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Matsuoka A, Miike T, Yamazaki H, Higuchi M, Komaki M, Shinada K, Nakayama K, Sakurai R, Asahi M, Yoshitake K, Narumi S, Koba M, Sugioka T, Sakamoto Y. Usefulness of a medical interview support application for residents: A pilot study. PLoS One 2022; 17:e0274159. [PMID: 36067154 PMCID: PMC9447879 DOI: 10.1371/journal.pone.0274159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/23/2022] [Indexed: 12/02/2022] Open
Abstract
To conduct an appropriate medical interview, education and clinical experience are necessary. The usefulness of computer-based medical diagnostic support systems has been reported in medical interviewing. However, only a few reports have actually applied these systems and noted changes in the quality of the medical interview of residents. We aimed to examine how the use of a medical interview support application changes the medical interviews of residents. The study was conducted on 15 residents (with less than two years post-graduation) and ran from November 2020 to March 2021. Faculty members played the role of simulated patients in 20 cases, and the residents conducted the medical interviews. In 10 of the 20 cases, a medical interview support application was used. After the interview, the residents were asked to list up to 10 differential diseases; the interview was considered appropriate if it included the disease portrayed by the simulated patient. Furthermore, the duration of the medical interview, the number of questions asked, and changes in stress parameters were evaluated. The use of a medical interview support application increased the percentage of appropriate medical interviews. Considering the frequency, the use of a medical interview support application increased the rate of appropriate medical interviews in the rare disease group, as well as the number of questions and duration of the interviews. No stress reduction was observed. The medical interview support application may be a useful tool in identifying appropriate differential diseases during medical interviews by residents.
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Affiliation(s)
- Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
- * E-mail:
| | - Toru Miike
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Hirotaka Yamazaki
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Masahiro Higuchi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Moe Komaki
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Kota Shinada
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Kento Nakayama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Ryota Sakurai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Miho Asahi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Kunimasa Yoshitake
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Shogo Narumi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Mayuko Koba
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
| | - Takashi Sugioka
- Community Medical Support Institute, Faculty of Medicine, Saga University, Saga City, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Japan
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Teufel A, Binder H. Clinical Decision Support Systems. Visc Med 2021; 37:491-498. [PMID: 35087899 PMCID: PMC8738909 DOI: 10.1159/000519420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND By combining up-to-date medical knowledge and steadily increasing patient data, a new level of medical care can emerge. SUMMARY AND KEY MESSAGES Clinical decision support systems (CDSSs) are an arising solution to handling rich data and providing them to health care providers in order to improve diagnosis and treatment. However, despite promising examples in many areas, substantial evidence for a thorough benefit of these support solutions is lacking. This may be due to a lack of general frameworks and diverse health systems around the globe. We therefore summarize the current status of CDSSs in medicine but also discuss potential limitations that need to be overcome in order to further foster future development and acceptance.
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Affiliation(s)
- Andreas Teufel
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Vaidyam AN, Linggonegoro D, Torous J. Changes to the Psychiatric Chatbot Landscape: A Systematic Review of Conversational Agents in Serious Mental Illness: Changements du paysage psychiatrique des chatbots: une revue systématique des agents conversationnels dans la maladie mentale sérieuse. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:339-348. [PMID: 33063526 PMCID: PMC8172347 DOI: 10.1177/0706743720966429] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The need for digital tools in mental health is clear, with insufficient access to mental health services. Conversational agents, also known as chatbots or voice assistants, are digital tools capable of holding natural language conversations. Since our last review in 2018, many new conversational agents and research have emerged, and we aimed to reassess the conversational agent landscape in this updated systematic review. METHODS A systematic literature search was conducted in January 2020 using the PubMed, Embase, PsychINFO, and Cochrane databases. Studies included were those that involved a conversational agent assessing serious mental illness: major depressive disorder, schizophrenia spectrum disorders, bipolar disorder, or anxiety disorder. RESULTS Of the 247 references identified from selected databases, 7 studies met inclusion criteria. Overall, there were generally positive experiences with conversational agents in regard to diagnostic quality, therapeutic efficacy, or acceptability. There continues to be, however, a lack of standard measures that allow ease of comparison of studies in this space. There were several populations that lacked representation such as the pediatric population and those with schizophrenia or bipolar disorder. While comparing 2018 to 2020 research offers useful insight into changes and growth, the high degree of heterogeneity between all studies in this space makes direct comparison challenging. CONCLUSIONS This review revealed few but generally positive outcomes regarding conversational agents' diagnostic quality, therapeutic efficacy, and acceptability, which may augment mental health care. Despite this increase in research activity, there continues to be a lack of standard measures for evaluating conversational agents as well as several neglected populations. We recommend that the standardization of conversational agent studies should include patient adherence and engagement, therapeutic efficacy, and clinician perspectives.
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Affiliation(s)
- Aditya Nrusimha Vaidyam
- 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Danny Linggonegoro
- 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Torous
- 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Koman J, Fauvelle K, Schuck S, Texier N, Mebarki A. Physicians' Perceptions of the Use of a Chatbot for Information Seeking: Qualitative Study. J Med Internet Res 2020; 22:e15185. [PMID: 33170134 PMCID: PMC7685916 DOI: 10.2196/15185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 01/23/2023] Open
Abstract
Background Seeking medical information can be an issue for physicians. In the specific context of medical practice, chatbots are hypothesized to present additional value for providing information quickly, particularly as far as drug risk minimization measures are concerned. Objective This qualitative study aimed to elicit physicians’ perceptions of a pilot version of a chatbot used in the context of drug information and risk minimization measures. Methods General practitioners and specialists were recruited across France to participate in individual semistructured interviews. Interviews were recorded, transcribed, and analyzed using a horizontal thematic analysis approach. Results Eight general practitioners and 2 specialists participated. The tone and ergonomics of the pilot version were appreciated by physicians. However, all participants emphasized the importance of getting exhaustive, trustworthy answers when interacting with a chatbot. Conclusions The chatbot was perceived as a useful and innovative tool that could easily be integrated into routine medical practice and could help health professionals when seeking information on drug and risk minimization measures.
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Affiliation(s)
- Jason Koman
- Kap Code, Paris, France.,CNRS, PASSAGES, Bordeaux, France.,Bordeaux Population Health Research Center, University of Bordeaux, Inserm, Bordeaux, France
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Common pre-diagnostic features in individuals with different rare diseases represent a key for diagnostic support with computerized pattern recognition? PLoS One 2019; 14:e0222637. [PMID: 31600214 PMCID: PMC6786570 DOI: 10.1371/journal.pone.0222637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rare diseases (RD) result in a wide variety of clinical presentations, and this creates a significant diagnostic challenge for health care professionals. We hypothesized that there exist a set of consistent and shared phenomena among all individuals affected by (different) RD during the time before diagnosis is established. OBJECTIVE We aimed to identify commonalities between different RD and developed a machine learning diagnostic support tool for RD. METHODS 20 interviews with affected individuals with different RD, focusing on the time period before their diagnosis, were performed and qualitatively analyzed. Out of these pre-diagnostic experiences, we distilled key phenomena and created a questionnaire which was then distributed among individuals with the established diagnosis of i.) RD, ii.) other common non-rare diseases (NRO) iii.) common chronic diseases (CD), iv.), or psychosomatic/somatoform disorders (PSY). Finally, four combined single machine learning methods and a fusion algorithm were used to distinguish the different answer patterns of the questionnaires. RESULTS The questionnaire contained 53 questions. A total sum of 1763 questionnaires (758 RD, 149 CD, 48 PSY, 200 NRO, 34 healthy individuals and 574 not evaluable questionnaires) were collected. Based on 3 independent data sets the 10-fold stratified cross-validation method for the answer-pattern recognition resulted in sensitivity values of 88.9% to detect the answer pattern of a RD, 86.6% for NRO, 87.7% for CD and 84.2% for PSY. CONCLUSION Despite the great diversity in presentation and pathogenesis of each RD, patients with RD share surprisingly similar pre-diagnosis experiences. Our questionnaire and data-mining based approach successfully detected unique patterns in groups of individuals affected by a broad range of different rare diseases. Therefore, these results indicate distinct patterns that may be used for diagnostic support in RD.
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Zikos D, Shrestha A, Fegaras L. Estimation of the Mismatch between Admission and Discharge Diagnosis for Respiratory Patients, and Implications on the Length of Stay and Hospital Charges. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:192-201. [PMID: 31258971 PMCID: PMC6568083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Admission and discharge diagnoses in hospitals are often in discord, and this has significant implications for the cost of care and patient safety. In this paper we used medical claims data to examine these differences for beneficiaries with respiratory conditions and quantified the degree to which specific respiratory conditions are mistaken for other ones, on admission. Since respiratory problems have seasonality, we performed two separate analyses, for summer and for winter admissions. The length of stay and hospital charges were compared between matching and non-matching {admission, discharge Dx} pairs, using independent samples t-test analysis. Results were integrated into a standalone application where physicians can select an admission diagnosis to see (i) the probability for this diagnosis to be correct (matching the discharge Dx), (ii) the probabilities for mismatch and (iii) pair-specific differential diagnosis criteria to consider reassessing the patient before confirming the admission diagnosis.
