Search PubMed⌕ Search

Biomedical subjects

A S Elstein

Publications and source records attributed to A S Elstein.

At least 19 recordsLinked to original sources
PubMed1987

Computer modeling of clinical judgment.

Four main developments leading to computer modeling of clinical judgment are described in this paper. These include information processing psychology, clinical vs. statistical prediction studies, behavioral decision theory, and Bayesian decision analysis approaches. One clear catalyst in these developments has been the computer, which has been used as an information management tool rather than a data-processing device. Future directions of these efforts are delineated, and problems as well as prospects of computerizing clinical judgment are described.

Artificial Intelligence↗
PubMed1979

Development and exploratory trials of a cognitive preference inventory for medical students.

A medical cognitive preference inventory was developed and tested with two samples, one in Israel and the other in the United States. Acceptable levels of internal consistency of the whole test and of its three subtests were demonstrated. Direct and indirect evidence for the validity of the test was provided. The potential uses of the test for student selection and evaluation as well as for programme evaluation were discussed. Two forms, E and F, each consisting of eighteen items, are recommended for use with medical students. A combination of these two forms is designed as form G. Administration of one form to half of a sample and the other form to the other half, followed by pooling the individual scores, thereby obtaining results comparable to those of form G, is recommended when time to administer the inventory is limited.

Anatomy↗
PubMedDate not supplied

Decision analysis in surgical education.

Surgical education can no longer be considered adequate if limited to description of surgical diseases and methods of management. Due to the growth in numbers of surgical diagnostic and therapeutic procedures, the surgeon of the future will find it increasingly necessary to understand the principles by which algorithms are constructed and by which individualized decisions should be made. Several systematic approaches for assisting clinical decision makers have been developed. Decision analysis is particularly appealing because it is flexible and readily adapted to a wide range of clinical situations. It explicitly guides the decision maker in determining the crucial variables in a clinical decision, and permits both objective data and personal preferences to play a part in decision making. Because it provides for personal estimates and preferences, decision analysis is not dehumanizing, even though it is quantitative, explicit, and mathematically rigorous. Topics for a series of seminars or case conferences are suggested. Decision analysis should be part of the intellectual preparation of every clinician.

Decision Support Techniques↗
PubMedDate not supplied

Women's and physicians' utilities for health outcomes in estrogen replacement therapy.

Estrogen replacement therapy (ERT) prevents fractures and relieves vasomotor symptoms, but it increases the risk of endometrial cancer. Previous studies and national prescribing patterns show that physicians are conservative in their approach to this therapy. The authors interviewed physicians and perimenopausal women to assess their utilities for the various health outcomes of estrogen replacement therapy. On all outcomes, physicians rated illness episodes followed by recovery as being closer to perfect health than did perimenopausal women. Physicians, in judging which outcomes were most important to women, estimated relief of symptoms above fracture prevention, whereas women rated fracture prevention above symptom relief. These results emphasize the need to assess patients' utilities directly, particularly when utilities for the outcome of a particular therapy may influence the choice of a therapeutic regimen.

Adult↗
PubMedDate not supplied

Laboratory use: attitudes implicit in a national examination.

The quantitative principles of test selection and interpretation have been reluctantly integrated into clinical practice. This reluctance may reflect an underlying faculty attitude towards the laboratory. To evaluate this attitude, the scoring standards used for 23 patient management problems (PMPs) in the 1980 and 1983 Medical Knowledge Self-Assessment Programs were reviewed. All diagnostic options were categorized by dollar cost, risk, and a determination of "routineness." Attitudes were probed by reviewing the scores obtained by indiscriminate selection of all items in a category. Our analysis indicated that the examiners valued routine, little-ticket, little-risk items. Such selection would be rewarded 85% of the time and in 95%, no penalty would be received. Further, indifference was more frequent for little-ticket items and accounted for 11.7% of acceptable diagnostic expense. An examinee analyzing these scoring keys could reasonably conclude that routine, little-ticket items should be ordered whenever offered. Hence, at a national level, there is an attitude that implicitly encourages the use of these items in clinical practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Framing effects.

Explore the source record for details and available documents.

Breast Neoplasms↗
PubMedDate not supplied

Hormonal replacement therapy: analysis of clinical strategies used by residents.

The authors investigated strategies employed by resident physicians to decide whether to prescribe hormonal replacement therapy (HRT) for menopausal women, a matter of continuing clinical controversy. Verbal protocols were obtained from 21 residents in three specialties as they responded to 12 brief case descriptions. The cases incorporated three levels of cancer risk and two levels of osteoporosis risk in a 3 x 2 factorial design with two replications in each cell. Substantial variation in willingness to prescribe HRT was observed. By clustering subjects with relatively similar approaches to the problem, three treatment strategies were formulated that accounted for the decisions of 20 subjects. Each strategy is a simplified representation of the conflicting considerations in this clinical dilemma that facilitates rapid decision making. The differences between these representations and formal decision-analytic models help to explain why observed clinical decisions were inconsistent with expected utility maximization.

Breast Neoplasms↗
PubMedDate not supplied

The effect of incomplete knowledge on the diagnoses of a computer consultant system.

The knowledge bases (KBs) of diagnostic decision support systems are often incomplete, and gaps in the KB could potentially lead systems to reach diagnoses that are implausible to physicians. To investigate this possibility we studied Iliad (Version 2.01), a computer consultant system that generates differential diagnosis across the domain of internal medicine. Data from the history, physical examination, and laboratory findings of 50 grand-rounds cases were entered into Iliad by a computer consultant aware of the diagnosis but blinded to its presence or absence in Iliad's KB. Two experienced internists were asked to diagnose these cases before and after seeing the results of the computer consultation, and to assess the plausibility of the computer's diagnoses. Twenty-eight of the 50 cases (56.0%) were diseases contained in Iliad's KB. After seeing Iliad's diagnoses for cases in the KB, physicians assigned to their correct diagnoses a higher mean ranked position (1.5 versus 2.0, p less than 0.008) and a higher mean probability (84.0% versus 77.6%, p less than 0.008) compared with their pre-Iliad values, whereas for cases not in the KB, mean position and probability for correct diagnoses did not change. Physician diagnostic accuracy did not change after consultation on cases included or not included in the KB. After adjusting for case difficulty, mean plausibility of Iliad's diagnoses was judged significantly higher (on a seven-point scale) for cases in the KB than for cases not in the KB (4.2 versus 3.2, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