Diagnostic Reasoning (diagnostic + reasoning)

Distribution by Scientific Domains


Selected Abstracts


Experienced and Less-Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical Thinking

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2003
Catherine G. Ferrario DNSc
PURPOSE. To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (,5 years' experience) and novice (<5 years' experience) emergency nurses. METHODS. Clinical simulations were completed by a nationwide randomly selected sample of 173 experienced and 46 less-experienced emergency nurses (N =229). FINDINGS. Experienced nurses used the heuristic, Judging by Causal Systems (diagnostic inferences deduced from systems of causal factors) significantly more did than less-experienced nurses. PRACTICE IMPLICATIONS. Standardized nursing diagnoses may cut short the time needed to develop representational thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote students' cognitive development through strategies that promote active, reflective, and integrative learning. Search terms: Clinical experience, diagnostic reasoning [source]


Abductive Diagnosis Using Time-Objects: Criteria for the Evaluation of Solutions

COMPUTATIONAL INTELLIGENCE, Issue 1 2001
Elpida T. Keravnou
Diagnostic problem solving aims to account for, or explain, a malfunction of a system (human or other). Any plausible potential diagnostic solution must satisfy some minimum criteria relevant to the application. Often there will be several plausible solutions, and further criteria will be required to select the "best" explanation. Expert diagnosticians may employ different, complex criteria at different stages of their reasoning. These criteria may be combinations of some more primitive criteria, which therefore should be represented separately and explicitly to permit their flexible and transparent combined usage. In diagnostic reasoning there is a tight coupling between the formation of potential solutions and their evaluation. This is the essence of abductive reasoning. This article presents an abductive framework for diagnostic problem solving. Time-objects, an association of a property and an existence, are used as the representation formalism and a number of primitive, general evaluation criteria into which time has been integrated are defined. Each criterion provides an intuitive yardstick for evaluating the space of potential solutions. The criteria can be combined as appropriate for particular applications to define plausible and best explanations. The central principle is that when time is diagnostically significant, it should be modeled explicitly to enable a more accurate formulation and evaluation of diagnostic solutions. The integration of time and primitive evaluation criteria is illustrated through the Skeletal Dysplasias Diagnostician (SDD) system, a diagnostic expert system for a real-life medical domain. SDD's notions of plausible and best explanation are reviewed so as to show the difficulties in formalizing such notions. Although we illustrate our work by medical problems, it has been motivated by consideration of problems in a number of other domains (fermentation monitoring, air and ground traffic control, power distribution) and is intended to be of wide applicability. [source]


Separation of haemoglobin HbE and HbA2 by the fully automated, high-pressure liquid chromatography Tosoh HLC-723 G7 analyzer

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2008
G. LIPPI
Summary High-pressure liquid chromatography instruments specifically devised for separating haemoglobin (Hb) fractions have been increasingly employed by the hospital laboratories over the recent years since they allow easy and fast screening for several Hb variants. Although such instruments may be proposed as sensitive, specific and reliable alternatives to the classic electrophoretic techniques, a major drawback of this screening strategy is the almost identical retention time of several Hb variants. In particular, at least 18 Hb variants have been reported in the same retention window as HbA2, including HbE, the second most common ,-chain variant in humans after sickle cell trait. Recently, we evaluated the performance characteristics of an improved buffer formulation originally conceived for Hb variants separation procedures on the fully automated high-pressure liquid chromatography instrument Tosoh G7. At variance with other fully automated high-pressure liquid chromatography analyzers, the elution pattern on the G7 in subjects heterozygous for HbE is characterized by the presence of four suggestive peaks (HbF, HbA, HbA2 and HbE), confirming the effective separation of HbE from HbA2. Because of its potential value in the diagnosis of the thalassaemia syndromes, the effective separation of HbA2 from HbE can provide clinical laboratories with a valuable information for the diagnostic reasoning. [source]


A Computerized Nursing Process Support System in Brazil

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003
Maria da Graša Oliveira Crossetti
BACKGROUND Hospital de Clinicas de Porto Alegre introduced the nursing process model as the basis for nursing practice at the hospital more than 20 years ago. A computerized nursing order system based on nursing diagnoses was introduced. The strategies used in the development of the system included establishment of Nursing Diagnosis Work Groups in 1998; systematic analysis of nursing processes based on the work of existing studies, the NANDA taxonomy in 1999; development and implementation of a data collection instrument to analyze the nursing diagnosis process; training of all nursing staff during 1999,2000; meetings between analysts and nursing staff to articulate the nursing process needs the system would be required to support; pilot implementation of the computerized nursing process system in the ICU in February 2000; and hospital-wide implementation in December 2000. The system supports nursing diagnoses and orders. It was developed in-house by the information systems group at the hospital and is implemented as an Oracle database accessed in client server mode over a Windows NT-based Ethernet network. The system is part of the hospital's larger clinical information management system. MAIN CONTENT POINTS The patient care module includes medical orders and nursing orders. On entering the nursing orders module, the user selects a patient and the system presents a list all current orders completed and pending. These orders can be examined, updated, and reprinted, and new daily nursing orders can also be input at this time. The "new order" screen provides the user with any previous orders to ensure consistency in nursing care. New nursing orders are prepared based on the patient history, physical exam, and daily evaluations. Required interventions are identified based on changes in the patient's "basic human needs." This process can be realized through two distinct paths through the nursing care module: one associated with diagnoses and the other with signs and symptoms. A nurse with more clinical experience and knowledge of diagnostic reasoning will opt to develop orders based on diagnoses. After the diagnosis and associated etiology is input, the system generates a list of possible interventions for selection. The duration and frequency of the intervention can then be specified and the order individualized to a patient's particular needs. Less experienced nurses and students will develop nursing orders based on a patient's signs and symptoms. The system generates a list of diagnoses, etiology, and associated basic human needs in response to the signs and symptoms input. The nurse selects the appropriate diagnoses and etiology and the system generates the list of nursing intervention options. Nurses following either path are required to confirm their orders. They then have the option of developing other orders for the same patient until all that patient's basic human needs have been addressed. The orders can be printed but also remain in the system for nursing staff to implement. CONCLUSIONS The application of systematic, evidence-based methods in nursing care results in improved quality of service that conforms to individual patients' basic human needs. [source]


Experienced and Less-Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical Thinking

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2003
Catherine G. Ferrario DNSc
PURPOSE. To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (,5 years' experience) and novice (<5 years' experience) emergency nurses. METHODS. Clinical simulations were completed by a nationwide randomly selected sample of 173 experienced and 46 less-experienced emergency nurses (N =229). FINDINGS. Experienced nurses used the heuristic, Judging by Causal Systems (diagnostic inferences deduced from systems of causal factors) significantly more did than less-experienced nurses. PRACTICE IMPLICATIONS. Standardized nursing diagnoses may cut short the time needed to develop representational thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote students' cognitive development through strategies that promote active, reflective, and integrative learning. Search terms: Clinical experience, diagnostic reasoning [source]


How neurologists think: A cognitive psychology perspective on missed diagnoses,

ANNALS OF NEUROLOGY, Issue 4 2010
Barbara G. Vickrey MD
Physicians use heuristics or shortcuts in their decision making to help them sort through complex clinical information and formulate diagnoses efficiently. Practice would come to a halt without them. However, there are pitfalls to the use of certain heuristics, the same ones to which humans are prone in everyday life. It may be possible to improve clinical decision making through techniques that minimize biases inherent in heuristics. Five common clinical heuristics or other sources of cognitive error are illustrated through neurological cases with missed diagnoses, and literature from cognitive psychology and medicine are presented to support the occurrence of these errors in diagnostic reasoning as general phenomena. Articulation of the errors inherent in certain common heuristics alerts clinicians to their weaknesses as diagnosticians and should be beneficial to practice. Analysis of cases with missed diagnoses in teaching conferences might proceed along formal lines that identify the type of heuristic used and of inherent potential cognitive errors. Addressing these cognitive errors by becoming conscious of them is a useful tool in neurologic education and should facilitate a career-long process of continuous self-improvement. ANN NEUROL 2010;67:425,433 [source]