Algorithms in medical decision-making and in everyday life: what's the difference?

Algorithms are a ubiquitous part of modern life. Despite being a component of medicine since early efforts to deploy computers in medicine, clinicians' resistance to using decision support and use algorithms to address cognitive biases has been limited. This resistance is not just limited to the use of algorithmic clinical decision support, but also evidence and stochastic reasoning and the implications of the forcing function of the electronic medical record.

Student Perceptions of a New Course Using Argumentation in Medical Education.

Purpose: Critical thinking and the ability to engage with others of differing views in a civil manner is essential to the practice of medicine. A new format for medical student education ("Argue-to-Learn") that uses staged debates followed by small group discussions was introduced into the curriculum of first year medical school at the Penn State College of Medicine. The goal was to create a structured environment for spirited, civil discourse, and to encourage students to think critically about clinically controversial topics.

Clinician-Scientist Faculty Mentoring Program (FAME) - A New Inclusive Training Model at Penn State Increases Scholarly Productivity and Extramural Grant Funding.

Purpose: Clinician-scientists have a high attrition rate at the junior-faculty level, before they gain independent funding. We identified the lack of skill set, clinician-scientist community and collaboration between clinician-scientists and clinicians with predominantly clinical duties, as key problems in our medium-size college of medicine.

Methods: We designed a novel two-year educational program, the Clinician-scientist Faculty Mentoring program (FAME) specifically to target junior clinician-scientists.

Controversies in Hypertension II: The Optimal Target Blood Pressure.

The optimal target blood pressure in the treatment of hypertension is undefined. Whether more intense therapy is better than standard, typically <140/90 mm Hg, is controversial. The most recent American guidelines recommend ≤130/80 mm Hg for essentially all adults.

Association Between Baseline Diastolic Blood Pressure and the Efficacy of Intensive vs Standard Blood Pressure-Lowering Therapy.

Importance: Low diastolic blood pressure (DBP) has been found to be associated with increased adverse cardiovascular events; however, it is unknown whether intensifying blood pressure therapy in patients with an already low DBP to achieve a lower systolic blood pressure (SBP) target is safe or effective.

Objective: To evaluate whether there is an association of baseline DBP and intensification of blood pressure-lowering therapy with the outcomes of all-cause death and cardiovascular events.

Design, Setting, And Participants: This cohort study analyzed patients who were randomized to intensive or standard BP control in the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial and Systolic Blood Pressure Intervention Trial (SPRINT).

Building a System to Engage and Sustain Research Careers for Physicians.

There are increasing needs for physician-investigators to translate the rapid expansion of knowledge, technology/interventions, and big data into the clinical realm at a time of increasing age-related disabilities and communicable diseases. Yet, the number of physician-investigators has continued to decline, and only a small number of medical school graduates in the United States are actively engaged in research. This problem may be particularly pronounced in small- and medium-sized academic institutions due to more limited educational and mentoring infrastructure.

Competition for limited neural resources in older adults leads to greater asymmetry of bilateral movements than in young adults.

We previously demonstrated that lateralization in the neural control of predictive and impedance mechanisms is reflected by interlimb differences in control of bilateral tasks. Aging has been shown to reduce lateralization during unilateral performance, presumably due to greater recruitment of the ipsilateral hemisphere. We now hypothesize that aging-related reduction in the efficiency of neural resources should produce greater behavioral asymmetry during bilateral actions that require hemispheric specialization for each arm.

Campylobacter culture fails to correctly detect Campylobacter in 30% of positive patient stool specimens compared to non-cultural methods.

Campylobacter diagnosis is hampered because many laboratories continue to use traditional stool culture, which is slow and suffers false-negative results. This large multi-site study used a composite reference method consisting of a new FDA-cleared immunoassay and four molecular techniques to compare to culture. Prospectively collected patient fecal specimens (1552) were first preliminarily categorized as positive or negative by traditional culture.

Handedness results from complementary hemispheric dominance, not global hemispheric dominance: evidence from mechanically coupled bilateral movements.

Two contrasting views of handedness can be described as 1) complementary dominance, in which each hemisphere is specialized for different aspects of motor control, and 2) global dominance, in which the hemisphere contralateral to the dominant arm is specialized for all aspects of motor control. The present study sought to determine which motor lateralization hypothesis best predicts motor performance during common bilateral task of stabilizing an object (e.g.

Characteristics of early acute respiratory distress syndrome in newly diagnosed acute myeloid leukemia.

Acute respiratory complications occur frequently during the early phase of acute myeloid leukemia (AML) but information on the most severe form, acute respiratory distress syndrome (ARDS), is lacking. We retrospectively analyzed 280 patients with newly diagnosed AML in order to describe the incidence, risk factors and early mortality associated with ARDS within 15 d. Univariate and then multivariate analysis were performed.

