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1.
Actual. osteol ; 19(2): 144-159, sept. 2023. ilus, tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1523956

ABSTRACT

Osteoporosis and vertebral and non-vertebral fractures are common in glucocorticoids (GC) treated patients. Oral GC treatment leads to bone loss, particularly of trabecular bone. The benefits of GC used in rheumatological and traumatological disorders are known but they would have possible negative effects on bone. This systematic review aimed to evaluate the effects of epidural steroid injections (ESI), and intra-articular and intramuscular GC administration on bone mineral density (BMD) and fragility fractures. A systematic review of Medline/PubMed, Cochrane, and LILACS up to November 2020 was conducted. Meta-analyses, systematic reviews, randomized and non-randomized controlled trials, and prospective and retrospective studies comparing the effect of ESI, intra-articular or intramuscular GC used compared to a control group or baseline measurements were included. Results: A total of 8272 individuals were included among the 13 selected articles (10 about ESI and 3 about intra-articular GC; no article was found evaluating intramuscular GC). Only a few studies showed a negative effect of ESI on bone in the qualitative analysis considering osteopenia and osteoporosis in lumbar spine, femoral neck and total hip and BMD as surrogate outcomes. On the other hand, the qualitative analysis showed that most studies found an increased risk of fragility fracture. However, only two studies could be included in the quantitative analysis, in which there were no differences between patients exposed to ESI versus controls in all evaluated regions. In conclusion, there was insufficient evidence to suggest that ESI and intra-articular GC, unlike oral GC, negatively affect bone mass. Longitudinal studies are needed to obtain more knowledge regarding the effect of ESI or intra-articular GC on BMD and fragility fractures. (AU)


La osteoporosis y las fracturas vertebrales y no vertebrales son comunes en pacientes tratados con glucocorticoides (GC). El tratamiento oral con GC conduce a la pérdida ósea, particularmente del hueso trabecular. Los beneficios de los GC utilizados en patologías reumatológicas y traumatológicas son conocidos, pero tendrían posibles efectos negativos sobre el hueso. Esta revisión sistemática tuvo como objetivo evaluar los efectos de las inyecciones epidurales de esteroides (ESI), GC intraarticulares e intramusculares sobre la densidad mineral ósea (DMO) y las fracturas por fragilidad. Se realizó una revisión sistemática de Medline/PubMed, Cochrane y LILACS hasta noviembre de 2020. Se incluyeron metanálisis, revisiones sistemáticas, ensayos controlados aleatorizados y no aleatorizados, estudios prospectivos y retrospectivos que compararon el efecto de ESI, GC intraarticular o intramuscular utilizado en comparación con un grupo de control o mediciones iniciales. Resultados: Se incluyeron un total de 8272 individuos entre los 13 artículos seleccionados (10 sobre ESI y 3 sobre GC intraarticular; no se encontró ningún artículo que evaluara GC intramuscular). Solo unos pocos estudios mostraron un efecto negativo del ESI sobre el hueso en el análisis cualitativo considerando la osteopenia y la osteoporosis en la columna lumbar, el cuello femoral y la cadera total y la DMO como un resultado indirecto. Por otro lado, el análisis cualitativo mostró que la mayoría de los estudios encontraron un mayor riesgo de fractura por fragilidad. Sin embargo, solo dos estudios pudieron incluirse en el análisis cuantitativo, en los que no hubo diferencias entre los pacientes expuestos a ESI versus los controles en todas las regiones evaluadas. En conclusión, no hallamos datos suficientes para sugerir que la ESI y los GC intraarticulares, a diferencia de los GC orales, afectan negativamente a la pérdida ósea. Se necesitan estudios longitudinales para obtener más conocimiento sobre el efecto de ESI o GC intraarticular en la DMO y las fracturas por fragilidad. (AU)


Subject(s)
Humans , Osteoporosis/etiology , Bone Diseases, Metabolic/etiology , Bone Density/drug effects , Osteoporotic Fractures/chemically induced , Glucocorticoids/adverse effects , Review Literature as Topic , Bias , Drug Administration Routes , Meta-Analysis as Topic , Clinical Trials as Topic , Risk Assessment , Densitometry , Estrogens/adverse effects
2.
Dolor ; 33(76): 16-22, ago. 2023. ilus
Article in Spanish | LILACS | ID: biblio-1510384

ABSTRACT

Los sesgos cognitivos son un constructo que acuñaron Kahneman & Tveysky (1972) en su Enfoque de Sesgos dentro de la Psicología Cognitiva. Estos son atajos intelectuales que realizan siempre las personas, desde un razonamiento probabilístico intuitivo. El presente trabajo es una primera aproximación que intenta aplicar y describir algunos sesgos cognitivos en el complejo mundo de las representaciones mentales en la experiencia dolorosa, como la ilusión de control; del presente; la confirmación; representatividad; disponibilidad, entre otros. Los sesgos en dolor nos permiten comprender el procesamiento de información frente al dolor y utilizar estrategias comunicacionales más efectivas para su abordaje.


