Relevant Clinical Knowledge Research Articles

The performance of AI in medical examinations: an exploration of ChatGPT in ultrasound medical education.

This study aims to evaluate the accuracy of ChatGPT in the context of China's Intermediate Professional Technical Qualification Examination for Ultrasound Medicine, exploring its potential role in ultrasound medical education. A total of 100 questions, comprising 70 single-choice and 30 multiple-choice questions, were selected from the examination's question bank. These questions were categorized into four groups: basic knowledge, relevant clinical knowledge, professional knowledge, and professional practice. ChatGPT versions 3.5 and 4.0 were tested, and accuracy was measured based on the proportion of correct answers for each version. ChatGPT 3.5 achieved an accuracy of 35.7% for single-choice and 30.0% for multiple-choice questions, while version 4.0 improved to 61.4 and 50.0%, respectively. Both versions performed better in basic knowledge questions but showed limitations in professional practice-related questions. Version 4.0 demonstrated significant improvements across all categories compared to version 3.5, but it still underperformed when compared to resident doctors in certain areas. While ChatGPT did not meet the passing criteria for the Intermediate Professional Technical Qualification Examination in Ultrasound Medicine, its strong performance in basic medical knowledge suggests potential as a supplementary tool in medical education. However, its limitations in addressing professional practice tasks need to be addressed.

Generating Actionable Insights from Patient Medical Records and Structured Clinical Knowledge.

While adherence to clinical guidelines improves the quality and consistency of care, personalized healthcare also requires a deep understanding of individual disease models and treatment plans. The structured preparation of medical routine data in a certain clinical context, e.g. a treatment pathway outlined in a medical guideline, is currently a challenging task. Medical data is often stored in diverse formats and systems, and the relevant clinical knowledge defining the context is not available in machine-readable formats. We present an approach to extract information from medical free text documentation by using structured clinical knowledge to guide information extraction into a structured and encoded format, overcoming the known challenges for natural language processing algorithms. Preliminary results have been encouraging, as one of our methods managed to extract 100% of all data-points with 85% accuracy in details. These advancements show the potential of our approach to effectively use unstructured clinical data to elevate the quality of patient care and reduce the workload of medical personnel.

A Study on Pre-clinical Anaesthesia Elective in Shaping Medical Students' Knowledge and Career Perspectives

Anesthesiology stands out as one of the rapidly growing and highly competitive medical specialties, necessitating students to cultivate an interest in anesthesia early and prepare extensively for clinical electives. Pre-clinical electives that introduce students to anesthesia and ready them for clinical settings in the early stages of their academic journey may confer benefits and enhance their competitiveness as residency applicants. This study implemented an eight-week pre-clinical elective titled "The History of Anesthesia" for first- and second-year students at Baylor College of Medicine. Eighty-eight students participated in the elective, with thirteen completing both pre-course and post-course surveys. The survey, consisting of thirteen questions related to anesthesia interest and relevant clinical knowledge, was analyzed, and statistical significance was calculated. The survey results demonstrated significantly elevated levels of self-assessed knowledge in the post-course survey compared to the pre-course survey (p < .05). Notably, topics considered more clinically relevant, such as modern anesthetic techniques, regional anesthesia, and obstetric anesthesia, exhibited significantly higher average survey results in the post-course compared to the pre-course results. The implementation of pre-clinical electives focusing on success in clinical settings appears beneficial for students aspiring to apply to an anesthesiology residency. Institutions should consider exposing students to anesthetic topics earlier in their academic journey to adequately prepare them for the competitive residency application process.

A Cross Attention Approach to Diagnostic Explainability Using Clinical Practice Guidelines for Depression.

The lack of explainability in using relevant clinical knowledge hinders the adoption of artificial intelligence-powered analysis of unstructured clinical dialogue. A wealth of relevant, untapped Mental Health (MH) data is available in online communities, providing the opportunity to address the explainability problem with substantial potential impact as a screening tool for both online and offline applications. Inspired by how clinicians rely on their expertise when interacting with patients, we leverage relevant clinical knowledge to classify and explain depression-related data, reducing manual review time and engendering trust. We developed a method to enhance attention in contemporary transformer models and generate explanations for classifications that are understandable by mental health practitioners (MHPs) by incorporating external clinical knowledge. We propose a domain-general architecture called ProcesS knowledgeinfused cross ATtention (PSAT) that incorporates clinical practice guidelines (CPG) when computing attention. We transform a CPG resource focused on depression, such as the Patient Health Questionnaire (e.g. PHQ-9) and related questions, into a machine-readable ontology using SNOMED-CT. With this resource, PSAT enhances the ability of models like GPT-3.5 to generate application-relevant explanations. Evaluation of four expert-curated datasets related to depression demonstrates PSAT's applicationrelevant explanations. PSAT surpasses the performance of twelve baseline models and can provide explanations where other baselines fall short.

