Journal articles on the topic 'Biais cognitifs – Diagnostic'
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Field, Morton H. "Cognitive bias and diagnostic error (November 2015)." Cleveland Clinic Journal of Medicine 83, no. 6 (June 2016): 407–8. http://dx.doi.org/10.3949/ccjm.83c.06003.
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Aoki, Yosuke. "2. Introducing Representative Cognitive Bias (in Diagnostic Reasoning)." Nihon Naika Gakkai Zasshi 108, Suppl (February 28, 2019): 139b—140a. http://dx.doi.org/10.2169/naika.108.139b.
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Aoki, Yosuke. "2. Introducing Representative Cognitive Bias (in Diagnostic Reasoning)." Nihon Naika Gakkai Zasshi 108, no. 9 (September 10, 2019): 1842–46. http://dx.doi.org/10.2169/naika.108.1842.
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Nichols, Emma, Yizhou Chen, Adina Zeki Al Hazzouri, Alden Gross, Niranjani Nagarajan, Jinkook Lee, and Joshua Ehrlich. "VISION IMPAIRMENT AND COGNITION IN INDIA: ASSOCIATIONS AFTER ADJUSTMENT FOR POTENTIAL BIAS." Innovation in Aging 7, Supplement_1 (December 1, 2023): 1156–57. http://dx.doi.org/10.1093/geroni/igad104.3711.
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Abstract Increasing evidence suggests that vision impairment may be an important modifiable risk factor for dementia, particularly in low- and middle-income settings where the prevalence of uncorrected vision impairment is high. Although prior studies in various settings, including India, have found strong associations between vision impairment and cognition, this work has not considered potential bias in cognitive testing due to vision impairment. We evaluated and adjusted for measurement differences by vision impairment status using data from the Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI-DAD) study (N=3780). We used Multiple Indicators Multiple Causes models to assess differential item functioning (DIF) (e.g. bias) in cognitive testing by objective near and distance vision impairment. We estimated associations between vision impairment and cognition adjusting for hypothesized confounders before and after DIF adjustment. Although there was statistical evidence of DIF (near vision: 3/10 items, distance vision: 4/10 items), differences between DIF-unadjusted and -adjusted scores were small compared to the standard error of measurement, indicating no evidence of clinically meaningful measurement differences. Both near and distance vision impairment were associated with cognition before and after DIF-adjustment; after DIF-adjustment, severe near and distance vision impairment were associated with -0.43 [95% CI -0.53--0.33] and -0.60 [-0.76--0.43] standard deviation units lower cognitive scores compared to those with normal vision, respectively. In well-conducted large-scale surveys, bias in cognitive testing due to vision impairment is likely minimal, even in low- and middle-income settings. Findings strengthen the evidence base on vision impairment as a risk factor for dementia.
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Mull, Nikhil, James B. Reilly, and Jennifer S. Myers. "In reply: Cognitive bias and diagnostic error (November 2015)." Cleveland Clinic Journal of Medicine 83, no. 6 (June 2016): 408. http://dx.doi.org/10.3949/ccjm.83c.06004.
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Watari, Takashi, Yasuharu Tokuda, Yu Amano, Kazumichi Onigata, and Hideyuki Kanda. "Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self-Reflection Survey." International Journal of Environmental Research and Public Health 19, no. 8 (April 12, 2022): 4645. http://dx.doi.org/10.3390/ijerph19084645.
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This cross-sectional study aimed to clarify how cognitive biases and situational factors related to diagnostic errors among physicians. A self-reflection questionnaire survey on physicians’ most memorable diagnostic error cases was conducted at seven conferences: one each in Okayama, Hiroshima, Matsue, Izumo City, and Osaka, and two in Tokyo. Among the 147 recruited participants, 130 completed and returned the questionnaires. We recruited primary care physicians working in various specialty areas and settings (e.g., clinics and hospitals). Results indicated that the emergency department was the most common setting (47.7%), and the highest frequency of errors occurred during night-time work. An average of 3.08 cognitive biases was attributed to each error. The participants reported anchoring bias (60.0%), premature closure (58.5%), availability bias (46.2%), and hassle bias (33.1%), with the first three being most frequent. Further, multivariate logistic regression analysis for cognitive bias showed that emergency room care can easily induce cognitive bias (adjusted odds ratio 3.96, 95% CI 1.16−13.6, p-value = 0.028). Although limited to a certain extent by its sample collection, due to the sensitive nature of information regarding physicians’ diagnostic errors, this study nonetheless shows correlations with environmental factors (emergency room care situations) that induce cognitive biases which, in turn, cause diagnostic errors.
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Nosker, Jennifer L., Stephen L. Aita, Nicholas C. Borgogna, Tina Jimenez, Keenan A. Walker, Tasha Rhoads, Janelle M. Eloi, Zachary J. Resch, and Victor A. Del Bene. "35 The Effect of Diagnostic Method on Racial Disparities in Mild Cognitive Impairment and Dementia Diagnosis Using the NACC Database." Journal of the International Neuropsychological Society 29, s1 (November 2023): 909–10. http://dx.doi.org/10.1017/s1355617723011177.
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Objective:Population studies have shown that Black individuals are at higher risk for MCI and dementia than White individuals but are more likely to be underdiagnosed or misdiagnosed. Although multiple contributory factors have been identified in relation to neurocognitive diagnostic disparities among persons of color, few studies have investigated race-associated differences in MCI and dementia classification across diagnostic methods. The current study examined the agreement of cognitive classification made via semi-structured interview and neuropsychological assessment.Participants and Methods:Only participants assigned normal cognitive status or cognitive impairment with presumed Alzheimer’s etiology were included in the study. Baseline visit data in the National Alzheimer’s Coordinating Center (NACC) dataset was collected to compare correspondence of cognitive classification (normal cognition, MCI, dementia) via semi-structured interview (Clinical Dementia Rating; CDR) with formal NACC diagnostic determination. NACC diagnostic determination was further separated by single clinician and consensus diagnostic methods. Inter-rater agreement was evaluated using chi-squared tests, and respective analyses were stratified for race (Black vs White), ethnicity (Hispanic vs Non-Hispanic), and education (<12 years vs. >12 years).Results:The sample size included 4,739 Black and 26,393 White participants across 43 Alzheimer’s Disease Research Centers (ADRCs). Inter-rater analyses between CDR (semi-structured interview) versus single-clinician and formal consensus NACC diagnostic methods showed strong (all (pc>.70) consistency in cognitive diagnoses overall, irrespective of race, ethnicity, and education. The percentage of agreement between diagnostic methods was nearly 100% for those categorized as cognitively normal or with dementia. However, the agreement for MCI was considerably lower (ranging from 28-74%) and revealed a disparity in diagnostic method between Black and White individuals. White individuals diagnosed with MCI via CDR (CDR total =0.5) were more likely to be labeled as having dementia regardless of NACC diagnostic method. However, Black individuals diagnosed with MCI via CDR were equally likely to be diagnosed as cognitively normal or with dementia via the formal consensus method.Conclusions:Irrespective of race and other demographic variables, diagnostic methods had high agreement for groups labeled with normal cognition and dementia. Agreement was consistently lower for the group labeled with MCI, with Black individuals having greater variability in diagnostic differentials when diagnosed via formal consensus method. The results of the study suggest that neuropsychological assessment continues to be an integral component of diagnosing individuals with MCI, reducing possible sources of bias.
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Burke, Shanna L., Miriam J. Rodriguez, Warren Barker, Maria T. Greig-Custo, Monica Rosselli, David A. Loewenstein, and Ranjan Duara. "Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia." Journal of the International Neuropsychological Society 24, no. 2 (September 18, 2017): 176–87. http://dx.doi.org/10.1017/s1355617717000820.
