@Article{info:doi/10.2196/69742,
author="Bousquet, Cedric
and Beltramin, Div{\`a}",
title="Advantages and Inconveniences of a Multi-Agent Large Language Model System to Mitigate Cognitive Biases in Diagnostic Challenges",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="20",
volume="27",
pages="e69742",
keywords="large language model",
keywords="multi-agent system",
keywords="diagnostic errors",
keywords="cognition",
keywords="clinical decision-making",
keywords="cognitive bias",
keywords="generative artificial intelligence",
doi="10.2196/69742",
url="https://www.jmir.org/2025/1/e69742"
}


@Article{info:doi/10.2196/59439,
author="Ke, Yuhe
and Yang, Rui
and Lie, An Sui
and Lim, Yi Taylor Xin
and Ning, Yilin
and Li, Irene
and Abdullah, Rizal Hairil
and Ting, Wei Daniel Shu
and Liu, Nan",
title="Mitigating Cognitive Biases in Clinical Decision-Making Through Multi-Agent Conversations Using Large Language Models: Simulation Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="19",
volume="26",
pages="e59439",
keywords="clinical decision-making",
keywords="cognitive bias",
keywords="generative artificial intelligence",
keywords="large language model",
keywords="multi-agent",
abstract="Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. Objective: This study aimed to explore the role of large language models (LLMs) in mitigating these biases through the use of the multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy compared with humans. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent framework, we leveraged GPT-4 (OpenAI) to facilitate interactions among different simulated agents to replicate clinical team dynamics. Each agent was assigned a distinct role: (1) making the final diagnosis after considering the discussions, (2) acting as a devil's advocate to correct confirmation and anchoring biases, (3) serving as a field expert in the required medical subspecialty, (4) facilitating discussions to mitigate premature closure bias, and (5) recording and summarizing findings. We tested varying combinations of these agents within the framework to determine which configuration yielded the highest rate of correct final diagnoses. Each scenario was repeated 5 times for consistency. The accuracy of the initial diagnoses and the final differential diagnoses were evaluated, and comparisons with human-generated answers were made using the Fisher exact test. Results: A total of 240 responses were evaluated (3 different multi-agent frameworks). The initial diagnosis had an accuracy of 0\% (0/80). However, following multi-agent discussions, the accuracy for the top 2 differential diagnoses increased to 76\% (61/80) for the best-performing multi-agent framework (Framework 4-C). This was significantly higher compared with the accuracy achieved by human evaluators (odds ratio 3.49; P=.002). Conclusions: The multi-agent framework demonstrated an ability to re-evaluate and correct misconceptions, even in scenarios with misleading initial investigations. In addition, the LLM-driven, multi-agent conversation framework shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios. ",
doi="10.2196/59439",
url="https://www.jmir.org/2024/1/e59439"
}


@Article{info:doi/10.2196/54687,
author="Iyengar, Sriram M.
and Block Ngaybe, G. Maiya
and Gonzalez, Myla
and Arora, Mona",
title="Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="12",
volume="13",
pages="e54687",
keywords="health informatics",
keywords="data science",
keywords="climate change",
keywords="pandemics",
keywords="COVID-19",
keywords="migrations",
keywords="mobile phone",
doi="10.2196/54687",
url="https://www.i-jmr.org/2024/1/e54687",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133540"
}


@Article{info:doi/10.2196/48212,
author="Umeria, Rishi
and Mowforth, Oliver
and Veremu, Munashe
and Davies, Benjamin
and Kotter, Mark",
title="Radiological Progression of Degenerative Cervical Myelopathy in a Clinically Stable Patient: Case Report",
journal="Interact J Med Res",
year="2024",
month="Jun",
day="27",
volume="13",
pages="e48212",
keywords="degenerative cervical myelopathy",
keywords="neurosurgery",
keywords="radiology",
keywords="magnetic resonance imaging",
doi="10.2196/48212",
url="https://www.i-jmr.org/2024/1/e48212"
}


