The relationship between time to diagnose and diagnostic accuracy among internal medicine residents: a randomized experiment.

BACKGROUND: Diagnostic errors have been attributed to cognitive biases (reasoning shortcuts), which are thought to result from fast reasoning. Suggested solutions include slowing down the reasoning process. However, slower reasoning is not necessarily more accurate than faster reasoning. In this study, we studied the relationship between time to diagnose and diagnostic accuracy. METHODS: We conducted a multi-center within-subjects experiment where we prospectively induced availability bias (using Mamede et al.'s methodology) in 117 internal medicine residents. Subsequently, residents diagnosed cases that resembled those bias cases but had another correct diagnosis. We determined whether residents were correct, incorrect due to bias (i.e. they provided the diagnosis induced by availability bias) or due to other causes (i.e. they provided another incorrect diagnosis) and compared time to diagnose. RESULTS: We did not successfully induce bias: no significant effect of availability bias was found. Therefore, we compared correct diagnoses to all incorrect diagnoses. Residents reached correct diagnoses faster than incorrect diagnoses (115 s vs. 129 s, p < .001). Exploratory analyses of cases where bias was induced showed a trend of time to diagnose for bias diagnoses to be more similar to correct diagnoses (115 s vs 115 s, p = .971) than to other errors (115 s vs 136 s, p = .082). CONCLUSIONS: We showed that correct diagnoses were made faster than incorrect diagnoses, even within subjects. Errors due to availability bias may be different: exploratory analyses suggest a trend that biased cases were diagnosed faster than incorrect diagnoses. The hypothesis that fast reasoning leads to diagnostic errors should be revisited, but more research into the characteristics of cognitive biases is important because they may be different from other causes of diagnostic errors.

Spatial variability in size at maturity of golden king crab (Lithodes aequispinus) and implications for fisheries management.

Many crab fisheries around the world are managed by size, sex and season, where males are given at least one opportunity to reproduce before being harvested. Golden king crab (Lithodes aequispinus) supports a commercial fishery in Southeast Alaska and legal size is based on growth and maturity information from other parts of their range. Size-at-maturity estimates varied for crabs among seven management areas in Southeast Alaska, where male maturity estimates increased in size with increases in latitude, while maturity estimates across their North Pacific range decreased in size with increases in latitude. Depth, temperature and harvest history were not related to variation observed in male maturity estimates. Management implications from this research include reducing legal size in some areas to maximize harvest potential and increasing in others to allow male crabs the opportunity to reproduce before being harvested. A more conservative strategy would incorporate the largest maturity estimate, thus increasing the legal size which would have a negative impact to the commercial fishery, but allow male crabs the opportunity to reproduce before being harvested. This study shows the importance of understanding how life-history characteristics change over space and the challenge incorporating spatial variability for improved fisheries management.

Clinical comparison of high-speed rare-earth screen and par-speed screen for diagnostic efficacy and radiation dosage.

One hundred patients underwent excretory urography and a comparison was made of ten-minute, well-collimated images that were obtained with both par-speed and rare-earth screens, the latter being 6.5 times faster than the par-speed calcium tungstate screens. Radiation dose was greatly reduced with the rare-earth screens. There were fewer inferior examinations, even though fine detail was imaged poorly, and there was a slightly increased quantum mottle, which was only a minor problem at this low 65 kVp. Since quantum mottle increases with kVp, however, our results are not applicable to higher kVp examinations. Despite reduced detail and increased mottle, the overall image quality obtained with the rare-earth screen was superior to the image quality obtained with the par-speed screen.

Chemical effects of alkali on polymethylmethacrylate intraocular lenses.

Polymethylmethacrylate intraocular lenses were left in 10% NaOH or 10% KOH for various periods of time. Contact angles were unaltered and electron spectroscopy for chemical analysis was unchanged. This concentration of alkali does not appear to chemically change the lens surface during the study period.

Radiation exposure to the pediatric patient during cardiac catheterization and angiocardiography. Emphasis on the thyroid gland.

Thermoluminescent dosimetry was used to measure the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocardiography using cine photofluorography. Average exposures were 17.1 R to the skin, 2.3 R to the thyroid and 0.1 R to the gonads. Fluoroscopy accounted for approximately 80% of the skin and thyroid exposure and cine photofluorography for 20-25%. Occasional primary-beam irradiation was the major contributor to gonad exposure. Internal scatter of the incident x-ray beam was primarily responsible for thyroid exposure, so that infants received relatively high exposures; one receiving 7.3 R. The thyroid was not frequently in the primary beam. The significance of high radiation exposure to the thyroid, and in particular its relationship to thyroid carcinoma, are discussed. The results are compared with other series in the literature and relative exposures of cine photofluorography and serial filming are contrasted.