%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69742 %T Advantages and Inconveniences of a Multi-Agent Large Language Model System to Mitigate Cognitive Biases in Diagnostic Challenges %A Bousquet,Cedric %A Beltramin,Divà %+ Laboratory of Medical Informatics and Knowledge Engineering in e-Health, Inserm, Sorbonne University, 15 rue de l'école de Médecine, Paris, F-75006, France, 33 0477127974, cedric.bousquet@chu-st-etienne.fr %K large language model %K multi-agent system %K diagnostic errors %K cognition %K clinical decision-making %K cognitive bias %K generative artificial intelligence %D 2025 %7 20.1.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39832364 %R 10.2196/69742 %U https://www.jmir.org/2025/1/e69742 %U https://doi.org/10.2196/69742 %U http://www.ncbi.nlm.nih.gov/pubmed/39832364 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59439 %T Mitigating Cognitive Biases in Clinical Decision-Making Through Multi-Agent Conversations Using Large Language Models: Simulation Study %A Ke,Yuhe %A Yang,Rui %A Lie,Sui An %A Lim,Taylor Xin Yi %A Ning,Yilin %A Li,Irene %A Abdullah,Hairil Rizal %A Ting,Daniel Shu Wei %A Liu,Nan %+ Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66016503, liu.nan@duke-nus.edu.sg %K clinical decision-making %K cognitive bias %K generative artificial intelligence %K large language model %K multi-agent %D 2024 %7 19.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature.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. %M 39561363 %R 10.2196/59439 %U https://www.jmir.org/2024/1/e59439 %U https://doi.org/10.2196/59439 %U http://www.ncbi.nlm.nih.gov/pubmed/39561363 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54687 %T Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors %A Iyengar,M Sriram %A Block Ngaybe,Maiya G %A Gonzalez,Myla %A Arora,Mona %+ University of Arizona College of Medicine, 475 North 5th Street, E967C, Phoenix, AZ, 85004, United States, 1 2817934733, msiyengar@arizona.edu %K health informatics %K data science %K climate change %K pandemics %K COVID-19 %K migrations %K mobile phone %D 2024 %7 12.8.2024 %9 Viewpoint %J Interact J Med Res %G English %X Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no “one size fits all” solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors. %M 39133540 %R 10.2196/54687 %U https://www.i-jmr.org/2024/1/e54687 %U https://doi.org/10.2196/54687 %U http://www.ncbi.nlm.nih.gov/pubmed/39133540 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48212 %T Radiological Progression of Degenerative Cervical Myelopathy in a Clinically Stable Patient: Case Report %A Umeria,Rishi %A Mowforth,Oliver %A Veremu,Munashe %A Davies,Benjamin %A Kotter,Mark %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 1223 336946, mrk25@cam.ac.uk %K degenerative cervical myelopathy %K neurosurgery %K radiology %K magnetic resonance imaging %D 2024 %7 27.6.2024 %9 Case Report %J Interact J Med Res %G English %X Degenerative cervical myelopathy (DCM) is a common neurological condition, with disease progression that is both variable and difficult to predict. Here, we present a case of DCM in a gentleman in his late 60s with significant radiological disease progression without consequent change in clinical symptoms. The case serves as a reminder of an enduring medical aphorism that clinical history and examination should be prioritized above more complex data, such as imaging investigations. In addition, the case also highlights that guidelines should be contextualized within individual clinical circumstances. %M 38935951 %R 10.2196/48212 %U https://www.i-jmr.org/2024/1/e48212 %U https://doi.org/10.2196/48212 %U http://www.ncbi.nlm.nih.gov/pubmed/38935951 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54497 %T Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report %A Qsous,Ghaith %A Ramaraj,Prashanth %A Avtaar Singh,Sanjeet Singh %A Herd,Philip %A Sooraj,Nayandra Runveer %A Will,Malcolm Brodie %+ Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, United Kingdom, 44 01315361000 ext 21076, Prashanth.ramaraj@nhs.net %K capnodissection %K pleurectomy %K VATS %K video-assisted thorascopic surgery %K novel technique %K thoracic surgery %K surgical innovation %K pneumothorax %K spontaneous pneumothorax %K pleurodesis %K management %K bullectomy %K bullae %K young patient %K lung diseases %K chronic obstructive pulmonary disease %K COPD %K surgical treatment %K male %K capnothorax %D 2024 %7 21.6.2024 %9 Case Report %J Interact J Med Res %G English %X Spontaneous pneumothorax is one of the most common conditions encountered in thoracic surgery. This condition can be treated conservatively or surgically based on indications and guidelines. Traditional surgical management includes pleurodesis (mechanical or chemical) in addition to bullectomy if the bullae can be identified. Mechanical pleurodesis is usually performed by surgical pleurectomy or pleural abrasion. In this case report, we present a case of a young patient with spontaneous pneumothorax who needed a surgical intervention. We performed a new, innovative surgical technique for surgical pleurectomy where we used carbon dioxide for dissection of the parietal pleura (capnodissection). This technique may provide similar efficiency to the traditional procedure but with less risk of bleeding and complications. %M 38905630 %R 10.2196/54497 %U https://www.i-jmr.org/2024/1/e54497 %U https://doi.org/10.2196/54497 %U http://www.ncbi.nlm.nih.gov/pubmed/38905630 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e52507 %T Periorbital Necrotizing Fasciitis: Case Presentation %A Huang,Ryan S %A Patil,Nikhil S %A Khan,Yasser %+ Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada, 1 4038911818, ry.huang@mail.utoronto.ca %K periorbital necrotizing fasciitis %K Streptococcus pyogenes A %K skin infection %K soft tissue infection %K dermatology infection %K skin reaction %K periorbital %K necrotizing fasciitis %K necrotizing %K necrosis %K case report %K case reports %K fasciitis %K fatal %K life-threatening %K fascia %K soft tissue %K infection %K pathology %K pathophysiology %K periorbital %K eye %K orbital %K orbit %K muscle %K bacteria %K bacterial %K Streptococcus %K inflammation %K tissue %K tissues %D 2023 %7 28.11.2023 %9 Case Report %J Interact J Med Res %G English %X Necrotizing fasciitis (NF) is an aggressive and potentially life-threatening infection of the superficial fascia and surrounding skin, fat, fascia, muscle, and other soft tissue structures. Here, we outline the rare case of a 26-year-old man with a periorbital Streptococcus pyogenes A NF infection. Our case report underscores a unique instance of periorbital NF, distinctively presenting without any predisposing risk factors, shedding light on its presentation, treatment, and pathophysiology. %M 37971729 %R 10.2196/52507 %U https://www.i-jmr.org/2023/1/e52507 %U https://doi.org/10.2196/52507 %U http://www.ncbi.nlm.nih.gov/pubmed/37971729 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e48222 %T Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report %A Rujeedawa,Tanzil %A Mowforth,Oliver %A Kotter,Mark %A Davies,Benjamin %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, The Old Schools, Trinity Ln, Cambridge, CB2 1TN, United Kingdom, 1 44 01223 337733, benjamin.davies4@nhs.net %K cervical myelopathy %K ossification of posterior longitudinal ligament %K spondylosis %K disk herniation %K stenosis %K spine %K spinal %K neck %K disk %K myelopathy %K case %K cervical %K woman %K women %K ligament %K gait %D 2023 %7 28.8.2023 %9 Case Report %J Interact J Med Res %G English %X A female patient in her early 40s presented with a several-month history of gait unsteadiness and dragging her left leg. She had a background of congenital hydrocephalus, treated with a ventriculoatrial shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays identified hydrocephalus secondary to a disconnected shunt. Magnetic resonance imaging (MRI) of her cervical spine was also performed as part of the workup for her presenting symptoms and demonstrated features compatible with degenerative cervical myelopathy (DCM). The patient subsequently underwent a shunt revision. Following the operation, her walking and hand function deteriorated over a period of several weeks. She consequently underwent an anterior cervical decompression and fusion for DCM, which