Abstract:
RATIONALE:Diagnostic reasoning is a critical aspect of clinical performance, having a high impact on quality and safety of care. Although diagnosis is fundamental in medicine, we still have a poor understanding of the factors that determine its course. According to traditional understanding, all information used in diagnostic reasoning is objective and logically driven. However, these conditions are not always met. Although we would be less likely to make an inaccurate diagnosis when following rational decision making, as described by normative models, the real diagnostic process works in a different way. Recent work has described the major cognitive biases in medicine as well as a number of strategies for reducing them, collectively called debiasing techniques. However, advances have encountered obstacles in achieving implementation into clinical practice. AIMS AND OBJECTIVES:While traditional understanding of clinical reasoning has failed to consider contextual factors, most debiasing techniques seem to fail in raising sound and safer medical praxis. Technological solutions, being data driven, are fundamental in increasing care safety, but they need to consider human factors. Thus, balanced models, cognitive driven and technology based, are needed in day-to-day applications to actually improve the diagnostic process. The purpose of this article, then, is to provide insight into cognitive influences that have resulted in wrong, delayed or missed diagnosis. CONCLUSIONS:Using a cognitive approach, we describe the basis of medical error, with particular emphasis on diagnostic error. We then propose a conceptual scheme of the diagnostic process by the use of fuzzy cognitive maps.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Lucchiari C,Pravettoni Gdoi
10.1111/j.1365-2753.2011.01771.xsubject
Has Abstractpub_date
2012-02-01 00:00:00pages
82-8issue
1eissn
1356-1294issn
1365-2753journal_volume
18pub_type
杂志文章abstract:RATIONALE, AIMS AND OBJECTIVES:The spontaneous reporting of adverse drug reactions (ADRs) through the yellow card and made concrete by the knowledge and attitudes of doctors, has been rousing a great deal of bibliographical interest in recent years. However, there does not seem to be any actual revision in the theme on...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2003.00456.x
更新日期:2004-11-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The extent to which best practice for falls prevention is being routinely delivered by health care providers for community-dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized heal...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12119
更新日期:2014-06-01 00:00:00
abstract:UNLABELLED:RATIONAL AND AIMS: In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non-pharmacological treatment of CHF in primary care, which was non-optimal in earlier studies, is limited. We aim to describe current pharmacolo...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01455.x
更新日期:2010-06-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Health-care professions have long been considered prone to work-related stress, yet recent research in Bulgaria indicates alarmingly high levels of burnout. Cloninger's inventory is used to analyse and evaluate correlation between personality characteristics and degree of burnout syndrome...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2012.01895.x
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:The Adolescent Drug Abuse Diagnosis (ADAD) and Health of Nation Outcome Scales for Children and Adolescents (HoNOSCA) are both measures of outcome for adolescent mental health services. AIMS:To compare the ADAD with HoNOSCA; to examine their clinical usefulness. METHODS:Comparison of the ADAD and HoNOSCA o...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00654.x
更新日期:2006-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of SA. This study describ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12103
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. MATERIAL AND METHODS:A cross-sectional multicentric ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/jep.13257
更新日期:2019-12-01 00:00:00
abstract::Progressive improvements in antihypertensive drug therapy over the past four decades have provided clear benefits in limiting cardiovascular complications. Unfortunately, and largely inexplicably, the inclusion in meta-analyses of defective trials plus the employment of inappropriate diagnostic criteria for adverse co...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2753.2001.00300.x
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVE:Very few studies have addressed the magnitude of the effect of the condition of the patients and the surgical volume on possible cost savings in coronary artery bypass grafting (CABG). The objectives of this study were to analyse and compare the costs of the CABG operating room (OR) between two hospitals, and...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01251.x
更新日期:2010-12-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01541.x
更新日期:2012-02-01 00:00:00
abstract::The Central Research and Development Committee is seeking to involve lay perspectives in the NHS R&D Programme. This paper describes some recent examples of lay involvement in each step of the research process from setting the agenda to making use of research findings. Innovative approaches have involved lay people in...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.1996.tb00057.x
更新日期:1996-11-01 00:00:00
abstract::Independent qualitative evaluation of a project designed to ensure that clinical policy in specific areas of care in three obstetric units within one English health district was based on authoritative evidence. Data from nonparticipant observation, interviews, questionnaires and documents were combined to generate a d...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2000.00224.x
更新日期:2000-05-01 00:00:00
abstract::Identified as a mental disorder by Emil Kraepelin and Eugen Bleuler (1858-1939), schizophrenia has been subject to various criticisms, on both political and scientific grounds. Still, until the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, as the'Spectrum of Schizophrenia and Othe...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12608
更新日期:2017-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Little is known about the quality of occupational health care provided to National Health Service (NHS) staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01574.x
更新日期:2012-04-01 00:00:00
abstract:INTRODUCTION:While shared decision-making (SDM) training programmes for health professionals have been developed in several countries, few have been evaluated. In Norway, a comprehensive curriculum, "klar for samvalg" (ready for SDM), for interprofessional health-care teams was created using generic didactic methods an...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13380
更新日期:2020-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The management of rheumatoid arthritis (RA) usually entails regular hospital reviews with a specialist often when the patient is well rather than during a period of exacerbation. An alternative approach where patients initiate appointments when they need them can improve patient satisfact...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/jep.12505
更新日期:2016-06-01 00:00:00
abstract::In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence-based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of "bias." To prevent unwarranted relativism and make better inferences in clinical practice, clinicians may...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13010
更新日期:2018-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Quantifying the impact of health care-associated infections (HAIs) on medical resource utilization is necessary for payers and providers to appropriately allocate limited resources for interventions. However, previous studies tend to involve single institutions and do not take into accoun...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1365-2753.2009.01121.x
更新日期:2010-02-01 00:00:00
abstract::Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themse...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00617.x
更新日期:2006-08-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Day surgery is evolving, with a majority of recoveries occurring at home. There is, in parallel, an evolution in telemedical technology. The aim of the present project was to identify patients' willingness to use predefined follow-up techniques and to clinically test preferred techniques ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12551
更新日期:2016-12-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13412
更新日期:2020-05-26 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12220
更新日期:2015-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12847
更新日期:2018-02-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2010.01599.x
更新日期:2012-04-01 00:00:00
abstract::Although disease management (DM) has been in existence for over a decade, there is still much uncertainty as to its effectiveness in improving health status and reducing medical cost. The main reason is that most programme evaluations typically follow weak observational study designs that are subject to bias, most not...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2005.00573.x
更新日期:2006-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01171.x
更新日期:2010-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12481
更新日期:2016-06-01 00:00:00
abstract::Outcomes assessment holds great promise to improve the quality and efficiency of health care. By subjecting practices to rigorous and systematic analysis, we should be in a position to make judgments about what does and does not work in clinical practice. However, the outcomes of outcomes assessment themselves should ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.1998.tb00098.x
更新日期:1998-11-01 00:00:00
abstract:INTRODUCTION:Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13456
更新日期:2020-08-16 00:00:00
abstract::The difference between the pth quantiles of 2 survival functions can be used to compare patients' survival between 2 therapies. Setting p = 0.5 yields the median survival time difference. Varying p between 0 and 1 defines the quantile survival time difference curve which can be straightforwardly estimated by the horiz...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12948
更新日期:2018-08-01 00:00:00