Cognitive biases are a construct coined by Kahneman & Tveysky (1972) in their Approach to Biases in Cognitive Psychology. These are intellectual shortcuts that people always carry out, from an intuitive probabilistic reasoning. An attempt is made to apply and describe some cognitive biases in the complex world of mental representations in the painful experience, like the illusion of control; of the present; the confirmation; representativeness; availability among others. Biases in pain allow us to understand the processing of information in the face of pain and use more effective communication strategies to address it.


Subject(s)
Humans , Chronic Pain , Cognitive Psychology , Thinking , Bias , Intuition
3.
São Paulo; s.n; 20230301. 62 p.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1417551

ABSTRACT

O objetivo desta revisão sistemática foi coletar e comparar os dados de sobrevida após o reparo e substituição para restaurações com falhas em dentes decíduos e permanentes. As buscas foram realizadas em dez/2020 e atualizado em abr/2022 de forma sistemática nas bases de dados PubMed/MEDLINE, Scopus, Web of Science, Embase, OpenSigle e ProQuest. Dois revisores independentes calibrados (kappa=0,87) avaliados como critérios de inclusão: (1) estudos de reparo e substituição, (2) dados de sucesso, longevidade ou sobrevivência, (3) ensaios clínicos controlados aleatoriamente; e para os critérios de exclusão (1) perda para acompanhamento superior a 30%, (2) acompanhamento inferior a 12 meses, (3) dentes anteriores. A ferramenta RoB 2 foi utilizada para avaliar o risco de viés, enquanto que a certeza da evidência foi medida por meio da ferramenta GRADE. Foi identificado 4.070 publicações potencialmente relevantes, entretanto apenas três estudos apresentaram todos os critérios para elegibilidade e foram incluídos na análise qualitativa. Nenhum estudo reportou a taxa de sucesso das intervenções na dentição decídua. Foi coletado um tempo padrão de acompanhamento entre os estudos, e a taxa de sobrevivência agregada foi de 99% após três anos. Não houve diferença estatisticamente significativa entre as abordagens e nenhuma heterogeneidade entre os estudos foi apontada. Todos os estudos incluídos apresentaram alto risco de viés, além de que a certeza da evidência para a medida do desfecho sucesso foi muito baixa. É importante ressaltar que devido à longevidade similar de ambas as técnicas, é fortemente recomendado realizar a técnica de reparo para restaurações que apresentam falha, uma vez que esta técnica está associada à odontologia de intervenção mínima. Mais estudos clínicos bem delineados são necessários para aumentar a certeza da evidência. Registro do RS: Esta revisão sistemática foi registrada na plataforma Prospero (CRD42021238063)


Subject(s)
Humans , Tooth, Deciduous , Dentition, Permanent , Dental Restoration Failure , Dental Restoration, Permanent , Time Factors , Bias , Randomized Controlled Trials as Topic
4.
Neumol. pediátr. (En línea) ; 18(3): 62-63, 2023.
Article in Spanish | LILACS | ID: biblio-1512519

ABSTRACT

Los sesgos cognitivos son fallas en el razonamiento que pueden alterar los resultados de la investigación. Se presenta brevemente la historia de éstos y ejemplos para facilitar la comprensión y la reflexión en torno a esta "trampa del pensamiento".


Cognitive biases are flaws in reasoning that can alter research outcomes. The history of these biases is briefly presented, along with examples to facilitate understanding and reflection on this 'thinking trap'."


Subject(s)
Research , Bias , Cognition
6.
Article in Portuguese | LILACS | ID: biblio-1511449

