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Voices that matter:The impact of patient-reported outcome measures on clinical decision-making

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World Journal of Methodology 2025年第2期15卷 54-61页

作者： Naveen Jeyaraman Madhan Jeyaraman Swaminathan Ramasubramanian Sangeetha Balaji Sathish Muthu Department of Orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennaiTN 600077India Department of Research Methods Orthopaedic Research GroupCoimbatoreTN 641045India Department of Orthopaedics Government Medical CollegeOmandurar Government EstateChennaiTN 600002India Department of Biotechnology Faculty of EngineeringKarpagam Academy of Higher EducationCoimbatoreTN 641021India Department of Orthopaedics Government Medical CollegeKarurTN 639004India

The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific *** encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of *** integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments *** deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment ***,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health ***,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and *** these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of *** paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.

关键词： Patient-reported outcome measures clinical decision-making Patient-centered care Healthcare technology Data management Policy development

clinical decision making on the use of physical restraint in intensive care units

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International Journal of Nursing Sciences 2014年第4期1卷 446-450页

作者： Xinqian Li Tonks NFawcett Department of Nursing The First Affiliated Hospital of Dalian Medical UniversityNo.222 Zhongshan RoadXigang DistrictDalianLiaoning Province 116001China Student Learning(Nurse Education)Nursing Studies The School of Health in Social ScienceThe University of EdinburghEdinburghUnited Kingdom

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected ***,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived *** paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by *** reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent ***,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical *** that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be ***,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

关键词： clinical decision-making Intensive care units Intuition Heuristics Physical restraint

Healthcare providers’perspectives on factors influencing their critical care decision-making during the COVID-19 pandemic:An international pilot survey

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World Journal of Critical Care Medicine 2025年第1期14卷 100-110页

作者： Sonali Vadi Neha Sanwalka Pramod Thaker Department of Critical Care Medicine Kokilaben Dhirubhai Ambani Hospital and Medical Research InstituteMumbai 400053MahārāshtraIndia Department of Statistics HCJMRIJehangir HospitalPune 411001MahārāshtraIndia Medical Ethics Fellowship Harvard Medical SchoolBostonMA 02138United States

BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical *** analytical technique that can be helpful in uncertain situations is clinical *** must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies *** To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical *** This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with *** survey focused on topics related to their professional roles and personal *** examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical *** collected data were analyzed using theχ2 test for categorical *** A total of 102 clinicians from 23 specialties and 17 countries responded to the *** was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were *** doctors reported maintaining patient confidentiality regarding privacy and informed *** 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and *** from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed *** personal experiences,some respondents noted that treatment plans and preferences change

关键词： Survey clinical decision-making COVID-19 pandemic

USEVis:Visual analytics of attention-based neural embedding in information retrieval

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Visual Informatics 2021年第2期5卷 1-12页

作者： Xiaonan Ji Yamei Tu Wenbin He Junpeng Wang Han-Wei Shen Po-Yin Yen Institute for Informatics Washington University School of Medicine in St.LouisUnited States of America Computer Science and Engineering The Ohio State UniversityUnited States of America

Neural attention-based encoders,which effectively attend sentence tokens to their associated context without being restricted by long-term distance or dependency,have demonstrated outstanding performance in embedding sentences into meaningful representations(embeddings).The Universal Sentence Encoder(USE)is one of the most well-recognized deep neural network(DNN)based solutions,which is facilitated with an attention-driven transformer architecture and has been pre-trained on a large number of sentences from the *** the fact that USE has been widely used in many downstream applications,including information retrieval(IR),interpreting its complicated internal working mechanism remains *** this work,we present a visual analytics solution towards addressing this ***,focused on semantics and syntactics(concepts and relations)that are critical to domain clinical IR,we designed and developed a visual analytics system,i.e.,*** system investigates the power of USE in effectively extracting sentences’semantics and syntactics through exploring and interpreting how linguistic properties are captured by ***,by thoroughly examining and comparing the inherent patterns of these attentions,we are able to exploit attentions to retrieve sentences/documents that have similar semantics or are closely related to a given clinical problem in *** collaborating with domain experts,we demonstrate use cases with inspiring findings to validate the contribution of our work and the effectiveness of our system.

关键词： Interactive visual system Neural embedding Attention mechanism Document understanding Information retrieval clinical decision-making

Primary hepatic neuroendocrine neoplasm diagnosed by somatostatin receptor scintigraphy:A case report

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World Journal of clinical Cases 2022年第7期10卷 2222-2228页

作者： Miho Akabane Yuta Kobayashi Keiichi Kinowaki Satoshi Okubo Junichi Shindoh Masaji Hashimoto Division of Hepatobiliary-pancreatic Surgery Department of Gastroenterological SurgeryToranomon HospitalTokyo 105-8470Japan Department of Diagnostic Pathology Toranomon HospitalTokyo 105-8470Japan

BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic ***,we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful *** SUMMARY A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass,suspected to be a *** then,regular follow-up had been carried *** years later,she was referred to our institute due to the tumor(located in segment 4)having increased to 20 *** imaging studies depicted no apparent extrahepatic *** emission tomography(PET)/computed tomography exhibited significant accumulation in the mass lesion,which made us consider the possibility of *** hepatectomy was *** histopathological diagnosis was neuroendocrine tumor grade 2,with somatostatin receptor 2 a/5 *** somatostatin receptor scintigraphy(SRS)showed no other site,leading to the diagnosis of NEN of primary hepatic *** gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver *** In this case,positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

