Building bridges between doctors and patients: the design and pilot evaluation of a training session in argumentation for chronic pain experts

Shared decision-making requires doctors to be competent in exchanging views with patients to identify the appropriate course of action. In this paper we focus on the potential of a course in argumentation as a promising way to empower doctors in presenting their viewpoints and addressing those of patients. Argumentation is the communication process in which the speaker, through the use of reasons, aims to convince the interlocutor of the acceptability of a viewpoint. The value of argumentation skills for doctors has been addressed in the literature. Yet, there is no research on what a course on argumentation might look like. In this paper, we present the content and format of a training session in argumentation for doctors and discuss some insights gained from a pilot study that examined doctors' perceived strengths and limitations vis-à-vis this training

An Empirical Comparison of Three Inference Methods

In this paper, an empirical evaluation of three inference methods for uncertain reasoning is presented in the context of Pathfinder, a large expert system for the diagnosis of lymph-node pathology. The inference procedures evaluated are (1) Bayes' theorem, assuming evidence is conditionally independent given each hypothesis; (2) odds-likelihood updating, assuming evidence is conditionally independent given each hypothesis and given the negation of each hypothesis; and (3) a inference method related to the Dempster-Shafer theory of belief. Both expert-rating and decision-theoretic metrics are used to compare the diagnostic accuracy of the inference methods.Comment: Appears in Proceedings of the Fourth Conference on Uncertainty in Artificial Intelligence (UAI1988

Doctor of Philosophy

dissertationClinical decision support systems (CDSS) and electronic health records (EHR) have been widely adopted but do not support a high level of reasoning for the clinician. As a result, workflow incongruity and provider frustrations lead to more errors in reasoning. Other successful fields such as defense, aviation, and the military have used task complexity as a key factor in decision support system development. Task complexity arises during the interaction of the user and the tasks. Therefore, in this dissertation I have utilized different human factor methods to explore task complexity factors to understand their utility in health information technology system design. The first study addresses the question of generalizing complexity through a clinical complexity model. In this study, we integrated and validated a patient and task complexity model into a clinical complexity model tailored towards healthcare to serve as the initial framework for data analysis in our subsequent studies. The second study addresses the question of the coping strategies of infectious disease (ID) clinicians while dealing with complex decision tasks. The study concluded that clinicians use multiple cognitive strategies that help them to switch between automatic cognitive processes and analytical processes. The third study identified the complexity contributing factors from the transcripts of the observations conducted in the ID domain. The clinical complexity model developed in the first study guided the research for identifying the prominent complexity iv factors to recommend innovative healthcare technology system design. The fourth study, a pilot exploratory study, demonstrated the feasibility of developing a population information display from querying real complex patient information from an actual clinical database as well as identifying the ideal features of population information display. In summary, this dissertation adds to the knowledge about how clinicians adapt their information environment to deal with complexity. First, it contributes by developing a clinical complexity model that integrates both patient and task complexity. Second, it provides specific design recommendations for future innovative health information technology systems. Last, this dissertation also suggests that understanding task complexity in the healthcare team domain may help to better design of interface system

How communication affects prescription decisions in consultations for acute illness in children:a systematic review and meta-ethnography

BACKGROUND: Communication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach. RESULTS: Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation. CONCLUSIONS: Misunderstandings occurred due to parents and clinicians talking at cross purposes about the ‘seriousness’ of the illness and because parents’ expressions of concern or requests for additional information were sometimes perceived as a challenge to the clinicians’ diagnosis or treatment decision. This modifiable problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary care clinicians should be offered training to understand parent communication primarily as expressions of concern or attempts at understanding and always to check rather than infer parental expectations

