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("Cognitive Bias" OR "Cognitive Error") AND ("Medicine" OR "Nursing" OR "Triage" OR "Adverse Outcome")

Matt Sibbald, Jonathan Sherbino, Jonathan S Ilgen, Laura Zwaan, Sarah Blissett, Sandra Monteiro, Geoffrey Norman
There is an ongoing debate regarding the cause of diagnostic errors. One view is that errors result from unconscious application of cognitive heuristics; the alternative is that errors are a consequence of knowledge deficits. The objective of this study was to compare the effectiveness of checklists that (a) identify and address cognitive biases or (b) promote knowledge retrieval, as a means to reduce errors in ECG interpretation. Novice postgraduate year (PGY) 1 emergency medicine and internal medicine residents (n = 40) and experienced cardiology fellows (PGY 4-6) (n = 21) were randomly allocated to three conditions: a debiasing checklist, a content (knowledge) checklist, or control (no checklist) to be used while interpreting 20 ECGs...
January 29, 2019: Advances in Health Sciences Education: Theory and Practice
Annette Rogge, Victoria Dorothea Witt, José Manuel Valdueza, Christoph Borzikowsky, Alena Buyx
BACKGROUND: Outcome predictions in patients with acute severe neurologic disorders are difficult and influenced by multiple factors. Since the decision for and the extent of life-sustaining therapies are based on the estimated prognosis, it is vital to understand which factors influence such estimates. This study examined whether previous professional experience with rehabilitation medicine influences physician decision-making. METHODS: A case vignette presenting a typical patient with an extensive brain stem infarction was developed and distributed online to clinical neurologists...
January 3, 2019: Neurocritical Care
Mark C van der Wel, Gabe S Sonke, Gerben Keijzers
A doctor with good critical thinking skills will intervene when required, but abstain from intervening wherever possible. He or she has the ability to apply resource stewardship, acknowledges the limitations of guidelines and is able to deviate from protocols when appropriate, with sound arguments for why this is in the patient's best interest. We believe that critical thinking is an important skill for any doctor, and that it will contribute to better patient-centred outcomes at lower societal costs and with greater job satisfaction among healthcare professionals...
December 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Kenneth L Frye, Ademola Adewale, Carmen J Martinez Martinez, Clara Mora Montero
The emergency department is a challenging environment to practice medicine, primarily due to the pace and logistics of practicing emergency medicine. Cognitive errors and provider handoffs can lead to poor patient outcomes. By acknowledging and addressing cognitive errors, including premature closure, anchoring, and diagnosis momentum, we can potentially improve patient care. Additionally, by completing thorough, yet efficient sign-outs, as per The American College of Emergency Physicians' (ACEP) "Safer Sign Out Protocol," the chances of a poor outcome are further reduced...
October 12, 2018: Curēus
Robert E Freundlich, Sara E Nelson, Yuxuan Qiu, Jesse M Ehrenfeld, Warren S Sandberg, Jonathan P Wanderer
The prevention and treatment of hypothermia is an important part of routine anesthesia care. Avoidance of perioperative hypothermia was introduced as a quality metric in 2010. We sought to assess the integrity of the perioperative hypothermia metric in routine care at a single large center. Perioperative temperatures from all anesthetics of at least 60 min duration between January 2012 and 2017 were eligible for inclusion in analysis. Temperatures were displayed graphically, assessed for normality, and analyzed using paired comparisons...
December 8, 2018: Journal of Clinical Monitoring and Computing
Laura N Medford-Davis, Hardeep Singh, Prashant Mahajan
Emergency medicine requires diagnosing unfamiliar patients with undifferentiated acute presentations. This requires hypothesis generation and questioning, examination, and testing. Balancing patient load, care across the severity spectrum, and frequent interruptions create time pressures that predispose humans to fast thinking or cognitive shortcuts, including cognitive biases. Diagnostic error is the failure to establish an accurate and timely explanation of the problem or communicate that to the patient, often contributing to physical, emotional, or financial harm...
December 2018: Pediatric Clinics of North America
Paul S Jansson, Jeremiah D Schuur, Olesya Baker, Sean C Hagan, Eric S Nadel, Emily L Aaronson
OBJECTIVES: We sought to analyze the effect of an anonymous morbidity and mortality (M&M) conference on participants' attitudes toward the educational and punitive nature of the conference. We theorized that an anonymous conference might be more educational, less punitive, and would shift analysis of cases toward systems-based analysis and away from individual cognitive errors. METHODS: We implemented an anonymous M&M conference at an academic emergency medicine program...
November 16, 2018: Journal of Patient Safety
Leah Burt, Susan Corbridge
Problem/Background: The ability to accurately diagnose patients based on symptom profiles is a vital yet challenging skill that Nurse Practitioners (NPs) undertake frequently. PURPOSE: This integrative literature review highlights a variety of evidence based, practical educational strategies that foster the development of diagnostic reasoning. METHODS: An integrative literature review was conducted in order to identify original research focusing on diagnostic reasoning educational interventions...
