Can contemporary cognitive science explain clinical expertise? We argue that the answer could be "no." In support of this, we provide an analysis of two of the most essential expressions of clinical ...expertise in nursing and medicine, the ability to run a code blue and the ability to diagnose congestive heart failure. We show how it makes sense to treat both as examples of what we call inference to the best action, and we then argue that two of the standard explanatory paradigms of cognitive science - the Humean and Bayesian paradigms - are unable to provide a plausible analysis of inference to the best action.
Equipoise, generally defined as uncertainty about the relative effects of the treatments being compared in a trial, is frequently referenced as an ethical standard for the conduct of randomized ...clinical trials. However, it seems to be defined in several different ways and may be used differently by different individuals. We explored how clinical researchers, chairs of research ethics boards, and philosophers of science define and reason with this term.
We completed semi-structured interviews about clinical trial ethics with 15 clinical researchers, 15 research ethics board chairs, and 15 philosophers of science/bioethicists. Each participant was asked a standardized set of 10 questions, 4 of which were specifically about equipoise. All interviews were conducted telephonically and transcribed. Responses were grouped and analysed via a modified grounded theory method.
Forty-three respondents defined equipoise in 7 logically distinct ways, and 2 respondents could not explicitly define it. The most common definition, offered by 14 respondents (31%), defined "equipoise" as a disagreement at the level of a community of physicians. There was significant variability in definitions offered between and within groups. When asked how they would "operationalize" equipoise - i.e. check or test for its presence - respondents provided 7 alternatives, the most common being in relation to a literature review (15/45, 33%). The vast majority of respondents (35/45, 78%) felt the concept was helpful, though many acknowledged that the lack of a clear definition or operationalization was problematic.
There is significant variation in definitions of equipoise offered by respondents, suggesting that parties within groups and between groups may be referring to different concepts when they reference "equipoise". This non-uniformity may impact fairness and transparency and opens the door to potential ethical problems in the evaluation of clinical trials - for instance, a patient may understand equipoise very differently than the researchers enrolling her in a trial, which could cause her agreement to participate to be based upon false premises.
There is no settled definition of nursing science that describes how this field of scientific research is unique. This paper attempts to correct this problem. It uses a combination of historical ...analysis and abductive argument to support the thesis that nursing science is a sui generis social science that studies how to reconcile clinical ideals or norms that are applicable to practice in nursing with the messiness of human behavior.
To predict and ensure a healthy and high-performing nursing workforce, it is necessary to identify the antecedents that promote work engagement, especially among early-career nurses. To date no study ...has focused on this. This longitudinal survey, administered to 1204 nurses working in seven general hospitals with 200 or more beds in four prefectures in Japan at two different times in 2019, aims to examine the causal relationship between the personal and professional resources for nurses to work vigorously (PPR-N) and work engagement among nurses in the early stages of their careers, considering time as a key mediating factor. The analysis of structural equation modeling using the cross-lagged effect model supported that PPR-N had significant and positive effects on work engagement after 3 months among early-career nurses with less than 10 years of nursing experience. The PPR-N is a reliable antecedent of work engagement, which is typical of early-career nurses. These results may be provided guidance for managers in overseeing the work environment to ensure a thriving sustainable nursing workforce.
Because of this, it is important to keep in mind that, while RCTs are valuable to modern medical science and often reflect the most efficient way of determining the relative efficacy of two ...therapies, they are not immune from the same epistemological and psychological forces that render all other forms of scientific knowledge fallible. ...we wish to return to our three criteria, spelled out in more detail here, in order to illustrate the ways in which they can serve as practically useful criteria in the approval process, and thus operate as alternatives (or supplements) to considerations of equipoise: (1)No redundant research: there must be evidence-based uncertainty surrounding the question being addressed in the trial, in that it has not already been answered by previous research, whether or not this prior research comes in the form of an RCT. The issue of clinical trial regulation leads to fundamental questions about the nature and limitations of medical knowledge, impacting major initiatives meant to curb waste in research and clinical practice 33. ...while we have proposed the foundations of a framework to guide the future regulation of clinical trials, much work remains to be done before we can claim to fully understand all the criteria according to which RCTs can be truly said to be ethically justified.7 Postscript The arguments put forward here originated in 2015, when we were invited to draft an editorial for a different journal. ...our proposed conditions for the scientific justification of RCTs were felt to be flawed because they “would rule out the ethical conduct of most clinical trials.”
Explanations of how the brain makes successful predictions should refer to abstracta. But, the mind/brain system is for more than prediction alone. Creativity also plays an important role in supply ...the mind/brain system with abstracta that serve a number of valuable ends over and above prediction.
Clinical Trials Involving Hypertension Shamy, Michel; Fedyk, Mark
The New England journal of medicine,
01/2017, Letnik:
376, Številka:
3
Journal Article
ObjectiveNo systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients. In this scoping review, we aimed to identify all ...randomised controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularisation, and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design, setting and participantsWe systematically searched Medline, Embase, Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting, or any revascularisation (endarterectomy or stenting) with medical therapy in patients with symptomatic high-grade (>50%) carotid stenosis.ResultsFrom 1537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however, there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex.ConclusionsOnly half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.
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