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Biomedical subjects

D H Hickam

Publications and source records attributed to D H Hickam.

At least 19 recordsLinked to original sources
PubMed1994

Towards new measures of information retrieval evaluation.

All of the methods currently used to assess information retrieval (IR) systems have limitations in their ability to measure how well users are able to acquire information. We utilized a new approach to assessing information obtained, based on a short-answer test given to senior medical students. Students took the ten-question test and then searched one of two IR systems on the five questions for which they were least certain of their answer Our results showed that pre-searching scores on the test were low but that searching yielded a high proportion of answers with both systems. These methods are able to measure information obtained, and will be used in subsequent studies to assess differences among IR systems.

Evaluation Studies as Topic↗
PubMed1992

A comparison of retrieval effectiveness for three methods of indexing medical literature.

Conventional approaches to indexing medical literature include the human assignment of terms from a controlled vocabulary, such as MeSH, or the computer assignment of all words in the title and abstract as indexing terms. Human indexing suffers from inconsistency, while word-based indexing suffers from the multiple meanings of words. SAPHIRE is a computer program designed to provide indexing using controlled terms that are assigned by computer, based on their occurrence in the title and abstract. In this first evaluation of SAPHIRE, the authors compared the retrieval performance of the three indexing approaches--human-based MEDLINE with text words; machine-based SAPHIRE with text words; and text words only--for searches by measuring recall and precision for each search using a test collection of 200 abstracts. The abstracts were judged by human reviewers for relevance as applied to 12 literature queries. The results suggest that text word indexing is more effective than indexing with MeSH terms. SAPHIRE's indexing performance was slightly inferior but the program has other advantageous features.

Abstracting and Indexing↗
PubMed1992

Words, concepts, or both: optimal indexing units for automated information retrieval.

What is the best way to represent the content of documents in an information retrieval system? This study compares the retrieval effectiveness of five different methods for automated (machine-assigned) indexing using three test collections. The consistently best methods are those that use indexing based on the words that occur in the available text of each document. Methods used to map text into concepts from a controlled vocabulary showed no advantage over the word-based methods. This study also looked at an approach to relevance feedback which showed benefit for both word-based and concept-based methods.

Abstracting and Indexing↗
PubMed1991

Assessing predictive accuracy: how to compare Brier scores.

Several investigators have used the Brier index to measure the predictive accuracy of a set of medical judgments; the Brier scores of different raters who have evaluated the same patients provides a measure of relative accuracy. However, such comparisons may be difficult to interpret because of the lack of a statistical test for differentiating between two Brier scores. To demonstrate a method for addressing this issue we analyzed the judgments of five medical students, each of whom independently evaluated the same 25 patients with recurrent chest pain. Using the method we determined that two of the students gave judgments that were incompatible with the actual observed outcomes (p less than 0.05); of the three remaining students we detected a significant difference between two (p less than 0.05). These results differed from receiver operating characteristic curve area analysis, another technique used to evaluate predictive accuracy. We suggest that the proposed method can provide a useful tool for investigators using the Brier index to compare how well clinicians express uncertainty using probability judgments.

Chest Pain↗
PubMed1991

A prospective study of internal medicine residents' emotions and attitudes throughout their training.

To evaluate whether the negative emotions and attitudes that residents develop during internship continue throughout the remaining years of their residency, the authors undertook a four-year prospective study of two classes of internal medicine residents who completed their training in 1985 and 1986 in a residency program based at the Oregon Health Sciences University. Every two to three months over all three years of training, the residents indicated on Likert-type scales their levels of agreement with questions about their career satisfaction and emotional states, and the satisfying and dissatisfying aspects of their residency experiences. Between the internship and the end of their residencies, the physicians indicated significant improvements in their emotions and attitudes. Those experiences identified as satisfying continued to be so, whereas those considered dissatisfying became less so. Although more research of other classes of residents is needed, the findings suggest that while internal medicine internships may be dysphoric, the residents' emotional states and attitudes tend to normalize during the remainder of the residency.

Adult↗
PubMed1991

The validity of proxy-generated scores as measures of patient health status.

