONCLUSION: Four plausible explanations for the results are given including: a) a selection of lower ethical reasoners and/or an exodus of higher ethical reasoners from the community setting; b) a retrogression in the moral reasoning skills as community pharmacists obtain tenure in this setting; c) differences between the low and high moral reasoning groups may be due to a cohort effect; and d) the obtained practitioner sample may not have been representative of the population of community pharmacists.

Community Pharmacy Services↗

PubMed2004

Appearance vs. health reasons for seeking treatment among obese patients with binge eating disorder.

OBJECTIVE: This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." Patients' reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self-esteem). RESULTS: Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance-related reasons had lower BMIs than those reporting health-related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self-esteem. DISCUSSION: Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes.

Adult↗

PubMed1988

Proportional and functional analogical reasoning in normal and language-impaired children.

Teachers often use analogies in classroom settings to clarify new concepts for their students. However, analogies may inadvertently confuse the youngster who has difficulty identifying the one-to-one comparisons underlying them. Although analogical reasoning has been studied extensively in normal children, no information was available concerning this construct in children having a specific language impairment. Thus, it was unknown to what extent they might be deficient in analogical reasoning. Therefore, in the present study, 20 children ages 6-8 years (mean age = 7:6) having normal nonverbal intelligence but deficits in language comprehension were administered tasks of verbal and perceptual proportional analogical reasoning and a problem-solving task of functional analogical reasoning. Compared to a normal-language control group matched on the basis of chronological age and sex, the language-impaired group was deficient in all three tasks of analogical reasoning. However, when the factor of nonverbal intelligence was controlled statistically, the differences between the groups on each of the tasks were removed. Additional findings were that verbal proportional analogical reasoning was significantly correlated to perceptual proportional analogical reasoning and to functional analogical reasoning. Implications for assessment and intervention with young school-age language-impaired children are discussed.

Child↗

PubMed2003

Reasons for selecting an initial route of heroin administration and for subsequent transitions during a severe HIV epidemic.

AIM: To identify the most important reasons for selecting a particular route of heroin administration and for subsequent transitions during a period of epidemic HIV transmission. To study temporal trends in these reasons. DESIGN: Cross-sectional survey. PARTICIPANTS: Nine hundred heroin users in three Spanish cities: 305 in Seville, 297 in Madrid and 298 in Barcelona. MEASUREMENTS: A separate analysis was made of the reasons for five types of behaviour: (a) selecting injection as the initial usual route of heroin administration (URHA); (b) changing the URHA to injection; (c) never having injected drugs; (d) selecting the smoked or sniffed route as the initial URHA; and (e) changing the URHA to a non-injected route. Subjects were invited to evaluate the importance of each reason included in a closed list. Spontaneously self-perceived reasons were also explored in an open-ended question for each of the five types of behaviour studied. FINDINGS: The primary reason selected for each type of behaviour was: (a) pressure of the social environment; (b) belief that injection is a more efficient route than smoking or sniffing heroin; (c) concern about health consequences (especially fears of HIV and overdose), and fear of blood or of sticking a needle into one's veins; (d), pressure of the social environment and (e) concern about health consequences and vein problems. For women, having a sexual partner who injected heroin played a decisive role in initiating or changing to injection. Few people spontaneously mentioned market conditions for purchasing heroin as an important reason for any behaviour, nor did many mention risk of overdose as reasons for (c) or (d). CONCLUSIONS: These findings should be considered when designing interventions aimed at preventing initiation of injecting or facilitating the transition to non-injected routes.

Administration, Inhalation↗

PubMed2004

Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory.

BACKGROUND: Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts. AIMS: This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills. METHODS: Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking. FINDINGS: Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching-learning attention to self-regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory. It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts. CONCLUSIONS: Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning strategies. The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.

Clinical Competence↗