STAT3 mediates C6-ceramide-induced cell death in chronic lymphocytic leukemia.

The pathogenesis of chronic lymphocytic leukemia (CLL) is poorly understood and it remains incurable with current therapies. We have previously shown that nanoliposomal C6-ceramide (CNL) is an effective therapy in an murine model of CLL. However, the key signaling pathways mediating CNL-induced cell death in CLL remains unknown.

Survival Outcomes Following the Use of Extracorporeal Membrane Oxygenation as a Rescue Technology in Critically Ill Patients: Results From Pennsylvania 2007-2015.

Objective: To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade.

Design: Retrospective analysis of administrative discharge data.

Setting: State-wide administrative discharge data from Pennsylvania between 2007 and 2015.

Effect of leukapheresis on blood coagulation in patients with hyperleukocytic acute myeloid leukemia.

Introduction: Leukapheresis has been proposed to reduce white blood cell (WBC) count in hyperleukocytic acute myeloid leukemia (AML). However, no survival benefit has been proven and leukapheresis can potentially affect coagulation and worsen bleeding and disseminated intravascular coagulation (DIC). We analyzed the effect of leukapheresis on coagulation tests in a cohort of hyperleukocytic AML patients.

Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia: A retrospective cohort study of 73 patients.

Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce.We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100 × 10/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms.Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission.

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Background: Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis.

Methods: A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 × 10(9) cells/L and had ABGs performed.

Initial respiratory status in hyperleukocytic acute myeloid leukemia: prognostic significance and effect of leukapheresis.

This study investigated whether initial respiratory status in hyperleukocytic acute myeloid leukemia (AML), as defined by oxygen/ventilatory support, is (1) associated with early mortality and overall survival and (2) improved after leukapheresis. A retrospective chart review of 89 patients requiring leukapheresis was performed. White blood cell count (WBC) decreased from 153 (56-475) × 10(9)/L to 60 (17-259) × 10(9)/L after first leukapheresis (p < 0.

Handedness can be explained by a serial hybrid control scheme.

Our previous studies on healthy individuals and stroke patients led us to propose that the dominant and nondominant arms are specialized for distinct motor control processes. We hypothesize that the dominant arm is specialized for predictive control of limb dynamics, and the nondominant arm is specialized for impedance control. We previously introduced a hybrid control scheme to explain lateralization of single-joint elbow movements.

Limb dominance results from asymmetries in predictive and impedance control mechanisms.

Handedness is a pronounced feature of human motor behavior, yet the underlying neural mechanisms remain unclear. We hypothesize that motor lateralization results from asymmetries in predictive control of task dynamics and in control of limb impedance. To test this hypothesis, we present an experiment with two different force field environments, a field with a predictable magnitude that varies with the square of velocity, and a field with a less predictable magnitude that varies linearly with velocity.

Bioterrorism: a laboratory who does it?

In October 2001, the first disseminated biological warfare attack was perpetrated on American soil. Initially, a few clinical microbiology laboratories were testing specimens from acutely ill patients and also being asked to test nasal swabs from the potentially exposed. Soon after, a significant number of clinical microbiology and public health laboratories received similar requests to test the worried well or evaluate potentially contaminated mail or environmental materials, sometimes from their own break rooms.

Imaging approach to the cord T2 hyperintensity (myelopathy).

In clinically suspected cases of myelopathy, magnetic resonance imaging without and with gadolinium remains the modality of choice. The first and best imaging approach in the evaluation of myelopathy is to identify whether the cause of myelopathy is compressive or noncompressive. The commonest imaging finding in myelopathy is either focal or diffuse cord hyperintensity on the T2-weighted magnetic resonance images.

Neuroimaging of vascular dementia.

When atrophy is seen on imaging in adult patients, it does not necessarily represent Alzheimer disease. Many cases of dementia or cognitive decline could be caused by reversible or preventable diseases, such as vascular dementia. This article familiarizes the physician with various types of vascular lesions leading to dementia and cognitive decline and their imaging appearances.

A pattern approach to focal white matter hyperintensities on magnetic resonance imaging.

Evaluation of focal white matter hyperintensities on magnetic resonance imaging in any age group is always challenging because the cause of these hyperintensities varies extensively. Understanding the clinical presentation, pathophysiology, and associated imaging findings can allow the radiologist to limit the differential diagnosis. A specific imaging approach including age, pattern of distribution, signal characteristics on various sequences, enhancement pattern, and other ancillary findings helps to identify a correct cause for these hyperintensities.