November 2, 2018: International Journal of Nursing Education Scholarship
Saty Satya-Murti, Joseph J Lockhart
All evolving disciplines have long grappled with nomenclature inconsistencies. Precise terminology facilitates communication among individuals, clinicians, academics and researchers. To arrive at definitions, the concepts underlying basic scientific vocabularies must be universally acceptable to all users. This is not always easy. Tarachow cautioned in 1965 about how contractions and abbreviations, "…eliminated practically all the associations connected with the original title and did not at all have the evocative impact of the complete word or title"[1] (Tarachow, 1965)...
December 2018: Forensic Science International
Stephen Buetow
Nurses routinely engage in pattern recognition and interpretation in qualitative research and clinical practice. However, they risk spontaneously perceiving patterns among things that are not meaningfully related. Although all people are prone to this cognitive bias of "apophenia", nurses may be at increased risk because they commonly produce or at least use qualitative research that can be highly interpretive. Qualitative researchers have been silent on the risk of apophenia and hence on exploring how attention to apophenia could help to indicate and manage such unconscious biases...
September 26, 2018: International Journal of Nursing Studies
Mario Plebani
Current efforts focusing on better defining the prevalence of diagnostic errors, their causes and remediation strategies should address the role of laboratory testing and its contribution to high-quality care as well as a possible source of diagnostic errors. Data collected in the last few years highlight the vulnerability of extra-analytical phases of the testing cycle and the need for programs aiming to improve all steps of the process. Further studies have clarified the nature of laboratory-related errors, namely the evidence that both system-related and cognitive factors account for most errors in laboratory medicine...
November 27, 2018: Diagnosis
Joseph J Lockhart, Saty Satya-Murti
Background Clinical medicine has long recognized the potential for cognitive bias in the development of new treatments, and in response developed a tradition of blinding both clinicians and patients to address this specific concern. Although cognitive biases have been shown to exist which impact the accuracy of clinical diagnosis, blinding the diagnostician to potentially misleading information has received little attention as a possible solution. Recently, within the forensic sciences, the control of contextual information (i...
November 27, 2018: Diagnosis
E D O'Sullivan, S J Schofield
Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various 'debiasing strategies'. This paper describes the potential origins of bias based on 'dual process thinking', discusses and illustrates a number of the important biases that occur in clinical practice, and considers potential strategies that might be used to mitigate their effect...
September 2018: Journal of the Royal College of Physicians of Edinburgh
Benjamin H Schnapp, Jean E Sun, Jeremy L Kim, Reuben J Strayer, Kaushal H Shah
No abstract text is available yet for this article.
September 25, 2018: Diagnosis
Ashwin Gupta, Molly Harrod, Martha Quinn, Milisa Manojlovich, Karen E Fowler, Hardeep Singh, Sanjay Saint, Vineet Chopra
No abstract text is available yet for this article.
September 25, 2018: Diagnosis
Marcella L Woud, Simon E Blackwell, Jan C Cwik, Jürgen Margraf, Emily A Holmes, Susann Steudte-Schmiedgen, Stephan Herpertz, Henrik Kessler
INTRODUCTION: Influential theories of post-traumatic stress disorder (PTSD) suggest that dysfunctional appraisals of trauma play a key role in the maintenance of symptoms, and this suggestion is increasingly supported by research. Experimental studies have indicated that a simple computerised cognitive training procedure, here termed cognitive bias modification-appraisals (CBM-App), can modify trauma-relevant appraisals and reduce analogue trauma symptoms among healthy volunteers. This suggests the possibility that CBM-App could improve outcomes in PTSD via targeting the key process of dysfunctional appraisals, for example, if applied as an adjunct to treatment...
June 30, 2018: BMJ Open
Thomas T Klumpner, Joanna A Kountanis, Elizabeth S Langen, Roger D Smith, Kevin K Tremper
BACKGROUND: Maternal early warning systems reduce maternal morbidity. We developed an electronic maternal surveillance system capable of visually summarizing the labor and delivery census and identifying changes in clinical status. Automatic page alerts to clinical providers, using an algorithm developed at our institution, were incorporated in an effort to improve early detection of maternal morbidity. We report the frequency of pages generated by the system. To our knowledge, this is the first time such a system has been used in peripartum care...
June 26, 2018: BMC Anesthesiology
David Chu, Jane Xiao, Payal Shah, Brett Todd
No abstract text is available yet for this article.
September 25, 2018: Diagnosis
Thomas N Lawson
BACKGROUND: Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature. METHOD: A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning. RESULTS: Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm...
April 1, 2018: Journal of Nursing Education
Cathy Nikdel, Kian Nikdel, Ana Ibarra-Noriega, Elsbeth Kalenderian, Muhammad F Walji
Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes...
April 2018: Journal of Dental Education
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