A Bayesian Network Concept for Pain Assessment (Preprint)

2021 ◽  
Author(s):  
Omowunmi Sadik
Keyword(s):  
Rating Scale ◽  
Clinical Decision ◽  
Final Decision ◽  
Optimization Approach ◽  
Medical Practitioners ◽  
Bayes Network ◽  
Network Concept ◽  
Experienced Pain ◽  
Subjective Phenomenon ◽  
Combine Evidence

UNSTRUCTURED Pain is a subjective phenomenon caused/perceived centrally and modified by physical, physiological, or social influences. Currently, the most commonly used approaches for pain measurement rely on self-reporting of pain level on a discrete rating scale. This provides a subjective and only semi-quantitative indicator of pain. This paper presents an approach that combines self-reported pain with pain-related biomarkers to be obtained from biosensors (in development) and possibly other sources of evidence to provide more dependable estimates of experienced pain, a clinical decision support system. We illustrate the approach using a Bayes network, but also describe other artificial intelligence (AI) methods that provide other ways to combine evidence. We also propose an optimization approach for tuning the AI method parameters (opaque to clinicians) so as to best approximate the kinds of outputs most useful to medical practitioners. We present some data from a sample of 379 patients that illustrate several evidence patterns we may expect in real healthcare situations. The majority (79.7%) of our patients show consistent evidence suggesting this biomarker approach may be reasonable. We also found five patterns of inconsistent evidence. These suggest a direction for further exploration. Finally, we sketch out an approach for collecting medical experts’ guidance as to the way the combined evidence might be presented so as to provide the most useful guidance (also needed for any optimization approach). We recognize that one possible outcome may be that all this approach may be able to provide is a quantified measure of the extent to which the evidence is consistent or not, leaving the final decision to the clinicians (where it must reside). Pointers to additional sources of evidence might also be possible in some situations.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Assessment of Agreement Between Human Ratings and Lexicon-Based Sentiment Ratings of Open-Ended Responses on a Behavioral Rating Scale

Assessment ◽  
2021 ◽  
pp. 107319112199646
Author(s):  
Olivia Gratz ◽  
Duncan Vos ◽  
Megan Burke ◽  
Neelkamal Soares
Keyword(s):  
Sentiment Analysis ◽  
Language Processing ◽  
Rating Scales ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Clinical Decision ◽  
Assessment System ◽  
Word Count ◽  
Positive Correlation ◽  
Sentiment Score

To date, there is a paucity of research conducting natural language processing (NLP) on the open-ended responses of behavior rating scales. Using three NLP lexicons for sentiment analysis of the open-ended responses of the Behavior Assessment System for Children-Third Edition, the researchers discovered a moderately positive correlation between the human composite rating and the sentiment score using each of the lexicons for strengths comments and a slightly positive correlation for the concerns comments made by guardians and teachers. In addition, the researchers found that as the word count increased for open-ended responses regarding the child’s strengths, there was a greater positive sentiment rating. Conversely, as word count increased for open-ended responses regarding child concerns, the human raters scored comments more negatively. The authors offer a proof-of-concept to use NLP-based sentiment analysis of open-ended comments to complement other data for clinical decision making.

scholarly journals Effects of a Single Application of ScenarTM, a Low-Frequency Modulated Electric Current Therapy, for Pain Relief in Patients with Low Back and Neck Pain: A Randomized Single Blinded Trial

2021 ◽  
Vol 10 (23) ◽  
pp. 5570
Author(s):  
Mireille Michel-Cherqui ◽  
Avit Guirimand ◽  
Barbara Szekely ◽  
Titouan Kennel ◽  
Marc Fischler ◽  
...  
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Low Frequency ◽  
Numeric Rating Scale ◽  
Current Therapy ◽  
Low Back ◽  
Experienced Pain ◽  
The Difference ◽  
Pain At Rest ◽  
Numeric Rating