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AbstractObjectives:The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity.Methods:Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group.Results:Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects.Conclusions:Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018,24, 176–187)
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Loving, Vilert A., Elizabeth M. Valencia, Bhavika Patel, and Brian S. Johnston. "The Role of Cognitive Bias in Breast Radiology Diagnostic and Judgment Errors." Journal of Breast Imaging 2, no. 4 (April 29, 2020): 382–89. http://dx.doi.org/10.1093/jbi/wbaa023.
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Abstract Cognitive bias is an unavoidable aspect of human decision-making. In breast radiology, these biases contribute to missed or erroneous diagnoses and mistaken judgments. This article introduces breast radiologists to eight cognitive biases commonly encountered in breast radiology: anchoring, availability, commission, confirmation, gambler’s fallacy, omission, satisfaction of search, and outcome. In addition to illustrative cases, this article offers suggestions for radiologists to better recognize and counteract these biases at the individual level and at the organizational level.
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Olson, Robert, Maureen Parkinson, and Michael McKenzie. "Selection Bias Introduced by Neuropsychological Assessments." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 37, no. 2 (March 2010): 264–68. http://dx.doi.org/10.1017/s0317167100010039.
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Objective:Two prospective studies in patient with brain tumours were performed comparing the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The first assessed their feasibility and the second compared their diagnostic accuracy against a four-hour neuropsychological assessment (NPA). The introduction of the NPA decreased accrual and retention rates. We were therefore concerned regarding potential selection bias.Methods:Ninety-two patients were prospectively accrued and subsequently divided into three categories: a) no NPA required b) withdrew consent to NPA c) completed NPA. In order to quantify any potential bias introduced by the NPA, patient demographics and cognitive test scores were compared between the three groups.Results:There were significant differences in age (p<0.001), education (p=0.034), dexamethasone use (p=0.002), MMSE (p=0.005), and MoCA scores (p<0.001) across the different study groups. Furthermore, with increasing involvement of the NPA, patients' cognitive scores and educational status increased, while their age, dexamethasone use, and opioid use all decreased. Individuals who completed the NPA had higher MoCA scores than individuals who were not asked to complete the NPA (24.7 vs. 20.5; p < 0.001). In addition, this relationship held when restricting the analyses to individuals with brain metastases (p < 0.001).Conclusions:In this study, the lengthy NPA chosen introduced a statistically and clinically significant source of selection bias. These results highlight the importance of selecting brief and well tolerated assessments when possible. However, researchers are challenged by weighing the improved selection bias associated with brief assessments at the cost of reduced diagnostic accuracy.
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Flaks, M. K., O. V. Forlenza, F. S. Pereira, L. F. Viola, and M. S. Yassuda. "Short Cognitive Performance Test: Diagnostic Accuracy and Education Bias in Older Brazilian Adults." Archives of Clinical Neuropsychology 24, no. 3 (May 1, 2009): 301–6. http://dx.doi.org/10.1093/arclin/acp033.
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Raza, Muhammad Waqas, Maria Zubair, Mailk Irfan Ahmed, and Rehan Ahmed Khan. "Cognitive disposition to respond in postgraduate trainees of general surgery at Rawalpindi Medical University." Journal of Rawalpindi Medical College 24, no. 3 (September 30, 2020): 240–44. http://dx.doi.org/10.37939/jrmc.v24i3.1373.
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Introduction: Cognitive biases leading to diagnostic errors are associate with adverse outcomes and compromise patient safety and contribute to morbidity and mortality. Exploration and identification of cognitive biases have been a difficult task for the clinicians and medical educators. The literature is deficient in the identification of cognitive biases in surgical trainees. The objective of the study was to identify various cognitive biases that may negatively impact clinical reasoning skills and lead to diagnostic errors in trainees of general surgery.
Materials and Methods: A quantitative study was conducted involving 48 trainees of general surgery to explore the various cognitive biases. The questionnaire was devised and consisted of ten items devised to explore five biases. .Descriptive statistical analysis was done on SPSS 20 and the respondents with score >25 were categorized as predisposed to error scores of 20-25 were taken as a borderline and overall score of <25 was insignificant for the presence of cognitive bias.
Results: Premature closure was the most frequent cognitive bias found significant in 34 (70 %) of trainees followed by anchoring bias in 14 (58, 3 %) trainees. The relative frequencies of different biases are shown in Table 2. The mean score of the questionnaire was 22.7 (range 10 to 38) SD 7.2. Ten out of forty-eight (21%) trainees with a mean score of >25 showed a clear inclination toward cognitive errors whereas 11 (22%) with a score in the range of 21 to 25 were categorized as having an equivocal tendency towards committing an error, Whereas 27 (56%) with a score of less than 20 were less prone to cognitive errors.
Conclusion: The two most common errors seen in the study were anchoring bias and premature closure and both are related to information gathering. A larger study is required to explore the association of cognitive bias with different specialties and experience of clinicians.
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Sherbino, J., S. Monteiro, J. Ilgen, E. Hayden, E. Howey, and G. Norman. "P139: How available is availability bias? Examining factors that influence diagnostic error." CJEM 20, S1 (May 2018): S106. http://dx.doi.org/10.1017/cem.2018.337.
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Introduction: Cognitive bias is often cited as an explanation for diagnostic errors. Of the numerous cognitive biases currently discussed in the literature, availability bias, defined as the current case reminds you of a recent similar example is most well-known. Despite the ubiquity of cognitive biases in medical and popular literature, there is surprisingly little evidence to substantiate these claims. The present study sought to measure the influence of availability bias and identify contributing factors that may increase susceptibility to the influence of a recent similar case. Methods: To investigate the role of prior examples and category priming on diagnostic error at different levels of expertise, we devised a 2 phase experiment. The experimental intervention was in a validation phase preceding the test, where participants were asked to verify a diagnosis which was either i) representative of Diagnosis A, and similar to a test case, ii) representative of Diagnosis A and dissimilar to a test case, iii) representative of Diagnosis B and similar to a test case. The test phase consisted of 8 written cases, each with two approximately equally likely diagnoses(A or B). Each participant verified 2 cases from each condition, for a total of 6. They then diagnosed all 8 test cases; the remaining 2 test cases had no prior example. All cases were counterbalanced across conditions. Comparison between Condition i) and ii) and no prior showed effect of prior exemplar; comparison between iii) and no prior showed effect of category priming. Because cases were designed so that both Diagnosis A and B were likely, overall accuracy was measured as the sum of proportion of cases in which either was selected. Subjects were emergency medicine staff (n=40), residents (n=39) and medical students (n=32) from McMaster University, University of Washington, and Harvard Medical School. Results: Overall, staff had an accuracy (A + B) of 98%, residents 98% and students 85% (F=35.6,p<.0001). For residents and staff there was no effect of condition (all mean accuracies 97% to 100%); for students there was a clear effect of category priming, with accuracy of 84% for i), 87% for ii) and 94% for iii) but only 73% for the no prime condition (Interaction F= 3.54, p<.002) Conclusion: Although prior research has shown substantial biasing effects of availability, primarily in cases requiring visual diagnosis, the present study has shown such effects only for novices (medical students). Possible explanations need to be explored. Nevertheless, our study shows that with increasing expertise, availability may not be a source of error.
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Tanwani, Rajiv, Mercy O. Danquah, Nina Butris, Aparna Saripella, Ellene Yan, Paras Kapoor, Marina Englesakis, et al. "Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant–A systematic review and meta-analysis." PLOS ONE 18, no. 9 (September 12, 2023): e0291291. http://dx.doi.org/10.1371/journal.pone.0291291.
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Background The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. Objectives To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. Methods/Design We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. Results A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of “Index test” and “reference standard”. Conclusions The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.
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Broomfield, Niall M., Andrew I. Gumley, and Colin A. Espie. "Candidate Cognitive Processes in Psychophysiologic Insomnia." Journal of Cognitive Psychotherapy 19, no. 1 (March 2005): 5–17. http://dx.doi.org/10.1891/jcop.19.1.5.66328.