ABSTRACT

Objetivo: Identificar e analisar a qualidade das evidências científicas sobre a eficácia e segurança dos anticoagulantes orais direto (DOAC) disponíveis nos ensaios clínicos referenciados nas bulas dos medicamentos comercializados no Brasil. Método: Trata-se de um descritivo documental dividido em duas etapas, sendo elas: (i) identificação e análise da disponibilidade das referências bibliográficas contidas nas bulas dos DOAC e (ii) análise da qualidade dos estudos contidos nas bulas através da ferramenta da Cochrane Risk of Bias RevMan versão 5.4. Foram analisados setes domínios de importâncias para ensino clínico, sendo que cada domínio foi classificado como alto, incerto ou baixo risco de viés, segundo a avaliação dos colaboradores. Resultados: Foram analisadas 10 bulas destinadas aos profissionais da saúde. Sendo que destas, foram avaliados 25 ensaios clínicos. A análise da qualidade das evidências científicas, referenciadas nas bulas para profissionais dos DOAC, mostrou que os estudos citados apresentaram consistência metodológica. Entretanto, na maioria dos estudos, os domínios foram classificados como viés incerto, ou seja, não foi possível identificar como esses pontos foram abordados nos estudos. Conclusão: Portanto, o presente estudo evidenciou que a qualidade dos ensaios clínicos referenciados nas bulas dos DOAC apresentou incertezas metodológicas em seus ensaios. Sugere-se a necessidade de normativas que estabeleçam atualizações do conteúdo informativo presente nas bulas profissionais e estabeleçam descrição dos métodos de forma clara e coesa (AU).


Objective: Identify and analyze the quality of scientific evidence on the efficacy and safety of direct oral anticoagulants (DOAC) available in clinical trials referenced in the package leaflets of drugs marketed in Brazil. Method: This is a descriptive documentary study divided into two stages: (i) identification and analysis of the availability of the bibliographic references contained in the package leaflets of DOACs and (ii) analysis of the quality of the studies contained in the package leaflets through the Cochrane Risk of Bias RevMan tool version 5.4. Seven domains of importance for clinical teaching were analyzed, and each domain was classified as high, uncertain or low risk of bias, according to the assessment of the collaborators. Results: Ten package leaflets intended for health professionals were analyzed. Of these, 25 clinical trials were evaluated. The analysis of the quality of the scientific evidence referenced in the package leaflets for health professionals showed that the cited studies presented methodological consistency. However, in most studies, the domains were classified as uncertain bias, i.e., it was not possible to identify how these points were addressed in the studies. Conclusion: Therefore, the present study evidenced that the quality of clinical trials referenced in the package leaflets of DOACs presented methodological uncertainties in their trials. It is suggested the need for regulations that establish updates of the information content present in the professional package inserts and establish a description of the methods in a clear and cohesive way (AU).


Subject(s)
Thrombosis/therapy , Bias , Medicine Package Inserts , Anticoagulants
7.
Chinese Journal of Epidemiology ; (12): 1133-1138, 2023.
Article in Chinese | WPRIM | ID: wpr-985644

ABSTRACT

Controlling unmeasured confounders in non-randomized controlled studies is challenging. Negative control theory is based on the theoretical concept that the test result of negative controls must be negative. Setting appropriate negative control incorporates the specificity of association into population studies for the identification and control of unmeasured confounders. This paper explains the principles to control unmeasured confounders using negative control theory from a statistical perspective. A detailed introduction of derived methods based on negative control theory is also introduced, including adjusted standardized mortality ratio method, calibrating P-value method, generalized difference-in-difference model and double negative control method. The reasonable application of those derived methods is also comprehensively summarized based on representative case studies. Negative control is an important statistical design to identify, revise and control unmeasured confounders and a valuable method for comparative effectiveness research based on real-world data.


Subject(s)
Humans , Confounding Factors, Epidemiologic , Research Design , Comparative Effectiveness Research , Bias
8.
Chinese Journal of Epidemiology ; (12): 643-649, 2023.
Article in Chinese | WPRIM | ID: wpr-985540

ABSTRACT

Measurement bias (MB) has been described in causal structures but is still not entirely clear. In practice, the correctness of substitution estimate (SE) of effect is a prerequisite for causal inference, usually based on a bidirectionally non-differential misclassification between the measured exposure and the measured outcome. Based on a directed acyclic graph (DAG), this paper proposes a structure for the single-variable measure, where its MB is derived from the choice of an imperfect, "input/output device-like" measurement system. The MB of the SE is influenced both by the measurement system itself and by factors outside the measurement system: while the independence or dependence mechanism of the measurement system still ensures that the MB of the SE is bidirectionally non-differential; however, the misclassification can be bidirectionally non-differential, unidirectionally differential, or bidirectionally differential resulted from the factors outside the measurement system. In addition, reverse causality should be defined at the level of measurement, where measured exposures can influence measured outcomes and vice versa. Combined with temporal relationships, DAGs help elucidate MB's structures, mechanisms, and directionality.