This study examines the validity of proxy assessments as substitutes for patient assessments of patient physical and psychosocial health status. Data were obtained from 275 patient-proxy pairs who were enrolled in a national study of Adult Day Health Care. Patients and proxies (informal caregivers such as spouses) were asked to complete the Sickness Impact Profile (SIP) based on the patients health status. Findings showed that patient-generated and proxy-generated physical scores were highly correlated, although proxies rated patients as slightly more impaired than the patient's rated themselves. The correlation between psychosocial scores was not high enough to consider proxy responses as valid substitutes for patient responses. We explored these differences in response by comparing regression equations predicting patient-generated and proxy-generated physical and psychosocial SIP dimension scores. Variance in the patient-generated psychosocial score was explained by physical function, psychological distress, cognitive status and patient age. Proxy-generated psychosocial scores were primarily explained by the caregiver's psychological distress and perceived burden. These findings point out the importance of considering the source of patient health status estimates when interpreting the results of research studies.

Activities of Daily Living↗
PubMed1991

Clinicians' predictions of nursing home placement for hospitalized patients.

Identifying patients who will need long-term care may improve the efficiency and effectiveness of acute hospital care. This prospective study evaluated clinicians' ability to identify patients requiring nursing home care. The study had two principal objectives. The first objective was to measure whether registered nurses, physicians, and social workers made similar estimates of the probability of nursing home placement early in an acute care hospitalization. The second objective was to identify the clinical characteristics of patients for whom the clinicians incorrectly predicted that they would return home. The study subjects were 342 patients older than age 55 who were admitted to the medicine, surgery, and neurology services of two university-affiliated Veterans Affairs hospitals. Fifteen percent were discharged to nursing homes. The nurses, physicians, and social workers had high agreement in their estimates of the probability of nursing home placement for each patient. However, each of the provider groups assigned low probability estimates to more than 20% of the patients discharged to nursing homes. Examination of the characteristics of patients assigned low probability estimates revealed that mental impairment and functional disability were higher in those patients who ultimately were discharged to nursing homes than in those patients who returned to their homes. These findings suggest that better assessment and interpretation of patient characteristics early in the hospital stay may improve discharge planning. Some clinicians appear to underestimate mental and functional impairment as risk factors for long-term care needs.

Aftercare↗
PubMed1991

Evaluation of SAPHIRE: an automated approach to indexing and retrieving medical literature.

An analysis of SAPHIRE, an experimental information retrieval system featuring automated indexing and natural language retrieval, was performed on MEDLINE references using data previously generated for a MEDLINE evaluation. Compared with searches performed by novice and expert physicians using MEDLINE, SAPHIRE achieved comparable recall and precision. While its combined recall and precision performance did not equal the level of librarians, SAPHIRE did achieve a significantly higher level of absolute recall. SAPHIRE has other potential advantages over existing MEDLINE systems. Its natural language interface does not require knowledge of MeSH, and it provides relevance ranking of retrieved references.

Abstracting and Indexing↗
PubMed1990

Using the patient's history to estimate the probability of coronary artery disease: a comparison of primary care and referral practices.

PURPOSE: According to probability theory, the interpretation of new information should depend on the prior probability of disease. We asked if this principle applies to interpreting the history in patients with chest pain. We compared the prevalence of coronary artery disease (CAD) in patients who had similar histories but who came from populations with different disease prevalence. PATIENTS AND METHODS: We studied two high-disease-prevalence populations (patients referred for coronary arteriography) and two low-disease-prevalence populations (patients from primary care practices). We used clinical characteristics of one arteriography population to develop a logistic rule for estimating the probability of coronary artery narrowing. The number of clinical findings determined the logistic score, which was proportional to the prevalence of CAD. RESULTS: The prevalence of CAD was much lower in the primary care population than in the arteriography population, even when patients with similar logistic scores, and thus similar clinical histories, were compared. CONCLUSION: A clinician must take account of the overall prevalence of disease in the clinical setting when using the patient's history to estimate the probability of disease. Failure to observe this caution may lead to errors in test selection and interpretation.

Adult↗
PubMed1989

The identification and management of drug-seeking behavior in a medical center.

