-
Scientific Reports Sep 2023A complex pattern of preservation and deterioration in metacognition in aging is found, especially regarding predicting future memory retrieval (i.e.,... (Meta-Analysis)
Meta-Analysis
A complex pattern of preservation and deterioration in metacognition in aging is found, especially regarding predicting future memory retrieval (i.e., feeling-of-knowing, FOK). While semantic FOK (sFOK) is preserved with age, studies on episodic tasks (eFOK) produce equivocal findings. We present a meta-analysis of 20 studies on eFOK and sFOK, analyzing the difference in metacognitive sensitivity between 922 younger and 966 older adults, taking into account the difference in memory performance. The sFOK studies yielded no overall age effect (8 effects, g = -0.10 [-0.29, 0.10]). However, we found a reliable age-group difference on eFOK (22 effects, g = 0.53 [0.28, 0.78]), which was moderated when considering recognition performance. Moreover, using aggregated data of 134 young and 235 older adults from published and unpublished studies from our lab, we investigated memory performance as an explanation of the eFOK deficit. We show that older adults are less metacognitively sensitive than younger adults for eFOKs which is, at least partly, due to the age-related memory decline. We highlight two non-exclusive explanations: a recollection deficit at play in the first and second order tasks, and a confound between first order performance and the measure used to assess metacognitive sensitivity.
Topics: Semantics; Mental Recall; Judgment; Recognition, Psychology; Memory, Episodic
PubMed: 37777585
DOI: 10.1038/s41598-023-36251-9 -
PloS One 2023Amputation is an irreversible, last-line treatment indicated for a multitude of medical problems. Delaying amputation in favor of limb-sparing treatment may lead to...
Amputation is an irreversible, last-line treatment indicated for a multitude of medical problems. Delaying amputation in favor of limb-sparing treatment may lead to increased risk of morbidity and mortality. This systematic review aims to synthesize the literature on how ML is being applied to predict amputation as an outcome. OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. 1376 studies were screened; 15 articles were included. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g.: burns and peripheral vascular disease), models had similar performance (AUC: 0.81-1.0). Many studies were found to have a high PROBAST risk of bias, most often due to small sample sizes. In conclusion, multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting.
Topics: Humans; Prospective Studies; Amputation, Surgical; Peripheral Vascular Diseases; Machine Learning
PubMed: 37934767
DOI: 10.1371/journal.pone.0293684 -
Journal of Eating Disorders Oct 2023Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review,... (Review)
Review
BACKGROUND
Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents' views on the treatment and recovery process of anorexia nervosa in their adolescent child.
METHOD
A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents' views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis.
RESULTS
A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery.
CONCLUSION
Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
PubMed: 37904246
DOI: 10.1186/s40337-023-00910-z -
Saudi Journal of Anaesthesia 2024This review article examines the utility of artificial intelligence (AI) in anesthesia, with a focus on recent developments and future directions in the field. A total... (Review)
Review
This review article examines the utility of artificial intelligence (AI) in anesthesia, with a focus on recent developments and future directions in the field. A total of 19,300 articles were available on the given topic after searching in the above mentioned databases, and after choosing the custom range of years from 2015 to 2023 as an inclusion component, only 12,100 remained. 5,720 articles remained after eliminating non-full text. Eighteen papers were identified to meet the inclusion criteria for the review after applying the inclusion and exclusion criteria. The applications of AI in anesthesia after studying the articles were in favor of the use of AI as it enhanced or equaled human judgment in drug dose decision and reduced mortality by early detection. Two studies tried to formulate prediction models, current techniques, and limitations of AI; ten studies are mainly focused on pain and complications such as hypotension, with a P value of <0.05; three studies tried to formulate patient outcomes with the help of AI; and three studies are mainly focusing on how drug dose delivery is calculated (median: 1.1% ± 0.5) safely and given to the patients with applications of AI. In conclusion, the use of AI in anesthesia has the potential to revolutionize the field and improve patient outcomes. AI algorithms can accurately predict patient outcomes and anesthesia dosing, as well as monitor patients during surgery in real time. These technologies can help anesthesiologists make more informed decisions, increase efficiency, and reduce costs. However, the implementation of AI in anesthesia also presents challenges, such as the need to address issues of bias and privacy. As the field continues to evolve, it will be important to carefully consider the ethical implications of AI in anesthesia and ensure that these technologies are used in a responsible and transparent manner.
PubMed: 38654854
DOI: 10.4103/sja.sja_955_23 -
International Journal of Nursing... Dec 2023Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions,... (Review)
Review
BACKGROUND
Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions, is at the core of nursing practice and essential to provide safe and quality care. Instruments to assess nurses' perceptions of their clinical decision-making abilities or skills have been developed for research and education. Thus, it is essential to determine the most valid and reliable instruments available to reflect nurses' self-reported clinical decision-making accurately.
OBJECTIVE
To evaluate the measurement properties of self-reported clinical decision-making instruments in nursing.
METHODS
A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42022364549). Five bibliographical databases were searched in July 2022 using descriptors and keywords related to nurses, clinical decision-making, and studies on measurement properties. Two independent reviewers conducted reference selection and data extraction. The evaluation of the instruments' measurement properties involved assessing the quality of the studies, the quality of each measurement property (i.e., validity, reliability, responsiveness), and the quality of evidence based on the COSMIN.
RESULTS
Nine instruments evaluated in eleven studies with registered nurses or nursing students from various clinical contexts were identified. Five of the nine instruments were originals; four were translations or adaptations. Most focused on analytical and intuitive decision-making, although some were based on clinical judgment and clinical reasoning theories. Structural validity and internal consistency were the most frequently reported measurement properties; other properties, such as measurement error, criterion validity, and responsiveness, were not assessed for any instruments. A gap was also identified in the involvement of nurses or nursing students in the instrument development process and the content validity assessment. Six instruments appear promising based on the COSMIN criteria, but further studies are needed to confirm their validity and reliability.
CONCLUSIONS
The evidence regarding instruments to assess nurses' self-reported clinical decision-making is still minimal. Although no instruments could be recommended based on the COSMIN criteria, the Nurses Clinical Reasoning Scale had the most robust supporting evidence, followed by the adapted version of the Clinical Decision Making in Nursing Scale. Future efforts should be made to systematically assess content validity through the involvement of the target population and by ensuring that the results of other measurement properties, such as reliability, measurement error, or hypothesis testing, are rigorously assessed and reported.
TWEETABLE ABSTRACT
Despite limited evidence, this COSMIN review identified six promising instruments to assess nurses' clinical #decision-making, especially the Nurses Clinical Reasoning Scale and an adaptation of the Clinical Decision Making in Nursing Scale. #nursingresearch #nursingeducation.
PubMed: 38746590
DOI: 10.1016/j.ijnsa.2023.100122 -
Nurse Education in Practice Nov 2023This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to... (Review)
Review
OBJECTIVES
This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.
INTRODUCTION
Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.
INCLUSION CRITERIA
Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.
METHODS
The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.
RESULTS
Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.
CONCLUSION
This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.
Topics: Humans; Judgment; Clinical Competence; Education, Nursing; Students, Nursing; Nurses
PubMed: 37925834
DOI: 10.1016/j.nepr.2023.103818 -
Frontiers in Veterinary Science 2023Cognitive approaches are increasingly used to assess animal welfare, but no systematic review has been conducted on pigs despite their cognitive capacities. Our aims...
Cognitive approaches are increasingly used to assess animal welfare, but no systematic review has been conducted on pigs despite their cognitive capacities. Our aims were two-fold: first, to assess the popularity and heterogeneity of this approach by quantifying the different cognitive tasks used and welfare interventions studied. The second was to assess how often results from cognitive tasks supported treatment effects. The search yielded 36 studies that met our criteria. Eleven different cognitive tasks were applied (three most common: judgment bias, learned approach/aversion, and holeboard). Welfare interventions investigated were also diverse: the impact of 19 other different events/conditions/states were reported (most common: housing enrichment). We defined "supportive" as the observation of a significant difference between treatment groups consistent with an author's expectation or hypothesis. Supportive findings were reported in 44% of papers. Interventions yielded no significant difference in 33% of studies. In another 21% of reports, outcomes were mixed and a single study refuted the author's predictions. When considering specific cognitive tasks, authors' predictions of welfare differences were supported most often when using learned approach/aversion (55% of these studies). Similar supportive results were observed less commonly (40% each) when using judgment bias and holeboard tests. Analysis of additional concomitant measures of welfare (health, physiology or behavior) revealed that behavioral measures were most frequently supportive of author's expectations (41%) as well as often matching the actual outcomes of these cognitive tasks (47%). This systematic review highlights the growing popularity of cognitive tasks as measures of pig welfare. However, overall rates of supportive results, i.e., changes in performance on cognitive tasks due to welfare interventions, have been limited so far, even for the most employed task, judgment bias. The numerous different combinations of experimental paradigms and welfare interventions reported in the literature creates challenges for a critical meta-analysis of the field especially in evaluating the efficiency of specific cognitive tasks in assessing animal welfare. This work also highlights important knowledge gaps in the use of cognitive tasks that will require both further validation as well as novel innovation to ensure that their potential is fully realized in the measurement of pig welfare.
PubMed: 38033647
DOI: 10.3389/fvets.2023.1251070 -
Healthcare (Basel, Switzerland) Dec 2023Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course... (Review)
Review
BACKGROUND
Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students.
METHODS
A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies.
RESULTS
Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies.
CONCLUSIONS
This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.
PubMed: 38200996
DOI: 10.3390/healthcare12010090 -
Frontiers in Neurology 2023Chronic pain is common, disruptive, and often treatment-resistant. Hence, researchers and clinicians seek alternative therapies for chronic pain. Transcranial... (Review)
Review
BACKGROUND
Chronic pain is common, disruptive, and often treatment-resistant. Hence, researchers and clinicians seek alternative therapies for chronic pain. Transcranial alternating current stimulation (tACS) is an emerging neuromodulation technique that non-invasively modulates neural oscillations in the human brain. tACS induces pain relief by allowing the neural network to restore adequate synchronization. We reviewed studies on the effectiveness of tACS in controlling chronic pain.
METHODS
The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published until December 6, 2023. The key search phrase for identifying potentially relevant articles was [(Transcranial Alternating Current Stimulation OR tACS) AND pain]. The following inclusion criteria were applied for article selection: (1) studies involving patients with chronic pain; (2) tACS was applied for controlling pain; and (3) follow-up evaluations were performed to assess the degree of pain reduction after the application of tACS.
RESULTS
We identified 2,330 potentially relevant articles. After reading the titles and abstracts and assessing eligibility based on the full-text articles, we included four articles in our review. Among the included studies, tACS was used for fibromyalgia in one study, low back pain (LBP) in two studies, and migraine in one study. In the study on fibromyalgia, it did not show a better pain-reducing effect of tACS compared with sham stimulation. Two studies on LBP showed conflicting results. In migraine, tACS showed a positive pain-reducing effect 24-48 h after its application.
CONCLUSION
There is insufficient research to draw a conclusive judgment on the effectiveness of tACS in controlling chronic pain. More studies across various chronic pain-related diseases are required for a definitive conclusion.
PubMed: 38192572
DOI: 10.3389/fneur.2023.1323520 -
Neurocritical Care Apr 2024The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH)...
BACKGROUND
The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication.
METHODS
A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format.
RESULTS
Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality.
CONCLUSIONS
These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
Topics: Adult; Humans; Critical Illness; Reproducibility of Results; Cerebral Hemorrhage; Prognosis; Hospitalization
PubMed: 37923968
DOI: 10.1007/s12028-023-01854-7