In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

Vitamin B12 deficiency.

BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)

Supplement to: Time to treatment and mortality during mandated emergency care for sepsis.

Open Artificial Intelligence (AI) published an AI chatbot tool called ChatGPT at the end of November 2022. Generative Pre-trained Transformer (GPT) architecture is the foundation of ChatGPT. On the internet, ChatGPT has been rapidly growing. This chatbot enables users to discuss with the AI by inputting prompts, and it is based on OpenAI’s language model. Although ChatGPT is fantastic and produces exciting results for writing tales, poetry, songs, essays, and other things, it has certain restrictions. Users may ask the bot questions, and it will reply with pertinent, convincing subjects and replies. ChatGPT has now risen to the top of several academic agendas. Administrators create task teams and hold institution-wide meetings to react to the tools, with most of the advice being to adopt this technology. This paper briefs about the ChatGPT and its need. Further, various Progressive Work Flow Processes of the ChatGPT Tool are stated diagrammatically. Specific features and capabilities of the ChatGPT Support System are studied in this paper. Finally, we identified and discussed the significant roles of ChatGPT in the current scenario. The neural language models that form the foundation of character AI have been developed from the bottom up with talks in mind. This technology implies that the programme uses deep learning methods to analyse and produce text. The model “understands” the subtleties of human-produced natural language using vast amounts of data from the internet. 

An era of ChatGPT as a significant futuristic support tool: A study on features, abilities, and challenges

Contemporary theories of clinical reasoning espouse a dual processing model, which consists of a rapid, intuitive component (Type 1) and a slower, logical and analytical component (Type 2) Although the general consensus is that this dual processing model is a valid representation of clinical reasoning, the causes of diagnostic errors remain unclear Cognitive theories about human memory propose that such errors may arise from both Type 1 and Type 2 reasoning Errors in Type 1 reasoning may be a consequence of the associative nature of memory, which can lead to cognitive biases However, the literature indicates that, with increasing expertise (and knowledge), the likelihood of errors decreases Errors in Type 2 reasoning may result from the limited capacity of working memory, which constrains computational processes In this article, the authors review the medical literature to answer two substantial questions that arise from this work: (1) To what extent do diagnostic errors originate in Type 1 (intuitive) processes versus in Type 2 (analytical) processes? (2) To what extent are errors a consequence of cognitive biases versus a consequence of knowledge deficits?The literature suggests that both Type 1 and Type 2 processes contribute to errors Although it is possible to experimentally induce cognitive biases, particularly availability bias, the extent to which these biases actually contribute to diagnostic errors is not well established Educational strategies directed at the recognition of biases are ineffective in reducing errors; conversely, strategies focused on the reorganization of knowledge to reduce errors have small but consistent benefits

The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking

A 69-year-old man presented with fever, chill, and malaise. A thorough physical examination brought the correct diagnosis of psoas abscess to light. In this case, a physical examination is the only way to correct diagnosis.

Why-not-doing-high-tech-test Syndrome.

Diagnostic errors pose a significant risk to patient safety and have substantial medical and economic consequences. Despite their importance, diagnostic error education is currently lacking in standard pre-graduate curricula. This study aimed to investigate the incidence of diagnostic errors and the frequency of recognition among medical students in Japan.A pilot survey was conducted immediately after the General Medicine In-Training Examination (GM-ITE), a comprehensive post-graduation test, administered to new residents right after graduation from medical school. The survey assessed whether they received education on diagnostic errors during their formal undergraduate medical education and whether they recognized diagnostic errors during their clinical training.Of the 564 examinees, 421 participated in the study. The majority of participants (63.9 %) reported receiving education on diagnostic errors, and 15.7 % recognized diagnostic errors during their clinical training. Significantly, those who received education on diagnostic errors had a higher rate of recognizing such errors compared to those who did not (19.7 vs. 8.6 %; p=0.0017).These findings suggest that the recognition rate of diagnostic errors increases with improved literacy in diagnostic error education. This highlights the importance of incorporating diagnostic error education into medical curricula to develop effective strategies to prevent and manage diagnostic errors, and thereby enhance medical and patient safety. However, this study did not examine the specific educational content of the errors or the details of the recognition, necessitating further investigation in the future. 

Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study

A 73 year-old-man with a history of coronary artery disease (CAD) presented with cellulitis. On examination, Frank’s sign was noted bilaterally. He also showed preauricular vertical creases bilaterally (Picture). Frank’s sign has been reported to be a consequence of an inadequate blood supply to the earlobes lacking end arteries or the rupture and degeneration of elastin fibers in the earlobes; it is related to CAD with a sensitivity of 62% and specificity of 67% (1). Frank’s sign is said to be less common in Asian populations than in Westerners (2). Nevertheless, this sign can be useful, especially in young patients suspected of having CAD. Preauricular vertical creases are frequently seen with Frank’s sign. As in Frank’s sign, preauricular vertical creases are believed to be associated with the loss and degeneration of elastin and tears in the dermal and vascular elastic fibers. This sign can be a substitute finding to Frank’s sign, especially when patients have pierced ears for earrings.

Preauricular Vertical Creases.

Introduction Hospitalists in Japan have been at the forefront of the COVID-19 pandemic. However, contributions of Japanese hospitalists during the COVID-19 pandemic and hospitalists’ awareness of crisis management education remain unclear. Material and Methods We conducted a questionnaire survey to investigate the role of Japanese hospitalists during the COVID-19 pandemic. The questionnaire was conducted using email and Google Forms targeting the chairpersons of facilities certified by the Japanese Society of Hospital General Medicine (JSHGM). Members of the academic committee of the JSHGM and several hospitals conducted a narrative review and determined the questions for the survey in a discussion. Results We conducted descriptive statistics based on the responses of 97 hospitals that agreed to participate in this survey. In total, 91.8% of general medicine departments in the included hospitals were involved in the medical care of COVID-19 patients. Furthermore, in 73.2% of hospitals, hospitalists were involved in infection control for COVID-19 inside or outside the hospital. Our survey revealed that Japanese hospitalists were responsible for COVID-19 treatment in over 60% of hospitals and contributed to hospital management, infection control, and vaccination. In total, 79.4% of hospitals answered that “training of personnel who can provide practical care for emerging infectious diseases is necessary”, 78.4% indicated that “the establishment of an infection control system in advance to prepare emerging infectious diseases in the hospital is necessary”, and 74.2% stated that “the establishment of an educational system for responding to emerging infectious diseases is necessary.”. Conclusion In conclusion, during the pandemic, in addition to inpatient care, Japanese hospitalists provided outpatient care for COVID-19, which is the role of primary care physicians in other countries. Furthermore, Japanese hospitalists who experienced the COVID-19 pandemic expressed the need for personnel development and education to prepare for future emerging infectious disease pandemics.

Contributions of Japanese Hospitalists During the COVID-19 Pandemic and the Need for Infectious Disease Crisis Management Education for Hospitalists: An Online Cross-Sectional Study

Gastric syphilis.

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