Emergency medicine physicians’ perspectives on diagnostic accuracy in neurology: a qualitative study

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ava L. Liberman ◽  
Natalie T. Cheng ◽  
Benjamin W. Friedman ◽  
Maya T. Gerstein ◽  
Khadean Moncrieffe ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Content Analysis ◽  
Diagnostic Accuracy ◽  
Cognitive Biases ◽  
Neurological Diseases ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Structured Interviews ◽  
Diagnostic Uncertainty ◽  
Diagnostic Decision Making

Abstract Objectives We sought to understand the knowledge, attitudes, and beliefs of emergency medicine (EM) physicians towards non-specific neurological conditions and the use of clinical decision support (CDS) to improve diagnostic accuracy. Methods We conducted semi-structured interviews of EM physicians at four emergency departments (EDs) affiliated with a single US healthcare system. Interviews were conducted until thematic saturation was achieved. Conventional content analysis was used to identify themes related to EM physicians’ perspectives on acute diagnostic neurology; directed content analysis was used to explore views regarding CDS. Each interview transcript was independently coded by two researchers using an iteratively refined codebook with consensus-based resolution of coding differences. Results We identified two domains regarding diagnostic safety: (1) challenges unique to neurological complaints and (2) challenges in EM more broadly. Themes relevant to neurology included: (1) knowledge gaps and uncertainty, (2) skepticism about neurology, (3) comfort with basic as opposed to detailed neurological examination, and (4) comfort with non-neurological diseases. Themes relevant to diagnostic decision making in the ED included: (1) cognitive biases, (2) ED system/environmental issues, (3) patient barriers, (4) comfort with diagnostic uncertainty, and (5) concerns regarding diagnostic error identification and measurement. Most participating EM physicians were enthusiastic about the potential for well-designed CDS to improve diagnostic accuracy for non-specific neurological complaints. Conclusions Physicians identified diagnostic challenges unique to neurological diseases as well as issues related more generally to diagnostic accuracy in EM. These physician-reported issues should be accounted for when designing interventions to improve ED diagnostic accuracy.

scholarly journals Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 34-40 ◽  
Author(s):  
Jonathan Sherbino ◽  
Kulamakan Kulasegaram ◽  
Elizabeth Howey ◽  
Geoffrey Norman
Keyword(s):  
Emergency Medicine ◽  
False Positive ◽  
Cognitive Biases ◽  
Controlled Trial ◽  
Correct Diagnosis ◽  
Educational Interventions ◽  
Diagnostic Error ◽  
Control Group ◽  
Computer Based ◽  
The Difference

ABSTRACT Objectives: Cognitive forcing strategies (CFS)may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students. Methods: Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). At the end of the rotation examination, students were tested using computer-based cases. Application of CFS could enable reduction of diagnostic error, as evidenced by identifying multiple correct diagnoses for the two cases prone to search satisficing bias (SSB) and uncommon diagnoses for the two cases prone to availability bias (AB). Two “false positive” cases were included to test for possible “oversearching.” Results: There were 145 students in the intervention and 46 in the control group. For the SSB cases, 52% of students with CFS training and 48% in the control group initiated a search for the second diagnosis (χ2 = 0.13, df = 1, p = 0.91). More than half (54%) correctly identified the second diagnosis in the CFS group, and 48% identified it in the control group. The difference was not significant (χ2 = 2.25, df = 1, p = 0.13). For the second diagnosis in the false positive cases, 64% of the CFS group and 77% of the control group incorrectly identified it. There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98). Conclusions: The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.

A simulation-based approach to training in heuristic clinical decision-making

Diagnosis ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Ghazwan Altabbaa ◽  
Amanda D. Raven ◽  
Jason Laberge
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Clinical Decision ◽  
Order Effect ◽  
Medical Residents ◽  
Scenario Design ◽  
Diagnostic Decision ◽  
Momentum Bias ◽  
Diagnostic Decision Making