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In this review, we begin by highlighting the lack of available evidence to support current diagnostic criteria for psychophysiologic insomnia. We then outline 3 new testable candidate cognitive processes in psychophysiologic insomnia: attention bias, sleep effort, and metacognitive beliefs. Each candidate element is carefully described. Evidence of involvement in insomnia maintenance is discussed based on the existing literature. The need for an experimental research agenda to examine the interplay of these candidate cognitive processes is then emphasized. Research ideas are presented throughout our discussions.
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Eichbaum, Quentin, Brian Adkins, Laura Craig-Owens, Donna Ferguson, Daniel Long, Aaron Shaver, and Charles Stratton. "Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error." Diagnosis 6, no. 3 (August 27, 2019): 249–57. http://dx.doi.org/10.1515/dx-2018-0089.
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Abstract Background Heuristics and cognitive biases are thought to play an important role in diagnostic medical error. How to systematically determine and capture these kinds of errors remains unclear. Morbidity and mortality rounds (MMRs) are generally focused on reducing medical error by identifying and correcting systems failures. However, they may also provide an educational platform for recognizing and raising awareness on cognitive errors. Methods A total of 49 MMR cases spanning the period 2008–2015 in our pathology department were examined for the presence of cognitive errors and/or systems failures by eight study participant raters who were trained on a subset of 16 of these MMR cases (excluded from the main study analysis) to identify such errors. The Delphi method was used to obtain group consensus on error classification on the remaining 33 study cases. Cases with <75% inter-rater agreement were subjected to subsequent rounds of Delphi analysis. Inter-rater agreement at each round was determined by Fleiss’ kappa values. Results Thirty-six percent of the cases presented at our pathology MMRs over an 8-year period were found to contain errors likely due to cognitive bias. Conclusions These data suggest that the errors identified in our pathology MMRs represent not only systems failures but may also be composed of a significant proportion of cognitive errors. Teaching trainees and health professionals to correctly identify different types of cognitive errors may present an opportunity for quality improvement interventions in the interests of patient safety.
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Fujimori, Taichi, Ryuichi Ohta, and Chiaki Sano. "Diagnostic Errors in Japanese Community Hospitals and Related Factors: A Retrospective Cohort Study." Healthcare 11, no. 11 (May 25, 2023): 1539. http://dx.doi.org/10.3390/healthcare11111539.
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Diagnostic error has recently become a crucial clinical problem and an area of intense research. However, the reality of diagnostic errors in regional hospitals remains unknown. This study aimed to clarify the reality of diagnostic errors in regional hospitals in Japan. A 10-month retrospective cohort study was conducted from January to October 2021 at the emergency room of Oda Municipal Hospital in central Shimane Prefecture, Japan. Participants were divided into groups with or without diagnostic errors, and independent variables of patient, physician, and environmental factors were analyzed using Fisher’s exact test, univariate (Student′s t-test and Welch’s t-test), and logistic regression analyses. Diagnostic errors accounted for 13.1% of all eligible cases. Remarkably, the proportion of patients treated without oxygen support and the proportion of male patients were significantly higher in the group with diagnostic errors. Sex bias was present. Additionally, cognitive bias, a major factor in diagnostic errors, may have occurred in patients who did not require oxygen support. Numerous factors contribute to diagnostic errors; however, it is important to understand the trends in the setting of each healthcare facility and plan and implement individualized countermeasures.
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Smith, Brent W., and Michael B. Slack. "The effect of cognitive debiasing training among family medicine residents." Diagnosis 2, no. 2 (June 1, 2015): 117–21. http://dx.doi.org/10.1515/dx-2015-0007.
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AbstractDebiasing education has been recommended for physicians in training. We report on the efficacy of a workshop designed to aid family medicine residents recognize and respond to their risk of misdiagnosis due to cognitive biases during patient care.Residents participated in a debiasing workshop in which they were taught to recognize and respond to cognitive biases likely to contribute to misdiagnosis. Metacognition was introduced and cognitive forcing strategies were demonstrated and practiced. While precepting clinic visits, attendings evaluated residents in the following areas: 1) diagnostic concordance between resident and attending, 2) ability of the resident to perceive their risk of cognitive bias, 3) the quality of the resident’s plan to mitigate this risk, and 4) the presence of an unrecognized cognitive bias. Pre and post workshop data were compared.Preceptor concurrence with the residents’ diagnoses was unchanged – 74% (63 of 85) vs. 78% (45 of 58, p=0.64). Residents’ ability to recognize their risk of cognitive bias was unchanged – 51% (43 of 85) vs. 57% (33 of 58, p=0.46). Residents’ formulation of an acceptable plan to mitigate the effect of cognitive bias increased from 84% (36 of 43) to 100% (33 of 33, p=0.02). Preceptors’ perception of an unrecognized cognitive bias in the residents’ presentation was unchanged – 12% (10 of 85) vs. 9% (5 of 58, p=0.55).A debiasing workshop for family medicine residents demonstrated improvement in one of four studied outcomes.
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Jeevakumar, Varshanie, Rebekah Sefton, Joyce Chan, Bamini Gopinath, Gerald Liew, Tejal M. Shah, and Joyce Siette. "Association between retinal markers and cognition in older adults: a systematic review." BMJ Open 12, no. 6 (June 2022): e054657. http://dx.doi.org/10.1136/bmjopen-2021-054657.
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ObjectivesTo appraise the existing literature reporting an association between retinal markers and cognitive impairment in adults aged 65 years and over and to provide directions for future use of retinal scanning as a potential tool for dementia diagnosis.DesignSystematic review of peer-reviewed empirical articles investigating the association of retinal markers in assessing cognitive impairment.Data sourcesThree electronic databases, Medline, PsycINFO and EMBASE were searched from inception until March 2022.Eligibility criteriaAll empirical articles in English investigating the association between retinal markers and cognition in humans aged ≥65 years using various retinal scanning methodologies were included. Studies with no explicit evaluation of retinal scanning and cognitive outcomes were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.Data extraction and synthesisData extraction was conducted by two authors (VJ, RS) and reviewed by another author (JS). Results were synthesised and described narratively.ResultsSixty-seven eligible studies examining 6815 older adults were included. Majority of studies were cross-sectional (n=60; 89.6%). Optical coherence tomography (OCT) was the most commonly used retinal scanning methodology to measure the thickness of retinal nerve fibre layer, the ganglion cell complex, choroid and macula. 51.1% of cross-sectional studies using OCT reported an association between the thinning of at least one retinal parameter and poor cognition. Longitudinal studies (n=6) using OCT also mostly identified significant reductions in retinal nerve fibre layer thickness with cognitive decline. Study quality was overall moderate.ConclusionRetinal nerve fibre layer thickness is linked with cognitive performance and therefore may have the potential to detect cognitive impairment in older adults. Further longitudinal studies are required to validate our synthesis and understand underlying mechanisms before recommending implementation of OCT as a dementia screening tool in clinical practice.PROSPERO registration numberCRD42020176757.
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Riordan, Patrick, Sandra L. Kletzel, Genessa Lahr, Jamie Walter, and Randi Wilson. "Directional Bias in Line Orientation Test Errors in Parkinson’s Disease." Archives of Clinical Neuropsychology 35, no. 6 (April 20, 2020): 683–91. http://dx.doi.org/10.1093/arclin/acaa020.