Enhanced abnormal data detection hybrid strategy based on heuristic and stochastic approaches for efficient patients rehabilitation

Over the last few years, substantial research has been conducted towards developing efficient abnormal detection techniques while considering efficiency, accuracy, high-dimensional data, distributed environments, and others. Researchers increasingly deal with “abnormalities” in clinical patient data to derive relevant clinical knowledge for making informed decisions. However, data collection for clinically relevant research is often guided by patient conditions and administrative or clinical requirements rather than a regular schedule. Therefore, clinical data is frequently obtained in an unreliable form, characterized by data outliers and inconsistencies, incomplete information, and an unstructured format that varies based on patient types and data structures. In this research study, an enhanced hybrid AD strategy is developed based on heuristic and stochastic methods to cope with abnormalities in the clinical data of patients. The proposed hybrid strategy employs optimal k-means clustering as a heuristic method to cluster the clinical data based on the patient’s routine exercise characteristics to cope with abnormalities efficiently. Next, an interquartile range-based stochastic approach is employed as a statistical method to detect and eliminate abnormal data points by providing only reliable and effectual data to medical practitioners. The main objective of this research article is to facilitate healthcare and research practitioners by dealing with a high dimensional massive amount of inconsistent and incomplete clinical data of patients to detect and discard anomalous data points for providing only efficacious information. Furthermore, the AutoML paradigm is employed to develop an optimal regression model for analyzing the impact of the proposed hybrid strategy for abnormal pattern detection. In addition, different statistical error estimation measures are used to evaluate the empirical effectiveness of the proposed hybrid strategy using AutoML. The experiment results show a noteworthy improvement in terms of the R2 score for predicting healthcare indicators compared to the existing state-of-the-art regression models. Our optimal regression model performed efficiently regarding the R2 score and MAPE; it achieved an R2 score of 0.9855 and 0.9850 for predicting the Borg RPE and TUG, respectively. Similarly, our model achieved a low prediction error in terms of MAPE for predicting both health functional indicators; it achieved a MAPE of 6.57% and 5.19% for Borg RPE and TUG prediction. Our contribution signifies that the performance of the AutoML improves and outperforms traditional regression models while applying our proposed hybrid abnormal detection model to the patient’s rehabilitation data for accurately dealing with anomalous data.

Adapting the Serious Illness Conversation Guide for Dementia Care.

Introduction: Advance care planning (ACP), a critical component of quality dementia care, is underutilized due to lack of clinician comfort and the challenging nature of ACP in this context. The Serious Illness Conversation Guide (SICG) is a well-validated clinician-facing tool, developed with patient and clinician input, to facilitate ACP. The aim of this project was to adapt the SICG for dementia for the first time to promote high-quality ACP. Methods: This study uses a mixed-methods approach to adapt the SICG tool for use in dementia care. Experts with relevant clinical, ethical, and topical knowledge were interviewed to develop alterations to the SICG for dementia care. Patients and caregivers were shown a mock interview of the adapted SICG for dementia (SICG-D) to elicit feedback. Results: 8 relevant experts were interviewed. Adaptations included topical alterations to make the conversation more applicable to dementia as well as alterations to the structure of the conversation to accommodate the patient-caregiver dyad. Twenty interviews were conducted with 14 patients and 18 caregivers (either together or separately). A thematic content analysis of interview transcripts demonstrated positive impressions of the tool. In anonymous survey results, 94% reported a positive impression of the conversation and 89% endorsed incorporation of the adapted guide into dementia healthcare. Conclusion: This paper presents the SICG-D, an adapted version of the SICG for use in dementia care. This guide leverages the strengths of the SICG to promote values-based ACP conversations and has been adapted to better facilitate patient-caregiver-clinician triadic communication.

Orthopaedic trauma observerships in North America for international surgeons: the visitors' perspective.

