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Biomedical subjects

D H Hickam

Publications and source records attributed to D H Hickam.

At least 55 records · Page 3Linked to original sources
PubMed1984

Tutored videotape-instruction in clinical decision-making.

Tutored videotape-instruction (TVI) is a method for providing high quality instruction in topics for which the supply of expert teachers is limited. A small group of students and a tutor can watch a videotaped lecture that can be interrupted for discussion or questions. The tutor facilitates discussion and directs the students to outside reading. The authors in this report describe the use of tutored videotape-instruction in teaching clinical decision-making. Students were randomly assigned to a tutored videotape-instruction group or to a group that heard identical live lectures. The two groups had the same mean score on a final examination on the course material. The group that heard the live lectures rated the quality of instruction higher than the videotape group; however, the ratings were high for both groups. Tutored videotape-instruction provides expertise in a specialized topic and the advantages of instruction in small groups.

Diagnosis↗
PubMed1982

A study of the implicit criteria used in diagnosing chest pain.

Although previous studies have reported the prevalence of coronary artery disease among patients with typical and atypical angina, criteria for the definition of these chest pain syndromes have not been well described. We studied the implicit criteria used by physicians to classify patients with chest pain. Five internists reviewed the histories of 190 subjects admitted to the hospital for elective coronary arteriography and rated each history as indicating either high or low risk of coronary disease. We applied logistic discriminant analysis to these ratings to create a decision rule for the classification of patients with anginal syndromes. The prevalence of confirmed coronary artery disease in subjects classified by the rule as at high risk was 0.83; the prevalence was 0.57 in subjects classified as at low risk. These prevalences are similar to those found for typical and atypical angina in previous large studies. We conclude that this linear model represents the physicians' decisions and provides criteria for defining anginal pain syndromes in certain settings.

Angina Pectoris↗
PubMedDate not supplied

Communication between physicians and surviving spouses following patient deaths.

The authors evaluated the perceptions and adjustments of surviving spouses following patient deaths. Of 128 married patients dying in a university hospital in 1983, the surviving spouses of 105 (82%) were personally interviewed a year after the death. The physicians' perspectives were recorded through chart review. Half of all spouses had had no subsequent contact with the physicians who had cared for the decreased, and 55% of spouses still had unanswered questions regarding the death a year later. Survivors of unexpected deaths were found to be at high risk for poor subsequent adjustment. Spouses with poorer adjustments consulted their own physicians more frequently, and used more alcohol and tranquilizers. The results identify areas where improvement is needed in communication with surviving spouses after patients' deaths.

Adaptation, Psychological↗
PubMedDate not supplied

Teaching medical students to estimate probability of coronary artery disease.

The authors conducted a randomized trial of two methods for teaching medical students how to estimate the probability of coronary artery disease in patients with chest pain. Eighty-two students were given a pre-test consisting of written protocols summarizing the histories of 25 patients who had undergone coronary arteriography. The students estimated the likelihood of coronary artery disease for each case and were then randomized to receive one of two short written clinical lessons: a cardiology textbook chapter on interpreting chest pain, or a lesson based on a prediction rule for estimating probability of coronary artery disease. All students were given a post-test similar to the pre-test. Students who were given the textbook lesson showed no change in the accuracy of their probability estimates. Students who were taught the prediction rule significantly improved their probability estimates, as measured by a statistical index of calibration. The authors conclude that traditional teaching methods do not provide students with guidance in estimating disease probability, and that better teaching methods are needed. In this study, a clinical prediction rule fulfilled the need for instruction in probability estimation.

Coronary Disease↗
PubMedDate not supplied

Predictors of clinical performance among internal medicine residents.

