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This study investigates how humanistic counselling psychologists and clinical psychologists practice their therapeutic work with patients who meet the criteria for the diagnosis of other specified feeding or eating disorder (OSFED). Eight humanistic counselling and clinical psychologists were interviewed and the data analysed using reflexive thematic analysis. The findings suggest that practitioners face complex negotiations and power dynamics when working with patients who may fit the criteria for OSFED. Practitioners balance evidence-based practice with their professional experience in service of their patients while managing the expectations of the medical model. The study highlights five themes related to the experiences of counselling and clinical psychologists working with patients who fit the criteria for OSFED. The first theme emphasises the problematic but powerful nature of the OSFED diagnosis, with concerns expressed about its use in therapy and negotiating its meaning between individualised and standardised care. The second theme focuses on how practitioners negotiate working within the medical system, including minimising damage, escaping, and relying on luck. The third theme discusses the power of the work setting on practitioners' therapeutic decisions. The fourth theme emphasises the situated integration of theory, evidence, and practice-based knowledge in providing therapy. The fifth theme explores how therapists redefine "success" in their therapeutic practices. The study's implications suggest a need for additional exploration and understanding of the OSFED diagnosis and the importance of practitioner input to its development. Clinical implications include the importance of practitioners being aware of the potential negative effects of using the OSFED diagnosis and to be prepared to negotiate its use and meanings with patients in therapy. This highlights the pressures on practitioners to effectively navigate the impact of the work environment

This transcendental phenomenological study aimed to understand the experience of clinical judgment for senior associate degree nursing students at a rural community college. The students completed a 60-minute simulation involving the cardiac system and debriefed after the active simulation. The theory that guided this study was David Kolb’s experiential learning theory, which defines the learning process as creating knowledge through transforming experience. Because the experiential learning theory is flexible, it can be readily applied to many disciplines such as nursing. This theory also helped to incorporate Tanner’s Clinical Judgment Model. Data for this transcendental qualitative study were collected using semi-structured interviews and observation during simulation experiences. The sample included senior nursing students in a rural Alabama community college associate degree program. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the software program MAXDQA as well has by hand. This phenomenological qualitative study helped in understanding the perception of clinical judgment by associate degree senior nursing students during a simulation experience.

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey fro

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey fro

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey fro

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey fro

Background: Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods: Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results: Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions: The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journe, Funding: Open access funding provided by Karolinska Institute.

Obstetric simulation can impact undergraduate prelicensure Bachelor of Science in nursing (BSN) students’ clinical judgment related to using and understanding fetal monitoring. The purpose of this study aimed to determine if a relationship exists between a student's obstetrical simulation practice and increased knowledge gained for fetal monitoring interpretation. Simulation practice provides a tangible way to test knowledge and competency, but is there an effect on student learning with the knowledge and understanding of fetal monitoring, and can simulation practice create that knowledge? A purposive sample of 24 undergraduate prelicensure BSN nursing students, within their obstetrical course, with the intent to determine if a significant relationship exists between the students' perceived self-efficacy of clinical reasoning with fetal monitoring pre- and post-simulation practice. A one-group pre-survey and post-simulation survey design study, collected by pre-and post-survey questions and with self-reflection journaling, did determine the relationship between students' perceived knowledge and understanding of fetal monitoring compared to knowledge and understanding acquired with simulation practice with the use of paired sample t tests, dependent t test, and ANOVA. Statistical results noted that the p values was < .001. Structured journaling questions will use coding that will capture the clinical reasoning and judgment during and after the simulation. The results concluded that simulation within the curriculum will significantly impact students' knowledge and understanding of fetal monitoring. Future research is needed on this topic as there are few articles on this, they are outdated, and to reflect how simulation can increase knowledge and understanding of fetal monitoring.