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Abstract Objective Value in evaluating error subtypes on visuospatial line orientation tests has been reported. Directional bias metrics for line orientation test errors represent easily quantifiable data that have not previously been studied. We evaluated whether patients with a clinical condition known to affect visuospatial functioning (Parkinson’s disease [PD]) exhibited unique directional error patterns on the RBANS Line Orientation test relative to other neuropsychology-referred patients. Method We compared overall directional bias in errors, directional bias by line location (left or right line and visual field), and absolute error rates (regardless of direction) by line location in a retrospective sample of patients with PD and a sample of neuropsychology-referred patients without PD. Groups were roughly matched on age, education, gender, and overall level of cognitive impairment. Results Patients with PD exhibited higher rates of leftward bias in errors, both overall and for the left stimulus line in each pair. Directional bias error scores better predicted PD versus non-PD group status than RBANS Line Orientation raw scores. Classification accuracy data for these variables were modest in the entire sample but stronger in a subsample of patients with mild levels of overall cognitive impairment. Conclusions Directional bias metrics for line orientation tests represent easily quantifiable data with potential theoretical and clinical value. In our sample, patients with PD made more left-biased line orientation errors than other neuropsychology-referred patients. By themselves, directional bias scores may have limited diagnostic potential, but they may be useful in diagnostic classification models and may have implications for clinical care.
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Morrison, Hamish D., Dafydd Morgan, Duncan J. McLauchlan, Catherine Clenaghan, and Anne E. Rosser. "Delayed diagnosis of spinal cord injuries in Huntington’s disease." Practical Neurology 21, no. 3 (February 4, 2021): 231–34. http://dx.doi.org/10.1136/practneurol-2020-002854.
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Huntington’s disease is a neurodegenerative disorder, characterised by progressive cognitive, motor and psychiatric symptoms. Patients with advanced disease presenting to emergency medical services can pose a diagnostic and management challenge for physicians unfamiliar with the condition. We describe two patients with Huntington’s disease in whom the diagnosis of traumatic spinal cord injury was delayed, discuss the role that cognitive bias and other factors played in this delay, and the lessons we can learn.
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Featherston, Rebecca Jean, Aron Shlonsky, Courtney Lewis, My-Linh Luong, Laura E. Downie, Adam P. Vogel, Catherine Granger, Bridget Hamilton, and Karyn Galvin. "Interventions to Mitigate Bias in Social Work Decision-Making: A Systematic Review." Research on Social Work Practice 29, no. 7 (December 23, 2018): 741–52. http://dx.doi.org/10.1177/1049731518819160.
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Purpose: This systematic review synthesized evidence supporting interventions aimed at mitigating cognitive bias associated with the decision-making of social work professionals. Methods: A systematic search was conducted within 10 social services and health-care databases. Review authors independently screened studies in duplicate against prespecified inclusion criteria, and two review authors undertook data extraction and quality assessment. Results: Four relevant studies were identified. Because these studies were too heterogeneous to conduct meta-analyses, results are reported narratively. Three studies focused on diagnostic decisions within mental health and one considered family reunification decisions. Two strategies were reportedly effective in mitigating error: a nomogram tool and a specially designed online training course. One study assessing a consider-the-opposite approach reported no effect on decision outcomes. Conclusions: Cognitive bias can impact the accuracy of clinical reasoning. This review highlights the need for research into cognitive bias mitigation within the context of social work practice decision-making.
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Coelho, Carlos Magalhães, Kullaya Pisitsungkagarn, Nattasuda Taephant, and Fernando Barbosa. "INSIGHT IN SPECIFIC PHOBIAS: A FORGOTTEN BIAS." Acta Neuropsychologica 15, no. 4 (December 13, 2017): 467–76. http://dx.doi.org/10.5604/01.3001.0010.7774.
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The term insight is a major concept in psychiatry, which nonetheless has a number of different connotations ranging from awareness of one’s disorder to achieving a clear and sudden solution of a problem or anosognosia. Although this concept is ubiquitous in the psychological literature, its definition is not clear, including in DSM-5; the most commonly used diagnostic system for mental disorders. This turns its use ambiguous, particularly for those who are not familiar with the historical background of the word. Here, we aim to a better understanding of insight in specific phobias and discuss the possible causes and implications in DSM-5 criterion changes. The historical analysis of this concept lead to conclude three main assumptions: 1) There are probably different etiopathogenic mechanisms subjacent to the deve lop ment of insight, anosognosia and possibly other “insight” related terms; 2) in the case of specific phobias, lack of insight is better seen and explained as a cognitive bias; 3) DSM use of an insight specifier for specific phobias could be of use; 4) lack of insight can be seen simply as a cognitive bias in most phobia cases.
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Abayomi, Simisola Naomi, Praveen Sritharan, Ellene Yan, Aparna Saripella, Yasmin Alhamdah, Marina Englesakis, Maria Carmela Tartaglia, David He, and Frances Chung. "The diagnostic accuracy of the Mini-Cog screening tool for the detection of cognitive impairment—A systematic review and meta-analysis." PLOS ONE 19, no. 3 (March 14, 2024): e0298686. http://dx.doi.org/10.1371/journal.pone.0298686.
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Background The Mini-Cog is a rapid screening tool that can be administered to older adults to detect cognitive impairment (CI); however, the accuracy of the Mini-Cog to detect CI for older patients in various healthcare settings is unclear. Objectives To evaluate the diagnostic accuracy of the Mini-Cog to screen for cognitive impairment in older patients across different healthcare settings. Methods/Design We searched nine electronic databases (including MEDLINE, Embase) from inception to January 2023. We included studies with patients ≥60 years old undergoing screening for cognitive impairment using the Mini-Cog across all healthcare settings. A cut-off of ≤ 2/5 was used to classify dementia, mild cognitive impairment (MCI), and cognitive impairment (defined as either MCI or dementia) across various settings. The diagnostic accuracy of the Mini-Cog was assessed against gold standard references such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). A bivariate random-effects model was used to estimate accuracy and diagnostic ability. The risk of bias was assessed using QUADAS-2 criteria. Results The systematic search resulted in 4,265 articles and 14 studies were included for analysis. To detect dementia (six studies, n = 4772), the Mini-Cog showed 76% sensitivity and 83% specificity. To detect MCI (two studies, n = 270), it showed 84% sensitivity and 79% specificity. To detect CI (eight studies, n = 2152), it had 67% sensitivity and 83% specificity. In the primary care setting, to detect either MCI, dementia, or CI (eight studies, n = 5620), the Mini-Cog demonstrated 73% sensitivity and 84% specificity. Within the secondary care setting (seven studies, n = 1499), the Mini-Cog to detect MCI, dementia or CI demonstrated 73% sensitivity and 76% specificity. A high or unclear risk of bias persisted in the patient selection and timing domain. Conclusions The Mini-Cog is a quick and freely available screening tool and has high sensitivity and specificity to screen for CI in older adults across various healthcare settings. It is a practical screening tool for use in time-sensitive and resource-limited healthcare settings.
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Uchevatkin, A. A., A. L. Yudin, N. I. Afanas'yeva, and E. A. Yumatova. "Shades of grey: how and why we make mistakes." Medical Visualization 24, no. 3 (October 10, 2020): 123–45. http://dx.doi.org/10.24835/1607-0763-2020-3-123-145.
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Purpose: to consider the epidemiology and classification of errors in radiologic diagnostics.Materials and methods. The analysis of articles devoted to elucidating the possible causes of diagnostic errors published before 2019 is carried out. A retrospective analysis of the research results revealed the most frequent cognitive biases affecting clinical decision making. Strategies have been developed to combat these distortions, which minimize the likelihood of errors.Discussion. Image analysis by doctors is a complex work based on a combination of psychophysiological and cognitive processes, which in itself is subject to a wide variety of errors, including perception errors (when pathological changes are simply skipped) and cognitive errors (those cases when pathological changes are detected visually but incorrectly interpreted). Although some of the changes in the radiation images may be skipped due to technical or physical limitations of the modality (resolution, signal-to-noise ratio, artifacts, etc.), most diagnostic discrepancies are associated with an incorrect interpretation of the findings by radiologists.Conclusions. Cognitive distortions can significantly affect the process of making diagnostic decisions, and lead to medical errors and negative consequences for patients. Various cognitive strategies and metacognitive practices can help minimize the impact of bias on decision making and reduce the frequency of diagnostic errors. Knowing one’s limitations and possibilities in interpreting radiation research, as well as understanding the role of the radiologist in the formation of the final diagnosis and, accordingly, in the fate of the patient, can lead to a more thoughtful analysis of images and clinical information and improve the quality of the diagnostic decision-making process.
