The efficacy of mindful practice in improving diagnosis in healthcare: a systematic review and evidence synthesis.

Despite a variety of definitions of mindfulness, over the past 20 years there have been increasing claims that mindful practice is helpful in improving the accuracy of clinical diagnosis. We performed a systematic review and evidence synthesis in order to: determine the nature and definitions of mindful practice and associated terms; evaluate the quality of evidence for the benefits of mindful practice; and conclude whether mindful practice may reduce diagnostic error. We screened 14397 refereed reports from the five common literature databases, to include 33 reports related to the use of mindful practice in clinical diagnosis. Our evidence synthesis contained no randomised controlled trials (level I evidence) of mindful practice, the majority of supporting evidence (26 reports or 79%) comprised conceptual commentary or opinion (level IV evidence). However, 2 supporting reports constituted controlled studies without randomisation (level IIa), 1 report was quasi-experimental (level IIb), and 4 reports were comparative studies (level III). Thus, we may tentatively conclude that mindful practice appears promising as a method of improving diagnostic accuracy, but that further definitive studies of efficacy are required. We identified a taxonomy of 71 terms related to mindful practice, 7 of which were deemed core terms due to being each cited 5 times or more. The 7 core terms appear to be sufficient to describe the findings at higher levels of evidence in our evidence synthesis, suggesting that future definitive studies of mindful practice should focus on these common core terms in order to promote more generalisable findings.

Humans and machines: Moving towards a more symbiotic approach to learning clinical reasoning.

Artificial intelligence is a growing phenomenon that is driving major changes to how we deliver healthcare. One of its most significant and challenging contributions is likely to be in diagnosis. Artificial intelligence is challenging the physician's exclusive role in diagnosis and in some areas, its diagnostic accuracy exceeds that of humans. We argue that we urgently need to consider how we will incorporate AI into our teaching of clinical reasoning in the undergraduate curriculum; students need to successfully navigate the benefits and potential issues of new and developing approaches to AI in clinical diagnosis. We offer a pedagogical framework for this challenging change to our curriculum.

In vitro validation of a method for neonatal urine collection and analysis.

OBJECTIVE: Urine collection and analysis is important for diagnosis, monitoring of clinical progress, and research in neonates. This study aims to validate a novel methodology for neonatal urine collection, which combines the convenience of cotton ball collection with accurate timing via a urine continence monitor. DESIGN: Laboratory model using a combined cotton ball and urinary incontinence monitor method with and without the presence of an impermeable membrane to prevent desiccation. MAIN OUTCOME MEASURES: Accuracy, bias and precision in measurement of urine volume, electrolytes (sodium, potassium, chloride), creatinine and gentamicin. Changes in analyte concentration over time, and evaporative loss of water, were tested using analysis of variance. The effects of time, temperature and humidity were explored using multivariate analysis of variance. RESULTS: With the use of an impermeable membrane, sodium concentration increased from a mean (SD) of 3.57% (0.68) at 1 min to 5.03% (0.74) at 120 min. There was no significant change in potassium, chloride or creatinine concentrations. Gentamicin concentration decreased by a mean (SD) of 9.05% (1.37) by 30 min. Multivariate analysis found that absolute change in weight, sodium and chloride were only dependent on duration. Gentamicin concentration was affected by duration, humidity and temperature. Relative evaporative loss was minimal at -0.58% (0.31), and the urinary continence monitor was 100% successful at detecting urination for all time points. CONCLUSIONS: This novel methodology provides a standardisable and practical method to collect small volumes of neonatal urine for accurate measurement of both urine output and analyte concentrations.

Where science meets practice: Olympic coaches' crafting of the tapering process.

Although there is research providing physiologically-based guidance for the content of the taper, this study was the first to examine how coaches actually implement the taper. The purpose of this study was to examine the taper planning and implementation processes of successful Olympic coaches leading up to major competitions and how they learned about tapering. Seven track and field coaches participated in semi-structured interviews exploring their tapering processes. To be considered for inclusion, coaches were required to have coached one or more athletes to an Olympic or Paralympic medal. Through a process of axial and open coding interview transcripts were analysed and lower and higher order themes developed describing the coaches' tapering processes. Our findings indicate that the strategies employed to achieve the desired physiological adaptions of the taper were consistent with research (e.g., reduction in volume whilst maintaining intensity and frequency). However, our findings also suggest that tapering is far from a straight forward "textbook" process. The taper was not restricted to physiological outcomes with coaches considering athletes' psychological as well as physical state. Coaches also involved the athlete in the process, adapted the taper to the athlete, continually monitored its progress, and adapted it further as required.