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey fro

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

Background Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. Method and results A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. Conclusions Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

In this chapter, we focus on an almost forgotten actor in talent research – the coach who has to make decisions on the future potential of children at different developmental stages. Coaches must make prognoses, often on the bases of little information, about how these young athletes will perform when they are at their prime. As we will argue in the first part of this chapter, making prognoses on athletes is not an easy task. In the second part, we provide the reader with an overview of current knowledge on the ‘coaches’ eye’ for identifying talent. We then place the coaches’ eye within a broader psychological framework of decision making. Finally, we consider how knowledge from decision making research might improve our understanding of talent selection processes in the future.

Clinical judgment is recognised as an essential skill for competent nursing practice. The clinical setting is an ideal place for students to explore clinical judgment. Clinical judgment is often used interchangeably with clinical reasoning, critical thinking, and clinical decision-making. There is limited information from the perspective of clinical nursing instructors. This study was undertaken to explore the experiences of clinical nursing instructors with regards to their understanding of clinical judgment, their perspectives on what enhances and what hinders its development, and to obtain their recommendations for new instructors. Five study participants answered questions regarding these topics. Of interest, was the discussion on hindrances to the development of clinical judgment and participant recommendations for new clinical instructors. Study results can help new and experienced instructors explore and expand their practice, and could be used to help support new instructors during their first couple of years of practice., 2019-08

Clinical judgment is recognised as an essential skill for competent nursing practice. The clinical setting is an ideal place for students to explore clinical judgment. Clinical judgment is often used interchangeably with clinical reasoning, critical thinking, and clinical decision-making. There is limited information from the perspective of clinical nursing instructors. This study was undertaken to explore the experiences of clinical nursing instructors with regards to their understanding of clinical judgment, their perspectives on what enhances and what hinders its development, and to obtain their recommendations for new instructors. Five study participants answered questions regarding these topics. Of interest, was the discussion on hindrances to the development of clinical judgment and participant recommendations for new clinical instructors. Study results can help new and experienced instructors explore and expand their practice, and could be used to help support new instructors during their first couple of years of practice., 2019-08

Clinical judgment is recognised as an essential skill for competent nursing practice. The clinical setting is an ideal place for students to explore clinical judgment. Clinical judgment is often used interchangeably with clinical reasoning, critical thinking, and clinical decision-making. There is limited information from the perspective of clinical nursing instructors. This study was undertaken to explore the experiences of clinical nursing instructors with regards to their understanding of clinical judgment, their perspectives on what enhances and what hinders its development, and to obtain their recommendations for new instructors. Five study participants answered questions regarding these topics. Of interest, was the discussion on hindrances to the development of clinical judgment and participant recommendations for new clinical instructors. Study results can help new and experienced instructors explore and expand their practice, and could be used to help support new instructors during their first couple of years of practice., 2019-08, 2019-09-16T21:43:51Z

INTRODUCTION: Health needs in the Mexican population are demanding and scientific advances in this area are leading us to the new challenges. One of them is the improvement in the quality of nursing care, so it is essential to know and apply the Practical theoretical knowledge in the nursing note. Objective: To identify and analyze the efficacy of the qualitative nursing note according to the clinical file. MATERIAL AND METHODS:retrospective, transversal study, with a sample of 73 nursing notes. By means of the certificate of evaluation of the "40 basic standards for the practice of nursing" that developed CONAMED, 10 articles belonging to the nursing note were extracted. RESULTS: Of the 73 nursing records, 38 (52%) had the correct identification of the patient, 51 (70%) the correct medical diagnosis, Evolution with 21 (29%). In compliance with regulations, 47 (64%) were not registered so they were omitted, while 26 (36%) were abbreviated and illegible. CONCLUSION:The effectiveness of the nursing notes are indispensable for the quality of care documentation, the basic foundation and the adherence to the normative limits its functionality within the clinical file, it is proposed an improvement in the nursing process by standardizing the evolutionary sequence Of interventions, this can be done through clinical judgment and scientific knowledge to expel a safe practice., INTRODUCCIÓN: Las necesidades de salud en la población mexicana son demandantes y los avances científicos en esta área nos encaminan a nuevos retos. Uno de ellos es el mejoramiento en la calidad de los cuidados de enfermería, por lo que es indispensable conocer y aplicar los conocimientos teórico práctico en la nota de enfermería. Objetivo: Identificar y analizar la eficacia de la nota cualitativa de enfermería en función del expediente clínico. MATERIAL Y MÉTODOS: estudio retrospectivo, transversal, con una muestra de 73 notas de enfermería. Por medio de la cédula de valoración de los “40 estándares básicos para la práctica de enfermería” que desarrollo la CONAMED, se extrajeron 10 ítems pertenecientes a la nota de enfermería. RESULTADOS:De las 73 notas de enfermería, 38 (52%) tuvieron la identificación correcta del paciente, 51 (70%) el diagnóstico médico correcto, los de menor porcentaje fueron realización de tratamientos con 26 (36%) así como eficacia respuesta y evolución con un 21 (29%). En el apego a la normatividad, 47 (64%) no fueron registradas por lo que se omitieron, mientras que 26 (36%) estaban con abreviaturas y eran ilegibles. CONCLUSIÓN: La eficacia de las notas de enfermería son indispensables para coadyuvar a la calidad de la documentación del cuidado, la deficiente fundamentación y apego a la normatividad limita su funcionalidad dentro del expediente clínico, se propone una mejora en el proceso de enfermería estandarizando la secuencia evolutiva de las intervenciones, esto se puede llevar acabo por medio del juicio clínico y conocimientos científicos para ejecutar una práctica segura