We aimed to demonstrate the antalgic effectiveness of ScenarTM (Self-Controlled Electro Neuro Adaptative Regulation) in patients experiencing low back and neck pain. Sixty patients were included and equally assigned by randomization to a Scenar-On group and to a Scenar-Off group (sham group). All patients received a 20 min application of ScenarTM on the area where they experienced pain. The pain at rest and during movement and the sensation of stiffness were assessed using a numeric rating scale at baseline, immediately after the session and 24 h after the session. The patients’ characteristics at entry were similar between groups. The pain at rest decreased after the session in both groups (from 8 (4) to 5.0 (3) in the Scenar-Off group, p = 0.0001, and from 7 (3) to 4 (4) in the Scenar-On group, p < 0.0001). The difference was not statistically significant for the groups (p = 0.22). Similar results were observed during movement, but the sensation of stiffness was not modified. Such beneficial results did not last until the next day. No undesirable major effects were noticed. Our study does not support the fact that one ScenarTM session improves low back and neck pain better than a sham session.

scholarly journals Oxidative Stress Applied in Diabetes Mellitus-A New Paradigm

Proceedings ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 7
Author(s):  
Pantea Stoian ◽  
Mitrofan ◽  
Colceag ◽  
Serafinceanu ◽  
Eftimie Totu ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Alternative Methods ◽  
Biological Processes ◽  
New Paradigm ◽  
Medical Practitioners ◽  
Complex Systems Theory ◽  
Network Concept ◽  
Living Organisms ◽  
Pathogenic Process

Although obesity and a sedentary lifestyle are well-known risk factors for type 2 diabetes, at molecular level, the oxidative stress is regarded as the primary contributor to the pathogenic process. Our work intends to evidence how the thinking models influence the way that medical practitioners understand the pathogenic mechanisms. Some research groups focused lately on the system’s dynamics and Complex Systems Theory. The living organisms as a complex system could be analyzed applying the network concept. Alternative methods for characterizing biological processes or phenomena based on feedback node structure have been developed [1].

scholarly journals Assessing tACS-induced phosphene perception using closed-loop Bayesian optimization

2017 ◽  
Author(s):  
Romy Lorenz ◽  
Laura E. Simmons ◽  
Ricardo P. Monti ◽  
Joy L. Arthur ◽  
Severin Limal ◽  
...  
Keyword(s):  
Relative Phase ◽  
Rating Scale ◽  
Computational Modelling ◽  
Human Perception ◽  
Past Research ◽  
Bayesian Optimization ◽  
Optimization Approach ◽  
Experimental Conditions ◽  
Combinatorial Explosion ◽  
Transcranial Alternating Current Stimulation

AbstractTranscranial alternating current stimulation (tACS) can evoke illusory flash-like visual percepts known as phosphenes. The perception of phosphenes represents a major experimental challenge when studying tACS-induced effects on cognitive performance. Besides growing concerns that retinal phosphenes themselves could potentially have neuromodulatory effects, the perception of phosphenes may also modify the alertness of participants. Past research has shown that stimulation intensity, frequency and electrode montage affect phosphene perception. However, to date, the effect of an additional tACS parameter on phosphene perception has been completely overlooked: the relative phase difference between stimulation electrodes. This is a crucial and timely topic given the confounding nature of phosphene perception and the increasing number of studies reporting changes in cognitive function following tACS phase manipulations. However, studying phosphene perception for different frequencies and phases simultaneously is not tractable using standard approaches, as the physiologically plausible range of parameters results in a combinatorial explosion of experimental conditions, yielding impracticable experiment durations. To overcome this limitation, here we applied a Bayesian optimization approach to efficiently sample an exhaustive tACS parameter space. Moreover, unlike conventional methodology, which involves subjects judging the perceived phosphene intensity on a rating scale, our study leveraged the strength of human perception by having the optimization driven based on a subject’s relative judgement. Applying Bayesian optimization for two different montages, we found that phosphene perception was affected by differences in the relative phase between cortical electrodes. The results were replicated in a second study involving new participants and validated using computational modelling. In summary, our results have important implications for the experimental design and conclusions drawn from future tACS studies investigating the effects of phase on cognition.

scholarly journals A randomized controlled trial to compare effects of different volume and concentration of lidocaine for preventing propofol injection pain in adults

2019 ◽  
Vol 8 (3) ◽  
pp. 564
Author(s):  
Ashish Patyal ◽  
Anjana Verma ◽  
Madhavi Buddhi
Keyword(s):  
Rating Scale ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Numeric Rating Scale ◽  
Injection Pain ◽  
Response Scale ◽  
Chi Square ◽  
Experienced Pain ◽  
Group A ◽  
Group B