Abstract Background Cognitive biases may negatively impact clinical decision-making. The dynamic nature of a simulation environment can facilitate heuristic decision-making which can serve as a teaching opportunity. Methods Momentum bias, confirmation bias, playing-the-odds bias, and order-effect bias were integrated into four simulation scenarios. Clinical simulation educators and human factors specialists designed a script of events during scenarios to trigger heuristic decision-making. Debriefing included the exploration of frames (mental models) resulting in the observed actions, as well as a discussion of specific bias-prone frames and bias-resistant frames. Simulation sessions and debriefings were coded to measure the occurrence of bias, recovery from biased decision-making, and effectiveness of debriefings. Results Twenty medical residents and 18 medical students participated in the study. Twenty pairs (of one medical student and one resident) and two individuals (medical residents alone) completed a simulation session. Evidence of bias was observed in 11 of 20 (55%) sessions. While most participant pairs were able to avoid or recover from the anticipated bias, there were three sessions with no recovery. Evaluation of debriefings showed exploration of frames in all the participant pairs. Establishing new bias-resistant frames occurred more often when the learners experienced the bias. Conclusions Instructional design using experiential learning can focus learner attention on the specific elements of diagnostic decision-making. Using scenario design and debriefing enabled trainees to experience and analyze their own cognitive biases.

scholarly journals Exploring the concept and structure of obstetric triage: a qualitative content analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Asieh Moudi ◽  
Mina Iravani ◽  
Mahin Najafian ◽  
Armin Zareiyan ◽  
Arash Forouzan ◽  
...  
Keyword(s):  
Content Analysis ◽  
Clinical Decision Making ◽  
Qualitative Content Analysis ◽  
Clinical Decision ◽  
Initial Assessment ◽  
Structured Interviews ◽  
Face To Face ◽  
Design And Implementation ◽  
Appropriate Treatment ◽  
The Right

Abstract Background Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. Methods The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. Conclusion Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

Exploring the concept and structure of obstetric triage: A qualitative content analysis

2020 ◽  
Author(s):  
Asieh Moudi ◽  
Mina - Iravani ◽  
Mahin Najafian ◽  
Armin Zareiyan ◽  
Arash Forouzan ◽  
...  
Keyword(s):  
Content Analysis ◽  
Clinical Decision Making ◽  
Qualitative Content Analysis ◽  
Clinical Decision ◽  
Initial Assessment ◽  
Structured Interviews ◽  
Face To Face ◽  
Design And Implementation ◽  
Appropriate Treatment ◽  
The Right

Abstract Background: Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. Methods: The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results: Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. Conclusion: Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

“We Speak the Truth!”

2019 ◽  
Vol 12 (2) ◽  
pp. 53-80
Author(s):  
Sari Hanafi
Keyword(s):  
Social Sciences ◽  
Content Analysis ◽  
Social Science ◽  
The Political ◽  
Structured Interviews ◽  
Social Phenomena ◽  
The Social ◽  
Academic Qualifications

This study investigates the preachers and their Friday sermons in Lebanon, raising the following questions: What are the profiles of preachers in Lebanon and their academic qualifications? What are the topics evoked in their sermons? In instances where they diagnosis and analyze the political and the social, what kind of arguments are used to persuade their audiences? What kind of contact do they have with the social sciences? It draws on forty-two semi-structured interviews with preachers and content analysis of 210 preachers’ Friday sermons, all conducted between 2012 and 2015 among Sunni and Shia mosques. Drawing from Max Weber’s typology, the analysis of Friday sermons shows that most of the preachers represent both the saint and the traditional, but rarely the scholar. While they are dealing extensively with political and social phenomena, rarely do they have knowledge of social science

scholarly journals Views about sensory modulation from people with schizophrenia and treating staff: A multisite qualitative study

2021 ◽  
pp. 030802262098847
Author(s):  
Tawanda Machingura ◽  
Chris Lloyd ◽  
Karen Murphy ◽  
Sarah Goulder ◽  
David Shum ◽  
...  
Keyword(s):  
Content Analysis ◽  
Treatment Option ◽  
Perceived Risk ◽  
Quantitative Methods ◽  
Qualitative Content Analysis ◽  
Treatment Options ◽  
Occupational Therapists ◽  
Sensory Modulation ◽  
Structured Interviews ◽  
Effective Training

Introduction Current non-pharmacological treatment options for people with schizophrenia are limited. There is, however, emerging evidence that sensory modulation can be beneficial for this population. This study aimed to gain insight into sensory modulation from the user’s and the treating staff’s perspectives. Method A qualitative content analysis design was used. Transcripts from occupational therapists ( n=11) and patients with schizophrenia ( n=13) derived from in-depth semi-structured interviews were analysed for themes using content analysis. Results Five themes emerged from this study: Service user education on the sensory approach is the key; A variety of tools should be tried; Sensory modulation provides a valued treatment option; There are challenges of managing perceived risk at an organisational level; and There is a shortage of accessible and effective training. Conclusion People with schizophrenia and treating staff had congruent perceptions regarding the use of sensory modulation as a treatment option. The findings suggest that sensory modulation can be a valued addition to treatment options for people with schizophrenia. We suggest further research on sensory modulation intervention effectiveness using quantitative methods so these results can be further explored.