A survey was distributed to overseas surgeons who participated in an orthopaedic trauma observership from 2009 to 2020. Surgeons were identified through North American institutions previously recognized by the authors as having hosted international observerships. Information gathered included participant demographics, details of and perceived impact of the observership, and barriers faced before, during, and after the program. Responses from 148 international surgeons (ISs) from 49 countries were analyzed. Sixty percent of observerships were at academic programs, 57% lasted 1-3 months, and 60% were self-funded. Participants identified cost and housing as primary barriers. After completing their observership, lack of funding, equipment and support staff, and excessive workload prevented participants from implementing changes at their clinical practice. Most observers believed that they gained relevant clinical (89%) and surgical knowledge (67%) and developed a professional network of North American hosts (63%). The most common suggested changes to the observership were greater hands-on experience in the operating room and structured goal setting relevant to the visiting surgeon. Visiting surgeons find North American orthopaedic trauma observerships helpful in improving their surgical and clinical skills. However, financial constraints and resource limitations at their clinical practice and limited operative experience during the observership present barriers to maximizing this clinical experience. To enhance the relevance of clinical observerships for ISs and impact global orthopaedic trauma care, the unique needs and challenges facing ISs must be addressed. IV-Cross-Sectional Study.

Effective web-based clinical practice guidelines resources: recommendations from a mixed methods usability study

BackgroundClinical practice guidelines (CPG) are an important knowledge translation resource to help clinicians stay up to date about relevant clinical knowledge. Effective communication of guidelines, including format, facilitates its implementation. Despite the digitalization of healthcare, there is little literature to guide CPG website creation for effective dissemination and implementation. Our aim was to assess the effectiveness of the content and format of the Diabetes Canada CPG website, and use our results to inform recommendations for other CPG websites.MethodsFourteen clinicians (family physicians, nurses, pharmacists, and dieticians) in diabetes care across Canada participated in this mixed-methods study (questionnaires, usability testing and interviews). Participants “thought-aloud” while completing eight usability tasks on the CPG website. Outcomes included task success rate, completion time, click per tasks, resource used, paths, search attempts and success rate, and error types. Participants were then interviewed.ResultsThe Diabetes Canada CPG website was found to be usable. Participants had a high task success rate of 79% for all tasks and used 144 (standard deviation (SD) = 152) seconds and 4.6 (SD = 3.9) clicks per task. Interactive tools were most frequently used compared to full guidelines and static tools. Misinterpretation accounted for 48% of usability errors. Participants overall found the website intuitive, with effective content and design elements.ConclusionDifferent versions of CPG information (e.g. interactive tools, quick reference guide, static tools) can help answer clinical questions more quickly. Effective web design should be assessed during CPG website creation for effective guideline dissemination and implementation.

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

The relationship between performance on the medical genetics and genomics in-training and certifying examinations

PurposeThe American Board of Medical Genetics and Genomics (ABMGG) certifying examinations (CEs) are designed to assess relevant basic knowledge, clinical knowledge, and diagnostic skills of board-eligible candidates in primary specialty areas. The ABMGG in-training examinations (ITEs) provide formative feedback regarding knowledge and learning over time and assess readiness to attempt board certification. This study addresses the validity of the ABMGG ITE by evaluating its relationship with performance on CE utilizing established psychometric approaches. MethodsStatistical analysis included bivariate Pearson correlation coefficients and linear regression to evaluate the strength of associations between ITE scores and CE scores. Logistic regression was used to assess the association between ITE scores and the probability of passing each CE. ResultsLogistic regression results indicated that ITE scores accounted for 22% to 44% of the variability in CE outcomes. Across 3 certification cycles, for every 1-point increase in ITE scores, the odds ratio for earning a passing score increased by a factor of 1.12 to 1.20 for the general CE, 1.14 to 1.25 for the clinical CE, and 1.12 to 1.20 for the laboratory CEs. ConclusionThe findings show a positive correlation between performance on the ITE examination and performance on and passing the ABMGG CE.

A comparative study of eating behaviours within and between conventional metabolic (bariatric) surgery procedures.

