Practical Judgment Research Articles

Pharmacy graduates' perceived impact of long-term undergraduate use of an ethical decision-support tool on their early practice

IntroductionValues-based practice is an important concept within healthcare decision-making that sits alongside evidence-based practice. Values Exchange (Vx) (http://www.vxcommunity.com) is an online tool that supports the development of ethical and professional decision-making skills through values transparency. The aim of this research was to explore the perceived impact of long-term use of the tool during undergraduate study on pharmacy graduates' early practice. MethodsAlumni in their pre-registration year or up to two years qualified were invited to participate via a question at the end of a survey, with additional students invited prospectively during an undergraduate lecture. All had completed three cases per year on Vx during the four-year master of pharmacy course. Semi-structured interviews were audio-recorded and transcribed verbatim, and framework analysis was applied. Ethical approval was obtained. ResultsA total of 18 interviews (nine pharmacists and nine pre-registration tutees) were conducted between May 2015 and March 2016. Thirteen participants were female, 13 were based in community pharmacy, and 10 were Caucasian. Interviews ranged from 50 min to 2 hours. Three themes emerged from the data: (1) the Vx learning environment, (2) learning and reflection, and (3) potential enhancements for learning. Participants perceived Vx to be an effective teaching tool supporting the development of skills necessary to exercise professional judgement in pharmacy practice. ConclusionsVx appears to be a worthy addition to the armoury of teaching methods necessary to support future pharmacists in their preparedness to deal with ethical and professional dilemmas in practice.

외국재판 승인 및 집행협약상 몇 가지 쟁점에 대한 소고

On July 2, 2019, the Hague Conference on Private International Law (HCCH) adopted a new multilateral Convention on the Recognition and Enforcement of foreign judgments in civil or commercial matters. When the Convention enters into force, the courts of the Contracting States shall be obliged to recognize and enforce civil and commercial judgments of other Contracting States. Traditionally, the recognition and enforcement of foreign judgments were entirely governed by the domestic laws and practices of each state. It is significant that after a long effort, the Convention on the recognition and enforcement of foreign judgments, which was internationally unified beyond the region, was launched. A substantial risk that a recognition and enforcement of a judgment of one country could be denied in another country has been largely eliminated In the future, the new Convention will complement the 2005 Hague Convention on Choice of Court Agreement and 1958 the New York Convention on the recognition and enforcement of foreign arbitral awards, and could contribute significantly to the stability, predictability of cross-border commercial transactions and thereby improve trade, investment and the global economy. The Convention is now waiting for each country's accession and ratification, and it is noteworthy how well each country will respond and achieve the same success as the New York Convention. In this paper, several issues are reviewed, particularly recognition and enforcement under national law, the method of acceptance by domestic law, fraud as a reason for refusal of recognition and enforcement of judgments, a substantive or procedural violation of public policy, reciprocity, the possibility of setting a uniform standard of habitual residence, the mechanism for declaring of refusal are reviewed. It is necessary to quickly become acquainted with the judgment Convention, in practice and academic circles, including courts dealing with recognition and enforcement of foreign judgments by preparation and distribution of commentary on the Convention. Watching the trend of many countries joining the Convention, we need to review proactively the timing of Korea's accession to the Convention.

Re-evaluation of psychometric evidence and update of normative data for the Test of Practical Judgment

Objective The Test of Practical Judgment (TOP-J) has shown utility in inpatient and outpatient settings in older adults who present with mild cognitive impairment and various dementia subtypes. The TOP-J has two versions (i.e. 9 items and 15 items), and was initially validated within a small rural non-Hispanic White sample. In the current study, we re-evaluated the psychometric evidence and refined scoring criteria and administration guidelines in older adults with more diverse demographic characteristics than the original validation sample. Method: Participants (N = 348) were recruited from several boroughs of New York City and surrounding areas (mean/median age = 79; mean years education = 15, median = 15.5; 68% female; 30% Black/African-American, 8% Hispanic). Results: Reliability and validity were comparable to original findings. Based on confirmatory factor analysis, one item was replaced on the 9-item version, now called TOP-J Form A. Normative data for cognitively intact participants (n = 261) were updated and stratified by two education groups. Conclusions: The TOP-J is increasingly used in clinical and research settings in the U.S. and abroad, and the current study provides improved normative data and administration and scoring guidelines for use with demographically diverse older individuals.

