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Search Results: 1 - 10 of 219304 matches for " Violato C "
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Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning
Gabriel A, Violato C
Advances in Medical Education and Practice , 2013, DOI: http://dx.doi.org/10.2147/AMEP.S38372
Abstract: oblem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning Original Research (524) Total Article Views Authors: Gabriel A, Violato C Published Date January 2013 Volume 2013:4 Pages 11 - 16 DOI: http://dx.doi.org/10.2147/AMEP.S38372 Received: 21 September 2012 Accepted: 31 October 2012 Published: 10 January 2013 Adel Gabriel,1,2 Claudio Violato2 1Departments of Psychiatry, University of Calgary, Calgary; 2Medical Education, Community Health Sciences, University of Calgary Calgary, Canada Background: The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry. Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses. Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices. Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.
Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning
Gabriel A,Violato C
Advances in Medical Education and Practice , 2013,
Abstract: Adel Gabriel,1,2 Claudio Violato21Departments of Psychiatry, University of Calgary, Calgary; 2Medical Education, Community Health Sciences, University of Calgary Calgary, CanadaBackground: The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry.Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses.Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices.Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.Keywords: diagnostic reasoning, knowledge structure, psychiatric diagnosis, hypothetic-deductive, scheme-inductive
The development of a knowledge test of depression and its treatment for patients suffering from non-psychotic depression: a psychometric assessment
Adel Gabriel, Claudio Violato
BMC Psychiatry , 2009, DOI: 10.1186/1471-244x-9-56
Abstract: A total of 63 depressed patients and twelve psychiatric experts participated. Based on empirical evidence from an extensive review, theoretical knowledge and in consultations with experts, 27-item MCQ knowledge of depression and its treatment test was constructed. Data collected from the psychiatry experts were used to assess evidence of content validity for the instrument.Cronbach's alpha of the instrument was 0.68, and there was an overall 87.8% agreement (items are highly relevant) between experts about the relevance of the MCQs to test patient knowledge on depression and its treatments. There was an overall satisfactory patients' performance on the MCQs with 78.7% correct answers. Results of an item analysis indicated that most items had adequate difficulties and discriminations.There was adequate reliability and evidence for content and convergent validity for the instrument. Future research should employ a lager and more heterogeneous sample from both psychiatrist and community samples, than did the present study. Meanwhile, the present study has resulted in psychometrically tested instruments for measuring knowledge of depression and its treatment of depressed patients.Many people who have personal experience with depression cannot recognize it in vignettes, can't differentiate depression from normal sadness [1], their knowledge about its causes is distorted and over half of the subjects who have major depression (MD) do not seek treatment for the episode [2-4]. Moreover, only 40% consider antidepressants to be helpful [2], few recommend treatment from a counselor, telephone service or psychologist, and many consider a psychiatrist as harmful [3]. There is, however, emerging evidence to suggest that mental health literacy can be improved with educational interventions [5,6].If the public's mental health literacy is not improved, public acceptance of evidence-based mental health care may be hindered. There is still much to be done to provide an empirical basis
Structural equation modeling in medical research: a primer
Tanya N Beran, Claudio Violato
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-267
Abstract: To facilitate its use we provide a series of steps for applying SEM to research problems. We then present three examples of how SEM has been utilized in medical and health sciences research.When many considerations are given to research planning, SEM can provide a new perspective on analyzing data and potential for advancing research in medical and health sciences.Structural equation modeling (SEM) is a powerful multivariate analysis technique that is widely used in the social sciences [1]. Its applications range from analysis of simple relationships between variables to complex analyses of measurement equivalence for first and higher-order constructs [2]. It provides a flexible framework for developing and analyzing complex relationships among multiple variables that allow researchers to test the validity of theory using empirical models. Perhaps its greatest advantage is the ability to manage measurement error, which is one of the greatest limitations of most studies. Although its application has been seen in many disciplines, it has yet to be extensively used in medical research and epidemiology.In a recent paper, we provided a "how to" for medical education researchers [3]. Specific principles and examples for the field of medical education were utilized. The purpose of the present paper, however, is to introduce structural equation modeling through explanation and demonstration of its methods in an attempt to disseminate it more widely in medical and health sciences research.The use of SEM has now become widespread across research domains. In psychology, for example, the citation frequency of SEM has steadily increased from 164 in 1994 to 343 in 2000 and then to 742 in the last year (based on the citation frequency of SEM and M[ANOVA] of PsychINFO database 1970-2010) [4,5]. This suggests that researchers recognize its application to a variety of research questions, types of data, and methods of study. An increase in use of sophisticated tools of analysis reflec