Background: Pain on propofol injection is an unwanted effect which can lead to decreased patient satisfaction. Although many studies have shown that pre-treatment with lidocaine injection is effective in this pain, nevertheless, very few studies have been done  on different concentration and volume of lidocaine, effective of reducing pain significantly. Objective of the current study was to assess and compare the efficacy of intravenous lidocaine with  0.4% and 2% concentration in reducing the incidence and severity of propofol injection pain.Methods: A total of 126 American Society of Anesthesiologist grade I and II patients with age ≥18 years, scheduled for an elective surgery, were enrolled in the study. Patients were randomized into two equal groups of 63 each. Group A (n = 63) received pretreatment with 0.4% lidocaine and group B (n = 63) received 2% lidocaine. Propofol injection pain was measured by using Numeric Rating Scale (NRS) and Withdrawl Response Scale (WRS). Unpaired t test, ANOVA and Chi square test were used for statistical analysis.Results: A statistically significant decrease in the pain was recorded in group A (0.4% lidocaine) as compared to group B (2% lidocaine). Using NRS scale, 12% of patients in group A as compared to 33% patients of group B, experienced pain (p =0.02); while using WRS, 8% patients of group A as compared to 27% group B patients experienced pain (p= 0.04).Conclusions: The pain on injection of propofol is significantly decreased by the use of 0.4% lidocaine in comparison with 2% Lidocaine.

scholarly journals Increasing Neonatal Healthcare Productivity using Clinical Reasoning Coaching Tools

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Mossad AbdelHak Shaban Mohamed ◽  
Taher Halawa ◽  
Taufiq Hidayat ◽  
Asrar Abu Bakar ◽  
Azamin Anuar ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Research Question ◽  
Control Policy ◽  
Clinical Decision ◽  
Medical Practitioners ◽  
Continuous Contact ◽  
Diagnostic Skills ◽  
Medical Subspecialty ◽  
Diagnostic Thinking

Introduction: Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.

Validity of the numeric rating scale as a measure of dyspnea

1998 ◽  
Vol 7 (3) ◽  
pp. 200-204 ◽  
Author(s):  
AG Gift ◽  
G Narsavage
Keyword(s):  
Clinical Decision Making ◽  
Rating Scale ◽  
Clinical Decision ◽  
Numeric Rating Scale ◽  
T Test ◽  
Measurement Scale ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Numeric Rating ◽  
Paired T Test

BACKGROUND: Dyspnea, a devastating sign, is rarely monitored by clinicians. One reason may be the lack of a valid measurement scale that is easy to use in a clinical setting. OBJECTIVES: To establish the validity of the numeric rating scale as a measure of present dyspnea (dyspnea at rest). METHODS: A total of 188 patients with chronic obstructive pulmonary disease rated their present dyspnea by using the Visual Analog Dyspnea Scale and the numeric rating scale. They also rated their usual dyspnea (dyspnea during the past week). Demographic information was collected from each patient's chart, and pulmonary status was assessed with portable spirometry, pulse oximetry, or both. RESULTS: Concurrent validity of the numeric rating scale was supported by the high correlation of its scores with scores from the Visual Analog Dyspnea Scale. Conversion of the numeric rating scale to a 0-to-100 scale and comparison with the visual analog scale (by using a paired t test to determine if the correlated scores were similar for clinical decision making) showed that scores were not significantly different. A paired t test showed a difference in scores on the numeric rating scale obtained before and after ambulation, supporting the construct validity of the numeric rating scale. Scores on the numeric rating scale for present dyspnea were poorly correlated with ratings of usual dyspnea, indicating that present dyspnea and usual dyspnea are different constructs. CONCLUSION: Present and usual dyspnea are different constructs. The numeric rating scale is a valid measure of present dyspnea.

Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

2013 ◽  
Vol 7 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Ramin Asgary ◽  
Karen Jacobson
Keyword(s):  
Public Health ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Medical Personnel ◽  
Clinical Decision ◽  
Medical Providers ◽  
Medical Practitioners ◽  
Use Of Resources ◽  
Public Health Training ◽  
Site Training

AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

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