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Biomedical subjects

J F Arocha

Publications and source records attributed to J F Arocha.

17 recordsLinked to original sources
PubMed2006

Health literacy and the World Wide Web: comparing the readability of leading incident cancers on the Internet.

PRIMARY OBJECTIVE: to assess the readability level of Web-based information on leading incident cancers. RESEARCH DESIGN: websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis. METHODS: readability was assessed using SMOG, Flesch-Kincaid (F - K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 - 30 lines of continuous text. Identical text was entered into Microsoft Word 2002 where F - K and FRE scores were determined automatically by the word processor. RESULTS: the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F - K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs. CONCLUSIONS: findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Adult↗
PubMed2001

Methods of cognitive analysis to support the design and evaluation of biomedical systems: the case of clinical practice guidelines.

This article provides a theoretical and methodological framework for the use of cognitive analysis to support the representation of biomedical knowledge and the design of clinical systems, using clinical-practice guidelines (CPGs) as an example. We propose that propositional and semantic analyses, when used as part of the system-development process, can improve the validity, usability, and comprehension of the resulting biomedical applications. The framework we propose is based on a large body of research on the study of how people mentally represent information and subsequently use it for problem solving. This research encompasses many areas of psychology, but the more important ones are the study of memory and the study of comprehension. Of particular relevance is research devoted to investigating the comprehension and memory of language, expressed verbally or in text. In addition, research on how contextual variables affect performance is informative because these psychological processes are influenced by situational variables (e.g., setting, culture). One important factor limiting the acceptance and use of clinical-practice guidelines (CPGs) may be the mismatch between a guideline's recommended actions and the physician-user's mental models of what seems appropriate in a given case. Furthermore, CPGs can be semantically complex, often composed of elaborate collections of prescribed procedures with logical gaps or contradictions that can promote ambiguity and hence frustration on the part of those who attempt to use them. An improved understanding of the semantics and structure of CPGs may help to improve such matching, and ultimately the comprehensibility and usability of CPGs. Cognitive methods of analysis can help guideline designers and system builders throughout the development process, from the conceptual design of a computer-based system to its implementation phases. By studying how guideline creators and developers represent guidelines, both mentally and in text, and how end-users understand and make decisions with such guidelines, we can inform the development of technologies that seek to improve the match between the representations of experts and practitioners. We urge informaticians to recognize the potential relevance of cognitive analysis methods and to begin more extensive experimentation with the their use in biomedical informatics research.

Cognition↗
PubMed2001

Cognitive psychological studies of representation and use of clinical practice guidelines.

Clinical practice guidelines provide a means to enhance physician performance. This investigation was undertaken in an attempt to understand the nature of impact of guideline use on physician performance. We investigated the impact of (a) algorithmic-based and (b) text-based practice guidelines on clinical decision-making by physicians at varying levels of expertise. Data were collected using clinical scenarios and a think-aloud paradigm, both with (primed) and without (spontaneous) the use of the guidelines. The two guidelines used in the study were management of diabetes and screening for thyroid disease. The results show that guidelines were used as reminders for both experts and non-experts. Guidelines acted as an educational tool for non-experts by assisting in knowledge reorganization, particularly for the non-experts. Text and algorithmic guideline formats were both useful to physician performance depending on the purpose of use: solving clinical problems or learning. These results provide insights into how guidelines can be fine-tuned for different users and for different purposes. Empirical research, coupled with design principles from the cognitive sciences, can form an essential component of guideline design and development.

Adult↗
PubMed2001

Impact of undergraduate medical training on housestaff problem-solving performance: implications for problem-based curricula.

This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used data-driven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found this pattern to be true for medical students trained in two different curriculum formats. Although all housestaff generated equal numbers of diagnostic hypotheses during the reasoning process, housestaff from the conventional curriculum generated a greater number of accurate hypotheses than residents in PBLC. These results are discussed in relation to assumptions in health professional curricula about the adequacy of hypothetico-deductive methods of reasoning as teaching mechanisms and the need for clinical and biomedical knowledge integration.

Acute Disease↗
PubMed2000

Cognitive models in training health professionals to protect patients' confidential information.

Recent advances in theories of learning and knowledge acquisition in culturally-situated environments have illuminated the role of cognition in changing behavior, and in turn on influencing performance for the long term. One such advance focuses on the relationship between explicit formal training and implicit knowledge acquired through daily interactive activities in schools and organizations. The former relates more to instruction regarding the policy issues whereas the latter is tied closely to cultural, moral and organizational values. In this paper, we draw on these theories of cognition and learning to show the shift in thinking that is needed regarding education of health professionals, including steps required to assure that the protection of confidential information becomes part of their routine practices. Illustrative examples are used to show the nature of conceptual change in the health professional's knowledge organization and reasoning strategies that is necessary for more sustained behavior change with regards to protecting data confidentiality and privacy of individual patients. This re-conceptualization is intended to be reflected at various levels of training and education for health professionals, including influences on personal and organizational practices as well as revisions in medical-school and graduate-medical curricula.

Cognition↗
PubMed2000

Cognition and expertise: acquisition of medical competence.

