Forming a medical diagnosis is a complicated reasoning process undertaken by physicians. Although there has been much research focusing on clinical reasoning approaches, there is limited empirical evidence in relation to causal attribution in medical diagnosis. The research on which this thesis is based explored and examined the social process of medical diagnosis and provides an explanation of the clinical reasoning and causal attribution used by physicians. The research was undertaken in an Emergency Department within an acute hospital, the data were collected using mixed method approach including one to one semi-structured interviews with individual physicians; observation of their medical assessments of patients and secondary data analysis of the subsequent recorded medical notes. The study involved 202 patients and 26 physicians. The analysis of the physicians’ semi-structured interviews, shows how physicians describe the diagnostic step process and how they blend their clinical reasoning skills and professional judgment with evidence-based medicine. Physicians apply prior learning of taught biomedical and pathophysiological knowledge to question patients using pattern recognition of common signs and symptoms of disease. These findings are portrayed through taped narratives of the physician/patient interaction during the medical diagnostic process, which shows how physicians control the medical encounter. The analysis/interpretation of documentary evidence (recorded medical notes) provides an insight into the way in which physicians used the information gathered during the diagnostic step process. By using SPSS it was possible to cluster the cases (individual patients) into groups. This stage-ordered classification procedure demonstrated commonality amongst individual cases whilst highlighting the uniqueness of any cases. A pattern emerged of two groups of cases: Group 1 - comprised of patients with the presenting complaints of chest pain, shortness of breath, collapse, abdominal pain, per rectal bleed, nausea, vascular and neurological problems and Group 2 - comprised of patients presenting with trauma, mechanical falls, miscarriage/gynaecological problems, allergies/rashes and dental problems. Findings show that the clinical reasoning approaches used varied according to the complexity of the patient’s presenting complaint. The recorded medical notes for the patients in Group 1, were comprehensive and demonstrated a combined approach of hypothetic-deductive and probabilistic reasoning which enabled the physicians to deal with the degree of uncertainty that is inherent in medicine. The recorded process in the medical notes was shortened for the majority of patients in Group 2, and here the clinical reasoning approach used was found to deterministic. It is acknowledged, that this is not always the case. By using crisp set QCA it was possible to explore causal conditions consistent with Group 1. Further analysis led to examination of the link of causal conditions presented in the medical notes with the individual impression/working diagnosis made by physicians.

Betrachtet man die geschichtliche Entwicklung der Medizin in Europa und der arabischen Welt, so ist diese geprägt vom gegenseitigen Austausch und dem grenzübergreifenden Transfer von Wissen. In der frühislamischen Blütezeit legten arabische Wissenschaftler das empirische Fundament, auf dem heutzutage die moderne Schulmedizin fußt. Medizinische Werke, wie der al-qānūn fi cilm aṭ-ṭibb des Ibn Sīnā1 gelangten ins spätmittelalterliche Euro-pa, in dem die Wissenschaften unter dem Druck religiös motivierte Repressionen und aber-gläubischer Vorstellungen nahezu zum Erliegen gekommen war und blieben dort lange die einzige Grundlage für die theoretische Weiterentwicklung der Medizin2. Auf der Suche nach einer Thematik, die in Orient und Okzident gleichermaßen von Relevanz und präsent ist, um sie auf terminologischer und struktureller Ebene einander gegenüberzu-stellen, bot sich die Medizin daher als besonders geeigneter Untersuchungsgegenstand für eine solche Bestandsaufnahme, sprich für dieses Arbeit, an. Die darauf folgende thematische Eingrenzung war zu einem nicht unwesentlichen Teil beeinflusst und motiviert durch die Ausbildung und Berufserfahrung des Verfassers als Rettungssanitäter. Nichtsdestotrotz wurden persönliche Erfahrungen hier nicht als empirische Quelle missverstanden. Vielmehr wurden mit Rücksicht auf die wissenschaftliche Form und den daraus resultierenden Anforderungen an vorliegende Arbeit alle Informationen in angemessener Weise und sorgfältig recherchiert. Aufgrund struktureller und bildungspolitischer Faktoren ergab die Recherche und Sichtung der vorhandenen Fachliteratur fast erwartungsgemäß ein quantitatives und qualitatives Ungleichgewicht zugunsten englisch- und deutschsprachiger Publikationen. Dieser vergleichsweise lückenhafte Publikationsstand arabischer Fachliteratur im notfallmedizinischen Bereich, der symptomatisch für die insgesamt defizitäre rettungsdienstliche Situation im arabischen Raum ist, war zugleich Herausforderung und Ansporn, zu diesem Thema zu recherchieren und das Vorhandene in dieser Arbeit zusammenzutragen. Neben der Einordnung der Notfallmedizin im historischen Kontext, der Beleuchtung praktischer Aspekte des Rettungsdienstes und einer exemplarischen Momentaufnahme rettungsdienstlicher Strukturen in ausgewählten arabischen Ländern, soll vorliegendes Glossar Dolmetschern und Übersetzern nützliches Werkzeug bei der Vorbereitung und Ausführung von Aufträgen im medizinischen und notfallmedizinischen Bereich sein.

