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Medical heuristics

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https://www.readbyqxmd.com/read/29754203/prospective-analysis-of-decision-making-during-joint-cardiology-cardiothoracic-conference-in-treatment-of-107-consecutive-children-with-congenital-heart-disease
#1
Sophie Duignan, Aedin Ryan, Dara O'Keeffe, Damien Kenny, Colin J McMahon
The complexity and potential biases involved in decision making have long been recognised and examined in both the aviation and business industries. More recently, the medical community have started to explore this concept and its particular importance in our field. Paediatric cardiology is a rapidly expanding field and for many of the conditions we treat, there is limited evidence available to support our decision-making. Variability exists within decision-making in paediatric cardiology and this may influence outcomes...
May 12, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29720792/preventing-neurophobia-remodeling-neurology-education-for-21-st-century-medical-students-through-effective-pedagogical-strategies-for-neurophilia
#2
REVIEW
Bhaskara P Shelley, Thomas V Chacko, Balakrishnan R Nair
Neurology has a reputation, particularly as a complex "head-to-toe" discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline...
January 2018: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/29691206/designing-for-clinical-change-creating-an-intervention-to-implement-new-statin-guidelines-in-a-primary-care-clinic
#3
Melissa DeJonckheere, Claire H Robinson, Lindsey Evans, Julie Lowery, Bradley Youles, Adam Tremblay, Caitlin Kelley, Jeremy B Sussman
BACKGROUND: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike...
April 24, 2018: JMIR Human Factors
https://www.readbyqxmd.com/read/29668967/reducing-blindness-from-retinopathy-of-prematurity-rop-in-argentina-through-collaboration-advocacy-and-policy-implementation
#4
Luxme Hariharan, Clare E Gilbert, Graham E Quinn, Frances K Barg, Celia Lomuto, Ana Quiroga, Joan McLeod-Omawale, Andrea Zin, Zulma Ortiz, Ernesto Alda, Liliana Bouzas, Marina Brussa, Adriana Cattaino, Alejandro Dinerstein, Norma Erpen, Adriana Fandiño, Lidia Galina, Julio Manzitti, Silvia Marinaro, Teresa Sepúlveda, Patricia Visintín, Juan Carlos Silva, Cynthia Magluta, Alicia Benitez
Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system...
April 16, 2018: Health Policy and Planning
https://www.readbyqxmd.com/read/29629847/understanding-the-cognitive-and-affective-mechanisms-that-underlie-proxy-risk-perceptions-among-caregivers-of-asthmatic-children
#5
James A Shepperd, Nikolette P Lipsey, Thorsten Pachur, Erika A Waters
OBJECTIVE: Medical decisions made on behalf of another person-particularly those made by adult caregivers for their minor children-are often informed by the decision maker's beliefs about the treatment's risks and benefits. However, we know little about the cognitive and affective mechanisms influencing such "proxy" risk perceptions and about how proxy risk perceptions are related to prominent judgment phenomena. METHODS: Adult caregivers of minor children with asthma ( N = 132) completed an online, cross-sectional survey assessing 1) cognitions and affects that form the basis of the availability, representativeness, and affect heuristics; 2) endorsement of the absent-exempt and the better-than-average effect; and 3) proxy perceived risk and unrealistic comparative optimism of an asthma exacerbation...
April 1, 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29617797/distributed-deep-learning-networks-among-institutions-for-medical-imaging
#6
Ken Chang, Niranjan Balachandar, Carson Lam, Darvin Yi, James Brown, Andrew Beers, Bruce Rosen, Daniel L Rubin, Jayashree Kalpathy-Cramer
Objective: Deep learning has become a promising approach for automated support for clinical diagnosis. When medical data samples are limited, collaboration among multiple institutions is necessary to achieve high algorithm performance. However, sharing patient data often has limitations due to technical, legal, or ethical concerns. In this study, we propose methods of distributing deep learning models as an attractive alternative to sharing patient data. Methods: We simulate the distribution of deep learning models across 4 institutions using various training heuristics and compare the results with a deep learning model trained on centrally hosted patient data...
March 29, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29610737/variable-selection-in-logistic-regression-model-with-genetic-algorithm
#7
EDITORIAL
Zhongheng Zhang, Victor Trevino, Sayed Shahabuddin Hoseini, Smaranda Belciug, Arumugam Manivanna Boopathi, Ping Zhang, Florin Gorunescu, Velappan Subha, Songshi Dai
Variable or feature selection is one of the most important steps in model specification. Especially in the case of medical-decision making, the direct use of a medical database, without a previous analysis and preprocessing step, is often counterproductive. In this way, the variable selection represents the method of choosing the most relevant attributes from the database in order to build a robust learning models and, thus, to improve the performance of the models used in the decision process. In biomedical research, the purpose of variable selection is to select clinically important and statistically significant variables, while excluding unrelated or noise variables...