The cognitive study of expertise in knowledge domains has generated a great deal of knowledge that can be used in the education and training of health care providers. This research has looked at the development and characteristics of expert performance. Design of medical and health education systems that are informed by this research can be powerful tools to improve the quality of medical education.

Cognition↗
PubMed1998

Cognitive assessment and health education in children from two different cultures.

This paper presents research aimed at investigating high level comprehension and problem solving processes in children in two different countries, India and Colombia. To this end, we use a series of health-related cognitive tasks as assessment tools. In one study, we also examine children's performance on these cognitive tasks, in relation to their nutritional status and parasitic load. The ages of the children tested ranged from 2 through 14 years. The tasks were designed to assess comprehension of sequences, organization of concepts, understanding of health routines (hygiene practices) and evaluation of hypothesis and evidence. The results show that children approach the different tasks with a baggage of beliefs and local knowledge of the world which determines their reasoning process, their comprehension and their problems solving. The results are discussed in terms of cognitive assessment approaches, as applied to classroom instruction. Given that children construct their understanding of reality based on what they already know and that education does not take this into account, we recommend that assessment tools should be devised that can tap prior knowledge and understanding, such that this can be analyzed and understood in relation to knowledge taught in the classroom. Current educational assessment fails in such an endeavor.

Adolescent↗
PubMed1995

Steering through the murky waters of a scientific conflict: situated and symbolic models of clinical cognition.

The situated action perspective, which embraces a diversity of views, challenges several of the fundamental assumptions of the symbolic information-processing framework underlying cognitive science and artificial intelligence. In this paper, we consider the following issues; symbolic representations, plans and actions, distributed cognition, and the transfer of learning. We evaluate each of these issues in terms of research and theories in clinical cognition and examine the implications for education and training, and for the integration of intelligent systems in medical practice. We argue for a reconceptualization of the symbolic framework in terms of the way the role of internal representations and cognitive activities are perceived. However, symbolic representations are integral to medical cognition and should continue to be central in any theoretical framework. A re-examination of cognitive science in medicine in terms of the relationship among physicians, technology, and the workplace could prove to be constructive in bridging the gap between theory and practice.

Artificial Intelligence↗
PubMed1995

Cognitive models of clinical reasoning and conceptual representation.

This paper presents an approach to conceptual representation, informed by theories and methods from cognitive psychology. Our investigation of clinical case comprehension and reasoning from textual information has shifted from instantiation models in which text processing is carried out through schema fitting to more dynamic models that account for how schemata are constructed by a process of construction and integration of meaning, which depends on specific situations. We give an example involving doctor-patient dialogue to illustrate this point. Nonetheless, our main approach has been propositionally-based. As we conduct research into more specific aspects of medical understanding, such as understanding of physiological systems, we have included alternative approaches, such as qualitative functional graphs. We present examples of their use in our research. These representational formalisms allow us better to capture reasoning and understanding in dynamic systems.

Artificial Intelligence↗
PubMed1990

Medical expertise as a function of task difficulty.

This paper is concerned with factors that disrupt the pattern of forward reasoning characteristic of experts with accurate performance. Two experiments are described. In the first, the performances of cardiologists, psychiatrists, and surgeons in diagnostic explanation of a clinical problem in cardiology were examined. In the second, the performances of cardiologists and endocrinologists in diagnostic explanation of clinical problems within and outside their domains of expertise were examined. The performances of researchers and practicing physicians are also compared. The results of Experiment 1 replicated earlier results regarding the relationship between forward reasoning and accurate diagnosis. There were no differences in recall as a function of expertise. Experts did not show any bias toward using specific knowledge from their own areas of expertise. The results of Experiment 2 showed that the breakdown of forward reasoning was related to the structure of the task. In particular, nonsalient cues induced some backward reasoning even in subjects with accurate diagnoses. Some differences were also found between the types of explanation used by researchers and practitioners. The practitioners referred more to clinical components in their explanations, whereas the researchers focused more on the biomedical components.

Attention↗
PubMed1988

Causal reasoning and the treatment of diarrhoeal disease by mothers in Kenya.

A study of reasoning about the cause and treatment of childhood diarrhoea by Maasai schooled and unschooled mothers was carried out in Kenya, using a method of analysis developed within cognitive psychology. A dramatic difference in the conceptual structures of mothers' reasoning about both the cause and treatment of diarrhoea was found between the unschooled and schooled group. The unschooled mothers' explanation of diarrhoea was in terms of illness, resulting from social and moral factors. The knowledge structures generated showed global coherence. The schooled mothers explained diarrhoea with a series of quasi-biomedical facts about the disease with little or no connections between facts. The role of understanding the underlying disease processes for learning in health education is discussed in the context of Kenyan culture.

Adult↗
PubMedDate not supplied

Evaluating evidence against diagnostic hypotheses in clinical decision making by students, residents and physicians.

