Evidence combination for incremental decision-making processes

The establishment of a medical diagnosis is an incremental process highly fraught with uncertainty. At each step of this painstaking process, it may be beneficial to be able to quantify the uncertainty linked to the diagnosis and steadily update the uncertainty estimation using available sources of information, for example user feedback, as they become available. Using the example of medical data in general and EEG data in particular, we show what types of evidence can affect discrete variables such as a medical diagnosis and build a simple and computationally efficient evidence combination model based on the Dempster-Shafer theory

Artificial Intelligence in Medicine: A New Way to Diagnose and Treat Disease

Artificial intelligence (AI) has immense potential to transform medicine by improving diagnostic accuracy and enabling personalized treatments. This paper explores how AI systems analyze medical images, lab tests, genetic data, and patient histories to detect disease earlier and guide therapy selection. Though still an emerging field, impressive results demonstrate AI can surpass human clinicians on diagnostic tasks. For example, an AI system detected breast cancer from mammograms more accurately than expert radiologists. In ophthalmology, AI outperformed ophthalmologists in diagnosing diabetic retinopathy. By finding subtle patterns in complex datasets, AI promises to catch diseases like cancer in early, more treatable stages. Beyond diagnosis, AI can identify optimal treatments for individual patients based on their genetic makeup and lifestyle factors. Researchers are also using AI to design new medications. While AI offers many benefits, challenges remain regarding clinician displacement, legal liability, data privacy, and the "black box" nature of AI reasoning. More research is needed, but it is clear that AI will fundamentally alter medical practice. AI empowers clinicians to provide earlier, more precise diagnoses and tailored therapies for patients. Though it will not replace doctors, by automating routine tasks and uncovering hidden insights, AI can free physicians to focus on holistic care. The future of medicine lies in humans and smart machines working together

Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice. AIM: To explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice. DESIGN AND SETTING: Comparison of audio-recordings of follow-up consultations in UK primary care. METHOD: Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use. RESULTS: Of the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items. CONCLUSION: VC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less 'information rich' than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.Chief Scientist Office for Scotlan

Clinical Reasoning in the Real World Is Mediated by Bounded Rationality: Implications for Diagnostic Clinical Practice Guidelines

Background: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. Method: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. Results: Four main themes were identified: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. Discussion: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration. Copyright: © 2010 Bonilauri Ferreira et al

Association between Visual Evoked Potential and Disease Severity, Disease Duration and Visual Hallucination in Patients with Idiopathic Parkinsonism

Background: Parkinson's disease (PD) is a neurodegenerative disorder impairing motor, verbal and other abilities. Visual evoked potential (VEP) assessment is a useful method for analysis of visual system and its function. The present study was designed in order to evaluate whether VEP changes are associated with PD.Materials and Methods: In the present study, 100 subjects encompassing 40 patients with Idiopathic Parkinson’s Disease (Idiopathic PD) and 60 aged-matched controls were selected and assigned into case and control groups, respectively. VEP analysis was conducted in either group and the results were compared.Results: In the present study, 16 patients (40%) showed prolonged P100 latency. P100 latency in the case group was significantly longer than in controls. P100 Amplitude was significantly higher in case group than control. There were no significant association between prolonged VEP and sex and diseases duration, in the participants. Also from our participants who suffer from visual hallucination, P100 latency was significantly longer than in the controls.  There was a significant association between prolonged P100 latency and severity of disease in the case group.Conclusion: We suggest that prolonged VEP latencies and amplitude are associated with PD and might be associated with a predisposition for visual hallucinations

Under the Umbrella: Redefining the Spectrum of Autism

This research examines the scope of how autism spectrum disorders (ASD) have changed over the history of special education. From Dr. Leo Kanner’s initial study in 1943 to the present-day DSM-5, the diagnostic criteria for an accurate identification of autism in children has been extremely varied, resulting in an increased prevalence rate and confusion as to what actually constitutes ASD. A major discovery by Wing and Gould in 1979 brought to the forefront the concept of a spectrum of disorders within the autism category. Leading to an over-diagnosis of children requiring related services and supports in schools and at home, also examined is the response to the American Psychological Association (APA) removal of the spectrum in the latest Diagnostic and Statistical Manual Fifth Edition (DSM-5) manual. This paper explores the field of autism study including the assessments used to determine a diagnosis, suggestions for evidence-based interventions and strategies with proven success, and how the changes in the DSM-5 have impacted the community of children and families with autism. An explanation for meeting the needs of the whole child, not just their label or stigmatized disability category under IDEA, is also investigated to assist teachers in making accurate and appropriate accommodations for children with autism spectrum disorders in their classrooms

Examining the Use of Institutionally Designed Documentation Templates as a Vehicle for Changing Values and Practices in Health Care

Changing values and requirements are common occurrences in today’s health care settings. Institutionally designed documentation templates are often developed to demonstrate that these changes have been incorporated into clinical work. Little research has been completed to examine whether the use of these institutional templates leads to the intended change or whether the changes clash with other influences on clinical work. This paper illustrates how two qualitative methods: think aloud interviews and frame analysis can be combined to examine the use of the templates, the changing values themselves, and the influences on changes in clinical practice. An analysis of local change from expert planning to person centered planning is used to illustrate the value of the approach. The analysis reveals influences that affect the adoption of this particular change, the usability of the template, and points of change that need to be negotiated with the users of those documents