To compare eating behaviours within and between gastric bypass, sleeve gastrectomy and gastric band procedures and to investigate associations between eating behaviours and body weight. Eating behaviours are subjective constructs representing physiological need and the hedonic need to eat. After metabolic surgery, eating behaviours have been observed to change. Little is known about whether eating behaviour change differs according to the metabolic procedure performed. Adults (n=204) with severe obesity from three countries were followed 1year after metabolic surgical procedures (n=121). We measured eating behaviours using the Three-Factor Eating Questionnaire and used linear mixed models to compare eating behaviours within and between three procedure groups. We complied with the STROBE checklist for reporting observational studies. Within groups, there were statistically significant increases in restraint and decreases in disinhibition and hunger. Between groups, we observed differences in disinhibition associated with the band procedure. There were no significant differences between any group for body weight or body mass index a year post-surgery. Disinhibition was the only eating behaviour associated with body weight, body mass index and the per cent of weight loss. Eating behaviours in adults with severe obesity who underwent any of the three metabolic procedures were associated with eating behaviour change 1year post-surgery. Disinhibition was the only eating behaviour that was associated with body weight. Irrespective of the procedure, we found participants had a statistically significant increase in restraint and decreases in disinhibition and hunger 1year post-surgery. Despite the significant reduction in disinhibition within the band group, this behaviour was more pronounced post-surgery compared with other groups. Although the reduction in hunger showed the greatest change, it was not associated with weight outcomes. This is relevant clinical knowledge for nurses who support bariatric surgical patients.

Medical students as adverse drug event managers, learning about side effects while improving their reporting in clinical practice

Managing adverse drug reactions (ADRs) is a challenge, especially because most healthcare professionals are insufficiently trained for this task. Since context-based clinical pharmacovigilance training has proven effective, we assessed the feasibility and effect of a creating a team of Junior-Adverse Drug Event Managers (J-ADEMs). The J-ADEM team consisted of medical students (1st–6th year) tasked with managing and reporting ADRs in hospitalized patients. Feasibility was evaluated using questionnaires. Student competence in reporting ADRs was evaluated using a case-control design and questionnaires before and after J-ADEM program participation. From Augustus 2018 to Augustus 2019, 41 students participated in a J-ADEM team and screened 136 patients and submitted 65 ADRs reports to the Netherlands Pharmacovigilance Center Lareb. Almost all patients (n = 61) found it important that “their” ADR was reported, and all (n = 62) patients felt they were taken seriously by the J-ADEM team. Although attending physicians agreed that the ADRs should have been reported, they did not do so themselves mainly because of a “lack of knowledge and attitudes” (50%) and “excuses made by healthcare professionals” (49%). J-ADEM team students were significantly more competent than control students in managing ADRs and correctly applying all steps for diagnosing ADRs (control group 38.5% vs. intervention group 83.3%, p < 0.001). The J-ADEM team is a feasible approach for detecting and managing ADRs in hospital. Patients were satisfied with the care provided, physicians were supported in their ADR reporting obligations, and students acquired relevant basic and clinical pharmacovigilance skills and knowledge, making it a win-win-win intervention.

“It’s like my kid came back overnight”: Experiences of trans and non-binary young people and their families seeking, finding and engaging with clinical care in England

Background Trans and non-binary children and young people in England, UK struggle to gain access to affirming clinical care, despite the international research evidence pointing toward this best practice approach. Concurrently, they are subject to constant discussion in the UK national media and politics, where many negative assumptions are made about their needs, experiences and clinical provision. Their journey to seek appropriate care has not yet been documented. Aims We trace the experiences of trans and non-binary children and youth and their families in their decision to seek, searches for and experiences with affirmative and non-affirmative clinical input for help with their gender. Method 27 dyadic, semi-structured interviews were undertaken with trans and non-binary children and young people and their parents from 13 families. Results The process of seeking support via National Health Service clinical routes in England, UK is beset with lengthy waiting lists, issues with geographical inaccessibility, a lack of relevant clinical knowledge, and a failure to recognize the value of family expertise. Family doctors provide contraceptive hormones in lieu of proper access to puberty blocking or gender affirming hormones, and most families resort to private care they can ill afford. Discussion Training in gender identity and gender dysphoria is recommended for both family doctors, and children’s mental health services. Gender identity development services could be decentralized, with local hubs offering more accessible support.

The Canadian Assisted Reproductive Technologies Register (CARTR) Plus database: a validation study.

