The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.

INTRODUCTION: Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. MATERIALS AND METHODS: A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. RESULTS: Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). CONCLUSION: Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters

Debatable issues in automated ECG reporting

Although automated ECG analysis has been available for many years, there are some aspects which require to be re-assessed with respect to their value while newer techniques which are worthy of review are beginning to find their way into routine use. At the annual International Society of Computerized Electrocardiology conference held in April 2017, four areas in particular were debated. These were a) automated 12 lead resting ECG analysis; b) real time out of hospital ECG monitoring; c) ECG imaging; and d) single channel ECG rhythm interpretation. One speaker presented the positive aspects of each technique and another outlined the more negative aspects. Debate ensued. There were many positives set out for each technique but equally, more negative features were not in short supply, particularly for out of hospital ECG monitoring

Recent advances of HCI in decision-making tasks for optimized clinical workflows and precision medicine.

The ever-increasing amount of biomedical data is enabling new large-scale studies, even though ad hoc computational solutions are required. The most recent Machine Learning (ML) and Artificial Intelligence (AI) techniques have been achieving outstanding performance and an important impact in clinical research, aiming at precision medicine, as well as improving healthcare workflows. However, the inherent heterogeneity and uncertainty in the healthcare information sources pose new compelling challenges for clinicians in their decision-making tasks. Only the proper combination of AI and human intelligence capabilities, by explicitly taking into account effective and safe interaction paradigms, can permit the delivery of care that outperforms what either can do separately. Therefore, Human-Computer Interaction (HCI) plays a crucial role in the design of software oriented to decision-making in medicine. In this work, we systematically review and discuss several research fields strictly linked to HCI and clinical decision-making, by subdividing the articles into six themes, namely: Interfaces, Visualization, Electronic Health Records, Devices, Usability, and Clinical Decision Support Systems. However, these articles typically present overlaps among the themes, revealing that HCI inter-connects multiple topics. With the goal of focusing on HCI and design aspects, the articles under consideration were grouped into four clusters. The advances in AI can effectively support the physicians' cognitive processes, which certainly play a central role in decision-making tasks because the human mental behavior cannot be completely emulated and captured; the human mind might solve a complex problem even without a statistically significant amount of data by relying upon domain knowledge. For this reason, technology must focus on interactive solutions for supporting the physicians effectively in their daily activities, by exploiting their unique knowledge and evidence-based reasoning, as well as improving the various aspects highlighted in this review

Adviser\u27s Guide to Health Care, Volume 1: An Era of Reform—The Four Pillars

https://egrove.olemiss.edu/aicpa_guides/2720/thumbnail.jp

Anticoagulation for atrial fibrillation in general practice: a critical evaluation of the implementation of changes to practice

This thesis critically evaluated, and updated existing knowledge, improving scholarship about the nature of oral-anticoagulation (OAC) use and changes to OAC management in general-practice in patients with atrial fibrillation (AF). This thesis represents an original contribution to knowledge by presenting a new integrated-care model for AF/OAC care in general-practice; Developed uniquely via an Insider-Researcher lens and assessment of AF/OAC care; Which used context-specific data to combine existing methods within related methodologies in a novel way; To provide an original exploration of the embedding processes involved in AF/OAC care in general-practice. This thesis also provides a significant contribution to knowledge in several ways. Firstly, this thesis challenges the previously accepted assumptions about OAC use and underuse in general-practice, establishes and answers a knowledge-gap about the extent of GP involvement in the OAC rates reported. Secondly, this thesis proposes a new, initial theory, of how a general-practice affected the OAC rates reported; whilst, also identifying a further literary gap about the essential roles for General-Practice Nurses (GPNs) required to deliver improved AF/OAC care, via a general-practice integrative-care model. Thirdly, the insider-researcher approach that was taken using a form of realist evaluation incorporating the Normalization Process Theory (NPT), positively impacts on existing nurse-led research within general-practice settings. The context of this study is the high stroke burden attributable to the increasingly prevalent cardiac arrythmia AF, for which an effective risk-reducing treatment, OAC, is historically underused and for which general-practice holds responsibility. This study involves a mixed-methods approach, which includes a quantitative examination of the clinical pathways and management of an AF cohort, and a qualitative investigation about clinicians’ experiences of transformation of OAC practice in a large general-practice in Northern England. Using realism as a methodological perspective, an insider-researcher approach incorporating the Normalization Process Theory (NPT) produced a new program theory about the roles of general practitioners and other practice staff in stroke prevention work in AF patients. Between June and October 2013, the electronic records of 297 AF patients included in a general-practice caseload were analyzed, following their initial presentation to eventual diagnosis and treatment with OAC. Then, between October and December 2013, clinical staff within the same setting were also questioned about their roles before, during and after changes to OAC and AF care in the general practice. Findings showed that historic underuse did exist as suggested by the literature with only 51.9% of patients initially taking OAC in 2013. Furthermore, the findings also indicated the presence of a limited GP role, who were involved in only 24.9% of all previous AF diagnoses. However, several contextual factors, which resulted in a series of mechanisms for OAC service change, also existed. These led to increased general-practice diagnoses of AF, totaling 78.6% of new AF patients and a 91.1% uptake of OAC in all patients diagnosed with AF after 2013 up to 2017. Historical OAC use in treating AF patients in general practice has been previously shaped by the GPs’ willingness to refer to specialists and by the outcomes of decision-making by specialists. Furthermore, there has been no previous recognized role for nurses in AF/OAC care, both within the literature, and within this practice. This was exemplified by a lack of awareness about stroke, AF and OAC; which also resulted in significant clinical anxiety. AF and OAC care are complex interventions that require multiple Context-Mechanism-Outcome (CMO) factors, occurring in various configurations, to achieve changes in clinical general-practice. Nursing activity in general practice was integral to achieving improvements in OAC treatment change and improved outcomes. The nature of roles, knowledge and agency are critically integrated to processes of OAC and AF treatment change and are, themselves, constructs of power that reflect embedded historical general-practice funding models. Outcomes of significantly increased OAC use, routine AF case-finding and internal OAC initiation occurred because of role-specific CMO-configurations. Increases in OAC use to prevent stroke is possible in general-practice using an integrated-care approach. But further research is required to explore the possible variations of integrated care that are used more widely in general-practice, and explore patients’ roles within decisions about OAC use, within these integrated-care models

National Space Biomedical Research Institute

The National Space Biomedical Research Institute (NSBRI) sponsors and performs fundamental and applied space biomedical research with the mission of leading a world-class, national effort in integrated, critical path space biomedical research that supports NASA's Human Exploration and Development of Space (HEDS) Strategic Plan. It focuses on the enabling of long-term human presence in, development of, and exploration of space. This will be accomplished by: designing, implementing, and validating effective countermeasures to address the biological and environmental impediments to long-term human space flight; defining the molecular, cellular, organ-level, integrated responses and mechanistic relationships that ultimately determine these impediments, where such activity fosters the development of novel countermeasures; establishing biomedical support technologies to maximize human performance in space, reduce biomedical hazards to an acceptable level, and deliver quality medical care; transferring and disseminating the biomedical advances in knowledge and technology acquired through living and working in space to the benefit of mankind in space and on Earth, including the treatment of patients suffering from gravity- and radiation-related conditions on Earth; and ensuring open involvement of the scientific community, industry, and the public at large in the Institute's activities and fostering a robust collaboration with NASA, particularly through Johnson Space Center