Clinical decision making – choosing between intuition, experience and scientific evidence

Nalliah, Romesh

doi:10.1038/sj.bdj.2016.942

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…It shows a high level of complexity due to the expectations of the patient, and the contemplations the health care professional must make in selecting a treatment that is not only effective, but additionally maximizes benefits and health-related quality of life of the patient while minimizing risks. Often the construction of a decision selecting a definite treatment option may be linked to empirical principles or experiences of the dentist, which explains why dental education or training affects the treatment choices of oral healthcare professionals [ 28 ]. This effect may arise from differences in the diagnosis or identification of certain conditions [ 29 ], the preferred decisions to treat these conditions according to the dentist’s awareness of the risks and progression of the disease, as well as the most appropriate procedure applied for treatment [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

Conrad

Retelsdorf

Attia

et al. 2020

IJERPH

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Currently, there is no standard treatment protocol for apical periodontitis (AP). Thus, restorable teeth might get extracted and replaced prosthetically. This study evaluated German dentists’ preferred AP treatment decisions and the influencing factors for selecting tooth retention by initial/repeated surgical/non-surgical root-canal treatment (RCT) or extraction with/without prosthetic replacement. Through an online-survey, participants (n = 260) rated different treatment options for four case scenarios with AP in anterior/posterior teeth without/with previous RCT. Statistical analysis included the Friedman test for intra-case comparisons and Chi-squared test for factor-associations (p ≤ 0.05). Tooth retention using initial/repeated RCT was ranked first in all scenarios and rated as (very) appropriate by most participants, while implant-supported crowns (ISC) and apicoectomy had the second ratings. ISC were preferred more on posterior teeth or previous root-canal-treated teeth. Rating levels of treatment options displayed significant differences for all case scenarios. Posterior tooth retention by RCT demonstrated a significant association with work experience. Tooth retention with previous RCT displayed a significant correlation with dentists’ privately insured patients. Most dentists preferred tooth preserving with initial/repeated RCT, while others selected non-evidence-based choices. This reflects a lack of consensus of AP treatment decisions in Germany. Fixed treatment guidelines and further evaluation of treatment–decision-correlated factors are recommended for correct treatment planning.

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Section: Discussionmentioning

confidence: 99%

German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

Conrad

Retelsdorf

Attia

et al. 2020

IJERPH

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“…Intra-operatively, the decision-making process occurs irrespective of the surgical skills. It takes approximately five years for a new surgeon to adjust to care according to nuances at all stages [ 41 ]. The older surgeon may “read the game”, and will intuitively understand when to play the winners, possibly from a recollection of similar scenarios; an extrapolation of its sport analogy [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Surgical Effort Using Explainable Artificial Intelligence in Advanced Stage Epithelial Ovarian Cancer

Laios

Kalampokis

Johnson

et al. 2022

Cancers

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(1) Background: Surgical cytoreduction for epithelial ovarian cancer (EOC) is a complex procedure. Encompassed within the performance skills to achieve surgical precision, intra-operative surgical decision-making remains a core feature. The use of eXplainable Artificial Intelligence (XAI) could potentially interpret the influence of human factors on the surgical effort for the cytoreductive outcome in question; (2) Methods: The retrospective cohort study evaluated 560 consecutive EOC patients who underwent cytoreductive surgery between January 2014 and December 2019 in a single public institution. The eXtreme Gradient Boosting (XGBoost) and Deep Neural Network (DNN) algorithms were employed to develop the predictive model, including patient- and operation-specific features, and novel features reflecting human factors in surgical heuristics. The precision, recall, F1 score, and area under curve (AUC) were compared between both training algorithms. The SHapley Additive exPlanations (SHAP) framework was used to provide global and local explainability for the predictive model; (3) Results: A surgical complexity score (SCS) cut-off value of five was calculated using a Receiver Operator Characteristic (ROC) curve, above which the probability of incomplete cytoreduction was more likely (area under the curve [AUC] = 0.644; 95% confidence interval [CI] = 0.598–0.69; sensitivity and specificity 34.1%, 86.5%, respectively; p = 0.000). The XGBoost outperformed the DNN assessment for the prediction of the above threshold surgical effort outcome (AUC = 0.77; 95% [CI] 0.69–0.85; p < 0.05 vs. AUC 0.739; 95% [CI] 0.655–0.823; p < 0.95). We identified “turning points” that demonstrated a clear preference towards above the given cut-off level of surgical effort; in consultant surgeons with <12 years of experience, age <53 years old, who, when attempting primary cytoreductive surgery, recorded the presence of ascites, an Intraoperative Mapping of Ovarian Cancer score >4, and a Peritoneal Carcinomatosis Index >7, in a surgical environment with the optimization of infrastructural support. (4) Conclusions: Using XAI, we explain how intra-operative decisions may consider human factors during EOC cytoreduction alongside factual knowledge, to maximize the magnitude of the selected trade-off in effort. XAI techniques are critical for a better understanding of Artificial Intelligence frameworks, and to enhance their incorporation in medical applications.

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“…According to Albert Einstein said that the rational brain is a faithful servant and the intuitive brain is a sacred gift. But, the society that has been created more honours the servant and forgotten the gift itself [17], [18] In fact, the social and educational environment more emphasized in the rational brain rather than intuitive brain as a noble gift.…”

Section: B Intuitive Brainmentioning

confidence: 99%

Rational Brain Transmutation Into Intuitive Brain Based on Neuroscience in Islamic Education

Shalihin¹,

Suyadi²,

Yusmaliana³

et al. 2021

Proceedings of the 2nd EAI Bukittinggi International Conference on Education, BICED 2020, 14 September, 2020, Bukititinggi, Wes

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The brain is one of the ultimate power and complicated operating systems work as a united and integrated area. Nevertheless, Islamic education study focused solely on logical, rational, and empirical brain processes. Besides, the brain also has the power of intuitive thinking whereas current findings show that intuition in the form of holistic can be superior for some reasons. In fact, people with this capability develop and retain their intuitive brain as important roles in strategic making decisions. Unfortunately, the typical type for both rational and intuitive brain has been separated and splitted personality in Islamic education study. Consequently, a logical person would be highly appreciated than an intuitive person. In this study, the researchers analyzed the rational and intuitive brain based on scientific models qualitative way, in the form of literacy research. The research results showed that the transmutation from rational to the intuitive brain through the point of fatigue to the Higher Order Thinking (C4-C6), SOLO Taxonomy, and Marzano's Taxonomy.

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Clinical decision making – choosing between intuition, experience and scientific evidence

Cited by 15 publications

References 33 publications

German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

Factors Predicting Surgical Effort Using Explainable Artificial Intelligence in Advanced Stage Epithelial Ovarian Cancer

Rational Brain Transmutation Into Intuitive Brain Based on Neuroscience in Islamic Education

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