February 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29589563/a-pattern-learning-based-method-for-temporal-expression-extraction-and-normalization-from-multi-lingual-heterogeneous-clinical-texts
#8
Tianyong Hao, Xiaoyi Pan, Zhiying Gu, Yingying Qu, Heng Weng
BACKGROUND: Temporal expression extraction and normalization is a fundamental and essential step in clinical text processing and analyzing. Though a variety of commonly used NLP tools are available for medical temporal information extraction, few work is satisfactory for multi-lingual heterogeneous clinical texts. METHODS: A novel method called TEER is proposed for both multi-lingual temporal expression extraction and normalization from various types of narrative clinical texts including clinical data requests, clinical notes, and clinical trial summaries...
March 22, 2018: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/29582981/predicting-outcomes-after-severe-traumatic-brain-injury-science-humanity-or-both
#9
Kwok M Ho
Predicting long-term outcome after severe traumatic brain injury (TBI) is difficult, but accurate assessment is paramount for both families of the patients and medical decision- making, as well as quality assurance or research purposes. Many important prognostic factors for patients with severe TBI have been identified, but most - if not all - including the Glasgow Coma Score and magnetic resonance imaging are not accurate enough to be used alone to predict patient outcomes. Clinicians should also be wary about how their predictions and decision-making can be affected by heuristics and cognitive biases...
March 26, 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29539648/focus-section-health-it-usability-applying-a-task-technology-fit-model-to-adapt-an-electronic-patient-portal-for-patient-work
#10
Sana B Ali, Juana Romero, Kevin Morrison, Baria Hafeez, Jessica S Ancker
OBJECTIVES: Although electronic patient portals are offered by most health care organizations, poor usability and poor fit to patient needs may pose barriers to adoption. We collaborated with an academic hospital to conduct iterative user evaluation of a newly deployed portal designed to deliver inpatient data upon hospital discharge. METHODS: Three evaluators applied heuristic usability evaluation and conducted 23 individual user testing sessions with patients with chronic disease or managing the care of family members with chronic disease...
January 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29528716/heuristics-and-cognitive-error-in-medical-imaging
#11
Jason N Itri, Sohil H Patel
OBJECTIVE: The field of cognitive science has provided important insights into mental processes underlying the interpretation of imaging examinations. Despite these insights, diagnostic error remains a major obstacle in the goal to improve quality in radiology. In this article, we describe several types of cognitive bias that lead to diagnostic errors in imaging and discuss approaches to mitigate cognitive biases and diagnostic error. CONCLUSION: Radiologists rely on heuristic principles to reduce complex tasks of assessing probabilities and predicting values into simpler judgmental operations...
May 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29499315/comparison-of-two-heuristic-evaluation-methods-for-evaluating-the-usability-of-health-information-systems
#12
Reza Khajouei, Sadrieh Hajesmaeel Gohari, Moghaddameh Mirzaee
OBJECTIVES: In addition to following the usual Heuristic Evaluation (HE) method, the usability of health information systems can also be evaluated using a checklist. The objective of this study is to compare the performance of these two methods in identifying usability problems of health information systems. METHODS: Eight evaluators independently evaluated different parts of a Medical Records Information System using two methods of HE (usual and with a checklist)...
April 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29375240/learning-to-compose-domain-specific-transformations-for-data-augmentation
#13
Alexander J Ratner, Henry R Ehrenberg, Zeshan Hussain, Jared Dunnmon, Christopher Ré
Data augmentation is a ubiquitous technique for increasing the size of labeled training sets by leveraging task-specific data transformations that preserve class labels. While it is often easy for domain experts to specify individual transformations, constructing and tuning the more sophisticated compositions typically needed to achieve state-of-the-art results is a time-consuming manual task in practice. We propose a method for automating this process by learning a generative sequence model over user-specified transformation functions using a generative adversarial approach...
December 2017: Advances in Neural Information Processing Systems
https://www.readbyqxmd.com/read/29314508/how-the-dual-process-model-of-human-cognition-can-inform-efforts-to-de-implement-ineffective-and-harmful-clinical-practices-a-preliminary-model-of-unlearning-and-substitution
#14
Christian D Helfrich, Adam J Rose, Christine W Hartmann, Leti van Bodegom-Vos, Ian D Graham, Suzanne J Wood, Barbara R Majerczyk, Chester B Good, Leonard M Pogach, Sherry L Ball, David H Au, David C Aron
RATIONALE AND OBJECTIVES: One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics...