Subject(s)
Humans , Confounding Factors, Epidemiologic , Data Interpretation, Statistical , Bias , Causality
9.
Salud trab. (Maracay) ; 30(2): 129-130, dic. 2022. ilus., tab.
Article in Spanish | LILACS, LIVECS | ID: biblio-1452062

ABSTRACT

El objetivo de este documento es mostrar una síntesis de los principales sesgos que pueden aparecer en el estudio de la salud del trabajo, sus orígenes y consecuencias. Para ello, se realizó una revisión documental de libros y artículos publicados en los últimos 10 años en inglés y español. Se dejó fuera aquellos documentos que no estuvieran publicados en revistas con comité editorial y en caso de los libros, que no tuvieran registro ISBN. Se incluyeron 7 libros y 14 artículos. Un sesgo es un error sistemático, que sucede en el proceso de investigación y que pueden darse durante la planeación, recolección y procesamiento de datos. Se revisarán dos tipos principales de sesgos: 1) Selección y 2) Información y/o medición, en cada caso se describe la definición, potencial impacto en los resultados y se plantean una serie de ejemplos que ayudan a su compresión. Uno de los efectos principales de la presencia de sesgos en investigación es que ocasiona un error de clasificación en los participantes, que puede ser diferencial o no, esto impacta los resultados al sobre o subestimarlos, en otras palabras, se encuentran efectos mayores a los reales o peor, no los encontramos cuando si existen. Para ilustrar el impacto de los sesgos, se revisan distintos escenarios que ejemplifican los casos de sobreestimación y subestimación que originan resultados poco confiables(AU)


This document aims to show a synthesis of the main biases that can be present in occupational health studies, their origins and their consequences. For this purpose, a documentary review was conducted of books and articles published in the last 10 years in English and Spanish. Excluding those documents that were not published in journals with an editorial board and, in the case of books, that did not have an ISBN registry. A total of 7 books and 14 articles were included. A bias is a systematic error that occurs in the research process and can occur during the data planning, collection, and processing. Two main types of biases will be reviewed: 1) Selection and 2) Information and/or measurement biases, in each case their definition and, their possible impact on the results are described, a series of examples that may help to understand them are provided. One of the main effects of the presence of biases in research is that they cause an error in the classification of participants, which can be differential or not, and this has an impact on the results by overestimating or underestimating them, i.e., finding stronger effects than the real ones, or worse, not finding them when they exist. To illustrate the impact of biases, different scenarios were reviewed that provide examples of cases of overestimation and underestimation that lead to unreliable results(AU)


Subject(s)
Humans , Epidemiologic Studies , Bias , Occupational Health , Observer Variation , Selection Bias
10.
Rev. cir. (Impr.) ; 74(4): 400-409, ago. 2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1407927

ABSTRACT

Resumen Los resultados de diversos hallazgos de investigación han sido objeto de crítica, en especial en los últimos años, debido a presencia de errores sistemáticos (sesgos), los que ponen en duda la validez interna de los resultados obtenidos. Estos sesgos pueden ocurrir en cualquier etapa del curso de una investigación, es decir, desde la planificación del estudio hasta la presentación y publicación de sus resultados. Los sesgos se han clasificado de diferentes formas, intentado agruparlos bajo dimensiones conceptuales, objeto de organizar de mejor forma la información existente, que además es considerable. Los sesgos pueden ocurrir por diversos motivos, pero en general, los más frecuentes son aquellos originados por el observador (él o los que miden), por lo que es observado (sujeto en estudio); y aquello con lo que se observa (instrumento de medición). Por otra parte, varios de los múltiples sesgos existentes, se pueden agrupar en: sesgos de selección, de medición o información, y de confusión. El objetivo de este manuscrito fue comentar la importancia de los sesgos más comunes en la investigación quirúrgica, y su relación con algunos diseños de investigación; así como, conocer las estrategias existentes para minimizar su ocurrencia.


The results of many research findings have come under scrutiny in recent years due to the introduction of systematic errors (biases), which can occur at any stage during an investigation, from planning to presentation of results and their presentation and further publication. Biases have been classified in different ways, trying to group them under conceptual dimensions to better organize the existing information, which is considerable. Biases can occur for various reasons, but in general, the most frequent are those originated by the observer, what is observed; and what is observed with. I.e., the subject that is measured, who measures it and with what it measures it. On the other hand, several of the multiple biases can be grouped into selection, measurement or information, and confounding biases. The aim of this manuscript was to comment on the importance of the most common biases in surgical research, and their relationship with some research designs; as well as know the existing strategies to reduce its occurrence.


