School of Medicine, University of São Paulo and LIM 01-HCMFMUSP, Dr, Arnaldo 455, 01246-903, São Paulo, Brazil.
BMC Neurosci. 2013 Oct 1;14:109. doi: 10.1186/1471-2202-14-109.
Despite new brain imaging techniques that have improved the study of the underlying processes of human decision-making, to the best of our knowledge, there have been very few studies that have attempted to investigate brain activity during medical diagnostic processing. We investigated brain electroencephalography (EEG) activity associated with diagnostic decision-making in the realm of veterinary medicine using X-rays as a fundamental auxiliary test. EEG signals were analysed using Principal Components (PCA) and Logistic Regression Analysis
The principal component analysis revealed three patterns that accounted for 85% of the total variance in the EEG activity recorded while veterinary doctors read a clinical history, examined an X-ray image pertinent to a medical case, and selected among alternative diagnostic hypotheses. Two of these patterns are proposed to be associated with visual processing and the executive control of the task. The other two patterns are proposed to be related to the reasoning process that occurs during diagnostic decision-making.
PCA analysis was successful in disclosing the different patterns of brain activity associated with hypothesis triggering and handling (pattern P1); identification uncertainty and prevalence assessment (pattern P3), and hypothesis plausibility calculation (pattern P2); Logistic regression analysis was successful in disclosing the brain activity associated with clinical reasoning success, and together with regression analysis showed that clinical practice reorganizes the neural circuits supporting clinical reasoning.
尽管新的脑成像技术提高了人类决策背后过程的研究,但据我们所知,很少有研究试图调查医学诊断过程中的大脑活动。我们使用 X 射线作为基本辅助测试,研究了兽医领域中与诊断决策相关的大脑脑电图(EEG)活动。使用主成分(PCA)和逻辑回归分析对 EEG 信号进行了分析。
主成分分析揭示了三个模式,占记录脑电图活动总方差的 85%,这些模式与兽医阅读临床病史、检查与医疗案例相关的 X 射线图像以及在替代诊断假设中选择时的活动有关。其中两个模式被认为与视觉处理和任务的执行控制有关。另外两个模式被认为与诊断决策过程中发生的推理过程有关。
PCA 分析成功揭示了与假设触发和处理(模式 P1)、识别不确定性和流行评估(模式 P3)以及假设可信度计算(模式 P2)相关的不同大脑活动模式。逻辑回归分析成功揭示了与临床推理成功相关的大脑活动,并且与回归分析一起表明,临床实践重新组织了支持临床推理的神经回路。