Temporal stability of objective structured clinical exams: a longitudinal study employing item response theory
Baig Lubna A,Violato Claudio
BMC Medical Education , 2012, DOI: 10.1186/1472-6920-12-121
Abstract: Background The objective structure clinical examination (OSCE) has been used since the early 1970s for assessing clinical competence. There are very few studies that have examined the psychometric stability of the stations that are used repeatedly with different samples. The purpose of the present study was to assess the stability of objective structured clinical exams (OSCEs) employing the same stations used over time but with a different sample of candidates, SPs, and examiners. Methods At Time 1, 191 candidates and at Time 2 (one year apart), 236 candidates participated in a 10-station OSCE; 6 of the same stations were used in both years. Generalizability analyses (Ep2) were conducted. Employing item response analyses, test characteristic curves (TCC) were derived for each of the 6 stations for a 2-parameter model. The TCCs were compared across the two years, Time 1 and 2. Results The Ep2 of the OSCEs exceeded.70. Standardized thetas (θ) and discriminations were equivalent for the same station across the two year period indicating equivalent TCCs for a 2-parameter model. Conclusion The 6 OSCE stations used by the AIMG program over two years have adequate internal consistency reliability, stable generalizability (Ep2) and equivalent test characteristics. The process of assessment employed for IMG’s are stable OSCE stations that may be used several times over without compromising psychometric properties. With careful security, high-stakes OSCEs may use the same stations that have high internal consistency and generalizability repeatedly as the psychometric properties are stable over several years with different samples of candidates.
Ego identity development in physicians: a cross-cultural comparison using a mixed method approach
Tanya N Beran, Efrem Violato, Sonia Faremo, Claudio Violato, David Watt, Deidre Lake
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-249
Abstract: A total of 46 IMGs participated in a semi-structured interview - 20 were CIMGs and 26 were non-CIMGs.An iterative process of content analysis was conducted to categorize responses from five open-ended questions according to the Ego Identity Statuses theory of career decision-making. Event contingency analysis identified a significant difference between CIMGs and non-CIMGs, Fisher’s exact test (1)?=?18.79, p?<?.0001. A total of 55% of CIMGs were categorized as identity achieved and 45% as foreclosed; 100% of non-CIMGs were classified as identity foreclosed.About half of the Canadian citizens who had studied medicine in a foreign country had explored different careers before making a commitment to medicine, and half had not. No IMGs, however, who studied medicine in another country before immigrating to Canada, had explored various career opportunities before selecting medicine.As a result of increased professional migration, a large number of doctors are seeking licensure in a country other than where they were educated [1]. Known as International Medical Graduates (IMGs), they comprise approximately one quarter of the physician workforce in countries such as Canada, the U.S., the U.K., and Australia [2]. Despite their demonstrated competence and value to society, they are faced with many challenging assessment procedures and limited practice opportunities, which reportedly may result in alienation and isolation [3-5]. To facilitate their integration into the profession while ensuring that they meet standards of competence, it is critical that we understand how they develop their professional identity. The purpose of the present study was to identify how each group of IMGs decided to become doctors while they were applying for certification.There are two main types of IMGs who apply for licensure: Those who were local citizens before leaving to study medicine in a foreign country, and those who had studied medicine in a foreign country before immigrating. In Canada,
Resource Use and Costs Associated with Coeliac Disease before and after Diagnosis in 3,646 Cases: Results of a UK Primary Care Database Analysis
Mara Violato, Alastair Gray, Irini Papanicolas, Melissa Ouellet
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041308
Abstract: Background Despite the considerable health impact of coeliac disease (CD), reliable estimates of the impact of diagnosis on health care use and costs are lacking. Aims To quantify the volume, type and costs, in a United Kingdom primary care setting, of healthcare resources used by individuals diagnosed with CD up to ten years before and after diagnosis, and to estimate medical costs associated with CD. Methods A cohort of 3,646 CD cases and a parallel cohort of 32,973 matched controls, extracted from the General Practice Research Database (GPRD) over the period 1987–2005 were used i) to evaluate the impact of diagnosis on the average resource use and costs of cases; ii) to assess direct healthcare costs due to CD by comparing average resource use and costs incurred by cases vs. controls. Results Average annual healthcare costs per patient increased by £310 (95% CI £299, £320) after diagnosis. CD cases experienced higher healthcare costs than controls both before diagnosis (mean difference £91; 95% CI: £86, £97) and after diagnosis (mean difference £354; 95% CI: £347, £361). These differences were driven mainly by higher test and referral costs before diagnosis, and by increased prescription costs after diagnosis. Conclusions This study shows significant additional primary care costs associated with coeliac disease. It provides novel evidence that will assist researchers evaluating interventions in this area, and will challenge policymakers, clinicians, researchers and the public to develop strategies that maximise the health benefits of the resources associated with this disease.
