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Diagnostic Strategy in Medicine: Aiming for the Technological Singularity in Diagnostic Excellence

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (9 July 2023) | Viewed by 12314

Special Issue Editor


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Guest Editor
Diagnostic and Generalist Medicine, Dokkyo Medical University Graduate School of Medicine, Tochigi, 321-0293 Japan
Interests: diagnostic strategy; clinical reasoning; diagnostic error; medical education
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is the second edition of “Diagnostic Strategy in Medicine in the Era of Digital Assistance and Machine Learning”.

https://www.mdpi.com/journal/ijerph/special_issues/DSMEDAML

Diagnosis is one of the essential parts of clinical expertise in medicine. The mastery of diagnostic (clinical) reasoning is a crucial mission of physicians who practice medicine since ascertaining the correct diagnosis is vital to proper treatment and the health management of patients. The Institute of Medicine concluded that diagnostic error occurs in nearly every patient throughout their lifetime. The phenomena are observed in any clinical setting, ranging from rural to urban, clinic to a tertiary hospital, and community to university. Today, physicians can enjoy digital assistance and the support of artificial intelligence in daily clinical practices. These cutting-edge technologies allow us to access the needed information swiftly and ultimately uncover hidden or unknown diagnoses. These “artificial” systems are seemingly powerful tools in diagnosis, but they have their disadvantages. For example, they may often be designed not to work independently, specifically to utilize information from external input acquired by human medical professionals.

It is reasonable to say that it is very challenging for the digital system to obtain subtle signs and history information because every patient has a unique history, background, and personality. On obtaining a clinical history and physical examination, physicians should account for a patient’s clinical context, perception of symptoms, and potentially hidden complaints or signs which are not apparent through routine data gathering methods. Identifying and eliciting case-by-case information can be a hurdle for statistical patterns induced by current machine learning systems. The other disadvantage of artificial intelligence is that machine learning systems replace humans’ intuitive diagnostic processes. Dual processing theory (DPT) has been the leading theory in humans’ diagnostic decision making, which comprises an intuitive process (system 1) and analytical process (system 2). Machine learning is categorized as part of system 2, and human clinical reasoning covers both systems 1 and 2. At present, this system is considered to be the most widely accepted way of thinking about the human diagnostic process. For learning and practicing diagnostic thinking, the diagnostic thinking principle, known as “diagnostic strategy (DS),” has been advocated and clinically applied among frontline physicians internationally. This strategy is designed for humans and can be installed in digital systems, augmenting diagnostic accuracy. In this manner, humans and machines can collaborate and establish better diagnostic outcomes.

The term “technological singularity” has been used since the book The Singularity is Near by Raymond Kurzweil was published in 1998. Initially, the term “singularity” is used to describe infinite sizes, and this term was applied to the development of AI, advocated by a statistician named IJ Good.

Kurzweil defined the year 2045 as the point of technological singularity. The singularity would imply unimaginable social changes, leading to the unpredictable change in the scene of diagnosis. However, in the field of diagnosis, the day occurs at a more distant point in time. This phenomenon is because the medical diagnosis process is a highly complicated field involving human cognitive psychology and situational factors, which act as a barrier that the singularity will take a little longer to adopt. In any case, the turning point will undoubtedly come. The singularity does not come naturally but is achieved through human and technological progress. Therefore, we need to guide evolution in a better direction while guaranteeing the augmentation of humans and technology.

In this Special Issue, authors report the current concept and scope of humans’ diagnostic thinking systems and diagnostic systems with a wide range of technology, elucidating future perspectives for augmentation between both systems.

Dr. Taro Shimizu
Guest Editor

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Keywords

  • diagnostic strategy
  • clinical reasoning
  • diagnostic error
  • artificial intelligence
  • machine learning
  • deep learning
  • medical education
  • pivot and cluster strategy

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Published Papers (4 papers)