STUDY QUESTIONAre data accurately documented in the Canadian Assisted Reproductive Technologies Register (CARTR) Plus database?SUMMARY ANSWERMeasures of validity were strong for the majority of variables evaluated while those with moderate agreement were FSH levels, oocyte origin and elective single embryo transfer.WHAT IS KNOWN ALREADYHealth databases and registries are excellent sources of data. However, as these databases are typically not established for the primary purpose of performing research, they should be evaluated prior to utilization for research both to inform the study design and to determine the extent to which key study variables, such as patient characteristics or therapies provided, are accurately documented in the database. CARTR Plus is Canada’s national register for collecting extensive information on IVF and corresponding pregnancy outcomes, and it has yet to be validated.STUDY DESIGN, SIZE, DURATIONThis study evaluating the data translation CARTR Plus database examined IVF cycles performed in 2015 using data directly from patient charts. Six clinics across Canada were recruited to participate, using a purposive sampling strategy. Fixed random sampling was employed to select 146 patient cycles at each clinic, representing unique patients. Only a single treatment cycle record from a unique patient at each clinic was considered during chart selection.PARTICIPANTS/MATERIALS, SETTING, METHODSTwenty-five data elements (patient characteristics, treatments and outcomes) were reabstracted from patient charts, which were declared the reference standard. Data were reabstracted by two independent auditors with relevant clinical knowledge after confirming inter-rater reliability. These data elements from the chart were then compared to those in CARTR Plus. To determine the validity of these variables, we calculated kappa coefficients, sensitivity, specificity, positive predictive value and negative predictive value with 95% CI for categorical variables and calculated median differences and intraclass correlation coefficients (ICC) for continuous variables.MAIN RESULTS AND THE ROLE OF CHANCESix clinics agreed to participate in this study representing five Canadian provinces. The mean age of patients was 35.5 years, which was similar between the two data sources, resulting in a near perfect level of agreement (ICC = 0.99; 95% CI: 0.99, 0.99). The agreement for FSH was moderate, ICC = 0.68 (95% CI: 0.64, 0.72). There was nearly perfect agreement for cycle type, kappa = 0.99 (95% CI: 0.98, 1.00). Over 90% of the cycles in the reabstracted charts used autologous oocytes; however, data on oocyte source were missing for 13% of cycles in CARTR Plus, resulting in a moderate degree of agreement, kappa = 0.45 (95% CI, 0.37, 0.52). Embryo transfer and number of embryos transferred had nearly perfect agreement, with kappa coefficients greater than 0.90, whereas that for elective single or double embryo transfer was much lower (kappa = 0.55; 95% CI: 0.49, 0.61). Agreement was nearly perfect for pregnancy type, and number of fetal sacs and fetal hearts on ultrasound, all with kappa coefficients greater than 0.90.LARGE-SCALE DATAN/ALIMITATIONS, REASONS FOR CAUTIONCARTR Plus contains over 200 variables, of which only 25 were assessed in this study. This foundational validation work should be extended to other CARTR Plus database variables in future studies.WIDER IMPLICATIONS OF THE FINDINGSThis study provides the first assessment of the quality of the data translation process of the CARTR Plus database, and we found very high quality for the majority of the variables that were analyzed. We identified key data points that are either too often lacking or inconsistent with chart data, indicating that changes in the data entry process may be required.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by Canadian Institutes of Health Research (CIHR) (Grant Number FDN-148438) and by the Canadian Fertility and Andrology Society Research Seed Grant (Grant Number: N/A). The authors report no conflict of interest.TRIAL REGISTRATION NUMBERNot applicable.

The Gut Microbiota: A Clinically Impactful Factor in Patient Health and Disease

The gut microbiota, often referred to as the body’s virtual organ, is a complex ecosystem made up of trillions of microorganisms that interact with host physiology in a myriad of ways. This lifelong interaction begins in the early stages of life, and it is subject to alterations exerted by environmental factors, especially those that characterise modern societies such as ultra-processed foods and pharmaceutical interventions, amongst others. These alterations, in turn, carry with them implications for host health and disease. Due to this putative role in human health and the fact that study of the gut microbiota is now rapidly evolving, it is of paramount importance that all clinicians be aware of the most up-to-date literature in this field. Herein, we present a state-of-the-art review which aims to outline the most relevant pre-clinical and clinical knowledge around the gut microbiota-host interaction. This review focuses primarily on the development and key functions of the gut microbiota with respect to host health and disease, but also addresses the basic concept of gut dysbiosis.

