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Functional psychology was less a system than an attitude that valued the utility of psychological inquiry. Assuming a philosophical underpinning from the pragmatism of William James and Charles Sanders Peirce, functional psychology fit well into the pioneering spirit of America. From its beginning, functional psychology had a clear emphasis on applying psychology to individual and social improvement, as was evident from the works of Münsterberg, McDougall, and Hall. The tradition of British natural science and evolutionary theory was integrated into psychology in the views on adaptation championed by the Chicago functionalists, such as Dewey, Angell, and Carr. Mental testing and the study of human capacity constituted important areas of investigation among the Columbia functionalists, represented by Cattell, Thorndike, and Woodworth. Although its reaction to structural psychology kept functional psychology from developing a systematic alternative model of psychological inquiry, this phase of American psychology resulted in two critical benefits. First, functionalism firmly entrenched the new science of psychology in America and imposed on it a particular American orientation toward applied psychology. Second, functional psychology provided a necessary transition from the restricted context of structural psychology to more viable models of psychology, permitting the science to progress.
The aim of this study was to perform a systematic review and meta-analysis of the diagnostic accuracy of a point-of-care ultrasound exam for undifferentiated shock in patients presenting to the emergency department.
Methods
Ovid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and research meeting abstracts were searched from 1966 to June 2018 for relevant studies. QUADAS-2 was used to assess study quality, and meta-analysis was conducted to pool performance data of individual categories of shock.
Results
A total of 5,097 non-duplicated studies were identified, of which 58 underwent full-text review; 4 were included for analysis. Study quality by QUADAS-2 was considered overall a low risk of bias. Pooled positive likelihood ratio values ranged from 8.25 (95% CI 3.29 to 20.69) for hypovolemic shock to 40.54 (95% CI 12.06 to 136.28) for obstructive shock. Pooled negative likelihood ratio values ranged from 0.13 (95% CI 0.04 to 0.48) for obstructive shock to 0.32 (95% CI 0.16 to 0.62) for mixed-etiology shock.
Conclusion
The rapid ultrasound for shock and hypotension (RUSH) exam performs better when used to rule in causes of shock, rather than to definitively exclude specific etiologies. The negative likelihood ratios of the exam by subtype suggest that it most accurately rules out obstructive shock.
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