Possible strategies in using diplomatic means of conflict resolution in South Sudan

The study was conducted in order to examine the possible strategies in using diplomatic means of conflict resolution in South Sudan. The research was carried out through a cross-sectional and survey research design, and obtained relevant data from 78 respondents. The research study established that the use of diplomatic approach through peace mediation, being accommodative to the diverse interests of all parties and treating the opposition as stake holders not as enemies is slowly and consistently helping the leadership in South Sudan and her neighbors to work together with lessened suspensions hence for example Uganda opening up her boundaries. Mediation is a broad and rapidly growing field in resolving conflicts in South Sudan. The mediated settlement of conflicts has been of vital chip in helping their people live in peaceful parts of the country, engage in regional trade, education and any other form of co-operation which may leap the country from rags to development. Using tact and diplomacy appropriately can lead to improved relationships with other people and are a way to build and develop mutual respect, which in turn can lead to more successful outcomes and less difficult or stressful communications. The application of shrewd diplomat uses skills centered around an understanding of the people on the opposite side and being sensitive to their opinions, beliefs, ideas and feelings. Developing effective tact and diplomacy skills requires practice and good judgement. The study recommended that all South Sudanese conflicts should be handled through mediation.

Rethinking the foundations: towards powerful professional knowledge in teacher education in the USA and England

ABSTRACT In this paper, we aim to outline what foundations can offer in terms of understanding education and educational practice, and thus for providing a basis for teachers’ professional knowledge. We look critically at the struggle foundation disciplines often experience with coherence and integration in terms of both their relation to each other and to broader (e.g. philosophical or sociological) thought. We begin to rethink foundations more as a (strong, disciplinary and professionally orientated) region rather than a singular or a set of singulars (to use Bernstein’s terms), although one that is rather different from other regions. In doing so, we suggest that Bernstein’s work, in providing a rich lens to understand curricula and pedagogic practice while holding social and political issues and implications close, is a useful exemplar of the type of educational knowledge which should be at the core of the foundations. A revitalized region of educational foundations can offer the ‘powerful professional knowledge’ that will enable teachers to make knowledgeable professional judgements in educational practice.

Informant report of practical judgment ability in a clinical sample of older adults with subjective cognitive decline, mild cognitive impairment, and dementia

ABSTRACT Despite the importance of capturing problems with judgment and decision-making during neuropsychological evaluations of older adults, there are a limited number of validated measures and no informant rating scales. We developed an informant measure that captures compromised judgment related to safety, medical, financial, and social-ethical issues After item refinement and piloting in a memory disorders clinic, we utilized the Test of Practical Judgment-Informant (TOP-J-Informant) at two clinics in the Midwestern U.S., including 189 patient/informant dyads (mean age = 79.0, median years of education = 13, % female = 67.7) with various preclinical and clinical dementia conditions. We found psychometric support, including evidence for convergent, divergent, and criterion-related validity, and internal consistency. Importantly, we were able to discriminate between diagnostic groups in the expected direction. The TOP-J-Informant is brief (<5 minutes), easy to administer, and can reveal areas of concern related to poor judgment when administered in the context of a neuropsychological evaluation or clinic visit.

Patient-tailored antithrombotic therapy following percutaneous coronary intervention.

Dual antiplatelet therapy has long been the standard of care in preventing coronary and cerebrovascular thrombotic events in patients with chronic coronary syndrome and acute coronary syndrome undergoing percutaneous coronary intervention, but choosing the optimal treatment duration and composition has become a major challenge. Numerous studies have shown that certain patients benefit from either shortened or extended treatment duration. Furthermore, trials evaluating novel antithrombotic strategies, such as P2Y12 inhibitor monotherapy, low-dose factor Xa inhibitors on top of antiplatelet therapy, and platelet function- or genotype-guided (de-)escalation of treatment, have shown promising results. Current guidelines recommend risk stratification for tailoring treatment duration and composition. Although several risk stratification methods evaluating ischaemic and bleeding risk are available to clinicians, such as the use of risk scores, platelet function testing , and genotyping, risk stratification has not been broadly adopted in clinical practice. Multiple risk scores have been developed to determine the optimal treatment duration, but external validation studies have yielded conflicting results in terms of calibration and discrimination and there is limited evidence that their adoption improves clinical outcomes. Likewise, platelet function testing and genotyping can provide useful prognostic insights, but trials evaluating treatment strategies guided by these stratification methods have produced mixed results. This review critically appraises the currently available antithrombotic strategies and provides a viewpoint on the use of different risk stratification methods alongside clinical judgement in current clinical practice.

Covid-19, ethical nursing management and codes of conduct: An analysis.

The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents in particular roles. Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions via an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.

Uncertainty and practical judgement in research: a call for attentive ‘listening’

This paper draws upon research projects in which efforts have been made to find ways of listening to young children’s voices in early years contexts. This listening, namely in the mosaic approach, helps us to see how children make sense of their world, and adopt our planning and ‘being with’ young children. After setting the context of early years pedagogy and ideology of mosaic approach, this paper focuses on the researcher’s journey to turn her gaze inward before making any claims about her engagement with and listening to young children. Since this approach purposely leaves unanswered the question what kind of data is going to be collected, researchers have to decide what data is in the course of a research project, through their engagement with children. We argue for befriending uncertainty and dilemmatic thinking as it provides us with a different way of seeing, knowing and listening the hard to know. Through writing about phronêsis, this paper focuses on the process of decision-making and judgements that researchers undertake. The final argument calls for attentiveness and aims to acknowledge practical judgements as a fundamental part of researching early years.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia.

ABSTRACT.Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions.Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both.Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br).Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82.Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

Доказательный подход в образовании: критический анализ актуальных дискуссий

The article analyzes the current discussions on how to define evidence and implement evidence-based practice in education. Despite their frequent use, the terms “evidence-based practice”, “evidence-based education” etc. remain something like “empty signs” the meaning of which still needs to be defined. The authors highlight several discussion topics regarding research for evidence-based practice and evidence-based process: hierarchical versus pluralistic conception of evidence; theoretical reasoning as evidence; top-down evidence-based practice versus bottom-up evidence-informed practitioner judgment; conception of research use as linear process of uptake or dissemination versus as bidirectional process by which research and practice mutually inform each other. It is presumed that although historically evidence-based approach was associated with an appeal to science primarily as an institution of prescription, in its actual versions the relationship between science and practice is much more complex.

The Ombudsman in the Eyes of the European Court of Human Rights

While the work of an Ombudsman (whether a national or the European Ombudsman) and the European Court of Human Rights might seem relatively different, the rule of law, democracy, transparency and access to documents, issues such as migration, and many more fundamental rights-related topics are at the focus of both institutions. The common goal for both, Ombudsmen in Europe and the Court, is to guarantee flawless protection of human rights. The article, via a thus-far unique closer look at the ECtHR case law related to Ombudsmen with regard to institutional, procedural, and substantial issues, examines how Ombudsmen and the Court can contribute, in co-operation with each other, to more effectively serving that common goal. Beyond the particularities of each specific case, the jurisprudence of the ECtHR does not consider the Ombudsman institution to be an effective remedy in general within the meaning of Article 35, §1 ECHR. Neither does a complaint to the Ombudsman usually constitute an effective remedy for the purposes of Article 13 ECHR, except in certain exceptional scenarios of fact wherein judicial remedies are unavailable. There may one day be a necessity to accept the Ombudsman as an applicant in a case before the ECtHR on behalf of the victim of a human rights violation. It would be welcomed to encourage Ombudsmen to intervene as a third party before the Court. The Ombudsman can in certain situations go further and make human-rights-friendly interpretations even if the situation does not in itself represent a violation of the minimum standards set by the ECHR. The conditions for a fair trial as stated in Article 6 ECHR and the case law of the ECtHR are applicable to the procedure before the Ombudsman if the latter determines the applicant’s civil rights and obligations, including (to a certain extent) dealing with administrative cases as covered by the case law of the ECtHR under Article 6 ECHR, and possibly in cases in which the Ombudsman could in some way determine criminal charges. On one hand, Ombudsmen use the case law of the ECtHR in their work and play an important role in enforcing the principles of the ECtHR judgments in practice. On the other hand, the ECtHR uses the work done by Ombudsmen in its judgments. References to findings of Ombudsmen are made (although mostly in the facts part, on a few occasions also under the findings in the judgments of the Court). In these cases, the Court is indirectly giving the Ombudsman’s work legal value. Ombudsmen should be not only a bridge between citizens and administration but also an intermediary between citizens and other human rights protection bodies in Europe. It is vital to strengthen the dialogue between the Ombudsmen and the ECtHR. Human rights are not a luxury, and the independence of Ombudsmen and courts is not their privilege but serves those who are searching for justice. Neither should one forget the ‘middle class’: the ordinary people who need protection, not only the weak and those belonging to minority groups. It is important that Ombudsmen and the Court also contribute to the development of human rights culture and raise human rights awareness.

ŞER’Î KAİDE VE DÂBITLARIN İSLAMİ FİNANS İŞLEMLERİNDE UYGULANMASI

Fıkıhçılar, yeni meseleler için fıkhi hükümler ortaya koymaya büyük çaba sarf etmişlerdir. Modern dönemlerde ortaya çıkan bazı fıkhi problemlere ve fıkıhçıların bunların hükmü noktasında nasıl hareket ettiklerine bakacak olursak bu noktada fıkıh konseylerinin önemli bir görev icra ettiğini görürüz. Yakın dönemlerde ortaya çıkan bu yeni meselelere ibadetler alanında bir örnek olarak, gece ve gündüz vakitlerinin 24 saati aştığı yerlerde bölgelerde namaz vakitlerinin belirlenmesi meselesi zikredilebilir. Malî muâmelât alanı da bankaların artması, ticareti işlemlerin çeşitlenerek çoğalması sebebiyle günümüzde fıkıh alanında ortaya çıkan yeni meselelerin başında gelmektedir. Fıkıh kuralları, İslam hukukunun genel hatlarını oluşturmaktadır. Bu kurallar, fıkıhçılar tarafından şerî kaynaklardan çıkartılarak özlü kelimelerle formüle edilmiş, İslam hukuk düşüncesinin veciz ifade biçimleridir. Öyle ki bu kuralların birçoğu hem İslam hukuku alanında hem de kanun alanında emsal teşkil edecek delil değerine ve bilinirliğe sahip olmuştur. Aynı zamanda hukukçular nezdinde de fıkhi kaidelerin birçoğu hukuk ilkesi olarak muteberdir. Çünkü bu kaideler; kanun, insanlar arası ilişkiler, hukuk ve yargı nezdinde sabit değerlere sahip hukuki ve zihinsel bir düşüncenin meyveleridir. Bu fıkıh kurallarından mali muâmelât alanına dair olanlardan bazıları şunlardır: “Ameller niyetlere göredir.” “Zarar vermek de zarara zararla karşılık vermek de yoktur.” “Mazarrât, menfaat mukabelesindedir.” “Menfaat tazmin karşılığındadır.” “Muâmelelerde karşılıklı rıza esastır.” “Müslümanlar öne sürdükleri şartları yerine getirirler.” “Davacıya delil, davalıya ise yemin gerekir.” “Ödünç alınan mal iade edilir.” “Borçlar emsalleriyle ödenir.” “Mal borçları kendileriyle ifa edilir.” “Akitlerde itibar maksat ve meâniye göredir, elfâz ve mebâniye göre değildir.” “Meşakkat teysîri celb eder.” “Muâmelelerde aslolan mübahlıktır.” “Muâmelelerde aslolan sıhhat, akitlerde aslolan geçerliliktir.” “Azının aksine garârın çoğu akdi ifsâd eder.” “İnsanların mallarını batıl yolla yemek haramdır.” “Asıl sakıt oldukta fer’i dahi sâkıt olur” ve diğerleri. Külli kaideler, genel fıkıh ilkelerini ve hükümlerini güzel bir şekilde tasvir etmektedir. Bu külli kurallar, ameli hükümleri tespit etmeyi kolaylaştıran teorik yol ve yöntemlerin ortaya çıkarılması olarak ifade edilir. Çeşitli fikhi hükümler, konuları ve mevzuları farklı olsa bile bu kaideler aracılığıyla açıklanabilmektedir. Nitekim fıkıh kuralları olmasaydı, fıkhi hükümler dağınık bir şekilde kalırdı. Bu kurallar, fıkıh ilminde o kadar önemli ve bunların faydaları çoktur ki bunlara hâkim olmak, fıkıhçının ilmi otoritesini arttırır, fetva yolları bu kurallarla belirginleşir, âlimler arasında fazilet sahibi olanlar bunlar sayesinde anlaşılır. Bununla birlikte, fıkhın kural ve kaidelerle anlatılması, bilgileri külli olarak gruplandırdığı ve başkalarına dağınık gelen bilgileri birleştirdiği için cüzî meselelerin hepsini ezberleme lüzumunu ortadan kaldırır. Fıkıh âlimleri, külli kural ve kaidelere şer’î kaynaklara bakarak ve onlardaki cüz’î nitelikli hükümleri okuyarak ulaşmışlardır. Bu külli kural ve kaideler, Kuran'ın vahyine ve sünnetin ortaya çıkmasına eşlik eden cüz’î ayrıntılar ve meselelerle sınırlı olmayan kapsamlı şer’î hükümleri ve dini sorumluluk sahibi/mükellef kişilerin hayatlarında karşılaşabilecekleri olayların benzerlerini içermektedir. Bu kural ve kaideler ile fıkıhçılar, insanların hayatlarındaki yenilikleri ve gelişmeleri kavrayabilmektedirler. Bu nedenle onlar, bu kurallara her zaman dikkat çekmiş, çeşitli akli ve nakli delillere dayanarak bunları genişletmiş ve farklı mezheplerde bu kural ve kaidelere dair telif çalışmaları yapılmıştır. Fakihlerin sözleri çerçevesinde fıkhi kural ve kaidelere çok büyük bir önem verildiğini, fıkıh ilminin gerek usul gerek füru alanıyla uğraşan her kişinin bu kurallardan müstağni kalamayacağını görmekteyiz.

Putting Phronetic leadership in Action for Social Innovation: A Tale of Social Enterprises

Social enterprises envisioned to pool resources in order to meet the un-met societal needs of the marginalized community. The performance of social enterprises is usually considered as quantifiable reflected through number of projects, number of beneficiaries, loan return ratio, amount of donation etc. but the subjective measure needs to define in social context. Therefore, this study is intended to understand and explore the subjective meanings of phronesis of leaders and its role in the creation of social innovation that can ultimately lead towards economically and socially Superior Pakistan. Taking case study as qualitative research inquiry, semi-structured interviews and observations were used to explore the phenomenon of social innovation. Purposive sampling was used to select the 13 informants (board of directors and project heads) of Akhuwat foundation and Al-Khidmat (top two social enterprises of Pakistan). To analyse the data, Gioia methodology was used based on the socially constructed thoughts/views of knowledge agents. The results of the study expressed that leader of social enterprises employ his/her practical wisdom, virtue, prudence, and value judgment to address social phenomenon through innovative and sustainable solutions.

Professional judgement in clinical practice (part 3): A better alternative to strong evidence-based medicine.

Parts 1 and 2 in this series of three articles have shown that and how strong evidence-based medicine has neither a coherent theoretical foundation nor creditable application to clinical practice. Because of its core commitment to the discredited positivist tradition it holds both a false concept of scientific knowledge and misunderstandings concerning clinical decision-making. Strong EBM continues attempts to use flawed adjustments to recover from the unsalvageable base view. Paper three argues that a promising solution is at hand if we can manage several modes of inclusion. A modified original, moderate version of EBM continues though usually overshadowed. As definitively laid out by Sackett in the 1990s, clinical decision making is intended to be person-centered, recognizing and integrating multiple modes of evidence and knowledge that have been marginalized: professional experience, illness narratives, and individual patients' values and preferences. Complementary resources are at hand: interpretative understanding and practice, such as philosophical anthropology, hermeneutical phenomenology, complexity theory, and phronetic practices respond to the major problems and open new possibilities. Phronesis is especially important in regard to public decision making. Within part 3 an additional tone necessarily occurs. While most of papers 1, 2, and 3 are written in the classical mode of contrasting the theoretical-logical and empirical evidence offered by contending positions bearing on the decision making and judgement in clinical practice, a shift occurs when considerations move beyond what is possible for clinical practitioners to accomplish. A different, discontinuous level of power operates in the trans-personal realm of instrumental policy, insurance, and hospital management practices. In this social-economic-political-ethical realm what happens in clinical practice today increasingly becomes a matter of what is "done unto" clinical practitioners, of what hampers their professional action and thus care of individual patients and clients.

Zoonoplasticity as an intuitive risk protocol for companion-animal-linked zoonoses

Zoonoses are diseases transmissible between non-human and human animals. Over 200 zoonoses are known, of which at least 60 are associated with (especially exotic) companion animals. Current risk-impact assessment approaches for zoonoses are largely cumbersome and, to be meaningful, may require extensive detailed information. A literature search and review were conducted for current risk assessment protocols for common zoonoses, with subsequent development of two novel rapid scoring methods for evaluating potential risk associated with companion-animal-linked zoonoses. Accordingly, a novel, two-tier methodological concept – ‘zoonoplasticity’ – was prepared using an intuitive risk approach. The first tier considers risk principles for companion animals and husbandry practices, and pre-weights animals by class or species. The second tier considers established pathogen- or disease-based questions and assigns a degree of risk. Thus, the zoonoplasticity concept enables pathogens or their resultant zoonoses to be scored and provides a clear points-based protocol offering guidance concerning potential threat, in particular where more quantifiable risk assessment is unavailable because of information deficits. The zoonoplasticity concept was tested with 15 animal species and 22 known zoonoses against European Centre for Disease Prevention and Control (ECDC) operational guidance as a comparative system. Risk categorisation was 100% consistent for 21 of the 22 specific zoonoses, while requiring minimal information input, and the overall comparison rate was 98.85%. Zoonoplasticity is not intended to provide an absolute measure of risk or to replace existing methodologies, rather it is an attempt to standardise a practical judgement protocol that accounts for various relevant issues, and to offer a potentially helpful indicator of concern. The zoonoplasticity concept will be relevant to remits for medical professionals, veterinary medical professionals, public health professionals, government administrators, biomedical researchers and others.

Professional judgement in clinical practice (part 1): Recovering original, moderate evidence-based health care.

Evidence-based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three-article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings-all of which raises more questions regarding its application to provider-patient decision making, pedagogy, and policy.

Professional judgement in clinical practice (part 2): knowledge into practice.

Though strong evidence-based medicine is assertive in its claims, an insufficient theoretical basis and patchwork of arguments provide a good case that rather than introducing a new paradigm, EBM is resisting a shift to actually revolutionary complexity theory and other emergent approaches. This refusal to pass beyond discredited positivism is manifest in strong EBM's unsuccessful attempts to continually modify its already inadequate previous modifications, as did the defenders of the Ptolemaic astronomical model who increased the number of circular epicycles until the entire epicycle-deferent system proved untenable. Narrative Review. The analysis in Part 1 of this three part series showed epistemological confusion as strong EBM plays the discredited positivistic tradition out to the end, thus repeating in a medical sphere and vocabulary the major assumptions and inadequacies that have appeared in the trajectory of modern science. Paper 2 in this series examines application, attending to strong EBM's claim of direct transferability of EBM research findings to clinical settings and its assertion of epistemological normativity. EBM's contention that it provides the "only valid" approach to knowledge and action is questioned by analyzing the troubled story of proposed hierarchies of the quality of research findings (especially of RCTs, with other factors marginalized), which falsely identifies evaluating findings with operationally utilizing them in clinical recommendations and decision-making. Further, its claim of carrying over its normative guidelines to cover the ethical responsibilities of researchers and clinicians is questioned.

Situational awareness in driving, and lessons for surgeons

It is often said that medicine could learn a lot from aviation. Human and system errors affect all complex organisations including healthcare, and there is increasing awareness of the role of non-technical skills in the safe practice of surgery. Comparisons are often drawn between the way in which the aviation industry learns from errors and the paucity of learning from errors in situational judgement in medical practice. Although many of us travel on planes, very few of us fly them, but most surgeons drive regularly. We review a series of motoring incidents that demonstrate poor situational awareness and judgement, and discuss the incidents, predisposing causes, and their relevance to medical practice. These errors are transferrable to medical practice, and perhaps we can learn from them.

An Aide Memoire for a Balancing Act? Critiquing The 'Balance Sheet' Approach to Best Interests Decision-Making.

The balance sheet is commonly used as a deliberative approach to decide best interests in Court of Protection cases in England and Wales, since Thorpe LJ in Re A (Male Sterilisation) described the balance sheet as a tool to enable judges and best interests decision-makers to quantify, compare, and calculate the different options at play. Recent judgments have critically reflected on the substance and practical function of the balance sheet approach, highlighting the practical stakes of its implicit conceptual assumptions and normative commitments. Using parallel debates in proportionality, we show that the balance sheet imports problematic assumptions of commensurability and aggregation, which can both overdetermine the outcome of best interests decisions and obfuscate the actual process of judicial deliberation. This means that the decision-making of judges and best interests assessors more generally could fail to properly reflect the nature of values at stake, as well as the skills of practical judgment needed to compare such values with sensitivity and nuance. The article argues that critical reflection of the balance sheet makes vital space for a more contextualised, substantive mode of deliberation which emphasises skills of qualitative evaluation towards enhancing conditions of articulation around the range of values involved in best interests decision-making.