Seidel Bastian M, Campbell Steven, Bell Erica
Wicking Dementia Education and Research Centre, University of Tasmania, Hobart, TAS, 7001, Australia.
School of Health Sciences, University of Tasmania, Launceston, TAS, 7250, Australia.
BMC Med Inform Decis Mak. 2015 Mar 21;15:19. doi: 10.1186/s12911-015-0136-8.
Better understanding of clinical reasoning could reduce diagnostic error linked to 8% of adverse medical events and 30% of malpractice cases. To a greater extent than the evidence-based movement, the clinical reasoning literature asserts the importance of practitioner intuition—unconscious elements of diagnostic reasoning. The study aimed to analyse the content of case report summaries in ways that explored the importance of an evidence concept, not only in relation to research literature but also intuition.
The study sample comprised all 789,712 abstracts in English for case reports contained in the database PUBMED for the period 1 January 1983 to 31 December 2012. It was hypothesised that, if evidence and intuition concepts were viewed by these clinical authors as essential to understanding their case reports, they would be more likely to be found in the abstracts. Computational linguistics software was used in 1) concept mapping of 21,631,481 instances of 201 concepts, and 2) specific concept analyses examining 200 paired co-occurrences for 'evidence' and research 'literature' concepts.
'Evidence' is a fundamentally patient-centred, intuitive concept linked to less common concepts about underlying processes, suspected disease mechanisms and diagnostic hunches. In contrast, the use of research literature in clinical reasoning is linked to more common reasoning concepts about specific knowledge and descriptions or presenting features of cases. 'Literature' is by far the most dominant concept, increasing in relevance since 2003, with an overall relevance of 13% versus 5% for 'evidence' which has remained static.
The fact that the least present types of reasoning concepts relate to diagnostic hunches to do with underlying processes, such as what is suspected, raises questions about whether intuitive practitioner evidence-making, found in a constellation of dynamic, process concepts, has become less important. The study adds support to the existing corpus of research on clinical reasoning, by suggesting that intuition involves a complex constellation of concepts important to how the construct of evidence is understood. The list of concepts the study generated offers a basis for reflection on the nature of evidence in diagnostic reasoning and the importance of intuition to that reasoning.
更好地理解临床推理可以减少与8%的不良医疗事件和30%的医疗事故相关的诊断错误。与循证医学运动相比，临床推理文献更强调从业者直觉（诊断推理中的无意识因素）的重要性。本研究旨在通过探索证据概念的重要性来分析病例报告摘要的内容，这种重要性不仅体现在与研究文献的关系上，还体现在与直觉的关系上。
研究样本包括数据库PUBMED中1983年1月1日至2012年12月31日期间所有789,712篇英文病例报告摘要。假设如果这些临床作者认为证据和直觉概念对于理解他们的病例报告至关重要，那么它们在摘要中出现的可能性会更高。使用计算语言学软件进行了两项操作：一是对201个概念的21,631,481个实例进行概念映射，二是对“证据”和研究“文献”概念的200对共现情况进行特定概念分析。
“证据”本质上是以患者为中心的直觉概念，与关于潜在过程、疑似疾病机制和诊断直觉的不太常见的概念相关。相比之下，临床推理中研究文献的使用与关于特定知识以及病例描述或呈现特征的更常见推理概念相关。“文献”是迄今为止最主要的概念，自2003年以来相关性不断增加，总体相关性为13%，而“证据”的相关性一直保持在5%且未变。
最少出现的推理概念类型与关于潜在过程的诊断直觉（如所怀疑的内容）相关，这引发了一个问题，即在一系列动态的过程概念中发现的从业者直觉性证据形成是否变得不那么重要。该研究为临床推理的现有研究提供了支持，表明直觉涉及对证据构建理解至关重要的一系列复杂概念。该研究所生成的概念列表为反思诊断推理中证据本质以及直觉对该推理的重要性提供了基础。