February 2018: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29310966/improving-the-anesthetic-process-by-a-fuzzy-rule-based-medical-decision-system
#15
Juan Albino Mendez, Ana Leon, Ayoze Marrero, Jose M Gonzalez-Cava, Jose Antonio Reboso, Jose Ignacio Estevez, José F Gomez-Gonzalez
OBJECTIVE: The main objective of this research is the design and implementation of a new fuzzy logic tool for automatic drug delivery in patients undergoing general anesthesia. The aim is to adjust the drug dose to the real patient needs using heuristic knowledge provided by clinicians. A two-level computer decision system is proposed. The idea is to release the clinician from routine tasks so that he can focus on other variables of the patient. METHODS: The controller uses the Bispectral Index (BIS) to assess the hypnotic state of the patient...
January 2018: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/29308293/a-neural-candidate-selector-architecture-for-automatic-structured-clinical-text-annotation
#16
Gaurav Singh, Iain J Marshall, James Thomas, John Shawe-Taylor, Byron C Wallace
We consider the task of automatically annotating free texts describing clinical trials with concepts from a controlled, structured medical vocabulary. Specifically we aim to build a model to infer distinct sets of (ontological) concepts describing complementary clinically salient aspects of the underlying trials: the populations enrolled, the interventions administered and the outcomes measured, i.e., the PICO elements. This important practical problem poses a few key challenges. One issue is that the output space is vast, because the vocabulary comprises many unique concepts...
November 2017: Proceedings of the ... ACM International Conference on Information & Knowledge Management
https://www.readbyqxmd.com/read/29305681/dynamically-accepting-and-scheduling-patients-for-home-healthcare
#17
Mustafa Demirbilek, Juergen Branke, Arne Strauss
The importance of home healthcare is growing rapidly since populations of developed and even developing countries are getting older and the number of hospitals, retirement homes, and medical staff do not increase at the same rate. We consider the Home Healthcare Nurse Scheduling Problem where patients arrive dynamically over time and acceptance and appointment time decisions have to be made as soon as patients arrive. The objective is to maximise the average number of daily visits for a single nurse. For the sake of service continuity, patients have to be visited at the same day and time each week during their episode of care...
January 5, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29300386/modeling-the-acmg-amp-variant-classification-guidelines-as-a-bayesian-classification-framework
#18
Sean V Tavtigian, Marc S Greenblatt, Steven M Harrison, Robert L Nussbaum, Snehit A Prabhu, Kenneth M Boucher, Leslie G Biesecker
PurposeWe evaluated the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) variant pathogenicity guidelines for internal consistency and compatibility with Bayesian statistical reasoning.MethodsThe ACMG/AMP criteria were translated into a naive Bayesian classifier, assuming four levels of evidence and exponentially scaled odds of pathogenicity. We tested this framework with a range of prior probabilities and odds of pathogenicity.ResultsWe modeled the ACMG/AMP guidelines using biologically plausible assumptions...
January 4, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/29278142/a-stratification-approach-using-logit-based-models-for-confounder-adjustment-in-the-study-of-continuous-outcomes
#19
Chuen Seng Tan, Nathalie C Støer, Ying Chen, Marielle Andersson, Yilin Ning, Hwee-Lin Wee, Eric Yin Hao Khoo, E-Shyong Tai, Shih Ling Kao, Marie Reilly
The control of confounding is an area of extensive epidemiological research, especially in the field of causal inference for observational studies. Matched cohort and case-control study designs are commonly implemented to control for confounding effects without specifying the functional form of the relationship between the outcome and confounders. This paper extends the commonly used regression models in matched designs for binary and survival outcomes (i.e. conditional logistic and stratified Cox proportional hazards) to studies of continuous outcomes through a novel interpretation and application of logit-based regression models from the econometrics and marketing research literature...
January 1, 2017: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/29230698/mode-2-knowledge-production-in-the-context-of-medical-research-a-call-for-further-clarifications
#20
Hojjat Soofi
The traditional researcher-driven environment of medical knowledge production is losing its dominance with the expansion of, for instance, community-based participatory or participant-led medical research. Over the past few decades, sociologists of science have debated a shift in the production of knowledge from traditional discipline-based (Mode 1) to more socially embedded and transdisciplinary frameworks (Mode 2). Recently, scholars have tried to show the relevance of Mode 2 knowledge production to medical research...
December 11, 2017: Journal of Bioethical Inquiry
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