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2015 ; 15
(ä): 19
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Evidence in clinical reasoning: a computational linguistics analysis of 789,712
medical case summaries 1983-2012
#MMPMID25880840
Seidel BM
; Campbell S
; Bell E
BMC Med Inform Decis Mak
2015[Mar]; 15
(ä): 19
PMID25880840
show ga
BACKGROUND: 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. METHODS: 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. RESULTS: '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. CONCLUSIONS: 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.