In article it has been proposed to look at mistaken trends of penetration in military psychiatry's practice such allied disciplines as psychology, neurology, psychophysiology, civil psychiatry that always caused negatively results. The article addressed not only psychiatrists but to doctors of other specialties, leaders of civil and military medicine., В статье предлагается более осмысленно взглянуть на спорные, на наш взгляд, тенденции проникновения в сферу деятельности военной психиатрии таких дисциплин, как психология, неврология, психофизиология, гражданская психиатрия. Рассуждения авторов адресованы не столько специалистам-психиатрам, сколько врачам широкого профиля, руководителям различного уровня в области гражданской и военной медицины.

This study examined the effect of an educational intervention utilizing principles of cognitive apprenticeship on students’ ability to apply clinical reasoning skills within the context of a purpose-built clinical vignette. A quasi-experimental, non-equivalent control-group design was used to evaluate the effect of the educational intervention on students’ accuracy, inaccuracy and self-confidence in clinical reasoning. This study makes an important contribution to nursing education by providing evidence to understand how best to facilitate nursing students’ development of clinical reasoning.

English: Clinical judgment is a skill that all nurses need in order to deliver safe patient care. It is a complex process and nursing students should be taught how to apply clinical judgment in practice as soon as possible. The first year baccalaureate nursing students at a nursing school of a university in Central South Africa, are taught from the first semester of their training what clinical judgment entails. Tanner’s Clinical Judgment Model is used to support this process and was also used as conceptual framework in this study. However, students need to be assessed on clinical judgment in order to determine whether training is effective. Lasater’s Clinical Judgment Rubric, based on Tanner’s Clinical Judgment Model, was used to assess the application of clinical judgment in simulation by first year nursing students. A quantitative, experimental pre-test/post-test control group design was used to describe first year nursing students’ application of clinical judgment during an immersive simulation session and to compare it with those students that received cognitive support by a preceptor and those who did not. All first year nursing students participated in this study because it was part of their curriculum and would add to their knowledge in both theory and clinical practice. Students participated in a pre-test simulation scenario that was recorded on digital video cameras. Thereafter, students were allocated to the clinical setting for at least five weeks in order to gain clinical experience. During this period of the study, the participating students were randomly divided into two groups. The students from the experimental group received cognitive support and feedback on their performance in the simulation session via the preceptors trained specifically for this process. The post-test took place, again in simulation, and was digitally recorded. The control group also received cognitive support, and feedback from the preceptors, but only after the post-test took, Afrikaans: Kliniese Oordeelsvermoë is ‘n vaardigheid wat alle verpleegkundiges benodig ten einde veilige pasiëntsorg te verseker. Dit is ‘n gevorderde proses en verpleegstudente moet so gou moontlik geleer word hoe om kliniese oordeelsvermoë toe te pas. Eerstejaar graad verpleegstudente by ‘n verpleegkunde skool aan ‘n universiteit in Sentraal Suid-Afrika, word vanaf die eerste kwartaal in hul opleiding geleer wat kliniese oordeelsvermoë behels. Die