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Chaves, Antônio Barbosa, Alexandre Sampaio Moura, Rosa Malena Delbone de Faria, and Ligia Cayres Ribeiro. "The use of deliberate reflection to reduce confirmation bias among orthopedic surgery residents." Scientia Medica 32, no. 1 (March 7, 2022): e42216. http://dx.doi.org/10.15448/1980-6108.2022.1.42216.
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Introduction: cognitive biases might affect decision-making processes such as clinical reasoning and confirmation bias is among the most important ones. The use of strategies that stimulate deliberate reflection during the diagnostic process seems to reduce availability bias, but its effect in reducing confirmation bias needs to be evaluated.Aims: to examine whether deliberate reflection reduces confirmation bias and increases the diagnostic accuracy of orthopedic residents solving written clinical cases.Methods: experimental study comparing the diagnostic accuracy of orthopedic residents in the resolution of eight written clinical cases containing a referral diagnosis. Half of the written cases had a wrong referral diagnosis. One group of residents used deliberate reflection (RG), which stimulates comparison and contrast of clinical hypotheses in a systematic manner, and a control group (CG), was asked to provide differential diagnoses with no further instruction. The study included 55 third-year orthopedic residents, 27 allocated to the RG and 28 to the CG.Results: residents on the RG had higher diagnostic scores than the CG for clinical cases with a correct referral diagnosis (62.0±20.1 vs. 49.1±21.0 respectively; p = 0.021). For clinical cases with incorrect referral diagnosis, diagnostic accuracy was similar between residents on the RG and those on the CG (39.8±24.3 vs. 44.6±26.7 respectively; p = 0.662). We observed an overall confirmation bias in 26.3% of initial diagnoses (non-analytic phase) and 19.5% of final diagnoses (analytic phase) when solving clinical cases with incorrect referral diagnosis. Residents from RG showed a reduction in confirmation of incorrect referral diagnosis when comparing the initial diagnosis given in the non-analytic phase with the one provided as the final diagnosis (25.9±17.7 vs. 17.6±18.1, respectively; Cohen d: 0.46; p = 0.003). In the CG, the reduction in the confirmation of incorrect diagnosis was not statistically significant.Conclusions: confirmation bias was present when residents solved written clinical cases with incorrect referral diagnoses, and deliberate reflection reduced such bias. Despite the reduction in confirmation bias, diagnostic accuracy of residents from the RG was similar to those from the CG when solving the set of clinical cases with a wrong referral diagnosis.
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Manzanares Tesón, N., M. Solé, M. J. Algora, A. Cabezas, and V. Sánchez-Gistau. "Cognitive biases in first psychotic episode with Attention deficit and hyperactivity disorder: a controlled study." European Psychiatry 65, S1 (June 2022): S204. http://dx.doi.org/10.1192/j.eurpsy.2022.535.
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Introduction Cognitive biases are a core feature of psychotic disorders. Moreover, people with first episode of psychosis (FEP) have more difficulties in social cognition, in particular in theory of mind. On the other hand, deficits in processing speed and distractibility appear to be core features of attention deficit hyperactivity disorder (ADHD) and impairment in these basic processes can lead to deficits in more complex functions, that could induced to cognitive biases. Objectives To evaluate whether FEP with and without ADHD differ in the rate and type of cognitive biases. Methods Participants 121 FEP treated at the Early Intervention Service of Reus and aged between 14 and 28 years. Instruments : The Diagnostic Interview for ADHD (DIVA) and the Cognitive Biases Questionnaire for Psychosis (CBQp) measuring 2 themes : anomalous perception (AP) and threatening events (TE) and 5 cognitive biases: Intentionalising (Int) , Catastrophising (Cat), Dichotomous thinking (DT), Jumping to conclusions (JTC) and Emotional reasoning (ER) Results 31 out 121 (25.6%) met criteria for childhood ADHD. Compared with FEP ADHD- , FEP-ADHD+ presented significant higher scores in the CBQp total score (U= 2.538 ; p=0.001), the AP theme (U=2.262; p=0.02) , the TE theme (U= 2.242 ; p=0.02) and DT bias ((U= 2.188 ; p=0.03) Conclusions Our findings support the fact that subjects with FEP-ADHD+ presented more cognitive biases than those ADHD-. So, FEP-ADHD+ subjects could represent a clinical subgroup with a worse prognosis than FEP-ADHD - subjects, presenting more delusions, distress and a worse cognitive insight. Disclosure No significant relationships.
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Chia, Doris X. Y., and Melvyn W. B. Zhang. "A Scoping Review of Cognitive Bias in Internet Addiction and Internet Gaming Disorders." International Journal of Environmental Research and Public Health 17, no. 1 (January 6, 2020): 373. http://dx.doi.org/10.3390/ijerph17010373.
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Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment.
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Shimizu, Taro, and Itiel E. Dror. "History information management strategy for minimising biases and noise for improved medical diagnosis." BMJ Open Quality 12, no. 3 (August 2023): e002367. http://dx.doi.org/10.1136/bmjoq-2023-002367.
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Despite measures for physicians’ excellence in diagnosis, the need for improvement of medical history techniques has been pointed out as one of the critical elements for improving diagnosis. Specific and proactive frameworks related to methods of effective history acquisition are needed to minimise bias and optimise decision-making. Therefore, this paper uses Linear Sequential Unmasking- Expanded to develop and propose a structured medical history acquisition strategy. The strength of this lies in its reliance on cognitive psychological processes. Breaking information gatherings and decisions into smaller tasks and ordering them correctly reduces cognitive load as well as minimises noise and bias cascade. Additionally, this approach can help physicians develop diagnostic expertise regardless of specialty.
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Sherbino, Jonathan, Kulamakan Kulasegaram, Elizabeth Howey, and Geoffrey Norman. "Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial." CJEM 16, no. 01 (January 2014): 34–40. http://dx.doi.org/10.2310/8000.2013.130860.
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ABSTRACT Objectives: Cognitive forcing strategies (CFS)may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students. Methods: Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). At the end of the rotation examination, students were tested using computer-based cases. Application of CFS could enable reduction of diagnostic error, as evidenced by identifying multiple correct diagnoses for the two cases prone to search satisficing bias (SSB) and uncommon diagnoses for the two cases prone to availability bias (AB). Two “false positive” cases were included to test for possible “oversearching.” Results: There were 145 students in the intervention and 46 in the control group. For the SSB cases, 52% of students with CFS training and 48% in the control group initiated a search for the second diagnosis (χ2 = 0.13, df = 1, p = 0.91). More than half (54%) correctly identified the second diagnosis in the CFS group, and 48% identified it in the control group. The difference was not significant (χ2 = 2.25, df = 1, p = 0.13). For the second diagnosis in the false positive cases, 64% of the CFS group and 77% of the control group incorrectly identified it. There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98). Conclusions: The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.
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Reilly, James B., Alexis R. Ogdie, Joan M. Von Feldt, and Jennifer S. Myers. "Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents." BMJ Quality & Safety 22, no. 12 (August 16, 2013): 1044–50. http://dx.doi.org/10.1136/bmjqs-2013-001987.
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Patel, Bhargav, Benjamin Jarrett, and Billie Bixby. "DIAGNOSTIC ERROR AND COGNITIVE BIAS IN THE ERA OF COVID-19: DON’T FORGET ABOUT ENDEMIC DISEASES." Chest 158, no. 4 (October 2020): A541—A542. http://dx.doi.org/10.1016/j.chest.2020.08.512.