Clinicians are faced with the difficulty of filtering large quantities of information and incorporating evidence to make safe and accurate diagnostic, therapeutic and management decisions. One solution to this difficulty is the development of evidence-based decision support tools designed to provide relevant and up-to-date evidence to clinicians. However, as investigations of medical decision making have found that hypothesis generation and clinical reasoning differ as a function of expertise, the gathering, interpretation and use of evidence against hypotheses depends on the prior knowledge of the clinician. The specific focus of the study is to understand how clinical evidence is gathered and evaluated during diagnostic reasoning. Verbal data during clinical interactions with physicians, residents and final year medical students were collected and transcribed. The dialogues were analyzed using three levels of coding: cognitive, epistemological and linguistic pragmatic perspectives. Results show that: (a) the ability to index and use adequate evidence by physicians, residents and students is a function of the early generation of accurate hypotheses: and (b) strategies for resolving inconsistent evidence differ as a function of medical expertise. The relationship between these findings and its application for the development of adequate knowledge-based systems for indexing and retrieval is discussed.

Clinical Competence↗
PubMedDate not supplied

Collaborative problem-solving in telemedicine and evidence interpretation in a complex clinical case.

This study examined clinical problem-solving processes in the context of a telemedical consultation, in order to verify to what extent the technological environment preserves the characteristics of medical reasoning that are known to occur in more traditional clinical settings. This study also provided an opportunity for examining certain fundamental aspects of medical reasoning about complex cases. Within a case-study design, we used a theoretical framework and qualitative methods originating from cognitive science. Expert physicians used reasoning strategies commensurate with the complexity of the case. The technological context of the telemedical consultation did not overly contrive the interaction, allowing them to use real-time problem-solving processes characterizing medical reasoning in naturalistic settings. The results also suggest that high levels of expertise in the presence of very complex cases may elicit a particular configuration of problem-solving processes, associating certain reasoning patterns that are usually related to non-expert problem-solving with others that are typical of expertise. We believe that the evaluation of image transmission and diagnostic performance in telemedicine, as well as the determination of its indications and technological configurations, may benefit from taking into account, with the help of cognitive methodologies, the interacting problem-solving modalities that may be encountered in this context.

Adult↗
PubMedDate not supplied

Representing clinical guidelines in GLIF: individual and collaborative expertise.

OBJECTIVE: An evaluation of the cognitive processes used in the translation of a clinical guideline from text into an encoded form so that it can be shared among medical institutions. DESIGN: A comparative study at three sites regarding the generation of individual and collaborative representations of a guideline for the management of encephalopathy using the GuideLine Interchange Format (GLIF) developed by members of the InterMed Collaboratory. MEASUREMENTS: Using theories and methods of cognitive science, the study involves a detailed analysis of the cognitive processes used in generating representations in GLIF. The resulting process-outcome measures are used to compare subjects with various types of computer science or clinical expertise and from different institutions. RESULTS: Consistent with prior studies of text comprehension and expertise, the variability in strategies was found to be dependent on the degree of prior experience and knowledge of the domain. Differing both in content and structure, the representations developed by physicians were found to have additional information and organization not explicitly stated in the guidelines, reflecting the physicians' understanding of the underlying pathophysiology. The computer scientists developed more literal representations of the guidelines; addition were mostly limited to specifications mandated by the logic of GLIF itself. Collaboration between physicians and computer scientists resulted in consistent representations that were more than the sum of the separate parts, in that both domain-specific knowledge of medicine and generic knowledge of guideline structure were seamlessly integrated. CONCLUSION: Because of the variable construction of guideline representations, understanding the processes and limitations involved in their generation is important in developing strategies to construct shared representations that are both accurate and efficient. The encoded guidelines developed by teams that include both clinicians and experts in computer-based representations are preferable to those developed by individuals of either type working alone.

Brain Diseases↗
PubMedDate not supplied

A primer on aspects of cognition for medical informatics.

As a multidisciplinary field, medical informatics draws on a range of disciplines, such as computer science, information science, and the social and cognitive sciences. The cognitive sciences can provide important insights into the nature of the processes involved in human- computer interaction and help improve the design of medical information systems by providing insight into the roles that knowledge, memory, and strategies play in a variety of cognitive activities. In this paper, the authors survey literature on aspects of medical cognition and provide a set of claims that they consider to be important in medical informatics.

Cognition↗
PubMedDate not supplied

Hypothesis generation and the coordination of theory and evidence in novice diagnostic reasoning.

This study investigates hypothesis generation and evaluation in clinical problem solving by medical trainees. The study focuses on 1) directionality of reasoning and 2) use of confirmation and disconfirmation strategies in generating and evaluating hypotheses. Two clinical problems were divided into segments of information containing presenting complaint, past history, and physical examination. The initial information indicated a typical myocardial infarct but subsequent information contradicted it. The results showed that the participating students predominantly used forward reasoning and confirmation strategies. When faced with contradictory evidence: 1) second-year students ignored cues in the problem or reinterpreted them to fit the hypothesis; 2) third-year students generated concurrent hypotheses to account for different sets of data; and 3) fourth-year students generated several initial hypotheses and subsequently narrowed the hypothesis space by generating a single coherent diagnostic explanation. The results are discussed in terms of coordination of clinical evidence and its relationship to scientific reasoning.

Aortic Dissection↗