The role of the teaching practice in undergraduate medical education: A perspective from the United States of America

This article describes and reflects on the role of teaching practices in undergraduate medical education on the basis of teaching experience in the United States of America. China in particular, but also other family medicine–emerging countries, continues to embark on a path of creating and embracing a family medicine–centric system. The purpose of this article is to provide a US perspective on teaching priorities and strategies for medical students, and how these fit into a larger structure of the family medicine clinical clerkship. We emphasize knowledge, clinical skills, clinical behaviors, and strategies for succeeding as a preceptor. We introduce key aspects of the University of Michigan family medicine clerkship and the highly effective structure provided by the leadership of the course directors. This organizational structure provides a framework for implementing the family medicine clerkship for teaching medical students. As China and other family medicine–emerging countries increasingly embrace the discipline, we hope these ideas will provide a meaningful reference. Significance statement Despite the growth of family medicine for more than 50 years in many countries, there remain many family medicine–emerging countries that have limited experience in the teaching of family medicine to medical students. This article provides suggestions for specific educational practices when one is teaching a medical student engaged in a clinical clerkship. Specifically, it focuses on both what to teach and how to teach family medicine–relevant clinical skills, knowledge, and behaviors to a medical student during a clinical rotation. Moreover, the article includes a series of formative and summative evaluation forms that are used at the University of Michigan that have content similar to the formats used in many US medical student training programs and that can be adapted for use in other settings.

A Survey of Payer Perspectives on Cannabis Use Disorder

ABSTRACTBackground: Cannabis use disorder (CUD) as described/defined in DSM 5, is characterized by impaired control of marijuana use and related personal, health, and legal consequences. CUD is a serious public health problem, affecting nearly 6 million individuals in the United States. There are no FDA approved medications to treat this disorder. The lack of available treatment options contributes to uncertainties by drug sponsors about formulary and reimbursement decision-making for CUD pharmacotherapies. Objective: To addresses this gap by presenting the first findings on managed care payers' perceptions of CUD treatments and clinical trial end points. Methods: An online survey was conducted with 50 payers from managed care organizations. The survey inquired about perceptions of unmet need in CUD treatment, relevant clinical trial end points, disease knowledge, and likelihood of review of new pharmacotherapies. Results: The majority of payers (62%) reported that they were at least moderately familiar with CUD treatment end points. Most (80%) rated the unmet need for new pharmacotherapies for CUD as at least moderately important. Payers rated the most important end points for clinical trials as abstinence and decreased resource utilization. Most participants said an FDA approved CUD treatment would be formally reviewed by payers within 6 months (58%) or a year (36%). Conclusions: Based on these findings, payers see an unmet need for CUD treatment. Furthermore, FDA-approved pharmacotherapies for CUD will likely be reviewed quickly by payers, especially if data are provided on the likelihood of achieving abstinence and reduced resource utilization.

An ontology-aware integration of clinical models, terminologies and guidelines: an exploratory study of the Scale for the Assessment and Rating of Ataxia (SARA)

BackgroundElectronic rating scales represent an important resource for standardized data collection. However, the ability to exploit reasoning on rating scale data is still limited. The objective of this work is to facilitate the integration of the semantics required to automatically interpret collections of standardized clinical data. We developed an electronic prototype for the Scale of the Assessment and Rating of Ataxia (SARA), broadly used in neurology. In order to address the modeling challenges of the SARA, we propose to combine the best performances from OpenEHR clinical archetypes, guidelines and ontologies.MethodsA scaled-down version of the Human Phenotype Ontology (HPO) was built, extracting the terms that describe the SARA tests from free-text sources. This version of the HPO was then used as backbone to normalize the content of the SARA through clinical archetypes. The knowledge required to exploit reasoning on the SARA data was modeled as separate information-processing units interconnected via the defined archetypes. Each unit used the most appropriate technology to formally represent the required knowledge.ResultsBased on this approach, we implemented a prototype named SARA Management System, to be used for both the assessment of cerebellar syndrome and the production of a clinical synopsis. For validation purposes, we used recorded SARA data from 28 anonymous subjects affected by Spinocerebellar Ataxia Type 36 (SCA36). When comparing the performance of our prototype with that of two independent experts, weighted kappa scores ranged from 0.62 to 0.86.ConclusionsThe combination of archetypes, phenotype ontologies and electronic information-processing rules can be used to automate the extraction of relevant clinical knowledge from plain scores of rating scales. Our results reveal a substantial degree of agreement between the results achieved by an ontology-aware system and the human experts.

Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient’s Breast Cancer Care Initiation

Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology’s relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction competence, and teamwork skill set.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis.