Decision making and semiotics: a view in homeopathy

This paper discusses medical action, homeopathic medical action in particular, from a semiotic perspective. Any doctor – patient relation and communication aims at an action. Action in medicine follows a decision which is determined by the meaning of signs and operations with signs. In their turn, signs are conditioned in their perception and interpretation by the meaning they have to their receivers, both intra- and intersubjectively. The meaning of signs in the medical context relates to reference values established by normative signs, around which semiotic fields are organized. Signs never appear isolated but in configurations, meaningful only from the perspective of some specific coherence. While decision-making is a consequence of meaning, meaning is conditioned by codes predetermined in both the sender and receiver of signs. Each and every medical action has an outcome which might give rise to a new series signs – decision – action. The outcome of medical action functions as a sign subsequent to previous ones, and a new configuration might appear, which allows for new action. Homeopathic signs have as their ultimate referent an individual; these signs are configured in a coherent way using the specific codes. Specific configurations allow for specific decisions and effective prescriptions of remedies when they point out to the individual. Keywords: Medical action; Medical semiotics; Decision-making; Homeopathy.  Decissão e semiótica: um olhar em homeopatia Resumo O presente artigo discute a ação médica, particularmente a homeopática, de uma perspectiva semiótica. Toda relação e comunicação médico-paciente visa uma ação. A ação, em medicina, segue a uma decisão, por sua vez determinada pelo sentido de signos e operações com signos. Os signos estão condicionados em sua percepção e interpretação pelo sentido que tém para seus receptores, tanto intra quanto intersubjetivamente. O sentido dos signos no contexto médico se relaciona com valores de referéncia estabelecidos por signos normativos, ao redor dos quais são organizados campos semióticos. Os signos nunca aparecem isolados, mas em configurações, significantes somente como função de uma coeréncia específica. Enquanto a decisão é conseqüéncia do sentido, este é condicionado por códigos pré-determinados, tanto no emissor quanto no receptor dos signos. Toda ação médica tem um resultados que, por sua vez, pode originar uma nova série de signos - decisão - ação. O resultado da ação mpedica opera como signo subseqüente aos anteriores, e dessa maneira pode aparecer uma nova configuração que leva a uma nova ação. Os signos homeopáticos tém como referente último um indivíduo; esses signos se configuram de maneira coerente graças a códigos específicos. Configurações específicas levam a decisões específicas e prescrições efetivas de medicamentos quando visam o indivíduo. Palavras-chave: Ação médica; Medicina semiótica; processo de tomada de decisão; Homeopatia.  Decisión y semiótica: una visión en homeopatía Resumen Este artículo discute la acción médica, particularmente la homeopática, desde una perspectiva semiótica. Toda relación y comunicación médico-paciente apunta para una acción. La acción, en medicina, sigue a una decisión, determinada por el sentido de signos y operaciones con signos. Los signos, a su vez, están condicionados en su percepción e interpretación por el sentido que tienen para sus receptores, tanto intra e intersubjetivamente. El sentido de los signos en el contexto médico se relaciona con valores de referencia establecidos por signos normativos, alrededor de los cuales se organizam campos semióticos. Los signos nunca aparecen aislados, sino en configuraciones, significantes solamente en función de una coherencia específica. Mientras que la decisión es consecuencia del sentido, éste es condicionado por códigos predeterminados, tanto en el emisor como en el receptor de los signos. Toda acción médica tiene un resultado que, a su vez, puede originar una nueva serie signos - decisión - acción. El resultado de la acción médica opera como signo subsiguiente a los anteriores, y así puede aparecer una nueva configuración, que lleva a una nueva acción. Los signos homeopáticos tienen como referente último un individuo; esos signos se configuran de manera coherente, gracias a códigos específicos. Configuraciones específicas llevan a decisiones específicas y prescripciones efectivas de medicamentos cuando apuntan al individuo. Palabras-clave: Acción de la medicina; Medicina semiótica, la toma de decisiones; Homeopatía.  Correspondence author: Gheorghe Jurj, [email protected] How to cite this article: Jurj G. Decision making and semiotics: A view in homeopathy. Int J High Dilution Res [online]. 2008 [cited YYYY Mmm DD]; 7(23): 103-112. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/270/346. ÂÂÂ

Leveraging medical context to recommend semantically similar terms for chart reviews

Background Information retrieval (IR) help clinicians answer questions posed to large collections of electronic medical records (EMRs), such as how best to identify a patient’s cancer stage. One of the more promising approaches to IR for EMRs is to expand a keyword query with similar terms (e.g., augmenting cancer with mets). However, there is a large range of clinical chart review tasks, such that fixed sets of similar terms is insufficient. Current language models, such as Bidirectional Encoder Representations from Transformers (BERT) embeddings, do not capture the full non-textual context of a task. In this study, we present new methods that provide similar terms dynamically by adjusting with the context of the chart review task. Methods We introduce a vector space for medical-context in which each word is represented by a vector that captures the word’s usage in different medical contexts (e.g., how frequently cancer is used when ordering a prescription versus describing family history) beyond the context learned from the surrounding text. These vectors are transformed into a vector space for customizing the set of similar terms selected for different chart review tasks. We evaluate the vector space model with multiple chart review tasks, in which supervised machine learning models learn to predict the preferred terms of clinically knowledgeable reviewers. To quantify the usefulness of the predicted similar terms to a baseline of standard word2vec embeddings, we measure (1) the prediction performance of the medical-context vector space model using the area under the receiver operating characteristic curve (AUROC) and (2) the labeling effort required to train the models. Results The vector space outperformed the baseline word2vec embeddings in all three chart review tasks with an average AUROC of 0.80 versus 0.66, respectively. Additionally, the medical-context vector space significantly reduced the number of labels required to learn and predict the preferred similar terms of reviewers. Specifically, the labeling effort was reduced to 10% of the entire dataset in all three tasks. Conclusions The set of preferred similar terms that are relevant to a chart review task can be learned by leveraging the medical context of the task.

Enhancing implementation of a standardized initial assessment for demand management in outpatient emergency care in Germany: a quantitative process evaluation

Background Inadequate assessment of the severity and urgency of health problems is one of the factors contributing to unnecessary emergency department visits. A software-based instrument for standardized initial assessment (SmED) aims to support healthcare professionals and steer patients to the appropriate source of care. The aim of this study was to evaluate the implementation process of SmED based on the point of view of users in order to facilitate sustainable implementation. Methods A quantitative process evaluation on the basis of a paper-based questionnaire was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Healthcare professionals who worked with SmED either at the joint contact points of the outpatient emergency care service and the emergency departments of hospitals ("Joint Counter", German “Gemeinsamer Tresen”) or at the initial telephone contact points of the outpatient emergency care service (116117) were invited to participate in the survey. Results 200 users of SmED completed the questionnaire comprising the five scales: Intervention effectiveness/efficacy, Interprofessional context/occupational Interest, Individual Context, Organisational Framework Conditions, and Medical Context. Several individual characteristics were related to the implementation process of SmED. Female and younger healthcare professionals and participants with less than five years of professional experience tended to evaluate the implementation process as more positive. Factors related to the Individual Context and to the Medical Context were associated with the reported use of SmED (p = 0.004 and 0.041, respectively). Conclusion The involvement of healthcare professionals, particularly more experienced professionals, in the implementation of SmED may help to facilitate sustainable implementation. In addition, training of potential user prior and during the implementation process and the adaption of Organisational Context factors are crucial. Trial registration The study was registered at the German Clinical Trials Register prior to the start of the study (DRKS00017014).

Closed-Loop Brain Devices in Offender Rehabilitation: Autonomy, Human Rights, and Accountability

The current debate on closed-loop brain devices (CBDs) mainly focuses on their use in a medical context; possible criminal justice applications have only received incidental scholarly attention. Unlike in medicine, in criminal justice, CBDs might be offered on behalf of the State and for the purpose of protecting security, rather than realizing healthcare aims. It would be possible to deploy CBDs in the rehabilitation of convicted offenders, similarly to the much-debated possibility of employing other brain interventions in this context. Although such use of CBDs could in principle be consensual, there are significant differences between the choice faced by a criminal offender offered a CBD in the context of criminal justice, and that faced by a patient offered a CBD in an ordinary healthcare context. Employment of CBDs in criminal justice thus raises ethical and legal intricacies not raised by healthcare applications. This paper examines some of these issues under three heads: autonomy, human rights, and accountability.

Sexual Orientation and Gender Identity Disclosure in the Medical Context

For individuals who identify as LGBTQ+, disclosing sexual orientation and/or gender identity can be a complex and risky conversation. However, in the medical context this conversation frequently becomes a central part of communication between patient and provider. Unfortunately, this conversation can also become a barrier that prevents patients from receiving or even accessing necessary medical care. LGBTQ+ individuals have reported experiencing significant discrimination in day-to-day life, and more specifically in patient–provider interactions. This discrimination leads LGBTQ+ individuals to avoid seeking necessary medical care and also frequently results in unsatisfactory care and poor health outcomes. This is of concern as LGBTQ+ individuals present with significantly higher rates of health issues and overall higher risks of cancer, chronic illnesses, and mental health concerns. Unfortunately, many medical providers are unequipped to properly care for LGBTQ+ patients and lack opportunities for education and training. This lack of experience leads many providers to operate medical offices that are unwelcoming or even inhospitable to LGBTQ+ patients, making it difficult for those patients to access inclusive care. This can be of particular concern when the patient’s sexual orientation or gender identity becomes relevant to their medical care, as they may feel uncomfortable sharing that information with a provider. Patient self-disclosure of sexual orientation or gender identity to a medical provider not only can contribute to a more positive relationship and improved quality of care but also can improve the psychological outlook of an LGBTQ+ individual. However, potential stigmatization can lead to the concealment of sexual orientation or gender identity information. These acts of concealment serve as intentional mechanisms of impression management within the patient–provider interaction. When LGBTQ+ patients do discuss their sexual orientation or gender identity with a provider, it is most often because the information is directly relevant to their health and disclosure, and therefore becomes essential and often forced. There are instances where LGBTQ+ patients are motivated to disclose to a provider who they believe will respond positively to information about their sexual orientation or gender identity. Disclosure of sexual orientation or gender identity may be direct in that it is clear and concrete. It may also be indirect in that individuals may use particular topics, such as talking about their partner, to broach the subject. Participants may also use specific entry points in the conversation, such as during taking a medical history about medications, to disclose. Some individuals plan and rehearse their disclosure conversations, whereas others disclose when they feel they have no other choice in the interaction. Increasing inclusivity on the part of providers and medical facilities is one way to promote comfortable disclosure of sexual orientation or gender identity. Additionally, updating the office environment and policies, as well as paperwork and confidentiality procedures, can also promote safe disclosure. Finally, improvements to training and education for healthcare professionals and office staff can dramatically improve interactions with LGBTQ+ patients. All of these efforts need to make integration of knowledge about how LGTBQ+ individuals can disclose comfortably and safely a central part of program design.

The drivers of overdiagnosis within modern healthcare systems - An interdisciplinary analysis

“Overdiagnosis” - when people are labelled with or treated for a disease that would never cause them harm - is increasingly highlighted as a significant issue within contemporary healthcare, yet one which to date, has received little attention outside of the medical context. As a society, our collective enthusiasm to diagnose and treat disease has paradoxically been shown to potentially do more harm than good, impacting individuals whilst simultaneously increasing financial costs to the health system. As health systems across the world continue to face unprecedented pressures, tackling this phenomenon represents an important step in reducing the proliferation of low-value care inherent within the practice of modern medicine, and contributing towards the development of sustainable health systems. This research represents the first interdisciplinary analysis of the factors contributing towards overdiagnosis within modern healthcare systems. The analysis finds that individual disciplines of a medical and non-medical origin elude to important insights in relation to the drivers of overdiagnosis which are not necessarily reflected across multiple disciplines. Drivers identified within literature which lies beyond the medical context likely represent new knowledge in relation to the causes of overdiagnosis, and collectively provide a starting point from which to consider the role of patients and clinicians in influencing overdiagnosis, the nature of the interaction between the drivers of overdiagnosis, and the role of the different models of health in providing a unique perspective of the wider phenomenon. These findings highlight the importance of interdisciplinarity within health research and contribute towards efforts to reduce the rise of low value care within modern healthcare, fostering the development of sustainable health systems.