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Bhatia, Triptish, Akhilesh Agarwal, Gyandeepak Shah, Joel Wood, Jan Richard, Raquel E. Gur, Ruben C. Gur, Vishwajit L. Nimgaonkar, Sati Mazumdar, and Smita N. Deshpande. "Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial." Acta Neuropsychiatrica 24, no. 2 (April 2012): 91–100. http://dx.doi.org/10.1111/j.1601-5215.2011.00587.x.
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Background:Yoga therapy (YT) improves cognitive function in healthy individuals, but its impact on cognitive function among persons with schizophrenia (SZ) has not been investigated.Objective:To evaluate the adjunctive YT for cognitive domains impaired in SZ.Methods:Patients with SZ received YT or treatment as usual (TAU;n= 65,n= 23, respectively). Accuracy and speed for seven cognitive domains were assessed using a computerised neurocognitive battery (CNB), thus minimising observer bias. Separately, YT was evaluated among patients with bipolar I disorder (n= 40), major depressive disorder (n= 37) and cardiology outpatients (n= 68). All patients also received routine pharmacotherapy. Patients were not randomised to YT or TAU.Results:In comparison with the SZ/TAU group, the SZ/YT group showed significantly greater improvement with regard to measures of attention following corrections for multiple comparisons; the changes were more prominent among the men. In the other diagnostic groups, differing patterns of improvements were noted with small-to-medium effect sizes.Conclusions:Our initial analyses suggest nominally significant improvement in cognitive function in SZ with adjunctive therapies such as YT. The magnitude of the change varies by cognitive domain and may also vary by diagnostic group.
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Sun, Ruifeng, Xiaoling Li, Ziman Zhu, Tiancong Li, Wenshan Li, Peiling Huang, and Weijun Gong. "Effects of Combined Cognitive and Exercise Interventions on Poststroke Cognitive Function: A Systematic Review and Meta-Analysis." BioMed Research International 2021 (November 17, 2021): 1–11. http://dx.doi.org/10.1155/2021/4558279.
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Objective. We investigated combined cognitive and exercise interventions in the literature and summarized their effectiveness in improving poststroke cognitive impairment (PSCI). Data Sources. Electronic databases and trial registries were searched from their inception until July 2020. Study Selection. Trials were collected with the following study inclusion criteria: (1) patients over 18 years of age who were diagnosed with PSCI; (2) combined cognitive-exercise interventions, regardless of the order of the two types of interventions or whether they were administered simultaneously; (3) any control group studied at the same time that was deemed acceptable, including no intervention/routine care, delayed intervention, sham intervention, and passive training; (4) the use of any validated cognitive neuropsychological test to evaluate cognitive function; and (5) clinically administered random trials with controls. Data Extraction. Five randomized controlled trials met the inclusion criteria. Two reviewers independently assessed the eligibility of the full texts and methodological quality of the included studies using the Cochrane risk of bias tool. Inconsistent results were resolved by additional discussion or decided by a third examiner, if necessary. Data Analysis. Meta-analysis demonstrated that the combined interventions had a significant effect on executive function and working memory [Stroop test (time), standardized mean difference SMD = 0.42 , 95% confidence interval (CI): 0.80–0.04, p = 0.02 ; Trail Making Test, SMD = 0.49 , 95% CI: 0.82–0.16, p = 0.004 ; Forward Digit Span Test, SMD = 0.91 , 95% CI: 0.54–1.29, p ≤ 0.001 ]. While it was impossible to conduct a meta-analysis of global cognitive function and other cognitive domains, individual experiments demonstrated that the combined interventions played a significant role in global cognition, reasoning ability, logical thinking, and visual-spatial memory function. Conclusions. Our analyses demonstrated that the combined interventions had a significant effect on the improvement of PSCI, particularly in terms of executive function. However, the moderate risk of bias in the included trials and the small number of relevant studies indicated a need for more uniform diagnostic and evaluation criteria, and larger trials would provide stronger evidence to better understand the effectiveness of the combined interventions. This trial is registered with trial registration number INPLASY202160090.
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Czerwinski-Alley, Natasha C., Tamara Chithiramohan, Hari Subramaniam, Lucy Beishon, and Elizabeta B. Mukaetova-Ladinska. "The Effect of Translation and Cultural Adaptations on Diagnostic Accuracy and Test Performance in Dementia Cognitive Screening Tools: A Systematic Review." Journal of Alzheimer's Disease Reports 8, no. 1 (April 8, 2024): 659–75. http://dx.doi.org/10.3233/adr-230198.
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Background: The current cognitive tests have been developed based on and standardized against Western constructs and normative data. With older people of minority ethnic background increasing across Western countries, there is a need for cognitive screening tests to address factors which influence performance bias and timely diagnostic dementia accuracy. The diagnostic accuracy in translated and culturally adapted cognitive screening tests and their impact on test performance in diverse populations have not been well addressed to date. Objective: This review aims to highlight considerations relating to the adaptation processes, language, cultural influences, impact of immigration, and level of education to assess for dementia in non-Western and/or non-English speaking populations. Methods: We conducted a systematic search for studies addressing the effects of translation and cultural adaptations of cognitive screening tests (developed in a Western context) upon their diagnostic accuracy and test performance across diverse populations. Four electronic databases and manual searches were conducted, using a predefined search strategy. A narrative synthesis of findings was conducted. Results: Search strategy yielded 2,890 articles, and seventeen studies (4,463 participants) met the inclusion criteria. There was variability in the sensitivity and specificity of cognitive tests, irrespective of whether they were translated only, culturally adapted only, or both. Cognitive test performance was affected by education, linguistic ability, and aspects of acculturation. Conclusions: We highlight the importance of translating and culturally adapting tests that have been developed in the Western context. However, these findings should be interpreted with caution as results varied due to the broad selection of included cognitive tests.
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Piguet, Olivier. "2022 ASSBI PRESIDENTIAL ADDRESS. Reflections on language and primary progressive aphasias." Brain Impairment 23, no. 3 (December 2022): 337–43. http://dx.doi.org/10.1017/brimp.2022.25.
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AbstractPrimary progressive aphasias are rare younger-onset dementias. As the label denotes, these dementias are characterised clinically by marked changes in language skills. Evidence over the years has shown that individuals with primary progressive aphasia experience widespread cognitive and behavioural changes that extend beyond language. This evidence, however, seems to be largely ignored or downplayed. This article proposes that linguistic relativity which induces a cognitive bias may be responsible for this omission; it also indicates that a revision of the current diagnostic criteria may need to be revised.
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Al-Khafaji, Jawad, Ryan F. Townsend, Whitney Townsend, Vineet Chopra, and Ashwin Gupta. "Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework." BMJ Open 12, no. 4 (April 2022): e058219. http://dx.doi.org/10.1136/bmjopen-2021-058219.
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ObjectivesTo apply a human factors framework to understand whether checklists reduce clinical diagnostic error have (1) gaps in composition; and (2) components that may be more likely to reduce errors.DesignSystematic review.Data sourcesPubMed, EMBASE, Scopus and Web of Science were searched through 15 February 2022.Eligibility criteriaAny article that included a clinical checklist aimed at improving the diagnostic process. Checklists were defined as any structured guide intended to elicit additional thinking regarding diagnosis.Data extraction and synthesisTwo authors independently reviewed and selected articles based on eligibility criteria. Each extracted unique checklist was independently characterised according to the well-established human factors framework: Systems Engineering Initiative for Patient Safety 2.0 (SEIPS 2.0). If reported, checklist efficacy in reducing diagnostic error (eg, diagnostic accuracy, number of errors or any patient-related outcomes) was outlined. Risk of study bias was independently evaluated using standardised quality assessment tools in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsA total of 30 articles containing 25 unique checklists were included. Checklists were characterised within the SEIPS 2.0 framework as follows: Work Systems subcomponents of Tasks (n=13), Persons (n=2) and Internal Environment (n=3); Processes subcomponents of Cognitive (n=20) and Social and Behavioural (n=2); and Outcomes subcomponents of Professional (n=2). Other subcomponents, such as External Environment or Patient outcomes, were not addressed. Fourteen checklists examined effect on diagnostic outcomes: seven demonstrated improvement, six were without improvement and one demonstrated mixed results. Importantly, Tasks-oriented studies more often demonstrated error reduction (n=5/7) than those addressing the Cognitive process (n=4/10).ConclusionsMost diagnostic checklists incorporated few human factors components. Checklists addressing the SEIPS 2.0 Tasks subcomponent were more often associated with a reduction in diagnostic errors. Studies examining less explored subcomponents and emphasis on Tasks, rather than the Cognitive subcomponents, may be warranted to prevent diagnostic errors.