Subject(s)
Humans , Bias , Clinical Trials as Topic/standards , Biomedical Research/standards , Research Design/standards , Research Design/statistics & numerical data , General Surgery/standards , General Surgery/trends , Total Quality Management , Sample Size , Biomedical Research/statistics & numerical data
11.
Rev. chil. neuro-psiquiatr ; 60(2): 176-184, jun. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1388432

ABSTRACT

RESUMEN: La toma de decisiones está influenciada por múltiples factores muchas veces no conscientes. En este artículo se sintetizan algunos correlatos neurobiológicos del componente afectivo y social sobre la toma de decisiones, incluyendo el impacto del estrés agudo y crónico y la perspectiva cognitiva de las heurísticas y los sesgos en la práctica clínica. A nivel afectivo, la hipótesis del marcador somático ha asociado la respuesta corporal periférica con estructuras nerviosas centrales en la configuración de las decisiones; intervienen estructuras como la corteza orbitofrontal y el hipocampo. En la toma de decisiones sociales se involucran las dimensiones recompensa y motivación. En este tipo de decisiones es crucial la capacidad de mentalizar a otro e integrar su perspectiva en la toma de decisiones. Esta función se ha relacionado con el surco temporal posterosuperior, la unión temporoparietal, la corteza cingulada anterior y la corteza prefrontal medial. No obstante, en la toma de decisiones sociales también se integra el cumplimiento de normas socialmente establecidas. El estrés agudo o crónico puede afectar la toma de decisiones, positiva o negativamente. En estos procesos se han involucrado al eje hipotálamo-hipófiso-adrenal junto con circuitos corticoestriados, prefrontales, amigdalinos e hipocampales. En la toma de decisiones clínicas se conjugan factores "prerreflexivos" emocionales, sociales y cognitivos que influyen directamente en las conductas adoptadas con los pacientes. Recomendamos enfatizar la investigación en esta área y fortalecer su enseñanza para reconocerlos adecuadamente.


ABSTRACT Decision-making is influenced by multiple unaware factors. We synthesize some neurobiological correlates of the affective and social components on decision-making, including the impact of acute and chronic stress. We also address the impact of heuristics and biases on clinical practice from the cognitive perspective. At an affective level, the hypothesis of the somatic marker has associated the peripheral body response with central nervous structures in the configuration of decisions; structures such as the orbitofrontal cortex and the hippocampus intervene. The reward and motivation dimensions are involved in social decision-making. In these types of decisions, the ability to mentally engage others and integrate their perspective into decision making is crucial. This function has been related to the posterior superior temporal sulcus, the temporoparietal junction, the anterior cingulate cortex, and the medial prefrontal cortex. However, compliance with socially established norms is also integrated into social decision-making. Acute or chronic stress may affect decision-making, positively or negatively. The hypothalamic-pituitary-adrenal axis has been involved in these processes together with corticostriatal, prefrontal, amygdala and hippocampal circuits. In clinical decision-making, "pre-reflective" emotional, social and cognitive factors are combined, influencing the decisions towards patients. We recommend emphasizing research in this field and strengthening education in this area to recognize these aspects adequately.


Subject(s)
Humans , Stress, Psychological , Emotions , Clinical Decision-Making , Social Factors , Neurosciences , Bias , Clinical Medicine , Decision Making , Heuristics
13.
Chinese Journal of Epidemiology ; (12): 739-746, 2022.
Article in Chinese | WPRIM | ID: wpr-935453

ABSTRACT

Objective: To introduce and compare four analysis methods of multiple parallel mediation model, including pure regression method, method based on inverse probability weighting, extended natural effect model method and weight-based imputation strategies. Methods: For the multiple parallel mediation model, the simulation experiments of three scenarios were carried out to compare the performance of different methods in estimating direct and indirect effects in different situations. Dataset from UK Biobank was then analyzed by using the four methods. Results: The estimation biases of the regression method and the inverse probability weighting method were relatively small, followed by the extended natural effect model method, and the estimation results of the weight-based imputation strategies were quite different from the other three methods. Conclusions: Different multiple parallel mediation analysis methods have different application situations and their own advantages and disadvantages. The regression method is more suitable for continuous mediator, and the inverse probability weighting method is more suitable for binary mediator. The extended natural effect model method has better performances when the residuals of two parallel mediators are positively correlated and the correlation degree is small. The weight-based imputation strategies might not be appropriate for parallel mediation analysis. Therefore, appropriate methods should be selected according to the specific situation in practice.


Subject(s)
Humans , Bias , Computer Simulation , Mediation Analysis , Models, Statistical , Probability , Regression Analysis , Research Design
14.
Chinese Journal of Epidemiology ; (12): 98-104, 2022.
Article in Chinese | WPRIM | ID: wpr-935356

ABSTRACT

This paper summaries the Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E), a tool for evaluating risk of bias about non-randomized studies of exposures (NRSE), and introduces the application of ROBINS-E in a published NRSE. According to the characteristics of NRSE, evaluation fields and signaling questions were designed in ROBINS-E to provide essential information about risk of bias for NRSE included in systematic reviews and GRADE. ROBINS-E is the tool in assessment of risk of bias in observational studies and quasi-randomized studies. Although the tool has been used in practice to some extent, but it still needs further improvement. Attention should be paid to its update and progress.