partially improved her symptoms.The sequence of events suggests that the shunt surgery may have precipitated a worsening of the DCM. Possible explanations include spinal cord injury related to neck extension or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required. %M 37639306 %R 10.2196/48222 %U https://www.i-jmr.org/2023/1/e48222 %U https://doi.org/10.2196/48222 %U http://www.ncbi.nlm.nih.gov/pubmed/37639306 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45504 %T Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review %A Bayshtok,Gabriella %A Tiosano,Shmuel %A Furer,Ariel %+ Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 972 52 927 7372, furera@gmail.com %K cardiac fitness %K cardiac patient %K cardiorespiratory fitness %K CRF %K clinical cardiology %K oxygen consumption %K peak VO2 %K smartwatch %K wearable device %D 2023 %7 15.8.2023 %9 Case Report %J Interact J Med Res %G English %X 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. %M 37581915 %R 10.2196/45504 %U https://www.i-jmr.org/2023/1/e45504 %U https://doi.org/10.2196/45504 %U http://www.ncbi.nlm.nih.gov/pubmed/37581915 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43295 %T Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report %A Goodwin,Glenn %A Ryckeley,Christian %A Fox,Davide %A Ashley,Michael %A Dubensky,Laurence %A Danckers,Mauricio %A Slesinger,Todd %+ Emergency Department, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, 33180, United States, 1 3056923392, ggoodwin954@gmail.com %K scleroderma %K systemic sclerosis %K spontaneous bowel perforation %K CREST syndrome %K calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis %K multisystem connective tissue disorder %K sclerosis %K skin %K dermatology %K internal medicine %K autoimmune %K perforation %K gastroenterology %K esophagus %K esophageal %K connective tissue %K emergency %K gastrointestinal %K case report %D 2023 %7 8.3.2023 %9 Case Report %J Interact J Med Res %G English %X Scleroderma is a group of autoimmune diseases that principally affects the skin, blood vessels, muscles, and viscera. One of the more well-known subgroups of scleroderma is the limited cutaneous form of the multisystem connective tissue disorder known as CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis) syndrome. In this report, we present a case of a spontaneous colonic bowel perforation in a patient with incomplete features of CREST. Our patient underwent a complicated hospital course involving broad-spectrum antibiotic coverage, surgical hemicolectomy, and immunosuppressives. She was eventually discharged home with a return to functional baseline status after esophageal dysmotility confirmation via manometry. Physicians managing patients with scleroderma ensuing to an emergency department encounter must anticipate the multitude of complications that can occur, as was seen in our patient. The threshold for pursuing imaging and additional tests, in addition to admission, should be relatively low, given the extremely high rates of complications and mortality. Early multidisciplinary involvement with infectious disease, rheumatology, surgery, and other respective specialties is crucial for patient outcome optimization. %M 36862558 %R 10.2196/43295 %U https://www.i-jmr.org/2023/1/e43295 %U https://doi.org/10.2196/43295 %U http://www.ncbi.nlm.nih.gov/pubmed/36862558 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e23443 %T COVID-19 #StayAtHome Restrictions and Deep Vein Thrombosis: Case Report %A Blum,Edna %A Abdelwahed,Youssef S %A Spiess,Eileen %A Mueller-Werdan,Ursula %A Leistner,David M %A Rosada,Adrian %+ Department of Geriatrics, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, , Germany, 49 30450514494, adrian.rosada@charite.de %K thrombosis %K public health %K social distancing %K physical inactivity %K pandemic management %K COVID-19 %K case study %K vein %K adverse effect %K physical activity %D 2021 %7 14.1.2021 %9 Short Paper %J Interact J Med Res %G English %X 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. %M 33400676 %R 10.2196/23443 %U http://www.i-jmr.org/2021/1/e23443/ %U https://doi.org/10.2196/23443 %U http://www.ncbi.nlm.nih.gov/pubmed/33400676