Kliniese Oordeelsvermoë model van Tanner is gebruik om hierdie proses te ondersteun en is ook as konseptuele raamwerk gebruik in hierdie studie. Dit is egter nodig om studente te meet ten opsigte van kliniese oordeelsvermoë ten einde te kan bepaal of opleiding wel effektief was. Die Kliniese Oordeelsvermoë rubriek van Lasater wat gebasseer is op Tanner se Kliniese Oordeelsvermoë model, is gebruik om eerstejaar verpleegstudente se toepassing van kliniese oordeelsvermoë gedurende simulasie, te bepaal. ‘n Kwantitatiewe, eksperimentele voor-toets/na-toets kontrolegroep studie is gebruik om eerstejaar verpleegstudente se toepassing van kliniese oordeelsvermoë gedurende ‘n simulasiesessie te beskryf asook die vermoëns van studente wat kognitiewe ondersteuning van ‘n preseptor ontvang het met die wat dit nie ontvang het nie, te bepaal. Al die eerstejaar verpleegstudente het deelgeneem aan die studie aangesien dit deel was van die kurrikulum en kennis sou toevoeg tot teorie en kliniese praktyk. Studente het deelgeneem aan ‘n voor-toets simulasie scenario wat digitaal op kameras vasgelê is. Daarna is studente vir vyf weke in die kliniese areas geplaas vir praktiese ondervinding. Gedurende hierdie tydperk is die deelnemende studente ewekansig in twee groepe verdeel. Studente in die eksperimentele groep het kognitiewe ondersteuning en terugvoer ten opsigte van hul prestasie in die voor-toets simulasie sessie van preseptore ontvang. Die kontrole groep het ook kognitiewe ondersteuning en terugvoer ontvang vanaf preseptore, maar eers

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care.The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design.The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time.The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient., För avläggande av doktorsexamen i Kvalitetsförbättring och ledarskap inom hälsa och välfärd som med tillstånd av Nämnden för utbildning och forskarutbildning vid Högskolan i Jönköping framläggs till offentlig granskning torsdagen den 5 juni 2014 kl.13.00 i sal M 204, Högskolan i Borås.

BackgroundWe aimed to compare the clinical judgments of a reference panel of emergency medicine academic physicians against evidence-based likelihood ratios (LRs) regarding the diagnostic value of selected clinical and paraclinical findings in the context of a script concordance test (SCT).FindingsA SCT with six scenarios and five questions per scenario was developed. Subsequently, 15 emergency medicine attending physicians (reference panel) took the test and their judgments regarding the diagnostic value of those findings for given diseases were recorded. The LRs of the same findings for the same diseases were extracted from a series of published systematic reviews. Then, the reference panel judgments were compared to evidence-based LRs. To investigate the test-retest reliability, five participants took the test one month later, and the correlation of their first and second judgments were quantified using Spearman rank-order coefficient. In 22 out of 30 (73.3%) findings, the expert judgments were significantly different from the LRs. The differences included overestimation (30%), underestimation (30%), and judging the diagnostic value in an opposite direction (13.3%). Moreover, the score of a hypothetical test-taker was calculated to be 21.73 out of 30 if his/her answers were based on evidence-based LRs. The test showed an acceptable test-retest reliability coefficient (Spearman coefficient: 0.83).ConclusionsAlthough SCT is an interesting test to evaluate clinical decision-making in emergency medicine, our results raise concerns regarding whether the judgments of an expert panel are sufficiently valid as the reference standard for this test.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

BackgroundWe aimed to compare the clinical judgments of a reference panel of emergency medicine academic physicians against evidence-based likelihood ratios (LRs) regarding the diagnostic value of selected clinical and paraclinical findings in the context of a script concordance test (SCT).FindingsA SCT with six scenarios and five questions per scenario was developed. Subsequently, 15 emergency medicine attending physicians (reference panel) took the test and their judgments regarding the diagnostic value of those findings for given diseases were recorded. The LRs of the same findings for the same diseases were extracted from a series of published systematic reviews. Then, the reference panel judgments were compared to evidence-based LRs. To investigate the test-retest reliability, five participants took the test one month later, and the correlation of their first and second judgments were quantified using Spearman rank-order coefficient. In 22 out of 30 (73.3%) findings, the expert judgments were significantly different from the LRs. The differences included overestimation (30%), underestimation (30%), and judging the diagnostic value in an opposite direction (13.3%). Moreover, the score of a hypothetical test-taker was calculated to be 21.73 out of 30 if his/her answers were based on evidence-based LRs. The test showed an acceptable test-retest reliability coefficient (Spearman coefficient: 0.83).ConclusionsAlthough SCT is an interesting test to evaluate clinical decision-making in emergency medicine, our results raise concerns regarding whether the judgments of an expert panel are sufficiently valid as the reference standard for this test.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

Seclusion is an intervention used in mental health settings, with nurses playing a key role in decisions related to secluding a patient. The purpose of this interpretive description study was to explore the place of ethics in mental health nurses’ clinical judgements on seclusion use. Data collection involved interviews of nine registered psychiatric nurses and eight registered nurses. Nurses described their experiences with seclusion and identified factors that impacted their decision to seclude. Ethical tensions related to seclusion use were outlined. Two themes were identified. The complexity of promoting safety and preventing harm illustrates nurses’ sometimes competing responsibilities to keep people safe, understanding of power differentials and patient vulnerability, and recognition of the various types of harms that can arise with seclusion. The importance of knowing for ethical action with seclusion use highlights the role of knowing oneself, the patient, other team members, and the unit in judgments to seclude.

Thesis (Ed. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, 2009., The literature suggests that children who struggle with communication during social interactions, called pragmatic language in the field of speech language pathology, have fewer opportunities to engage in social practices that promote learning because of inadequate skills in interacting with others. Children with even subtle difficulties in pragmatic language tend to have fewer friends, and more difficulties with aspects of behavior, mental health and learning. The American Speech-Language and Hearing Association recommends that pragmatic language assessment be part of complete communication assessment; however, research indicates this area is not assessed in a majority of children. Furthermore, speech-language pathologists (SLPs) do not always share the same definition of pragmatic language nor consistent ways to assess it. There are at least three distinctly different theoretical frameworks available to inform speech-language pathologists (SLPs) about the nature of pragmatic language, each suggesting different units of analysis and assessment tools. This, in turn, can result in an educational problem as, depending on the theoretical framework of the SLP evaluating them, children with the same pragmatic language problems may or may not be appropriately identified and, thus, served. Assuming a socio-constructivist framework and an action research paradigm, this study was designed with the ultimate goal of improving the pragmatic language assessment practices of the SLPs working in my clinic, as well as to contribute local knowledge about SLPs’ understanding and practices with respect to pragmatic language. At the core of the study is an intervention that engaged a group of SLPs from my clinic in a study group around pragmatic language. This led to two concrete products for the clinic: 1) a co-constructed operational definition of pragmatic language that melded five theoretical frameworks from the fields of cognitive psychology, education, sociology and linguistics a

Rationale, aims and objectives The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule-and principle-based moral orientation and biomedical knowledge and skills. less thanbrgreater than less thanbrgreater thanMethods Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. less thanbrgreater than less thanbrgreater thanResults Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Conclusion Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is

Rationale, aims and objectives: The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason, an ideal physician, incarnating the required virtues, skills and knowledge, is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills. Methods: Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. Results: Though prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways in which the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, though less strictly, will more reliably keep to moral objectives, be understandable, be more flexible in case the rules come to their limits and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to his own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Conclusion: Though an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions such as clinical practice, the agency of a moral human person is more trustworthy. Since this is a crucial precondition for good clinical practice, su

Inguinal hernia is a common surgical problem in the active duty population. The decision to perform a hernia repair in the traditional open manner versus a laparoscopic approach is somewhat controversial. Furthermore, the type of repair performed has not been analyzed in a systematic manner within an operational setting. We retrospectively reviewed all inguinal hernia repairs performed at Expeditionary Medical Facility Kuwait (EMFK) over an 18-month period, from April 2007 through October 2008. Operative times and time to return to duty were compared between active duty personnel undergoing open mesh repair and laparoscopic extrapedtoneal inguinal hernia repair. Results: One hundred seventy-six consecutive patients who underwent inguinal hernia repair by six different surgeons were analyzed. One hundred and four patients had an open repair and 72 patients underwent laparoscopic repair. The mean operative time was significantly longer in the laparoscopic group (20.2 minutes, p < 0.001). The mean time to return to duty was significantly shorter in the laparoscopic group (2.3 days, p = 0.008). Laparoscopic inguinal hernia repair is associated with longer operative times but shorter recovery periods. The laparoscopic approach may be a viable option for patients in the expeditionary setting., Published in Jnl. of Military Medicine, v174 n12 p1320-1323, Dec 2009. Clinical Investigation Program number EMFX.2009-L-H00000-001:A.

Klinisk blick är en term som frekvent återkommer under sjuksköterskeutbildningen och i klinisk verksamhet. Den återfinns ofta i samband med klinisk bedömning och som en övergripande beskrivning av en patient. Endast antydda betydelser har framkommit och då tätt knutna till andra termer och processer. Syftet med studien var att undersöka komponenterna intuition och tyst kunskap som delar i sjuksköterskans kliniska blick. Studien genomfördes som en litteraturstudie där 17 vetenskapliga artiklar granskades. Resultatet visar att intuition och tyst kunskap är huvudkomponenter i sjuksköterskans kliniska blick. Intuition verkar som en länk mellan kognitiva, affektiva och perceptuella processer. Tyst kunskap sammanbinder intuition och teoretisk kunskap. Intuition och tyst kunskap utvecklas över tid och baseras på personlighet, erfarenhet och teoretisk kunskap. Förslag till vidare forskning är att försöka utveckla och specificera termen och förstå de bakomliggande processerna bättre med syftet att utbilda och stödja sjuksköterskan i hennes professionella utveckling.

Klinisk blick är en term som frekvent återkommer under sjuksköterskeutbildningen och i klinisk verksamhet. Den återfinns ofta i samband med klinisk bedömning och som en övergripande beskrivning av en patient. Endast antydda betydelser har framkommit och då tätt knutna till andra termer och processer. Syftet med studien var att undersöka komponenterna intuition och tyst kunskap som delar i sjuksköterskans kliniska blick. Studien genomfördes som en litteraturstudie där 17 vetenskapliga artiklar granskades. Resultatet visar att intuition och tyst kunskap är huvudkomponenter i sjuksköterskans kliniska blick. Intuition verkar som en länk mellan kognitiva, affektiva och perceptuella processer. Tyst kunskap sammanbinder intuition och teoretisk kunskap. Intuition och tyst kunskap utvecklas över tid och baseras på personlighet, erfarenhet och teoretisk kunskap. Förslag till vidare forskning är att försöka utveckla och specificera termen och förstå de bakomliggande processerna bättre med syftet att utbilda och stödja sjuksköterskan i hennes professionella utveckling.

Intelligence analysts and mental health clinicians have some aspects of their respective crafts in common. In many cases both have to make predictions about future behavior. Findings from the clinical literature were used to make the point that humans, in general, are not particularly skilled at combining various pieces of information in order to make predictions, and by extension, intelligence analysts suffer the same fate. Understanding the problems involved in information processing can help us develop methods and tools to assist in mitigating three broad cognitive errors: (a) the tendency to see patterns where none exist, (b) the tendency to seek confirmatory evidence, and (c) the use of preconceived biases., Pub. in International Jnl. of Intelligence and CounterIntelligence, v19 n4 p622-641, 2006.