Subject(s)
Humans , Bias , Environmental Exposure , Systematic Reviews as Topic
15.
Psychol. av. discip ; 15(2): 13-31, jul.-dic. 2021. tab
Article in English | LILACS | ID: biblio-1387056

ABSTRACT

Abstract Metacognition is an important higher-order thinking process for successful learning. The present study investigated the relation between students' (N = 65) expectations about their grade (expressed as difference scores between expected grade and actual grade) and their metacognitive monitoring accuracy and bias and the extent to which these difference scores in expected grade versus actual grade predicted accuracy and bias, employing an explanatory sequential quantitative(QUALITATIVE mixed method research design. The study also explored how students develop and refine metacognitive judgments and the types of strategies they employ during this process. Results revealed that there were significant relations between difference scores in expected grade versus actual grade and accuracy and bias (r = .02 to r = .89 in absolute value), and that difference scores significantly predicted both accuracy (R 2 = .52) and bias (R 2 = .69). Further, qualitative findings revealed that there were differences in how students developed and refined metacognitive judgments as a function of four aspects of learning: effort/preparation, strategy selection/implementation, planning, and evaluation. Educators should explicitly teach metacognitive monitoring skills to improve students' self-regulated learning.


Resumen La metacognición es un proceso importante de pensamiento de orden superior para un aprendizaje exitoso. El presente estudio investigó la relación entre las expectativas de los estudiantes sobre su nota (expresadas como puntuaciones de diferencia entre la nota esperada y la nota real) (N = 65) y su precisión y sesgo de monitoreo metacognitivo y el grado en que estas diferencias en la nota esperada versus la nota real predijeron la precisión y el sesgo, empleando un diseño de investigación secuencial explicativo cuantitativo-CUALITATIVO de método mixto. El estudio también exploró cómo los estudiantes desarrollan y refinan juicios metacognitivos y los tipos de estrategias que emplean durante este proceso. Los resultados revelaron que había relaciones significativas entre las diferencia de puntajes en la nota esperada versus la nota real y la precisión y el sesgo (r = .02 to r = .89, en valor absoluto), y que estas diferencia de puntajes predijo significativamente tanto la precisión (R 2 = .52) como el sesgo (R 2 = .69). Además, los hallazgos cualitativos revelaron que había diferencias en la forma en que los estudiantes desarrollaban y refinaban juicios metacognitivos en función de cuatro aspectos del aprendizaje: esfuerzo / preparación, selección / implementación de estrategias, planificación y evaluación. Los docentes deben enseñar explícitamente habilidades de monitoreo metacognitivo para mejorar el aprendizaje autorregulado de los estudiantes.


Subject(s)
Metacognition , Learning , Motivation , Students , Thinking , Bias , Comprehension
16.
Iatreia ; 34(4): 325-334, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1350832

ABSTRACT

RESUMEN El entendimiento del razonamiento clínico es una necesidad para la investigación, la docencia y la práctica clínica. Los modelos teóricos subyacentes podrían agruparse en tres grandes ejes no excluyentes. El primero es denominado bayesiano informal según su estructura semejante al análisis de probabilidades condicionales. El segundo propone (desde las ciencias cognitivas) un razonamiento dual que es la suma de dos tipos de pensamientos: el tipo 1, rápido e intuitivo y, el tipo 2, hipotético-deductivo. El tercero, el conocimiento intersubjetivo que involucra la interacción del saber del paciente sobre su condición con el del médico, además, de hacer explícito el papel de la emoción. En esta segunda entrega se presenta una revisión narrativa de estas teorías para poder proponer una definición integradora, en la que se presenta al razonamiento clínico como un constructo complejo, iterativo y adaptativo.


SUMMARY Understanding clinical reasoning is a crucial for research, teaching, and daily clinical practice. Theoretical models could be grouped into three main non-exclusive axes. The first describes probability-based thinking, called informal Bayesian, because of its similarity to the conditional probability analysis structure. The second, from the cognitive sciences, describes reasoning as the sum of two types of thinking: type 1 (fast and intuitive) and type 2 (hypothetical-deductive). Finally, the third, intersubjective knowledge, which involves the interaction of the patient's knowledge about his condition with the doctor's knowledge and also makes explicit the role of emotion. In this second part, a narrative review of current theories is presented in order to propose an integrative definition, in which clinical reasoning is presented as a complex, iterative and adaptive construct.


