Application of a model based on fuzzy logic for evaluating nursing diagnostic accuracy of students

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Purpose: To describe a model for assessing nursing diagnostic accuracy and its application to undergraduate students, comparing students' performance according to the course year. Methods: This model, based on the theory of fuzzy sets, guides a student through three steps: (a) the student must parameterize the model by establishing relationship values between defining characteristic/risk factors and nursing diagnoses; (b) presentation of a clinical case; (c) the student must define the presence of each defining characteristic/risk factors for the clinical case. Subsequently, the model computes the most plausible diagnoses by taking into account the values indicated by the student. This gives the student a performance score in comparison with parameters and diagnoses that were previously provided by nursing experts. These nursing experts collaborated with the construction of the model indicating the strength of the relationship between the concepts, meaning, they parameterized the model to compare the student's choice with the expert's choice (gold standard), thus generating performance scores for the student. The model was tested using three clinical cases presented to 38 students in their third and fourth years of the undergraduate nursing course. Results: Third year students showed superior performance in identifying the presence of defining characteristic/risk factors, while fourth year students showed superior performance in the diagnoses by the model. Conclusions: The Model for Evaluation of Diagnostic Accuracy Based on Fuzzy Logic applied in this study is feasible and can be used to evaluate students' performance. In this regard, it will open a broad variety of applications for learning and nursing research. Limitations: Despite the ease in filling the printed questionnaires out, the number of steps and fields to fill in may explain the considerable number of questionnaires with incorrect or missing data. This was solved in the digital version of the questionnaire. In addition, in more complex cases, it is possible that an expert opinion can lead to a wrong decision due to the subjectivity of the diagnostic process. (C) 2013 Elsevier Ireland Ltd. All rights reserved.829875881Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Purpose: To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). Methods: A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++(R) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. In order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. Results: The overestimation of the accordance showed an excellent agreement (kappa = 0.92, p < 0.0001); and the underestimation provided a moderate agreement (kappa = 0.42, p < 0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). Conclusions: The decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. Limitations: In spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence. (C) 2012 Elsevier Ireland Ltd. All rights reserved.823201208Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)NIH [D43TW007015]BRIGHTConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)CNPq [CNPq 476854/2004-0]NIH [D43TW007015]CNPq [301735/2009

Telemedicine model for training non-medical persons in the early recognition of melanoma

A Web-based educational model, called JUTE, was developed for the early diagnosis of melanoma. It was compared with a control Website composed of information available on the Internet for teaching undergraduate medical students. The JUTE model was designed to allow the student linear navigation of the main topics that were assumed to be important in learning to make a diagnosis. The rate of success in correctly deciding to refer pigmented lesions to a dermatologist was compared among 34 new medical students who were randomly divided into two groups. There was no significant difference between the JUTE and control groups in the pre-test. When comparing the pre- and post-tests, the number of correct decisions increased significantly only in the JUTE group. In the JUTE group there was a slight but significant improvement when comparing decisions about thin melanoma before and after the training. The educational approach chosen for the JUTE Website appears to be useful for teaching the early recognition of melanoma and could be used for larger educational campaigns of skin cancer prevention.Univ Fed Sao Paulo, Fac Med, Dept Pathol Telemed, Sao Paulo, BrazilUNIFESP, Dept Dermatol, BR-04052110 Sao Paulo, BrazilUniv Fed Sao Paulo, Fac Med, Dept Pathol Telemed, Sao Paulo, BrazilUNIFESP, Dept Dermatol, BR-04052110 Sao Paulo, BrazilWeb of Scienc