Assessing clinical communication skills in physicians: are the skills context specific or generalizable
Lubna A Baig, Claudio Violato, Rodney A Crutcher
BMC Medical Education , 2009, DOI: 10.1186/1472-6920-9-22
Abstract: A psychometric design was used for identifying the reliability and validity of the communication skills instruments used for high-stakes exams for IMG's. Data were collected from 39 IMGs (19 men – 48.7%; 20 women – 51.3%; Mean age = 41 years) assessed at 14 station OSCE and subsequently in supervised clinical practice with several instruments (patient surveys; ITERs; Mini-CEX).All the instruments had adequate reliability (Cronbach's alpha: .54 – .96). There were significant correlations (r range: 0.37 – 0.70, p < .05) of communication skills assessed by examiner with standardized patients, and of mini-CEX with patient surveys, and ITERs. The intra-item reliability across all cases for the 13 items was low (Cronbach's alpha: .20 – .56). The correlations of communication skills within method (e.g., OSCE or clinical practice) were significant but were non-significant between methods (e.g., OSCE and clinical practice).The results provide evidence of context specificity of communication skills, as well as convergent and criterion-related validity of communication skills. Both in OSCEs and clinical practice, communication checklists need to be case specific, designed for content validity.Communication is one of the most important components of physicians' patient management skills and overall competence. Competence in a physician is a composite of clinical skills, interpersonal aspects of patient physician encounter, professionalism and communication skills [1-3]. A good communicator can extract appropriate history from the patient, formulate an appropriate diagnosis, build a strong doctor patient relationship, and can appropriately negotiate management strategy with the patient.OSCEs have been used extensively to assess communication skills. Measurement errors have been identified for case specificity, candidate-standardized patient (SP) interaction, and case-candidate interaction [4,5]. Although Hodges, Turnbull, Cohen et al. reported a significant difference in the mea
Reduction in weight and BMI and changes in Co-morbidities following laparoscopic adjustable gastric banding procedure for morbidly obese patients in Bahrain: a five year longitudinal study
Khalid Al Khalifa, Claudio Violato and Ahmed Al Ansari
SpringerPlus , 2013, DOI: 10.1186/2193-1801-2-19
Abstract: LAGB is a safe and effective surgical procedure for morbidly obese patients resulting in weight loss, BMI decrease and reduction in co-morbid illnesses.
The Impact of Sleeve Gastrectomy on Hyperlipidemia: A Systematic Review
Khalid Al Khalifa,Ahmed Al Ansari,Abdul Rahim Alsayed,Claudio Violato
Journal of Obesity , 2013, DOI: 10.1155/2013/643530
Abstract: Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was ?kg/m2 (range 37.2–65.3). The mean postoperative BMI was 35 ± 5.9?kg/m2 (range 26.3–49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7–84.5), with a mean followup of 19.1 months (range 6–60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3?mg/dL (range 178–213) and 181 ± 16.3?mg/dL (range 158–200), respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients. 1. Introduction Laparoscopic sleeve gastrectomy (LSG) was introduced initially as a first stage of the biliopancreatic diversion with duodenal switch (BPDDS) for severely obese patients who were regarded as high risk surgical candidates [1]. Due to its greater efficiency [2], technical simplicity [3], and low complication rates [4], LSG has become more widely accepted as a definitive treatment for morbidly obese patients [5]. In LSG, the stomach is divided vertically, while removing most of the fundus of the stomach and preserving the continuity of the digestive tract [6]. LSG leads to long-term weight loss and improvement or resolution of its associated comorbidities such as diabetes mellitus (DM), hypertension, and hyperlipidemia [7, 8]. In a recent systematic review on the effect of the LSG on co-morbidities, Sarkhosh et al. [8] reported resolution of hypertension in 58% and resolution or improvement of hypertension in 75% of patients following LSG. In another systematic review, Alamo et al. [9] reported resolution of type 2 diabetes mellitus (T2DM) in 84% of patients after LSG.
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