scholarly journals Perceptions of Autism Spectrum Disorder (ASD) Etiology among Parents of Children with ASD

2021 ◽  
Vol 18 (13) ◽  
pp. 6774
Author(s):  
Wei-Ju Chen ◽  
Zihan Zhang ◽  
Haocen Wang ◽  
Tung-Sung Tseng ◽  
Ping Ma ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Content Analysis ◽  
Neurodevelopmental Disorder ◽  
Autism Spectrum ◽  
Parental Perceptions ◽  
Repetitive Behaviors ◽  
Spectrum Disorder ◽  
Structured Interviews ◽  
Children With Asd ◽  
Religious Factors

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and restricted or repetitive behaviors. Parental perceptions of the etiology of their child’s ASD can affect provider–client relationships, bonding between parents and their children, and the prognosis, treatment, and management of children with ASD. Thus, this study sought to examine the perceptions of ASD etiology of parents of children with ASD. Methods: Forty-two parents of children diagnosed with ASD were recruited across Texas. Semi-structured interviews were conducted individually. All interviews were recorded and later transcribed verbatim for content analysis utilizing NVivo 12.0 (QSR International, Doncaster, Australia). Results: The content analysis identified the following themes regarding parental perceptions of ASD etiology: Genetic factors (40.5%), environmental factors (31.0%), problems that occurred during pregnancy or delivery (23.8%), vaccinations (16.7%), other health problems (7.1%), parental age at the time of pregnancy (4.8%), and spiritual or religious factors (2.4%). Conclusions: The parental perceptions of ASD etiology were diverse, but several views, such as vaccinations and spiritual or religious factors, were not based on scientific evidence. Health professionals and researchers can use these findings to develop and provide targeted education to parents who have children with ASD. Our findings also support policymakers in developing campaigns designed to increase parental ASD awareness and knowledge.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Iranian relatives’ attitudes towards culturally profiled nursing homes for individuals living with dementia

Dementia ◽  
2017 ◽  
Vol 18 (6) ◽  
pp. 2206-2219
Author(s):  
Mahin Kiwi
Keyword(s):  
Qualitative Research ◽  
Content Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Informal Caregivers ◽  
Family Members ◽  
Structured Interviews ◽  
Iranian Family

This article discusses Iranian family members’ attitudes towards the culturally profiled nursing home, their relationships with the staff, the obstacles, their hopes and their fears. This study is based on qualitative research using 29 semi-structured interviews with family members who had previously been informal caregivers, as well as using fieldwork, all in the same nursing home. The interviews were analysed by the three steps of content analysis. The results show the identification of three main categories with nine main subcategories. The categories and subcategories in the table clarify and explain how the interviewees tended to compare the situation in Iran with that in Sweden, how they perceived the situation in Sweden and finally how they also saw the culturally profiled nursing home.

scholarly journals Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern

2021 ◽  
pp. 108482232199077
Author(s):  
Paulina S. Sockolow ◽  
Kathryn H. Bowles ◽  
Carl Pankok ◽  
Yingjie Zhou ◽  
Sheryl Potashnik ◽  
...  
Keyword(s):  
Decision Making ◽  
Home Health Care ◽  
Clinical Decision ◽  
Structured Interviews ◽  
Skilled Nursing ◽  
Patient Interaction ◽  
Visit Frequency ◽  
Nursing Visit ◽  
Structured Information ◽  
Episode Duration

During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days. We examined admissions nurses’ visit pattern decision-making and whether it is influenced by documentation available before and during the first home visit, agency standards, other disciplines being scheduled, and electronic health record (EHR) use. This observational mixed-methods study included admission document analysis, structured interviews, and a think-aloud protocol with 18 nurses from 3 diverse HHC agencies (6 at each) admitting 2 patients each (36 patients). Findings show that prior to entering the home, nurses had an information deficit; they either did not predict the patient’s visit frequency and episode duration or stated them based on experience with similar patients. Following patient interaction in the home, nurses were able to make this decision. Completion of documentation using the EHR did not appear to influence visit pattern decisions. Patient condition and insurance restrictions were influential on both frequency and duration. Given the information deficit at admission, and the delay in visit pattern decision making, we offer health information technology recommendations on electronic communication of structured information, and EHR documentation and decision support.

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