OBJECTIVE: To determine whether personal characteristics influence residents' psychological states during training and to evaluate the relative importance of personal characteristics and psychological states in predicting clinical performance. DESIGN: Cohort study utilizing prospective, serial surveys of emotions (anxiety, depression, competence) and attitudes (satisfaction with the decision to become a physician) among two classes of internal medicine residents during all years of their training. Subjects completed a socio-demographic survey at the conclusion of training, and faculty-assigned clinical ranks and examination scores were used to rate their clinical performances. MAIN RESULTS: Personal characteristics had a stronger relationship to psychological states during the first training year than in subsequent years. The highest association was found for depression, for which 25% of the variation was accounted for by personal characteristics. The combination of personal characteristics and psychological states explained 48% of the variation in clinical ranks and 38% of the variation in American Board of Internal Medicine certifying examination scores. CONCLUSION: There are recognizable relationships among the personal characteristics of residents, their psychologic states during training, and their clinical performances. These results should be helpful to program directors and faculty in identifying potentially weak residents and avoiding pitfalls when working with troubled residents.

Anxiety↗
PubMedDate not supplied

Patients' interpretations of probability terms.

STUDY OBJECTIVES: To assess the meaning ascribed by patients to qualitative expressions of probability commonly used in medical care and to determine patient preferences for obtaining information when communicating with their physicians about medical risk numerically and/or qualitatively. DESIGN: Cross-sectional survey of consecutive patients. SETTING: A university-based Department of Veterans Affairs medical center. PARTICIPANTS: 133 patients sequentially seen in a general medicine clinic. MEASUREMENTS AND MAIN RESULTS: Subjects were given a randomly ordered list of 12 common terms, each a qualitative expression of probability. They were asked to indicate what they understood to be the numerical meaning of each word. The patients' probability estimates were found to comprise two groups of five terms each, with high intercorrelations among the probabilities assigned to the terms in each group. Mean probabilities assigned to terms in the first group all were greater than 60%, and mean probabilities assigned to terms in the second group all were below 50%. When asked whether they wanted chance information to be provided in numerical or qualitative terms, 32% reported that they wanted it only numerically; 35.3% wanted it only qualitatively; 21.8% wanted the information either way; and 8.3% wanted the information both ways. CONCLUSIONS: The numerical meanings that patients ascribe to probability terms fall into identifiable patterns. While patients vary in the actual values they assign to terms, the relative meanings of terms show consistent trends.

Analysis of Variance↗
PubMedDate not supplied

Interpretation of graphic data by patients in a general medicine clinic.

OBJECTIVE: To assess how patients use graphic data to decide on preferences between alternative treatments. DESIGN: Cross-sectional survey of patients, physicians, and medical students. The physicians and medical students served as a control group with which to compare the patients' responses. SETTING: A university-based Department of Veterans Affairs Medical Center. PARTICIPANTS: 152 patients seen in a general medicine clinic, 57 medical students, and 11 physicians. MEASUREMENTS AND RESULTS: Subjects were given a survival graph showing the patient outcomes for two different unidentified treatments for an unidentified serious disease. They were asked to indicate which treatment they preferred and which portion(s) of the curves most influenced their preference. A large majority of both patients and health professionals preferred the treatment that had worse short-term and better long-term survival. Eleven percent of patients and 51% of health professionals identified mid-curve data (points other than the curve end-points) as most influencing their preferences. CONCLUSIONS: A graphic survival curve appears to provide enough information to assess patient preferences between two alternative treatments. Patients appeared to differ from physicians and medical students in their interpretation of the curves.

Attitude to Health↗
PubMedDate not supplied

A performance and failure analysis of SAPHIRE with a MEDLINE test collection.

OBJECTIVE: Assess the performance of the SAPHIRE automated information retrieval system. DESIGN: Comparative study of automated and human searching of a MEDLINE test collection. MEASUREMENTS: Recall and precision of SAPHIRE were compared with those attributes of novice physicians, expert physicians, and librarians for a test collection of 75 queries and 2,334 citations. Failure analysis assessed the efficacy of the Metathesaurus as a concept vocabulary; the reasons for retrieval of nonrelevant articles and nonretrieval of relevant articles; and the effect of changing the weighting formula for relevance ranking of retrieved articles. RESULTS: Recall and precision of SAPHIRE were comparable to those of both physician groups, but less than those of librarians. CONCLUSION: The current version of the Metathesaurus, as utilized by SAPHIRE, was unable to represent the conceptual content of one-fourth of physician-generated MEDLINE queries. The most likely cause for retrieval of nonrelevant articles was the presence of some or all of the search terms in the article, with frequencies high enough to lead to retrieval. The most likely cause for nonretrieval of relevant articles was the absence of the actual terms from the query, with synonyms or hierarchically related terms present instead. There were significant variations in performance when SAPHIRE's concept-weighing formulas were modified.

Abstracting and Indexing↗
PubMedDate not supplied

Treatment preferences of patients and physicians: influences of summary data when framing effects are controlled.

The presentation of efficacy data influences preferences for treatment options. To determine how the amount of data provided to patients influenced patient decision making after framing and labeling effects were controlled, patients and physicians were presented results of two alternative treatments for an unidentified serious medical condition, derived from summary data of lung cancer treatment after surgery (better long-term survival) or radiation therapy (better short-term survival). These data are the same as used in previous studies of framing. When summary data at one month, one year, and five years were presented in terms of both survival and mortality, patients preferred the option that would be expected if only mortality data had been presented. When more detailed data were presented (data at six discrete time points), both patients and physicians preferred the option associated with a survival frame influence in previous studies. Thus, once framing influences are controlled, preference changes can be influenced by another attribute of summary data: the amount of data presented.

Adult↗
PubMedDate not supplied

Patients' and physicians' interpretations of graphic data displays.

To assess how patients' and physicians' treatment preferences are influenced by graphic data displays (five-year survival curves), a cross-sectional survey of patients, physicians, and medical students was done in a university-based Department of Veterans Affairs Medical Center. Participants in the study were 119 patients seen in a general medicine clinic, 43 physicians, and 67 medical students. Three five-year survival graphs were used. Each graph contained survival curves for two alternative unidentified treatments for an unidentified medical condition. Graph 1 was a baseline graph used in previous studies of framing effects. Graph 2 contained one survival curve having an area under the curve that was 24% greater than that in graph 1. Graph 3 contained one survival curve that had an area under the curve that was 42% greater than that in graph 1. Respondents were asked to indicate which treatment they preferred for each graph and which aspects of the five-year survival curves most influenced their choices. Respondents did not receive numerical data about the difference between the areas under the two curves. Most patients did not change their preferences across the three graphs. A significantly larger (p < or = 0.0001) proportion of physicians and medical students than of patients changed their preferences across the three graphs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A comparison of two methods for indexing and retrieval from a full-text medical database.

The objective of this study was to compare how well medical professionals are able to retrieve relevant literature references using two computerized literature searching systems that provide automated (non-human) indexing of content. The first program was SAPHIRE, which features concept-based indexing, free-text input of queries, and ranking of retrieved references for relevance. The second program was SWORD, which provides single-word searching using Boolean operators (AND, OR). Sixteen fourth-year medical students participated in the study. The database for searching was six volumes from the 1989 Yearbook series. The queries were ten questions generated on teaching rounds. All subjects searched half the queries with each program. After the searching, each subject was given a questionnaire about prior experience and preferences about the two programs. Recall (proportion of relevant articles retrieved from the database) and precision (proportion of relevant articles in the retrieved set) were measured for each search done by each participant. Mean recall was 57.6% with SAPHIRE; it was 58.6% with SWORD. Precision was 48.1% with SAPHIRE vs 57.6% with SWORD. Each program was rated easier to use than the other by half of the searchers, and preferences were associated with better searching performance for that program. Both systems achieved recall and precision comparable to existing systems and may represent effective alternatives to MEDLINE and other retrieval systems based on human indexing for searching medical literature.

Abstracting and Indexing↗