Subject(s)
Humans , Clinical Reasoning , Mental Processes , Decision Theory , Bias , Medical Errors
17.
Int. j. cardiovasc. sci. (Impr.) ; 34(5,supl.1): 114-120, Nov. 2021. tab, graf
Article in English | LILACS | ID: biblio-1346349

ABSTRACT

Abstract Background Self-reported hypertension is a useful method to estimate prevalence in the population. However, it is necessary to evaluate its accuracy, in relation to the gold-standard diagnostic methods of the disease. Objectives To estimate combined measures of sensitivity and specificity for self-reported hypertension, using Brazilian validation studies that included gold standard methods. Methods A systematic review and a meta-analysis were developed. Two independent examiners evaluated 1389 and read 113 potentially eligible articles. Since self-reported morbidity is influenced by the cultural and economic characteristics of a population, as well as by its accessibility to medical care, only studies from one country (Brazil) were included. First, a qualitative analysis was performed, evaluating the relationship between self-reported hypertension and its measurement through gold-standard methods. Subsequently, a meta-analysis estimated the combined sensitivity and specificity for the included studies. Due to a high heterogeneity among studies, the meta-analysis used a random effects model. Bias risks were evaluated by the QUADAS-2 protocol and the standard significance level of 10% was used in all modelling. Results Five studies were included in the qualitative analysis; and four had the necessary information for inclusion in the meta-analysis. Patient selection and Index Test (the question allowing for self-reporting) were the domains with the highest risk of bias. In the meta-analysis, combined sensitivity and specificity were 77%(95%CI:[74.5-79.0%]) and 88%(95%CI:[86.3-88.6%]), respectively. Conclusions The analysed studies allowed for the estimation of more reliable values for combined sensitivity and specificity. These values were higher than those usually found in studies with greater population heterogeneity.


Subject(s)
Humans , Self Report , Hypertension/epidemiology , Brazil/epidemiology , Bias , Sensitivity and Specificity , Hypertension/diagnosis
18.
Psico USF ; 26(4): 685-696, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, INDEXPSI | ID: biblio-1365244

ABSTRACT

Metacognition is predominantly measured by the self-report and think-aloud methods. This is problematic since they produce considerable both respondent and confirmatory biases, which implies damage to the measurement. The Metacognitive Monitoring Test (MMT) was created to evaluate metacognition through performance and eliminate the aforementioned biases. There is evidence of MMT convergent, divergent, structural, predictive and incremental validity. This article expands the validity studies about the MMT by analyzing the configural, metric and scalar invariance of MMT across sex, nationality, and educational level variables. The sample is composed of Brazilian and Honduran subjects, as well as 6st to 12st grades and higher education students. Results indicate configural, metric and scalar invariance for the sex variable, as well as configural invariance and metric and scalar partial invariance for nationality and educational level. It is concluded that the MMT allows comparing means of the latent variable measured in the analyzed groups. (AU)


Há uma hegemonia dos métodos de autorrelato e thinkaloud para avaliar metacognição. Isso é problemático, pois eles geram substanciais vieses do respondente e confirmatório, trazendo prejuízo à medida. O Teste de Monitoramento Metacognitivo (TMC) foi criado para avaliar a metacognição mediante o desempenho e eliminar os vieses supramencionados. Há evidências de validade convergente, divergente, estrutural, preditiva e incremental do TMC. Este artigo amplia os estudos de validade e analisa a invariância configural, métrica e escalar do TMC, em relação ao sexo, nacionalidade, e nível educacional. A amostra do estudo é composta por brasileiros e hondurenhos, e estudantes da 6ª à 12ª séries da educação básicae ensino superior. Os resultados indicam invariância configural, métrica e escalar para a variável sexo, assim como invariância configural e invariância parcial métrica e escalar para nacionalidade e nível educacional. Conclui-se que o TMC permite comparar médias da variável latente mensurada nos grupos analisados. (AU)


Hay un predominio de métodos de auto-reporte e think aloud para evaluar la metacognición. Esto es problemático, ya que dichos métodos producen un considerable sesgo de respuesta y confirmación, lo que implica un perjuicio en la medición. La Prueba de Monitoreo Metacognitivo (PMM) fue diseñada para evaluar la metacognición por medio del desempeño y eliminar los sesgos mencionados anteriormente. Hay evidencia de validez convergente, divergente, estructural, predictiva e incremental de la PMM. Este artículo amplía los estudios de validez sobre la PMM, analizando la invarianza configural, métrica y escalar de la PMM con respecto a las variables sexo, nacionalidad y nivel educativo. La muestra del estudio está formada por brasileños y hondureños, y estudiantes de 6º a 12º grado de educación básica y educación superior. Los resultados indican invarianza configural, métrica y escalar para la variable sexo así como invarianza configural e invarianza parcial escalar y métrica para nacionalidad y nivel educativo. Se concluye que la PMM permite comparar medias de la variable latente medida en los grupos analizados. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Metacognition , Students , Brazil , Bias , Reproducibility of Results , Sex Distribution , Education, Primary and Secondary , Self Report , Latent Class Analysis , Honduras
20.
Arq. bras. oftalmol ; 84(3): 203-208, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1248956

