Christopher P. Dwyer

Metacognitive Skill Development and Applied Systems Science: A Framework of Metacognitive Skills, Self-regulatory Functions and Real-World Applications

Metacognition, or thinking about thinking [1], refers to the application and regulation of cognitive processes. According to Boekaerts and Simons [2], Brown [3] and Ku and Ho [4], individuals think metacognitively in two ways: first, individuals must be aware of their own cognitive processes (e.g., through self-monitoring or self-regulation); second, individuals must be able to apply available cognitive processes for purposes of learning or devising solutions to problems [e.g., using critical thinking or reflective judgment [5]. Though a topic of research interest for almost 40 years, debate continues as to how best to conceptualise metacognition and cultivate metacognitive ability. However, due to what can be considered an exponential increase in the creation of new information every year [6, 7], higher-order, metacognitive skills are needed more than ever in order to aid individuals and groups in becoming more adaptable, flexible and better able to cope in the context of a rapidly evolving information society. In order to help guide the facilitation of metacognitive understanding in educational and applied settings, this chapter draws upon recent research in the learning sciences to propose a new framework of metacognition. Specifically, we outline a model of metacognition that integrates processes associated with self-other representations, executive function, emotion regulation, mindfulness, motivation, thinking dispositions, critical thinking, reflective judgment and collaborative systems thinking skills, which can be fostered in the context of individual and team-based tool use. Two cases studies are presented, which provide evidence for the value of both argument mapping and collective intelligence tools in facilitating the development of higher-order critical, reflective and collaborative metacognitive thinking skills. The chapter concludes with a number of recommendations for future research on applied systems science and metacognitive skills development.

An Evaluation of Critical Thinking Competencies in Business Settings

Although critical thinking (CT) skills are usually considered as domain general (Gabbenesch, 2006; Halpern, 2003), CT ability may benefit from expertise knowledge and skill. The current study examined both general CT ability and CT ability related to business scenarios for individuals (a) expert in business, (b) novice in business, and (c) with no business experience, as well as the effects of educational background on both general and business-related CT. Results are discussed in light of research and theory on CT and business, and implications for future research are discussed.

Protocol for a systematic review with network meta-analysis of the modalities used to deliver eHealth interventions for chronic pain

BackgroundAs eHealth interventions prove both efficacious and practical, and as they arguably overcome certain barriers encountered by traditional face-to-face treatment for chronic pain, their number has increased dramatically in recent times. However, there is a dearth of research that focuses on evaluating and comparing the different types of technology-assisted interventions. This is a protocol for a systematic review that aims to evaluate the eHealth modalities in the context of psychological and non-psychological (other than non-drug) interventions for chronic pain.Methods/designWe will search the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase and PsycINFO. Randomised controlled trials (RCTs) with more than 20 participants per trial arm that have evaluated non-drug psychological or non-psychological interventions delivered via an eHealth modality and have pain as an outcome measure will be included. Two review authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one outcome variable in accordance with the IMMPACT guidelines (i.e. pain severity, pain interference, physical functioning, symptoms, emotional functioning, global improvement and disposition). Secondary outcomes will be measures of depression and health-related quality of life (HRQoL). A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of modalities across treatment trials, which will return rankings for the eHealth modalities in terms of their effectiveness.DiscussionMost trials that use an eHealth intervention to manage chronic pain typically use one modality. As a result, little evidence exists to support which modality type is the most effective. The current review will address this gap in the literature and compare the different eHealth modalities used for technology-assisted interventions for chronic pain. With the growing reliance and use of technology as a medium for delivering treatment for chronic conditions more generally, it is imperative that research identify the most efficacious eHealth modalities and systematically identify the most important features of such treatment types, so they may be replicated and used for research and in the provision of care.Trial registrationPROSPERO, CRD42016035595

Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis

BackgroundThe prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension.MethodsA systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure.DiscussionThis study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy.Systematic review registrationPROSPERO CRD42017070579

Judgement analysis of case severity and future risk of disability regarding chronic low back pain by general practitioners in Ireland

Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients’ case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP–in combining information cues to form a judgement about current case severity and a judgement about the same patient’s risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.

Critical Thinking: Conceptual Perspectives and Practical Guidelines

Dwyers book is unique and distinctive as it presents and discusses a modern conceptualization of critical thinking – one that is commensurate with the exponential increase in the annual output of knowledge. The abilities of navigating new knowledge outputs, engaging in enquiry and constructively solving problems are not only important in academic contexts, but are also essential life skills. Specifically, the book provides a modern, detailed, accessible and integrative model of critical thinking that accounts for critical thinking sub-skills and real-world applications; and is commensurate with the standards of twenty-first-century knowledge. The book provides both opportunities to learn and apply these skills through a series of exercises, as well as guidelines on how critical thinking can be developed and practised, in light of existing psychological research, which can be used to enhance the experience of critical thinking training and facilitate gains in critical thinking ability.

Prevalence, impact and cost of multimorbidity in a cohort of people with chronic pain in Ireland: a study protocol

Introduction Multimorbidity (MM) refers to the coexistence of two or more chronic conditions within one person, where no one condition is considered primary. As populations age and healthcare provision improves, MM is becoming increasingly common and poses a challenge to the single morbidity approach to illness management, usually adopted by healthcare systems. Indeed, recent research has shown that 66.2% of the people in primary care in Ireland are living with MM. Healthcare usage and cost is significantly associated with MM, and additional chronic conditions lead to exponential increases in service usage and financial costs, and decreases in physical and mental well-being. Certain conditions, for example, chronic pain, are highly correlated with MM. This study aims to assess the extent, profile, impact and cost of MM among Irish adults with chronic pain. Methods and analysis Using cluster sampling, participants aged 18 years and over will be recruited from Irish pain clinics and provided an information package and questionnaire asking them to participate in our study at three time points, 1 year apart. The questionnaire will include our specially developed checklist to assess the prevalence and impact of MM, along with validated measures of quality of life, pain, depression and anxiety, and illness perception. Economic data will also be collected, including direct and indirect costs. Ethics and dissemination Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via journal articles and conference presentations.

Effectiveness of a biopsychosocial e-learning intervention on the clinical judgements of medical students and GP trainees regarding future risk of disability in patients with chronic lower back pain: study protocol for a randomised controlled trial

Introduction Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications. Aim The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees. Methods and analysis Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention. Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. Trial registration number ISRCTN53670726; Pre-results.