关键词： Hepatic neoplasm Scintigraphy Surgery Positron-emission tomography clinical decision-making Case report

A comparison of perspectives on costs in emergency care among emergency department patients and residents

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World Journal of Emergency Medicine 2017年第1期8卷 39-42页

作者： Stefanie K.Gilbert Leana S.Wen Jesse M.Pines Department of Emergency Medicine The George Washington UniversityWashingtonDC 20037USA

BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department(ED). We compare ED resident and patient perspectives surrounding costs in emergency ***: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients(>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded ***: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on ***: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insuf? cient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs.

关键词： Emergency medicine clinical decision-making Cost Communication Residency education

A systematic evaluation of the performance of GPT-4 and PaLM2 to diagnose comorbidities in MIMIC-IV patients

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Health Care Science

Health Care Science 2024年第1期3卷 3-18页

作者： Peter Sarvari Zaid Al-fagih Abdullatif Ghuwel Othman Al-fagih Rhazes AI LondonUK National Health Service England LondonUK

Background:Given the strikingly high diagnostic error rate in hospitals,and the recent development of Large Language Models(LLMs),we set out to measure the diagnostic sensitivity of two popular LLMs:GPT-4 and ***-scale studies to evaluate the diagnostic ability of LLMs have shown promising results,with GPT-4 demonstrating high accuracy in diagnosing test ***,larger evaluations on real electronic patient data are needed to provide more reliable ***:To fill this gap in the literature,we used a deidentified Electronic Health Record(EHR)data set of about 300,000 patients admitted to the Beth Israel Deaconess Medical Center in *** data set contained blood,imaging,microbiology and vital sign information as well as the patients'medical diagnostic *** on the available EHR data,doctors curated a set of diagnoses for each patient,which we will refer to as ground truth *** then designed carefully-written prompts to get patient diagnostic predictions from the LLMs and compared this to the ground truth diagnoses in a random sample of 1000 ***:Based on the proportion of correctly predicted ground truth diagnoses,we estimated the diagnostic hit rate of GPT-4 to be 93.9%.PaLM2 achieved 84.7%on the same data *** these 1000 randomly selected EHRs,GPT-4 correctly identified 1116 unique ***:The results suggest that artificial intelligence(AI)has the potential when working alongside clinicians to reduce cognitive errors which lead to hundreds of thousands of misdiagnoses every ***,human oversight of AI remains essential:LLMs cannot replace clinicians,especially when it comes to human understanding and ***,a significant number of challenges in incorporating AI into health care exist,including ethical,liability and regulatory barriers.

关键词： GPT-4 diagnostic errors MIMIC-IV clinical decision-making language model patient care health care efficiency

Domain knowledge enhanced deep learning for electrocardiogram arrhythmia classification

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Frontiers of Information Technology & Electronic Engineering 2023年第1期24卷 59-72页

作者： Jie SUN School of Cyber Science and Engineering Ningbo University of TechnologyNingbo 315211China

Deep learning provides an effective way for automatic classification of cardiac arrhythmias,but in clinical decisionmaking,pure data-driven methods working as black-boxes may lead to unsatisfactory results.A promising solution is combining domain knowledge with deep *** paper develops a flexible and extensible framework for integrating domain knowledge with a deep neural *** model consists of a deep neural network to capture the statistical pattern between input data and the ground-truth label,and a knowledge module to guarantee consistency with the domain *** two components are trained interactively to bring the best of both *** experiments show that the domain knowledge is valuable in refining the neural network prediction and thus improves accuracy.

关键词： Domain knowledge Cardiac arrhythmia Electrocardiogram(ECG) clinical decision-making

Vigilance in Nurses Working in Intensive Care Units

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Open Journal of Nursing 2021年第9期11卷 715-727页

作者： Mehdi Ajri-Khameslou Mojgan Najafi Mansoureh Karimollahi Nursing Department School of Nursing and Midwifery Ardabil University of Medical Sciences Ardabil Iran

Background and Aim: Vigilance is an essential element in intensive care nursing. This study was conducted to determine nursing vigilance in nurses working in the intensive care units of educational and medical centers in Ardabil, Iran. Methods: This was a cross-sectional descriptive-analytical study with 192 ICU nurses as the participants. The data were obtained through questionnaires regarding demographic characteristics and nursing vigilance. SPSS software version 24 was used for the statistical analysis. Results: The mean total vigilance score was 3.86 ± 0.23 of 5. The mean scores of the timely diagnosis of changes, pattern recognition, and clinical decision-making subscales were 4.07 ± 0.26, 04.04 ± 0.41, and 3.44 ± 0.25, respectively. No significant relationships were observed between the total or subscale vigilance scores and other demographic characteristics. Conclusion: We assessed ICU nurses’ vigilance behaviors and found that their mean vigilance score was higher than the expected average, indicating our participants had a high level of clinical vigilance. These results suggest a need for effective educational interventions to boost clinical decision-making skills in ICU nurses, especially younger nurses.

关键词： Nursing Vigilance Intensive Care Unit Nurse clinical decision-making