Knowledge is a critical element for the provision of quality health care. Optimal clinical decision making incorporates multiple types of knowledge including patient knowledge, clinical experiential knowledge and research knowledge. Understanding how knowledge is shared and used in best practice is challenging as a number of factors can facilitate or impede the process. Several authors have highlighted the value of using a theoretical framework when examining knowledge in health care. A theoretical framework provides direction for the generation and testing of hypotheses which can contribute to building a comprehensive body of knowledge in a field of study. Although the majority of knowledge exchanged in practice settings occurs between clinicians, current knowledge exchange and utilization models in health care generally focus specifically on the exchange of research knowledge between the scientific community and the practice community. Acknowledging and understanding the knowledge seeking and sharing behaviours of clinicians is a key element in the larger knowledge translation puzzle. Emergency medicine is a clinical speciality where there is evidence of a knowledge to practice gap, however, there is limited understanding of the factors that contribute to the gap. Emergency practitioners must make decisions in a busy and often chaotic environment that is prone to multiple interruptions and distractions. The challenge for consistent and quality care is also more pronounced in rural and some suburban areas where emergency care needs are similar but resources are limited. The purpose of this program of research is to identify factors relevant to knowledge exchange and utilization in rural and urban emergency departments with the aim of developing a Model for Knowledge Exchange and Utilization in Emergency Practice. A series of studies were carried out using a mixed method research design to further develop and describe 3 key dimensions (individual, context of practice, knowledge) which were identified through a review of the literature. Data was collected using surveys, participant observations and interviews with nurses and physicians working in rural and urban emergency departments in Nova Scotia. Triangulation of results across the studies contributed to developing a comprehensive and rigorous description of the 3 dimensions of interest.

No description available.

Thesis (M.Tech.: Emergency Medical Care)-Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 301 leaves, Annexures A-0 to A-7 / Paramedic clinical decision making (CDM) surrounding emergency airway management of the critically ill or injured patient in the pre-hospital environment is poorly understood. In order to deliver pre-hospital care effectively it is necessary to understand how paramedics make clinical decisions in this area and determine what influences clinical practice. This study primarily investigated the factors influencing paramedic CDM in the context of advanced emergency airway management with specific focus on the newly introduced skill of rapid sequence intubation (RSI). An evaluation of the correct application of RSI guidelines, the determination of the need for their review and the identification of measures to enhance CDM around RSI were secondary research questions.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis (Ph.D.)--University of Western Australia, 2007.

Background: Acute heart failure and chronic obstructive pulmonary disease (COPD) exacerbation are common, and are sometimes difficult to differentiate in the emergency department (ED). Objectives: To determine the clinical impact of Point-of-Care Ultrasonography (POCUS) in ED patients with suspected acute heart failure or COPD. Methods: We conducted a prospective health records review with 1:3 matching, and analyzed time to events using time-dependent Cox regression analyses, classification performance, and adverse events. Results: There were 81 patients with lung POCUS and 243 matched patients. No differences were found in ED length of stay or length of care, nor adverse events. Significance was found for time to treatment (P=0.03). Lung POCUS had high sensitivity (92.5%) and specificity (85.7%) for identifying acute heart failure. Conclusions: Lung POCUS could result in faster treatments for patients with suspected acute heart failure and COPD, and has high accuracy in identifying acute heart failure.

Syncope is a common Emergency Department (ED) presentation. An important proportion of syncope patients are at risk of developing serious adverse events (SAEs), such as deaths or arrhythmias following ED disposition. Currently, no clinically-useful decision tool exists to reliably identify high-risk patients. This study derived a clinical decision tool to identify syncope patients at risk of developing SAEs after ED disposition. This study also examined key methodological considerations involved in deriving decision tools by comparing two different methodological approaches: a traditional and modern approach. The traditional approach led to an eight-variable decision tool that allowed simple clinical interpretation and use. The modern approach, which aims to avoid data-driven methodology and statistical overfitting, was used to derive a ten-variable decision tool. Both decision tools displayed acceptable and comparable performance in internal validation studies (c-statistic 0.87, 95% confidence interval 0.84-0.89). A future external validation study is required to comprehensively compare the methods.

No description available.