We describe the development of a quality assurance program that monitors prescription medication misuse in a medical setting. The program focuses on patient activities that influence physician prescribing of abusable medications. Seven defining criteria have been developed to judge the presence of drug seeking by patients. When appropriate, a drug-seeking label is attached to the patient's chart and the hospital computer information system. The warning informs the physician and protects the patient from excessive medications.

Academic Medical Centers↗
PubMed1988

The doctor-patient relationship during medical internship: the evolution of dissatisfaction.

We prospectively examined perceptions of the doctor-patient relationship among interns in two different internal medicine training programs five times during the internship year. All 59 interns in the University of California, Irvine-Long Beach and the Oregon Health Sciences University Medical Programs participated in the study during the 1982-83 internship year. We serially administered a questionnaire that contained four major items: (1) a choice of one of six empirically developed role paradigms of the doctor-patient relationship; (2) a checklist of positive and negative aspects of internship; (3) a measure of level of satisfaction with the decision to become a physician; and (4) a rating list of mood descriptors. The six role paradigms portrayed a variety of positive and negative aspects of the doctor-patient relationship. At the beginning of the year, the interns were quite positive about the doctor-patient relationship and preferentially endorsed collegial models. As the year progressed, they endorsed significantly fewer positive and more negative models (P less than 0.001). Most respondents endorsed two models, one positive: "expert resource (doctor)--active cooperative participant (patient)" and one negative: "clerk, paperwork processor (doctor)--subscriber, seeker of eligibility (patient)." By the end of the year approximately half of the interns endorsed a positive and half a negative model. Interns selecting a negative model of the doctor-patient relationship identified more negative and fewer positive aspects of internship than those selecting a positive model. Specifically, they significantly more often (P less than 0.001) identified too much paper work and coping with difficult patients as negative aspects of internship.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Evaluation of physical examination skills. Reliability of faculty observers and patient instructors.

Effective teaching of physical examination skills requires an evaluation system that can identify trainees who need further instruction. To study the evaluation of physical examination skills by faculty observers and patient instructors, the reliability of their observation of medical students performing a general physical examination was measured. Faculty observers did not reliably evaluate 32% of examination skills. Faculty agreement was lowest when observing components of the head, neck, and abdominal examinations. Patient instructors, with limited faculty training, reliably evaluated 83% of those skills that were reliably assessed by the faculty. These findings demonstrate limitations in the current methods of evaluating performance and point out the need to examine systems of trainee assessment.

Clinical Competence↗
PubMed1987

Responsibilities of primary physicians in organ donation.

As transplantation success rates have improved, the demand for donor organs has steadily increased. A shortage of donor organs has led to legislation requiring hospital personnel to provide families routinely with the opportunity to authorize organ donation. Primary physicians have an important role in identifying potential donors while continuing to assure that the survivors' needs are met. The major implications of organ donation for the primary physician are reviewed. Patients who die will more frequently be eligible as cornea, skin, or bone donors, but the criteria for both tissue and internal organ donation are reviewed. Ethical issues unique to organ donation and responses of survivors to donation requests are described. If appropriately offered, the opportunity to authorize an anatomic gift can be a source of comfort to survivors while the donation provides the benefits of transplantation to persons on organ waiting lists.

Ethics, Medical↗
PubMed1986

Nurses' and physicians' attitudes toward tube-feeding decisions in long-term care.

We studied attitudes of health professionals toward life-sustaining treatment. A patient management questionnaire sent to staff physicians and nurses in 183 Oregon nursing homes consisted of eight patient sketches which varied age, mental status, and enjoyment of life. Respondents were asked whether they would favor tube-feeding to correct malnutrition in each case. Nurses showed higher preferences for tube-feeding than did physicians (P = .05). For both professions, patient happiness was the strongest and most significant (P less than .0001) influence upon preferences for tube-feeding. Both professions also showed a significant (P less than .001) tendency to give younger patients higher preferences for tube-feeding. Physicians showed a significant (P less than .001) influence of patient mental status upon preferences, while patient mental status did not affect nurses' preferences. Identifiable clinical factors appear to influence attitudes of physicians and nurses toward tube-feeding decisions.

Aged↗