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Palanica A, Flaschner P, Thommandram A, Li M, Fossat Y. Physicians' Perceptions of Chatbots in Health Care: Cross-Sectional Web-Based Survey. J Med Internet Res 2019; 21:e12887. [PMID: 30950796 PMCID: PMC6473203 DOI: 10.2196/12887] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background Many potential benefits for the uses of chatbots within the context of health care have been theorized, such as improved patient education and treatment compliance. However, little is known about the perspectives of practicing medical physicians on the use of chatbots in health care, even though these individuals are the traditional benchmark of proper patient care. Objective This study aimed to investigate the perceptions of physicians regarding the use of health care chatbots, including their benefits, challenges, and risks to patients. Methods A total of 100 practicing physicians across the United States completed a Web-based, self-report survey to examine their opinions of chatbot technology in health care. Descriptive statistics and frequencies were used to examine the characteristics of participants. Results A wide variety of positive and negative perspectives were reported on the use of health care chatbots, including the importance to patients for managing their own health and the benefits on physical, psychological, and behavioral health outcomes. More consistent agreement occurred with regard to administrative benefits associated with chatbots; many physicians believed that chatbots would be most beneficial for scheduling doctor appointments (78%, 78/100), locating health clinics (76%, 76/100), or providing medication information (71%, 71/100). Conversely, many physicians believed that chatbots cannot effectively care for all of the patients’ needs (76%, 76/100), cannot display human emotion (72%, 72/100), and cannot provide detailed diagnosis and treatment because of not knowing all of the personal factors associated with the patient (71%, 71/100). Many physicians also stated that health care chatbots could be a risk to patients if they self-diagnose too often (714%, 74/100) and do not accurately understand the diagnoses (74%, 74/100). Conclusions Physicians believed in both costs and benefits associated with chatbots, depending on the logistics and specific roles of the technology. Chatbots may have a beneficial role to play in health care to support, motivate, and coach patients as well as for streamlining organizational tasks; in essence, chatbots could become a surrogate for nonmedical caregivers. However, concerns remain on the inability of chatbots to comprehend the emotional state of humans as well as in areas where expert medical knowledge and intelligence is required.
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Affiliation(s)
- Adam Palanica
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | - Peter Flaschner
- Marketing Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | | | - Michael Li
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | - Yan Fossat
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
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Grigull L, Lechner W, Petri S, Kollewe K, Dengler R, Mehmecke S, Schumacher U, Lücke T, Schneider-Gold C, Köhler C, Güttsches AK, Kortum X, Klawonn F. Diagnostic support for selected neuromuscular diseases using answer-pattern recognition and data mining techniques: a proof of concept multicenter prospective trial. BMC Med Inform Decis Mak 2016; 16:31. [PMID: 26957320 PMCID: PMC4782522 DOI: 10.1186/s12911-016-0268-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/26/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diagnosis of neuromuscular diseases in primary care is often challenging. Rare diseases such as Pompe disease are easily overlooked by the general practitioner. We therefore aimed to develop a diagnostic support tool using patient-oriented questions and combined data mining algorithms recognizing answer patterns in individuals with selected neuromuscular diseases. A multicenter prospective study for the proof of concept was conducted thereafter. METHODS First, 16 interviews with patients were conducted focusing on their pre-diagnostic observations and experiences. From these interviews, we developed a questionnaire with 46 items. Then, patients with diagnosed neuromuscular diseases as well as patients without such a disease answered the questionnaire to establish a database for data mining. For proof of concept, initially only six diagnoses were chosen (myotonic dystrophy and myotonia (MdMy), Pompe disease (MP), amyotrophic lateral sclerosis (ALS), polyneuropathy (PNP), spinal muscular atrophy (SMA), other neuromuscular diseases, and no neuromuscular disease (NND). A prospective study was performed to validate the automated malleable system, which included six different classification methods combined in a fusion algorithm proposing a final diagnosis. Finally, new diagnoses were incorporated into the system. RESULTS In total, questionnaires from 210 individuals were used to train the system. 89.5 % correct diagnoses were achieved during cross-validation. The sensitivity of the system was 93-97 % for individuals with MP, with MdMy and without neuromuscular diseases, but only 69 % in SMA and 81 % in ALS patients. In the prospective trial, 57/64 (89 %) diagnoses were predicted correctly by the computerized system. All questions, or rather all answers, increased the diagnostic accuracy of the system, with the best results reached by the fusion of different classifier methods. Receiver operating curve (ROC) and p-value analyses confirmed the results. CONCLUSION A questionnaire-based diagnostic support tool using data mining methods exhibited good results in predicting selected neuromuscular diseases. Due to the variety of neuromuscular diseases, additional studies are required to measure beneficial effects in the clinical setting.
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Affiliation(s)
- Lorenz Grigull
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Carl-Neuberg Str. 1, D-30623, Hannover, Germany.
| | - Werner Lechner
- Improved Medical Diagnostics, IMD GmbH, Hannover, Germany.
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| | - Sandra Mehmecke
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| | | | - Thomas Lücke
- Klinik für Kinder- und Jugendmedizin im St. Josef Hospital, Ruhr- Universität Bochum, Bochum, Germany.
| | - Christiane Schneider-Gold
- Department of Neurology, Heimer-Institute at the BG University-Hospital Bergmannsheil GmbH, Ruhr- University Bochum, Bochum, Germany.
| | - Cornelia Köhler
- Klinik für Kinder- und Jugendmedizin im St. Josef Hospital, Ruhr- Universität Bochum, Bochum, Germany.
| | - Anne-Katrin Güttsches
- Department of Neurology, Heimer-Institute at the BG University-Hospital Bergmannsheil GmbH, Ruhr- University Bochum, Bochum, Germany.
| | - Xiaowei Kortum
- Ostfalia University of Applied Sciences, Wolfenbuettel, Germany.
| | - Frank Klawonn
- Ostfalia University of Applied Sciences, Wolfenbuettel, Germany. .,Helmholtz Centre for Infection Research, Biostatistics Group, Braunschweig, Germany.
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