ABSTRACT

ABSTRACT Purpose: To comparatively assess the macular sensitivity threshold of microperimetry and the fixation stability between the first (right) and second (left) tested eye of normal participants. Methods: Thirty healthy patients were randomly assigned to two groups. The participants underwent microperimetry in the fast mode and expert mode in groups I and II, respectively. Each participant underwent a single test and the right eye was tested first. Results: The mean macular sensitivity threshold (± standard deviation [SD]) was 24.5 ± 2.3 dB and 25.7 ± 1.1 dB in the first (right) and second (left) eyes of group I, respectively (p=0.0415) and 26.7 ± 4.5 dB and 27.3 ± 4.0 dB in the first (right) and second (left) eyes of group II, respectively (p=0.58). There was no statistically significant difference between eyes in either group (p=0.1512). Regarding fixation stability (evaluated in the microperimetry expert mode group), the mean ± SD percentage of fixation points within the 1-degree central macula (P1) was 87.9 ± 11.5% in the right eye and 93.8 ± 6.6% in the left eye. The paired t-test did not show a statistically significant difference between eyes (p=0.140). Mean ± SD P2 value was 95.5 ± 4.9% in the right eye and 98.5 ± 2.1% in the left eye. The analysis demonstrated an increase in the percentage of fixation points in the second tested eye compared with the first one (paired t-test= 2.364; p=0.034). There was a negative correlation between the macular sensitivity threshold of the right eye and the duration of the examination for both groups (microperimetry expert mode: r=-0.717; p=0.0026; microperimetry in the fast mode: r=-0.843; p<0.0001). Conclusion: Mean macular sensitivity threshold was higher in the second tested eye in the microperimetry in the fast mode group and was similar in both eyes in the expert mode. Our data suggest that comprehension of the examination by the individual may impact the results of the microperimetry test.(AU)


RESUMO Objetivo: Avaliar comparativamente o limiar de sensibilidade macular da microperimetria e a estabilidade de fixação entre o primeiro (direito) e o segundo (esquerdo) olhos testados de indivíduos normais. Métodos: Trinta pacientes saudáveis foram divididos aleatoriamente em 2 grupos. Os participantes foram submetidos à microperimetria no "fast mode" e no "expert mode" no grupo I e II, respectivamente. Cada participante foi submetido a um único teste e o olho direito foi testado primeiro. Resultados: No grupo I, o limiar médio de sensibilidade macular (± DP) foi de 24,5 ± 2,3 dB e 25,7 ± 1,1 dB nos olhos direito e esquerdo, respectivamente (p=0,0415). No grupo II foi de 26,7 ± 4,5 dB e 27,3 ± 4,0 dB nos olhos direito e esquerdo, respectivamente (p=0,58). Não houve diferença estatisticamente significativa entre os olhos dos dois grupos (p=0,1512). Em relação à estabilidade de fixação (avaliada no grupo microperimetria no "expert mode"), a média das porcentagens dos pontos de fixação dentro do 1 grau central da mácula (P1) ± DP foi de 87,9 ± 11,5% no olho direito e de 93,8 ± 6,6% no olho esquerdo. O teste t pareado não mostrou diferença estatística entre os olhos (p=0,140). O valor médio de P2 ± DP foi de 95,5 ± 4,9% no olho direito e 98,5 ± 2,1% no olho esquerdo. Foi demonstrado um aumento na porcentagem de pontos de fixação no segundo olho testado quando comparado ao primeiro (teste t pareado= 2,364; p=0,034). Houve correlação negativa entre o limiar de sensibilidade macular do olho direito e a duração do exame nos dois grupos (microperimetria no "expert mode": r=-0,717; p=0,0026; microperimetria no "fast mode": r=-0,843; p <0,0001). Conclusão: O limiar médio de sensibilidade macular foi maior no segundo olho testado no grupo microperimetria no "fast mode" e foi semelhante nos dois olhos no "expert mode". Nossos dados sugerem que a compreensão do exame pelo indivíduo pode impactar nos resultados da microperimetria.(AU)


Subject(s)
Humans , Visual Acuity , Fixation, Ocular , Macula Lutea/diagnostic imaging , Visual Fields , Bias
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