@Article{info:doi/10.2196/54497,
author="Qsous, Ghaith
and Ramaraj, Prashanth
and Avtaar Singh, Singh Sanjeet
and Herd, Philip
and Sooraj, Runveer Nayandra
and Will, Brodie Malcolm",
title="Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report",
journal="Interact J Med Res",
year="2024",
month="Jun",
day="21",
volume="13",
pages="e54497",
keywords="capnodissection",
keywords="pleurectomy",
keywords="VATS",
keywords="video-assisted thorascopic surgery",
keywords="novel technique",
keywords="thoracic surgery",
keywords="surgical innovation",
keywords="pneumothorax",
keywords="spontaneous pneumothorax",
keywords="pleurodesis",
keywords="management",
keywords="bullectomy",
keywords="bullae",
keywords="young patient",
keywords="lung diseases",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="surgical treatment",
keywords="male",
keywords="capnothorax",
doi="10.2196/54497",
url="https://www.i-jmr.org/2024/1/e54497"
}


@Article{info:doi/10.2196/52507,
author="Huang, S. Ryan
and Patil, S. Nikhil
and Khan, Yasser",
title="Periorbital Necrotizing Fasciitis: Case Presentation",
journal="Interact J Med Res",
year="2023",
month="Nov",
day="28",
volume="12",
pages="e52507",
keywords="periorbital necrotizing fasciitis",
keywords="Streptococcus pyogenes A",
keywords="skin infection",
keywords="soft tissue infection",
keywords="dermatology infection",
keywords="skin reaction",
keywords="periorbital",
keywords="necrotizing fasciitis",
keywords="necrotizing",
keywords="necrosis",
keywords="case report",
keywords="case reports",
keywords="fasciitis",
keywords="fatal",
keywords="life-threatening",
keywords="fascia",
keywords="soft tissue",
keywords="infection",
keywords="pathology",
keywords="pathophysiology",
keywords="eye",
keywords="orbital",
keywords="orbit",
keywords="muscle",
keywords="bacteria",
keywords="bacterial",
keywords="Streptococcus",
keywords="inflammation",
keywords="tissue",
keywords="tissues",
doi="10.2196/52507",
url="https://www.i-jmr.org/2023/1/e52507",
url="http://www.ncbi.nlm.nih.gov/pubmed/37971729"
}


@Article{info:doi/10.2196/48222,
author="Rujeedawa, Tanzil
and Mowforth, Oliver
and Kotter, Mark
and Davies, Benjamin",
title="Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report",
journal="Interact J Med Res",
year="2023",
month="Aug",
day="28",
volume="12",
pages="e48222",
keywords="cervical myelopathy",
keywords="ossification of posterior longitudinal ligament",
keywords="spondylosis",
keywords="disk herniation",
keywords="stenosis",
keywords="spine",
keywords="spinal",
keywords="neck",
keywords="disk",
keywords="myelopathy",
keywords="case",
keywords="cervical",
keywords="woman",
keywords="women",
keywords="ligament",
keywords="gait",
doi="10.2196/48222",
url="https://www.i-jmr.org/2023/1/e48222",
url="http://www.ncbi.nlm.nih.gov/pubmed/37639306"
}


@Article{info:doi/10.2196/45504,
author="Bayshtok, Gabriella
and Tiosano, Shmuel
and Furer, Ariel",
title="Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review",
journal="Interact J Med Res",
year="2023",
month="Aug",
day="15",
volume="12",
pages="e45504",
keywords="cardiac fitness",
keywords="cardiac patient",
keywords="cardiorespiratory fitness",
keywords="CRF",
keywords="clinical cardiology",
keywords="oxygen consumption",
keywords="peak VO2",
keywords="smartwatch",
keywords="wearable device",
abstract="Background: Oxygen consumption is an important index to evaluate in cardiac patients, particularly those with heart failure, and is measured in the setting of advanced cardiopulmonary exercise testing. However, technological advances now allow for the estimation of this parameter in many consumer and medical-grade wearable devices, making it available for the medical provider at the initial evaluation of patients. We report a case of an apparently healthy male aged 40 years who presented for evaluation due to an Apple Watch (Apple Inc) notification of low cardiac fitness. This alert triggered a thorough workup, revealing a diagnosis of familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. While the use of wearable devices for the measurement of oxygen consumption and related parameters is promising, further studies are needed for validation. Objective: The aim of this report is to investigate the potential utility of wearable devices as a screening and risk stratification tool for cardiac fitness for the general population and those with increased cardiovascular risk, particularly through the measurement of peak oxygen consumption (VO2). We discuss the possible advantages of measuring oxygen consumption using wearables and propose its integration into routine patient evaluation and follow-up processes. With the current evidence and limitations, we encourage researchers and clinicians to explore bringing wearable devices into clinical practice. Methods: The case was identified at Sheba Medical Center, and the patient's cardiac fitness was monitored through an Apple Watch Series 6. The patient underwent a comprehensive cardiac workup following his presentation. Subsequently, we searched the literature for articles relating to the clinical utility of peak VO2 monitoring and available wearable devices. Results: The Apple Watch data provided by the patient demonstrated reduced peak VO2, a surrogate index for cardiac fitness, which improved after treatment initiation. A cardiological workup confirmed familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. A review of the literature revealed the potential clinical benefit of peak VO2 monitoring in both cardiac and noncardiac scenarios. Additionally, several devices on the market were identified that could allow for accurate oxygen consumption measurement; however, future studies and approval by the Food and Drug Administration (FDA) are still necessary. Conclusions: This case report highlights the potential utility of peak VO2 measurements by wearable devices for early identification and screening of cardiac fitness for the general population and those at increased risk of cardiovascular disease. The integration of wearable devices into routine patient evaluation may allow for earlier presentation in the diagnostic workflow. Cardiac fitness can be serially measured using the wearable device, allowing for close monitoring of functional capacity parameters. Devices need to be used with caution, and further studies are warranted. ",
doi="10.2196/45504",
url="https://www.i-jmr.org/2023/1/e45504",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581915"
}


@Article{info:doi/10.2196/43295,
author="Goodwin, Glenn
and Ryckeley, Christian
and Fox, Davide
and Ashley, Michael
and Dubensky, Laurence
and Danckers, Mauricio
and Slesinger, Todd",
title="Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report",
journal="Interact J Med Res",
year="2023",
month="Mar",
day="8",
volume="12",
pages="e43295",
keywords="scleroderma",
keywords="systemic sclerosis",
keywords="spontaneous bowel perforation",
keywords="CREST syndrome",
keywords="calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis",
keywords="multisystem connective tissue disorder",
keywords="sclerosis",
keywords="skin",
keywords="dermatology",
keywords="internal medicine",
keywords="autoimmune",
keywords="perforation",
keywords="gastroenterology",
keywords="esophagus",
keywords="esophageal",
keywords="connective tissue",
keywords="emergency",
keywords="gastrointestinal",
keywords="case report",
doi="10.2196/43295",
url="https://www.i-jmr.org/2023/1/e43295",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862558"
}


@Article{info:doi/10.2196/23443,
author="Blum, Edna
and Abdelwahed, S. Youssef
and Spiess, Eileen
and Mueller-Werdan, Ursula
and Leistner, M. David
and Rosada, Adrian",
title="COVID-19 \#StayAtHome Restrictions and Deep Vein Thrombosis: Case Report",
journal="Interact J Med Res",
year="2021",
month="Jan",
day="14",
volume="10",
number="1",
pages="e23443",
keywords="thrombosis",
keywords="public health",
keywords="social distancing",
keywords="physical inactivity",
keywords="pandemic management",
keywords="COVID-19",
keywords="case study",
keywords="vein",
keywords="adverse effect",
keywords="physical activity",
abstract="Background: The COVID-19 pandemic triggered countermeasures like \#StayAtHome initiatives, which have changed the whole world. Despite the success of such initiatives in limiting the spread of COVID-19 to \#FlattenTheCurve, physicians are now confronted with the adverse effects of the current restrictive pandemic management strategies and social distancing measures. Objective: We aim to draw attention to the particular importance and magnitude of what may be the adverse effects of COVID-19--related policies. Methods: We herein report a case of an otherwise healthy 84-year-old woman with deep vein thrombosis (DVT) due to COVID-19--related directives. \#StayAtHome policies and consequential social isolation have diminished our patient's social life and reduced her healthy movement behaviors. The patient spent long hours in a seated position while focusing on the intensive flow of media information regarding the pandemic. Results: Reduced mobility due to preventive social isolation during the COVID-19 pandemic was the only identified cause of the DVT. Conclusions: While evaluating the effect of the COVID-19 pandemic and governmentally implemented containment measures, including social isolation and mobility reduction, adverse events should be considered. Digital approaches might play a crucial role in supporting public health. ",
doi="10.2196/23443",
url="http://www.i-jmr.org/2021/1/e23443/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33400676"
}