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Altabbaa, Ghazwan, Amanda D. Raven, and Jason Laberge. "A simulation-based approach to training in heuristic clinical decision-making." Diagnosis 6, no. 2 (June 26, 2019): 91–99. http://dx.doi.org/10.1515/dx-2018-0084.
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Abstract Background Cognitive biases may negatively impact clinical decision-making. The dynamic nature of a simulation environment can facilitate heuristic decision-making which can serve as a teaching opportunity. Methods Momentum bias, confirmation bias, playing-the-odds bias, and order-effect bias were integrated into four simulation scenarios. Clinical simulation educators and human factors specialists designed a script of events during scenarios to trigger heuristic decision-making. Debriefing included the exploration of frames (mental models) resulting in the observed actions, as well as a discussion of specific bias-prone frames and bias-resistant frames. Simulation sessions and debriefings were coded to measure the occurrence of bias, recovery from biased decision-making, and effectiveness of debriefings. Results Twenty medical residents and 18 medical students participated in the study. Twenty pairs (of one medical student and one resident) and two individuals (medical residents alone) completed a simulation session. Evidence of bias was observed in 11 of 20 (55%) sessions. While most participant pairs were able to avoid or recover from the anticipated bias, there were three sessions with no recovery. Evaluation of debriefings showed exploration of frames in all the participant pairs. Establishing new bias-resistant frames occurred more often when the learners experienced the bias. Conclusions Instructional design using experiential learning can focus learner attention on the specific elements of diagnostic decision-making. Using scenario design and debriefing enabled trainees to experience and analyze their own cognitive biases.
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Petrova-Antonova, Dessislava, Ivaylo Spasov, Yanita Petkova, Ilina Manova, and Sylvia Ilieva. "CogniSoft: A Platform for the Automation of Cognitive Assessment and Rehabilitation of Multiple Sclerosis." Computers 9, no. 4 (November 16, 2020): 93. http://dx.doi.org/10.3390/computers9040093.
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Cognitive disorders remain a major cause of disability in Multiple Sclerosis (MS). They lead to unemployment, the need for daily assistance, and a poor quality of life. The understanding of the origin, factors, processes, and consequences of cognitive disfunction is key to its prevention, early diagnosis, and rehabilitation. The neuropsychological testing and continuous monitoring of cognitive status as part of the overall evaluation of patients with MS in parallel with clinical and paraclinical examinations are highly recommended. In order to improve health and disease understanding, a close linkage between fundamental, clinical, epidemiological, and socio-economic research is required. The effective sharing of data, standardized data processing, and the linkage of such data with large-scale cohort studies is a prerequisite for the translation of research findings into the clinical setting. In this context, this paper proposes a software platform for the cognitive assessment and rehabilitation of patients with MS called CogniSoft. The platform automates the Beck Depression Inventory (BDI-II) test and diagnostic tests for the evaluation of memory and executive functions based on the nature of Brief International Cognitive Assessment for MS (BICAMS), as well as implementing a set of games for cognitive rehabilitation based on BICAMS. The software architecture, core modules, and technologies used for their implementation are presented. Special attention is given to the development of cognitive tests for diagnostics and rehabilitation. Their automation enables better perception, avoids bias as a result of conducting the classic paper tests of various neurophysiologists, provides easy administration, and allows data collection in a uniform manner, which further enables analysis using statistical and machine learning algorithms. The CogniSoft platform is registered as medical software by the Bulgarian Drug Agency and it is currently deployed in the Neurological Clinic of the National Hospital of Cardiology in Sofia, Bulgaria. The first experiments prove the feasibility of the platform, showing that it saves time and financial resources while providing subjectivity in the interpretation of the cognitive test results.
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Papuda-Dolińska, Beata, Tomasz Knopik, Grażyna Krasowicz-Kupis, and Katarzyna Wiejak. "The Psychological Assessment of Students with Developmental Needs – Universal Design Approach." International Journal of Special Education (IJSE) 38, no. 3 (December 29, 2023): 47–59. http://dx.doi.org/10.52291/ijse.2023.38.38.
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The purpose of this article is to present the application of the universal design model in the broad field of psychological assessment for education, covering the area of creating diagnostic tools as well as designing the process of assessment. A universally designed diagnostic tool enables fair and valid assessments of a wide range of users, including individuals with special educational needs. It also helps prevent bias in test scoring and interpretation and, at the same time, enables fairness in test use. The authors present the synthesis of the guidelines concerning the design of universal diagnostic tools and the diagnostic process itself at four key levels: conceptual, formal, test administration, and interpretative. As an example of a universally designed tool, the Comprehensive Analysis of Cognitive Processes (KAPP) has been mentioned. Discussion includes the benefits and limitations of applying the idea of universal design to psychological assessment with an emphasis on test development.
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Evans, Mavis, and Pat Mottram. "Diagnosis of depression in elderly patients." Advances in Psychiatric Treatment 6, no. 1 (January 2000): 49–56. http://dx.doi.org/10.1192/apt.6.1.49.
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Depression in old age is a pathological process, not a normal reaction to growing older. The majority of people cope with ageing, and many feel happy and fulfilled. However, there is a bias among health professionals and the community in general to accept lower functioning and more symptoms in older people (Alexopoulos, 1992). Depression tends to be denied by the current generation of elderly people, many of whom were raised in an atmosphere where showing feelings was discouraged, and this adds to diagnostic difficulties. Comorbid medical conditions, the tendency of patients to somatise, cognitive deterioration, and multiple life events, often of loss (e.g. bereavement, retirement, moving to smaller housing), all further complicate the diagnostic process.
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Scully, Aileen Eugenia, Edwin Choon Wyn Lim, Pei Pei Teow, and Dawn May Leng Tan. "A systematic review of the diagnostic utility of simple tests of change after trial removal of cerebrospinal fluid in adults with normal pressure hydrocephalus." Clinical Rehabilitation 32, no. 7 (March 7, 2018): 942–53. http://dx.doi.org/10.1177/0269215518760126.
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Objective: To synthesize the evidence regarding the diagnostic value of simple ancillary tests post cerebrospinal fluid drainage in normal pressure hydrocephalus. Data sources: MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Cochrane library databases; last searched on 12 September 2017. Review methods: This review was performed applying the steps of the PRISMA statement. The QUADAS 2 tool was used to assess the risk of bias. Prospective and retrospective trials were systematically reviewed, and data on diagnostic accuracy were extracted. Meta-analysis (where possible) was performed. Hierarchical summary receiver operating characteristic package was used to calculate pooled estimates of included diagnostic studies. Results: Seventeen trials (with 812 subjects in total) were identified for inclusion in the meta-analyses for the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test. The summary estimates of sensitivity and specificity for the 18-meter walk test was 0.83 (95% CI 0.57 to 0.99) and 0.67 (95% CI 0.33 to 0.95), video-recorded gait performance was 0.85 (95% CI 0.47 to 0.99) and 0.68 (95% CI 0.33 to 0.96), cognitive test was 0.82 (95% CI 0.41–0.99) and 0.75 (95% CI 0.39–0.99), and Timed Up and Go Test was 0.89 (95% CI 0.79–0.95) and 0.63 (95% CI 0.24–0.90), respectively. Conclusion: This review highlights the diagnostic value of the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test in predicting shunt outcomes among adults with normal pressure hydrocephalus.
