TY - JOUR AU - Bousquet, Cedric AU - Beltramin, Divā PY - 2025/1/20 TI - Advantages and Inconveniences of a Multi-Agent Large Language Model System to Mitigate Cognitive Biases in Diagnostic Challenges JO - J Med Internet Res SP - e69742 VL - 27 KW - large language model KW - multi-agent system KW - diagnostic errors KW - cognition KW - clinical decision-making KW - cognitive bias KW - generative artificial intelligence UR - https://www.jmir.org/2025/1/e69742 UR - http://dx.doi.org/10.2196/69742 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69742 ER - TY - JOUR AU - Ke, Yuhe AU - Yang, Rui AU - Lie, An Sui AU - Lim, Yi Taylor Xin AU - Ning, Yilin AU - Li, Irene AU - Abdullah, Rizal Hairil AU - Ting, Wei Daniel Shu AU - Liu, Nan PY - 2024/11/19 TI - Mitigating Cognitive Biases in Clinical Decision-Making Through Multi-Agent Conversations Using Large Language Models: Simulation Study JO - J Med Internet Res SP - e59439 VL - 26 KW - clinical decision-making KW - cognitive bias KW - generative artificial intelligence KW - large language model KW - multi-agent N2 - 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 Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature.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. UR - https://www.jmir.org/2024/1/e59439 UR - http://dx.doi.org/10.2196/59439 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59439 ER - TY - JOUR AU - Iyengar, Sriram M. AU - Block Ngaybe, G. Maiya AU - Gonzalez, Myla AU - Arora, Mona PY - 2024/8/12 TI - Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors JO - Interact J Med Res SP - e54687 VL - 13 KW - health informatics KW - data science KW - climate change KW - pandemics KW - COVID-19 KW - migrations KW - mobile phone UR - https://www.i-jmr.org/2024/1/e54687 UR - http://dx.doi.org/10.2196/54687 UR - http://www.ncbi.nlm.nih.gov/pubmed/39133540 ID - info:doi/10.2196/54687 ER - TY - JOUR AU - Umeria, Rishi AU - Mowforth, Oliver AU - Veremu, Munashe AU - Davies, Benjamin AU - Kotter, Mark PY - 2024/6/27 TI - Radiological Progression of Degenerative Cervical Myelopathy in a Clinically Stable Patient: Case Report JO - Interact J Med Res SP - e48212 VL - 13 KW - degenerative cervical myelopathy KW - neurosurgery KW - radiology KW - magnetic resonance imaging UR - https://www.i-jmr.org/2024/1/e48212 UR - http://dx.doi.org/10.2196/48212 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48212 ER - TY - JOUR AU - Qsous, Ghaith AU - Ramaraj, Prashanth AU - Avtaar Singh, Singh Sanjeet AU - Herd, Philip AU - Sooraj, Runveer Nayandra AU - Will, Brodie Malcolm PY - 2024/6/21 TI - Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report JO - Interact J Med Res SP - e54497 VL - 13 KW - capnodissection KW - pleurectomy KW - VATS KW - video-assisted thorascopic surgery KW - novel technique KW - thoracic surgery KW - surgical innovation KW - pneumothorax KW - spontaneous pneumothorax KW - pleurodesis KW - management KW - bullectomy KW - bullae KW - young patient KW - lung diseases KW - chronic obstructive pulmonary disease KW - COPD KW - surgical treatment KW - male KW - capnothorax UR - https://www.i-jmr.org/2024/1/e54497 UR - http://dx.doi.org/10.2196/54497 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54497 ER - TY - JOUR AU - Huang, S. Ryan AU - Patil, S. Nikhil AU - Khan, Yasser PY - 2023/11/28 TI - Periorbital Necrotizing Fasciitis: Case Presentation JO - Interact J Med Res SP - e52507 VL - 12 KW - periorbital necrotizing fasciitis KW - Streptococcus pyogenes A KW - skin infection KW - soft tissue infection KW - dermatology infection KW - skin reaction KW - periorbital KW - necrotizing fasciitis KW - necrotizing KW - necrosis KW - case report KW - case reports KW - fasciitis KW - fatal KW - life-threatening KW - fascia KW - soft tissue KW - infection KW - pathology KW - pathophysiology KW - eye KW - orbital KW - orbit KW - muscle KW - bacteria KW - bacterial KW - Streptococcus KW - inflammation KW - tissue KW - tissues UR - https://www.i-jmr.org/2023/1/e52507 UR - http://dx.doi.org/10.2196/52507 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971729 ID - info:doi/10.2196/52507 ER - TY - JOUR AU - Rujeedawa, Tanzil AU - Mowforth, Oliver AU - Kotter, Mark AU - Davies, Benjamin PY - 2023/8/28 TI - Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report JO - Interact J Med Res SP - e48222 VL - 12 KW - cervical myelopathy KW - ossification of posterior longitudinal ligament KW - spondylosis KW - disk herniation KW - stenosis KW - spine KW - spinal KW - neck KW - disk KW - myelopathy KW - case KW - cervical KW - woman KW - women KW - ligament KW - gait UR - https://www.i-jmr.org/2023/1/e48222 UR - http://dx.doi.org/10.2196/48222 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639306 ID - info:doi/10.2196/48222 ER - TY - JOUR AU - Bayshtok, Gabriella AU - Tiosano, Shmuel AU - Furer, Ariel PY - 2023/8/15 TI - Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review JO - Interact J Med Res SP - e45504 VL - 12 KW - cardiac fitness KW - cardiac patient KW - cardiorespiratory fitness KW - CRF KW - clinical cardiology KW - oxygen consumption KW - peak VO2 KW - smartwatch KW - wearable device N2 - 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. UR - https://www.i-jmr.org/2023/1/e45504 UR - http://dx.doi.org/10.2196/45504 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581915 ID - info:doi/10.2196/45504 ER - TY - JOUR AU - Goodwin, Glenn AU - Ryckeley, Christian AU - Fox, Davide AU - Ashley, Michael AU - Dubensky, Laurence AU - Danckers, Mauricio AU - Slesinger, Todd PY - 2023/3/8 TI - Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report JO - Interact J Med Res SP - e43295 VL - 12 KW - scleroderma KW - systemic sclerosis KW - spontaneous bowel perforation KW - CREST syndrome KW - calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis KW - multisystem connective tissue disorder KW - sclerosis KW - skin KW - dermatology KW - internal medicine KW - autoimmune KW - perforation KW - gastroenterology KW - esophagus KW - esophageal KW - connective tissue KW - emergency KW - gastrointestinal KW - case report UR - https://www.i-jmr.org/2023/1/e43295 UR - http://dx.doi.org/10.2196/43295 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862558 ID - info:doi/10.2196/43295 ER - TY - JOUR AU - Blum, Edna AU - Abdelwahed, S. Youssef AU - Spiess, Eileen AU - Mueller-Werdan, Ursula AU - Leistner, M. David AU - Rosada, Adrian PY - 2021/1/14 TI - COVID-19 #StayAtHome Restrictions and Deep Vein Thrombosis: Case Report JO - Interact J Med Res SP - e23443 VL - 10 IS - 1 KW - thrombosis KW - public health KW - social distancing KW - physical inactivity KW - pandemic management KW - COVID-19 KW - case study KW - vein KW - adverse effect KW - physical activity N2 - 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. UR - http://www.i-jmr.org/2021/1/e23443/ UR - http://dx.doi.org/10.2196/23443 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400676 ID - info:doi/10.2196/23443 ER -