The effect of awareness of measurement error on physical therapists' confidence in their decisions.
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This study examined whether physical therapists understand the meaning of measurement error and whether information about measurement error affects their decisions. One of four versions of two physical therapy problems was mailed to 500 randomly selected physical therapists. Therapists were asked to define reliability and error of measurement, to estimate the error of measurement of two assessments, and to make decisions about an intervention based on specific measurements. They were also asked to rate their confidence in those decisions. Problems varied on the presence or absence of measurement information and on the difference between an observed measurement and a criterion measurement against which the observed measurement must be compared to make a decision. The response rate was 62%; respondents represented a typical profile of practicing physical therapists. The therapists understood reliability, but they did not correctly describe the relationship between reliability and error of measurement. Their estimates of the error of measurement of the two assessments were reasonable for only one procedure. The presence or absence of measurement information and difference between observed and criterion measurements affected their confidence, albeit inappropriately, in only one problem. Confidence was not affected by the therapists' level of experience, type of reading, formal study, or degree earned. Therapists responded to the two problems differently. The problems involved different measures, roles, utilities, and structures. The process of decision making does not generalize to all decision types. Measurement principles and strategies of use in decision making must be emphasized in physical therapy curricula so that physical therapists can consider the quality of their assessment data in making clinical decisions. (+info)
The accuracy of guestimates.
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At times a clinician must describe the size of a lesion when measurement presents difficulties. A 'guestimate' may then be recorded. We tested the accuracy of forensic clinicians (10 physicians and 1 nurse) in guestimating the sizes of ten test objects, comparing their performance with 13 individuals from other professions. The participants were permitted to handle the objects but not to use a measuring device. For three of the objects (a balloon, a scratch and a coin) the entire sample of participants significantly overestimated size, by 13-22%. Both participant groups overestimated the size of a scratch, the clinicians being more accurate but not significantly so. Guestimates should be avoided unless the use of a ruler or tape measure will be against the interests of the client. (+info)
Methods and principles in biomedical ethics.
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The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the "standard" Jehovah's Witness case that having autonomously chosen the authority of his religious institution, a Jehovah's Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author's view of the child of a Jehovah's Witness scenario is that it is morally required-not merely permitted-to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (+info)
The virtues (and vices) of the four principles.
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Despite tendencies to compete for a prime place in moral theory, neither virtue ethics nor the four principles approach should claim to be superior to, or logically prior to, the other. Together they provide a more adequate account of the moral life than either can offer on its own. The virtues of principlism are clarity, simplicity and (to some extent) universality. These are well illustrated by Ranaan Gillon's masterly analysis of the cases he has provided. But the vices of this approach are the converse of its virtues: neglect of emotional and personal factors, oversimplification of the issues, and excessive claims to universality. Virtue ethics offers a complementary approach, providing insights into moral character, offering a blend of reason and emotion, and paying attention to the context of decisions. The cases provided can be more adequately understood if we combine the approaches. Both should foster the virtues of humility and magnanimity. (+info)
Asymmetries in stimulus comparisons by monkey and man.
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Similarity is a core concept in theories of object recognition, categorization, and reasoning. It is often conceptualized as a geometric distance in a multidimensional stimulus space. However, research in humans has revealed that similarity judgments involve more than a simple distance calculation and tend to be asymmetric when stimuli differ in factors such as prototypicality. For example, most people judge 99 to be more similar to 100 than 100 to 99. Up to now, it was not known whether such asymmetries might also occur in nonhuman subjects. This study reveals asymmetries in the pattern of errors made by four rhesus monkeys in a temporal same/different task. Monkeys usually perceived a smaller difference between two different stimuli when the first stimulus in a trial was less prototypical than the second, just as what was found previously for human subjects. The pattern of asymmetries differed between monkeys, and a control study showed that such variability is also present for human subjects. We propose that known neurophysiological mechanisms can account for asymmetry in the stimulus comparisons of both species. Thus, seemingly complex phenomena that occur when human subjects rate stimulus similarity are also present in macaques' similarity judgments and could be based on relatively simple mechanisms. (+info)
Should patient consent be required to write a do not resuscitate order?
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Consent ought to be required to withhold treatment that is in a patient's best interests to receive. Do not resuscitate (DNR) orders are examples of best interests assessments at the end of life. Such assessments represent value judgments that cannot be validly ascertained without patient input. If patient input results in that patient dissenting to the DNR order then individual physicians are not justified in overriding such dissent. To do so would give unjustifiable primacy to the values of the individual physician. Therefore patient consent is effectively required to write a DNR order. Patient dissent to a DNR order should trigger a fair process mechanism to resolve the dispute. (+info)
Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.
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OBJECTIVES: To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. DESIGN: Qualitative focus group study consisting of 11 focus groups with 67 participants. SETTING: General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. SAMPLE: Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. RESULTS: General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. CONCLUSIONS: Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered. (+info)
Thinking about actions: the neural substrates of person knowledge.
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Despite an extensive literature on the neural substrates of semantic knowledge, how person-related information is represented in the brain has yet to be elucidated. Accordingly, in the present study we used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of person knowledge. Focusing on the neural substrates of action knowledge, participants reported whether or not a common set of behaviors could be performed by people or dogs. While dogs and people are capable of performing many of the same actions (e.g. run, sit, bite), we surmised that the representation of this knowledge would be associated with distinct patterns of neural activity. Specifically, person judgments were expected to activate cortical areas associated with theory of mind (ToM) reasoning. The results supported this prediction. Whereas action-related judgments about dogs were associated with activity in various regions, including the occipital and parahippocampal gyri; identical judgments about people yielded activity in areas of prefrontal cortex, notably the right middle and medial frontal gyri. These findings suggest that person knowledge may be functionally dissociable from comparable information about other animals, with action-related judgments about people recruiting neural activity that is indicative of ToM reasoning. (+info)