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Shahmirzadi, Niloufar, and Hamid Marashi. "Cognitive diagnostic assessment of reading comprehension for high- stakes tests: Using GDINA model." Language Testing in Focus: An International Journal 8 (September 2023): 1–16. http://dx.doi.org/10.32038/ltf.2023.08.01.
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Cognitive diagnostic assessment (CDA) is used to study cognitive and educational psychology, and designed to diagnose the underlying abilities of test takers in comprehension language skills such as reading comprehension. Through applying CDA, a test has undergone accurate studies to remove biased test items which yield great impact on individuals, educational systems and societies. In this case, psychometric statistical analyses were applied, Differential Attribute Functioning (DAF)) was also used to detect the probability of the mastery of attributes among test takers, and Differential Item Functioning (DIF) was estimated to show item performance among different candidates in terms of gender, their GPAs in BA, and MA degrees. The randomly selected participants of this study were 7,420 females and males sitting for the nationwide PhD admission test to pursue their education in Applied Linguistics. Moreover, a Q-matrix was developed, data were fed into R studio software, and the Generalized Deterministic Inputs, Noisy “and” Gate (GDINA) model was run. The results of the study flagged large DIF in gender group in 2019; and in gender, BA, and MA groups in 2020. In sum, this study is an attempt to raise the awareness of test developers to shed light on the critical discursive sources of inequity and bias. The implication of this study can provide pedagogically useful diagnostic information for test designers and teachers since a proficiency test needs to be valid, reliable, and fair in the context of high-stakes tests so that it would lead to positive changes.
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McKenzie, Craig R. M. "Increased sensitivity to differentially diagnostic answers using familiar materials: Implications for confirmation bias." Memory & Cognition 34, no. 3 (April 2006): 577–88. http://dx.doi.org/10.3758/bf03193581.
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Burke, Robert E., Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, and S. Ryan Greysen. "Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility." Journal of Hospital Medicine 15, no. 01 (August 21, 2019): 22–27. http://dx.doi.org/10.12788/hm.3273.
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BACKGROUND: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions. OBJECTIVE: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases. DESIGN: Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians. SETTING: Three hospitals and three SNFs in a single metropolitan area. PATIENTS: Adults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings. MEASUREMENTS: We identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases. RESULTS: Authority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs. CONCLUSIONS: Cognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.
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Burke, Robert E., Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, and S. Ryan Greysen. "Cognitive Biases Influence Decision‐Making Regarding Postacute Care in a Skilled Nursing Facility." Journal of Hospital Medicine 15, no. 1 (August 21, 2019): 22–27. http://dx.doi.org/10.12788/jhm.3273.
Full textAbstract:
BACKGROUNDDecisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions.OBJECTIVETo understand whether cognitive biases play an important role in patient and clinician decision‐making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases.DESIGNSecondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians.SETTINGThree hospitals and three SNFs in a single metropolitan area.PATIENTSAdults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings.MEASUREMENTSWe identified potential cognitive biases from prior systematic and narrative reviews and conducted a team‐based framework analysis of interview transcripts to identify potential biases.RESULTSAuthority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision‐making about SNFs.CONCLUSIONSCognitive biases play an important role in decision‐making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high‐quality decisions consistent with their goals.
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Moro, Bruna L. P., Tatiane F. Novaes, Laura R. A. Pontes, Thais Gimenez, Juan S. Lara, Daniela P. Raggio, Mariana M. Braga, and Fausto M. Mendes. "The Influence of Cognitive Bias on Caries Lesion Detection in Preschool Children." Caries Research 52, no. 5 (2018): 420–28. http://dx.doi.org/10.1159/000485807.
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We aimed to evaluate whether children’s caries experience exerts an influence on the performance of visual and radiographic methods in detecting nonevident proximal caries lesions in primary molars. Eighty children (3–6 years old) were selected and classified as having a lower (≤3 decayed, missing, or filled surfaces; dmf-s) or higher (> 3 dmf-s) caries experience. Two calibrated examiners then assessed 526 proximal surfaces for caries lesions using visual and radiographic methods. As a reference standard, 2 other examiners checked the surfaces after temporary separation. Noncavitated and cavitated lesion thresholds were considered and Poisson multilevel regression analyses were conducted to evaluate the influence of caries experience on the performance of diagnostic strategies. Accuracy parameters stratified by caries experience were also derived. A statistically significant influence of caries experience was observed only for visual inspection, with more false-positive results in children with a higher caries experience at the noncavitated lesion threshold, and more false results at the cavitated threshold. The detection of noncavitated caries lesions in children with a higher caries experience was overestimated (specificity = 0.696), compared to children with a lower caries experience (specificity = 0.918), probably due to confirmation bias. However, the examiners underestimated the detection of cavitated lesions in children with a higher caries experience (sensitivity = 0.143) compared to lower-caries-experience children (sensitivity = 0.222), possibly because of representativeness bias. The radiographic method was not influenced by children’s caries experience. In conclusion, children’s caries experience influences the performance of visual inspection in detecting proximal caries lesions in primary teeth, evidencing the occurrence of cognitive biases.
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Waters, A. M., B. P. Bradley, and K. Mogg. "Biased attention to threat in paediatric anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, separation anxiety disorder) as a function of ‘distress’versus‘fear’ diagnostic categorization." Psychological Medicine 44, no. 3 (April 17, 2013): 607–16. http://dx.doi.org/10.1017/s0033291713000779.
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BackgroundStructural models of emotional disorders propose that anxiety disorders can be classified into fear and distress disorders. Sources of evidence for this distinction come from genetic, self-report and neurophysiological data from adults. The present study examined whether this distinction relates to cognitive processes, indexed by attention bias towards threat, which is thought to cause and maintain anxiety disorders.MethodDiagnostic and attention bias data were analysed from 435 children between 5 and 13 years of age; 158 had principal fear disorder (specific phobia, social phobia or separation anxiety disorder), 75 had principal distress disorder (generalized anxiety disorder, GAD) and 202 had no psychiatric disorder. Anxious children were a clinic-based treatment-seeking sample. Attention bias was assessed on a visual-probe task with angry, neutral and happy faces.ResultsCompared to healthy controls, children with principal distress disorder (GAD) showed a significant bias towards threat relative to neutral faces whereas children with principal fear disorder showed an attention bias away from threat relative to neutral faces. Overall, children displayed an attention bias towards happy faces, irrespective of diagnostic group.ConclusionsOur findings support the distinction between fear and distress disorders, and extend empirically derived structural models of emotional disorders to threat processing in childhood, when many anxiety disorders begin and predict lifetime impairment.
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Singh, Harpreet, Sanjay Kumar, Michael Pilling, and Alfred Veldhuis. "Investigating neural basis of biased attention to self-relevant information in depression." Cognitive Psychology Bulletin 1, no. 9 (January 30, 2024): 68–71. http://dx.doi.org/10.53841/bpscog.2024.1.9.68.
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This study examines the neural basis of attentional bias toward self-relevant information in depression. Using EEG data and a lateralised image task, we investigate the N2PC response around 200ms after stimulus onset, providing insights into early attentional processes. Our analysis aims to distinguish differences in self-referential processing between depressed and nondepressed individuals, potentially offering a diagnostic tool for depression based on EEG data. Data collection began in September 2023, supported by a grant from the BPS Cognitive Psychology Section.
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Johnson, Katie, Donald Chris Derauf, Raymond Stetson, Paul Galardy, and Jason Homme. "Keeping an Open Mind: Cognitive Bias in the Evaluation of an Infant with Posterior-Lateral Rib Fractures." Case Reports in Pediatrics 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/5163094.
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A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma.