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PubMedDate not supplied

Interrater reliability and discriminant validity of the deductive reasoning test.

OBJECTIVE: The purpose of this study was to determine the interrater reliability and discriminant validity of Toglia's Deductive Reasoning test for individuals with brain injuries. METHOD: Forty-two individuals with brain injuries and 51 participants without disabilities ranging in age from 18 to 84 years were given the Deductive Reasoning test three consecutive times. A between groups repeated measure design was used to examine differences between the two groups in performance of the Deductive Reasoning test across the three trials. RESULTS: An interclass correlation coefficient (ICC) was statistically significant, indicating good interrater reliability for participants without disabilities. A repeated measures analysis of variance (ANOVA) comparing performance across trials and between groups revealed a significant group main effect, F(1,91) = 52.68, p < .001, thus, participants with brain injuries performed significantly lower on the test than participants without disabilities. This analysis also revealed a significant increase in all participants' scores across trials, F(1.63, 148.67) = 35.094, p < .001. CONCLUSION: Findings confirm acceptable interrater reliability of the Deductive Reasoning test. Further, comparison of the performance of the two groups supports the discriminant validity of the Deductive Reasoning test for individuals with brain injuries. Thus, the Deductive Reasoning test was found to be an appropriate, valid, and reliable assessment tool for occupational therapists to assess deductive reasoning skills in individuals with brain injuries. Additional research is needed to continue to investigate the psychometric value of the Deductive Reasoning test so that clinicians and researchers can use it appropriately.

Adult↗

PubMedDate not supplied

Using a head-mounted video camera to explore current conceptualizations of clinical reasoning in occupational therapy.

OBJECTIVE: The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy. METHOD: Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework. FINDINGS: Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists' debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of "generalization reasoning" is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance. CONCLUSION: This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.

Adult↗

PubMed2003

[Diagnostic reasoning in neurology. An analysis of the more frequent errors].

Diagnostic reasoning is a cognitive proccess that has various performance and results. There are several kinds of clinical reasoning, such as model or pattern recognizing, causal or physiopathologic reasoning, deterministic, exhaustive, and hypotetic-deductive ones. Each form of reasoning may be relevant in certain clinical context, and all of the forms are also complementary. The logical consequence of diagnostic reasoning, like every cognitive proccess, is a clinical error. It is necessary that the neurologist knows the principles of diagnostic reasoning and the more frequent errors and biases. These can be summarized as: errors associated with the proccess of taking history and clinical examination, mnesic and semantic components of clinical reasoning, failure of hipotetic- deductive reasoning, and inadequate use of probability theory in Medicine.

Diagnostic Errors↗

PubMed2004

Clinical reasoning strategies in physical therapy.

BACKGROUND AND PURPOSE: Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. SUBJECTS: The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields. METHODS: Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. RESULTS: A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed "dialectical reasoning." DISCUSSION AND CONCLUSION: The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.

Data Collection↗

PubMedDate not supplied

Using focused reflection and articulation to promote clinical reasoning: an evidence-based teaching strategy.

This research explored the effects of instructing first-semester nursing students in the use of focused reflection and articulation to promote clinical reasoning. Student volunteers were randomly assigned to four clinical groups. Two groups that received instruction in the use of focused reflection and articulation scored significantly higher on the practice measure of clinical reasoning, accounting for 29 percent of the variance between groups. Once clinical reasoning scores were tabulated, the top six and bottom six scorers on clinical reasoning were interviewed to identify qualitative differences between students with different reasoning levels. Themes from the interviews revealed that those with high clinical reasoning reported a high frequency of use of focused reflection and articulation, engaged in abstract learning, and were more self-regulated in their learning than those who scored low on clinical reasoning. This study provides empirical evidence that using instructional methods that focus learners' attention on the concrete application of theory in the practicum setting helps enhance their reasoning skills.

Analysis of Variance↗

PubMed1995

The relationship of moral reasoning and AIDS knowledge to risky sexual behavior.

Two hypotheses were tested in this study: (a) moral reasoning and risky sexual behaviors are inversely correlated; (b) the relationship between AIDS knowledge and sexual behavior is mediated by moral reasoning such that AIDS knowledge and risky sexual behaviors are inversely correlated for higher-level moral reasoners but not for lower-level reasoners. Subjects were 103 undergraduate students who completed an instrument assessing moral reasoning, the Defining Issues Test, and two questionnaires assessing sexual behavior and knowledge about AIDS. Factor analysis identified five sexual risk-taking factors with alphas of .60 or higher. Results supported both hypotheses: (a) Risk taking during sexual intercourse (i.e., lower likelihood of using condoms) and risk taking during anal sex were significantly inversely correlated with moral reasoning; (b) For high moral reasoners, two measures of sexual risk taking were significantly negatively correlated with knowledge about AIDS: as knowledge increased, risk taking during sexual intercourse and engagement in a variety of sexual experiences decreased. The reverse relationship was true for low moral reasoners. Implications for moral development theory and research as well as for AIDS prevention campaigns are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Client and therapist reasons for termination: a conceptualization and preliminary validation.

While the comparison of client and therapist reasons for termination might shed light on their respective views of outcome and process, only one published study has examined directly the reasons given by therapist-client pairs. One barrier to such research is the absence of a systematic conceptualization of reasons for termination that incorporates both therapist and client perspectives. This article describes a comprehensive conceptualization, drawn from the existing literature, and applies a coding system based on that conceptualization to naturalistic clinical data from 123 therapist-client pairs in a psychology training clinic. Coders were able to categorize reliably open-ended client data into reasons for termination. For therapist and client data, the relationships between coding categories and participants' outcome ratings, generally were consistent with expectations, providing limited validation. Some support was found for concordance between therapist and client reasons, especially for those related to therapist or client departures, which were prominent in this setting. As expected, however, therapists were more likely than clients to endorse success as a reason for termination. Negative client feelings about therapy, including dissatisfaction, were reported infrequently as reasons for termination, and with little agreement between clients and therapists, but this may be due to methodological limitations.

Adolescent↗

PubMed1994

Causal reasoning and the diagnostic process.

BACKGROUND: Causal reasoning as a way to make a diagnosis seems convincing. Modern medicine depends on the search for causes of disease and it seems fair to assert that such knowledge is employed in diagnosis. Causal reasoning as it has been presented neglects to some extent the conception of multifactorial disease causes. GOAL: The purpose of this paper is to analyze aspects of causation relevant for discussing causal reasoning in a diagnostic context. PROCEDURES: The analysis will discuss different conceptions of causal reasoning in medical diagnosis, discriminating primarily between narrow causal diagnosis and more thorough causal explanation. The theory of causes as non-redundant factors in effective causal complexes is used as an analytical background. Causal explanations are performed according to different causal models. Such models of diagnosis are assumptions concerning structure and mechanisms, which cannot be directly or immediately observed. Conceptions and results of causal search strategies differ, according to the focus of the searcher. Causal reasoning is also seen in diagnosis in a more extensive meaning: the pin-pointing of factors responsible for the condition of the patient at any time during the course of disease. CONCLUSION: Causal reasoning and diagnosis go well in hand, especially if both concepts are widened. The theory of causes as non-redundant components in effective causal complexes, modulated by what is referred to as the stop problem and causal fields, is valuable for explaining the many aspects of causal reasoning in medical diagnosis.

Causality↗

PubMed2004

The effect of a reason's truth-value on the judgment of a fallacious argument.

Informal reasoning fallacies are arguments that are psychologically persuasive but not valid. In the context of informal reasoning fallacies, the truth-value of the reason in support of a given claim is irrelevant to judging the validity of the argument as a whole. This property stands in sharp contrast with the general role of the reason's truth-value in judging arguments in general. The aim of this study was to test the hypothesis that in the context of informal reasoning fallacies the truth-value of a reason influences pupils' judgment of the extent to which the reason supports the claim. The results of the study confirm the research hypothesis.

Adolescent↗

PubMed2006

Spatiotemporal reasoning about epidemiological data.

OBJECTIVE: In this article, we propose new methods to visualize and reason about spatiotemporal epidemiological data. BACKGROUND: Efficient computerized reasoning about epidemics is important to public health and national security, but it is a difficult task because epidemiological data are usually spatiotemporal, recursive, and fast changing hence hard to handle in traditional relational databases and geographic information systems. METHODOLOGY: We describe the general methods of how to (1) store epidemiological data in constraint databases, (2) handle recursive epidemiological definitions, and (3) efficiently reason about epidemiological data based on recursive and non-recursive Structured Query Language (SQL) queries. RESULTS: We implement a particular epidemiological system called West Nile Virus Information System (WeNiVIS) that enables the visual tracking of and reasoning about the spread of the West Nile Virus (WNV) epidemic in Pennsylvania. In the system, users can do many interesting reasonings based on the spatiotemporal dataset and the recursively defined risk evaluation function through the SQL query interfaces. CONCLUSIONS: In this article, the WeNiVIS system is used to visualize and reason about the spread of West Nile Virus in Pennsylvania as a sample application. Beside this particular case, the general methodology used in the implementation of the system is also appropriate for many other applications. Our general solution for reasoning about epidemics and related spatiotemporal phenomena enables one to solve many problems similar to WNV without much modification.

Animals↗

PubMed2004

Differential involvement of left prefrontal cortex in inductive and deductive reasoning.

While inductive and deductive reasoning are considered distinct logical and psychological processes, little is known about their respective neural basis. To address this issue we scanned 16 subjects with fMRI, using an event-related design, while they engaged in inductive and deductive reasoning tasks. Both types of reasoning were characterized by activation of left lateral prefrontal and bilateral dorsal frontal, parietal, and occipital cortices. Neural responses unique to each type of reasoning determined from the Reasoning Type (deduction and induction) by Task (reasoning and baseline) interaction indicated greater involvement of left inferior frontal gyrus (BA 44) in deduction than induction, while left dorsolateral (BA 8/9) prefrontal gyrus showed greater activity during induction than deduction. This pattern suggests a dissociation within prefrontal cortex for deductive and inductive reasoning.

Adult↗

PubMed2005

Representational and executive selection resources in 'theory of mind': evidence from compromised belief-desire reasoning in old age.

Effective belief-desire reasoning requires both specialized representational capacities-the capacity to represent the mental states as such-as well as executive selection processes for accurate performance on tasks requiring the prediction and explanation of the actions of social agents. Compromised belief-desire reasoning in a given population may reflect failures in either or both of these systems. We report evidence supporting this two-process model from belief-desire reasoning tasks conducted with younger and older adult populations. When task inferential complexity is held constant, neither group showed specific difficulty with reasoning about mental state content as compared with non-mental state content. However, manipulations that systematically increase executive performance demands within belief-desire reasoning caused systematic decreases in task performance in both older and younger adult groups. Moreover, the effect of increasing executive demands was disproportionately greater in the older group. Regression analysis indicated that measures of processing speed and inhibition contributed most to explaining variance in accuracy and response times in the belief-desire reasoning tasks. These results are consistent with the idea that compromised belief-desire reasoning in old age is likely the result of age-related decline in executive selection skills that supplement core mental state representational abilities, rather than as a result of failures in the representational system itself.

Adolescent↗

PubMed2006

Consistency between most important reasons for using contraception and current method used: the influence of health care providers.

OBJECTIVE: To identify factors related to consistency between women's "most important" reason for using contraception and their current contraceptive method. METHODS: A sample of 433 women completed a written questionnaire on demographics, contraceptive use history and the "most important" reason for using contraception. Women were grouped by whether their current contraceptive method "agreed" or "disagreed" with their "most important" reason for contracepting. Multivariable regression was used to identify factors associated with consistency between stated "most important" reason and current method used ("agreed"). RESULTS: Current contraceptive method was inconsistent with the "most important" reason for using a method in 25% of women. Demographic characteristics and knowledge of contraceptive effectiveness did not differ between the "agreed" and "disagreed" groups. Women using a method consistent with their reason were more likely to have discussed contraception with a health care provider (RR=1.59, 95% CI 1.13-2.25) even after adjusting for source of contraceptive method or source of contraceptive information (RR=1.57, 95% CI 1.10-2.23). CONCLUSION: Contact with a health care provider was the only factor associated with consistency between birth control method and reasons for initiating contraception. This association appears to be independent of knowledge about contraceptive effectiveness.

Adolescent↗

PubMed2004

Reasons patients recommend laser in situ keratomileusis.

PURPOSE: To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK. SETTING: Northeastern Eye Institute, Scranton, and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the University of California at Los Angeles, Los Angeles, California, USA. METHODS: Questionnaires assessing symptoms and satisfaction after LASIK were mailed to 2,100 patients. The questionnaires included items about night-vision symptoms and satisfaction and an open-ended question for patients to give their reasons for recommending LASIK to others. The open-ended responses were categorized and tabulated. RESULTS: Four hundred thirty-four patients provided reasons for recommending LASIK to others. Sixteen categories of reasons were identified. "No more spectacles/contact lenses" was listed by 180 patients (42%), followed by "better vision" (21%) and "convenience" (15%). Women were significantly more likely to cite "better comfort" (27 women versus 3 men; chi square = 8.99, P =.003) and "better quality of life" (41 women versus 9 men; chi square = 7.36, P =.007) as a reason for recommending LASIK. Of the 35 patients who reported dissatisfaction with post-LASIK vision, 20 (57%) would recommend LASIK to a friend because "LASIK helps others." CONCLUSIONS: Categories of reasons for recommending LASIK to others were similar to reasons given by patients for seeking LASIK. Some patients who reported dissatisfaction with their vision said they would recommend LASIK, suggesting that recommendation of LASIK to others is not necessarily a measurement of the quality of a patient's vision after LASIK.

Adult↗

PubMed2006

The clinical reasoning of pain by experienced musculoskeletal physiotherapists.

There is currently no research within Physiotherapy to explain the extent to which current theories and models of pain influence clinicians' reasoning related to clinical presentations of pain. The purpose of this qualitative study was to investigate the clinical reasoning of experienced musculoskeletal physiotherapists in relation to three different presentations of pain. A qualitative multiple-case studies method was used in this study. A purposive sample of seven experienced musculoskeletal physiotherapists viewed three videotaped patient-therapist clinical interviews describing three different pain presentations. An audio taped, semi-structured interview was carried out with each participant during which the participants were encouraged to verbalize their thoughts regarding aspects of each patient's pain presentation. All interviews were subsequently transcribed, coded and analysed. Results showed a dynamic, multidimensional nature to the therapists' clinical reasoning, which was found to be grounded in a number of established models of pain. Five main categories of pain-based clinical reasoning were identified. These were (i) biomedical, (ii) psychosocial, (iii) pain mechanisms, (iv) chronicity and (v) irritability/severity. Reasoning within these categories influenced therapists' prognostic decision-making as well as the planning of physical assessments and treatment. The clinical reasoning of pain by the participants in this study appeared to reflect the integration of diverse models and theories of pain into current clinical practice. Mechanisms-based clinical reasoning has not been previously observed amongst physiotherapists.

Data Collection↗

PubMed2002

A bird's eye view: biological categorization and reasoning within and across cultures.

Many psychological studies of categorization and reasoning use undergraduates to make claims about human conceptualization. Generalizability of findings to other populations is often assumed but rarely tested. Even when comparative studies are conducted, it may be challenging to interpret differences. As a partial remedy, in the present studies we adopt a 'triangulation strategy' to evaluate the ways expertise and culturally different belief systems can lead to different ways of conceptualizing the biological world. We use three groups (US bird experts, US undergraduates, and ordinary Itza' Maya) and two sets of birds (North American and Central American). Categorization tasks show considerable similarity among the three groups' taxonomic sorts, but also systematic differences. Notably, US expert categorization is more similar to Itza' than to US novice categorization. The differences are magnified on inductive reasoning tasks where only undergraduates show patterns of judgment that are largely consistent with current models of category-based taxonomic inference. The Maya commonly employ causal and ecological reasoning rather than taxonomic reasoning. Experts use a mixture of strategies (including causal and ecological reasoning), only some of which current models explain. US and Itza' informants differed markedly when reasoning about passerines (songbirds), reflecting the somewhat different role that songbirds play in the two cultures. The results call into question the importance of similarity-based notions of typicality and central tendency in natural categorization and reasoning. These findings also show that relative expertise leads to a convergence of thought that transcends cultural boundaries and shared experiences.

Adult↗

PubMed2003

Explaining modulation of reasoning by belief.

Although deductive reasoning is a closed system, one's beliefs about the world can influence validity judgements. To understand the associated functional neuroanatomy of this belief-bias we studied 14 volunteers using event-related fMRI, as they performed reasoning tasks under neutral, facilitatory and inhibitory belief conditions. We found evidence for the engagement of a left temporal lobe system during belief-based reasoning and a bilateral parietal lobe system during belief-neutral reasoning. Activation of right lateral prefrontal cortex was evident when subjects inhibited a prepotent response associated with belief-bias and correctly completed a logical task, a finding consistent with its putative role in cognitive monitoring. By contrast, when logical reasoning was overcome by belief-bias, there was engagement of ventral medial prefrontal cortex, a region implicated in affective processing. This latter involvement suggests that belief-bias effects in reasoning may be mediated through an influence of emotional processes on reasoning.

Adult↗

PubMed1999

Common errors of reasoning in child protection work.

OBJECTIVE: Repeated public inquiries into child abuse tragedies in Britain demonstrate the level of public concern about the services designed to protect children. These inquiries identify faults in professionals' practice but the similarities in their findings indicate that they are having insufficient impact on improving practice. This study is based on the hypothesis that the recurrent errors may be explicable as examples of the typical errors of human reasoning identified by psychological research. METHODS: The sample comprised all child abuse inquiry reports published in Britain between 1973 and 1994 (45 in total). Using a content analysis and a framework derived from psychological research on reasoning, a study was made of the reasoning of the professionals involved and the findings of the inquiries. RESULTS: It was found that professionals based assessments of risk on a narrow range of evidence. It was biased towards the information readily available to them, overlooking significant data known to other professionals. The range was also biased towards the more memorable data, that is, towards evidence that was vivid, concrete, arousing emotion and either the first or last information received. The evidence was also often faulty, due, in the main, to biased or dishonest reporting or errors in communication. A critical attitude to evidence was found to correlate with whether or not the new information supported the existing view of the family. A major problem was that professionals were slow to revise their judgements despite a mounting body of evidence against them. CONCLUSIONS: Errors in professional reasoning in child protection work are not random but predictable on the basis of research on how people intuitively simplify reasoning processes in making complex judgements. These errors can be reduced if people are aware of them and strive consciously to avoid them. Aids to reasoning need to be developed that recognize the central role of intuitive reasoning but offer methods for checking intuitive judgements more rigorously and systematically.

Child↗