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Purpose: Assessing expertise using psychometric models usually yields a measure of ability that is difficult to generalize to the complexity of diagnoses in clinical practice. However, using an item response modeling framework, it is possible to create a decision-aligned response model that captures a clinician's decision-making behavior on a continuous scale that fully represents competing diagnostic possibilities. In this proof-of-concept study, the authors demonstrate the necessary statistical conceptualization of this model using a specific electrocardiogram (ECG) example.
Method: The authors collected a range of ECGs with elevated ST segments due to either ST-elevation myocardial infarction (STEMI) or pericarditis. Based on pilot data, 20 ECGs were chosen to represent a continuum from "definitely STEMI" to "definitely pericarditis," including intermediate cases in which the diagnosis was intentionally unclear. Emergency medicine and cardiology physicians rated these ECGs on a 5-point scale ("definitely STEMI" to "definitely pericarditis"). The authors analyzed these ratings using a graded response model showing the degree to which each participant could separate the ECGs along the diagnostic continuum. The authors compared these metrics with the discharge diagnoses noted on chart review.
Results: Thirty-seven participants rated the ECGs. As desired, the ECGs represented a range of phenotypes, including cases where participants were uncertain in their diagnosis. The response model showed that participants varied both in their propensity to diagnose one condition over another and in where they placed the thresholds between the 5 diagnostic categories. The most capable participants were able to meaningfully use all categories, with precise thresholds between categories.
Conclusions: The authors present a decision-aligned response model that demonstrates the confusability of a particular ECG and the skill with which a clinician can distinguish 2 diagnoses along a continuum of confusability. These results have broad implications for testing and for learning to manage uncertainty in diagnosis.
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http://dx.doi.org/10.1097/ACM.0000000000004918 | DOI Listing |
ACS Appl Mater Interfaces
December 2024
Centre for Nanotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India.
Copper-based sulfides are attractive candidates for NIR I and II responsive photothermal therapy but often suffer from high hydrophobicity, suboptimal photothermal conversion, and poor biostability and biocompatibility. In the present work, a rapid, one-pot synthesis method was developed to obtain Au-doped CuS (ACSH NDs) dual plasmonic nanodots. ACSH NDs exhibit excellent peroxidase-like catalytic activity for pH-responsive OH radical generation along with efficient glutathione depletion under tumor microenvironment mimicking conditions.
View Article and Find Full Text PDFPsychedelic Med (New Rochelle)
December 2024
Departments of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Introduction: Psychedelic-induced experiences are thought to play an important role in the therapeutic actions of rapid-acting antidepressants. General anesthesia is one scenario in which patients can be rendered unconscious and masked to the psychedelic treatment, providing a simple yet effective method to examine drug-induced changes in the brain devoid of experiences.
Methods: Chronically stressed adult C57/BL6 male mice were given subhypnotic ketamine alone or ketamine and GABAergic anesthetic isoflurane at sedative (0.
Front Public Health
December 2024
Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States.
Objective: Individuals with Limited English Proficiency (LEP), including Spanish-preferred patients, face healthcare challenges due to language barriers. Despite the potential of digital health technologies to improve access and outcomes, there is a "digital divide" with underutilization among vulnerable populations, including Spanish-speaking LEP individuals, highlighting a need for increased understanding and equitable digital health solutions.
Materials And Methods: A multi-mode, multi-language cross-sectional survey was built based on the Technology Acceptance Model and deployed from a multi-state healthcare practice.
Regen Ther
March 2025
Department of Neurorehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China.
Spinal cord ischemia/reperfusion (IR) injury (SCII) can cause major autonomic, sensory, and motor damage and loss. The upregulation of Nrf2, a primary orchestrator of the oxidative stress response, has beneficial effects in SCII. Here, we aimed to uncover a SCII-related transcription factor that is able to elevate Nrf2 expression.
View Article and Find Full Text PDFMol Ther Nucleic Acids
December 2024
Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
There is an urgent need for agents that promote health and regeneration of cells and tissues, specifically to treat diseases of the aging nervous system. Age-associated nervous system degeneration and various diseases are driven by many different biochemical stresses, often making it difficult to target any one disease cause. Our laboratory has previously identified DNA aptamers with apparent regenerative properties in murine models of multiple sclerosis by selecting aptamers that bind oligodendrocyte membrane preparations.
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