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Research

12 pages, 1222 KiB  
Article
Intra-Oral Photograph Analysis for Gingivitis Screening in Orthodontic Patients
by Han-Na Kim, Kyuseok Kim and Youngjin Lee
Int. J. Environ. Res. Public Health 2023, 20(4), 3705; https://doi.org/10.3390/ijerph20043705 - 19 Feb 2023
Cited by 5 | Viewed by 3005
Abstract
This study aimed to confirm the presence of gingival inflammation through image analysis of the papillary gingiva using intra-oral photographs (IOPs) before and after orthodontic treatment and to confirm the possibility of using gingival image analysis for gingivitis screening. Five hundred and eighty-eight [...] Read more.
This study aimed to confirm the presence of gingival inflammation through image analysis of the papillary gingiva using intra-oral photographs (IOPs) before and after orthodontic treatment and to confirm the possibility of using gingival image analysis for gingivitis screening. Five hundred and eighty-eight (n  =  588) gingival sites from the IOPs of 98 patients were included. Twenty-five participants who had completed their orthodontic treatments and were aged between 20 and 37 were included. Six points on the papillary gingiva were selected in the maxillary and mandibular anterior incisors. The red/green (R/G) ratio values were obtained for the selected gingival images and the modified gingival index (GI) was compared. The change in the R/G values during the orthodontic treatment period appeared in the order of before orthodontic treatment (BO), mid-point of orthodontic treatment (MO), three-quarters of the way through orthodontic treatment (TO), and immediately after debonding (IDO), confirming that it was similar to the change in the GI. The R/G value of the gingiva in the image correlated with the GI. Therefore, it could be used as a major index for gingivitis diagnosis using images. Full article
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11 pages, 3597 KiB  
Article
Improvement of Ultrasound Image Quality Using Non-Local Means Noise-Reduction Approach for Precise Quality Control and Accurate Diagnosis of Thyroid Nodules
by Kyuseok Kim, Nuri Chon, Hyun-Woo Jeong and Youngjin Lee
Int. J. Environ. Res. Public Health 2022, 19(21), 13743; https://doi.org/10.3390/ijerph192113743 - 22 Oct 2022
Cited by 4 | Viewed by 2230
Abstract
This study aimed to improve the quality of ultrasound images by modeling an algorithm using a non-local means (NLM) noise-reduction approach to achieve precise quality control and accurate diagnosis of thyroid nodules. An ATS-539 multipurpose phantom was used to scan the dynamic range [...] Read more.
This study aimed to improve the quality of ultrasound images by modeling an algorithm using a non-local means (NLM) noise-reduction approach to achieve precise quality control and accurate diagnosis of thyroid nodules. An ATS-539 multipurpose phantom was used to scan the dynamic range and gray-scale measurement regions, which are most closely related to the noise level. A convex-type 3.5-MHz frequency probe is used for scanning according to ATS regulations. In addition, ultrasound images of human thyroid nodules were obtained using a linear probe. An algorithm based on the NLM noise-reduction approach was modeled based on the intensity and relative distance of adjacent pixels in the image, and conventional filtering methods for image quality improvement were designed as a comparison group. When the NLM algorithm was applied to the image, the contrast-to-noise ratio and coefficient of variation values improved by 28.62% and 19.54 times, respectively, compared with those of the noisy images. In addition, the image improvement efficiency of the NLM algorithm was superior to that of conventional filtering methods. Finally, the applicability of the NLM algorithm to human thyroid images using a high-frequency linear probe was validated. We demonstrated the efficiency of the proposed algorithm in ultrasound images and the possibility of capturing improved images in the dynamic range and gray-scale region for quality control parameters. Full article
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20 pages, 3429 KiB  
Article
Evaluation of a Single-Channel EEG-Based Sleep Staging Algorithm
by Shanguang Zhao, Fangfang Long, Xin Wei, Xiaoli Ni, Hui Wang and Bokun Wei
Int. J. Environ. Res. Public Health 2022, 19(5), 2845; https://doi.org/10.3390/ijerph19052845 - 1 Mar 2022
Cited by 14 | Viewed by 3270
Abstract
Sleep staging is the basis of sleep assessment and plays a crucial role in the early diagnosis and intervention of sleep disorders. Manual sleep staging by a specialist is time-consuming and is influenced by subjective factors. Moreover, some automatic sleep staging algorithms are [...] Read more.
Sleep staging is the basis of sleep assessment and plays a crucial role in the early diagnosis and intervention of sleep disorders. Manual sleep staging by a specialist is time-consuming and is influenced by subjective factors. Moreover, some automatic sleep staging algorithms are complex and inaccurate. The paper proposes a single-channel EEG-based sleep staging method that provides reliable technical support for diagnosing sleep problems. In this study, 59 features were extracted from three aspects: time domain, frequency domain, and nonlinear indexes based on single-channel EEG data. Support vector machine, neural network, decision tree, and random forest classifier were used to classify sleep stages automatically. The results reveal that the random forest classifier has the best sleep staging performance among the four algorithms. The recognition rate of the Wake phase was the highest, at 92.13%, and that of the N1 phase was the lowest, at 73.46%, with an average accuracy of 83.61%. The embedded method was adopted for feature filtering. The results of sleep staging of the 11-dimensional features after filtering show that the random forest model achieved 83.51% staging accuracy under the condition of reduced feature dimensions, and the coincidence rate with the use of all features for sleep staging was 94.85%. Our study confirms the robustness of the random forest model in sleep staging, which also represents a high classification accuracy with appropriate classifier algorithms, even using single-channel EEG data. This study provides a new direction for the portability of clinical EEG monitoring. Full article
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8 pages, 544 KiB  
Article
Bandemia as an Early Predictive Marker of Bacteremia: A Retrospective Cohort Study
by Taku Harada, Yukinori Harada, Kohei Morinaga, Takanobu Hirosawa and Taro Shimizu
Int. J. Environ. Res. Public Health 2022, 19(4), 2275; https://doi.org/10.3390/ijerph19042275 - 17 Feb 2022
Cited by 5 | Viewed by 2855
Abstract
This single-center retrospective observational study aimed to verify whether a diagnosis of bandemia could be a predictive marker for bacteremia. We assessed 970 consecutive patients (median age 73 years; male 64.8%) who underwent two or more sets of blood cultures between April 2015 [...] Read more.
This single-center retrospective observational study aimed to verify whether a diagnosis of bandemia could be a predictive marker for bacteremia. We assessed 970 consecutive patients (median age 73 years; male 64.8%) who underwent two or more sets of blood cultures between April 2015 and March 2016 in both inpatient and outpatient settings. We assessed the value of bandemia (band count > 10%) and the percentage band count for predicting bacteremia using logistic regression models. Bandemia was detected in 151 cases (15.6%) and bacteremia was detected in 188 cases (19.4%). The incidence of bacteremia was significantly higher in cases with bandemia (52.3% vs. 13.3%; odds ratio (OR) = 7.15; 95% confidence interval (CI) 4.91–10.5). The sensitivity and specificity of bandemia for predicting bacteremia were 0.42 and 0.91, respectively. The bandemia was retained as an independent predictive factor for the multivariable logistic regression model (OR, 6.13; 95% CI, 4.02–9.40). Bandemia is useful for establishing the risk of bacteremia, regardless of the care setting (inpatient or outpatient), with a demonstrable relationship between increased risk and bacteremia. A bandemia-based electronic alert for blood-culture collection may contribute to the improved diagnosis of bacteremia. Full article
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