Human-machine scientific discovery

International audienceHumanity is facing existential, societal challenges related to food security, ecosystem conservation, antimicrobial resistance, etc, and Artificial Intelligence (AI) is already playing an important role in tackling these new challenges. Most current AI approaches are limited when it comes to ‘knowledge transfer’ with humans, i.e. it is difficult to incorporate existing human knowledge and also the output knowledge is not human comprehensible. In this chapter we demonstrate how a combination of comprehensible machine learning, text-mining and domain knowledge could enhance human-machine collaboration for the purpose of automated scientific discovery where humans and computers jointly develop and evaluate scientific theories. As a case study, we describe a combination of logic-based machine learning (which included human-encoded ecological background knowledge) and text-mining from scientific publications (to verify machine-learned hypotheses) for the purpose of automated discovery of ecological interaction networks (food-webs) to detect change in agricultural ecosystems using the Farm Scale Evaluations (FSEs) of genetically modified herbicide-tolerant (GMHT) crops dataset. The results included novel food-web hypotheses, some confirmed by subsequent experimental studies (e.g. DNA analysis) and published in scientific journals. These machine-leaned food-webs were also used as the basis of a recent study revealing resilience of agro-ecosystems to changes in farming management using GMHT crops

Comprehensive Knowledge Assessment for Athletic Trainers: Part I

Purpose: Continuing education (CE) is intended to help clinicians maintain competence, develop and advance knowledge and skills, and enhance knowledge, skills, and abilities beyond the levels required for entry-level practice. Based on previous literature, the current mode of CE in athletic training does not appear to be helping clinicians maintain competence. The purpose of this research was to validate a comprehensive assessment based on the Role Delineation Study/Practice Analysis (6th ed.) through item analysis and estimates of reliability to be used to assess athletic trainers’ actual knowledge. Method: We conducted an instrumentation validation study using Qualtrics® web-based platform. Athletic trainers (n=191; age=31.5±8.1yrs; years of experience=8.9±11.1yrs) in good standing with the NATA and BOC completed both administrations of the assessment. Six experts developed 220 multiple-choice items for inclusion with broad application across the five domains of clinical practice (Injury/Illness and Wellness Protection [49 items], Clinical Evaluation and Diagnosis [63 items], Immediate and Emergency Care [29 items], Treatment and Rehabilitation [29 items], and Organizational and Professional Health and Wellbeing [50 items]). A random sample of NATA members were recruited via email, received weekly reminders, and then after four weeks, they completed a second administration of the assessment. We evaluated the assessment tool for item difficulty, item discrimination, internal consistency, item total statistics, and test-retest reliability. Results: We eliminated 42 items from the tool created by the experts that were too difficult (0.90). We eliminated 50 additional items due to point-biserial correlations between item performance and total domain score performance below 0.20. We identified additional weaknesses in 57 items through intraclass correlation coefficients (ICCConclusions: We developed a valid and reliable assessment tool to measure athletic trainers’ actual knowledge. Future research should utilize a validated assessment of actual knowledge to guide continuing education activities

J Biomed Inform

Objectives:To understand clinicians\u2019 impressions of and decision-making processes regarding an informatics-supported antibiotic timeout program to re-evaluate the appropriateness of continuing vancomycin and piperacillin/tazobactam.Methods:We implemented a multi-pronged informatics intervention, based on Dual Process Theory, to prompt discontinuation of unwarranted vancomycin and piperacillin/tazobactam on or after day three in a large Veterans Affairs Medical Center. Two workflow changes were introduced to facilitate cognitive deliberation about continuing antibiotics at day three: (1) teams completed an electronic template note, and (2) a paper summary of clinical and antibiotic-related information was provided to clinical teams. Shortly after starting the intervention, six focus groups were conducted with users or potential users. Interviews were recorded and transcribed. Iterative thematic analysis identified recurrent themes from feedback.Results:Themes that emerged are represented by the following quotations: (1) captures and controls attention (\u201cit reminds us to think about it\u201d), (2) enhances informed and deliberative reasoning (\u201cit makes you think twice\u201d), (3) redirects decision direction (\u201c\u2026because [there was no indication] I just [discontinued] it without even trying\u201d), (4) fosters autonomy and improves team empowerment (\u201cthe template\u2026forces the team to really discuss it\u201d), and (5) limits use of emotion-based heuristics (\u201cmy clinical concern is high enough I think they need more aggressive therapy\u2026\u201d).Conclusions:Requiring template completion to continue antibiotics nudged clinicians to re-assess the appropriateness of specified antibiotics. Antibiotic timeouts can encourage deliberation on overprescribed antibiotics without substantially curtailing autonomy. An effective nudge should take into account clinician\u2019s time, workflow, and thought processes.CC999999/Intramural CDC HHS/United States2019-05-08T00:00:00Z27327529PMC65056946242vault:3211