IF 2

Diagnosis Pub Date : 2025-10-07 DOI: 10.1515/dx-2025-0078

Dana M Al Baali, Mahmoud M Ajoub, Issa S Al Qarshoubi, Babikir M Ismail, Abdullah A Al Rawahi, Fabrizio Panaro, Abdulateef S Al Sulaimani, Abdullah Y Al Farai

{"title":"Multiple hepatic sclerosing hemangiomas mimicking malignant lesions, a diagnostic dilemma: case report and literature review.","authors":"Dana M Al Baali, Mahmoud M Ajoub, Issa S Al Qarshoubi, Babikir M Ismail, Abdullah A Al Rawahi, Fabrizio Panaro, Abdulateef S Al Sulaimani, Abdullah Y Al Farai","doi":"10.1515/dx-2025-0078","DOIUrl":"https://doi.org/10.1515/dx-2025-0078","url":null,"abstract":"Objectives: Hepatic sclerosing hemangioma (SH) is a rare benign liver lesion that poses a significant diagnostic challenge due to its ability to mimic malignant hepatic tumors on imaging.Case presentation: We report the case of a 67-year-old woman with diabetes, hypertension, and chronic kidney disease who presented with incidental liver lesions discovered during the workup of elevated alkaline phosphatase. Cross-sectional imaging, including MRI and PET-FDG, revealed multiple atypical hypodense hepatic lesions with perihilar biliary obstruction, initially raising concern for cholangiocarcinoma. Multiple tissue biopsies including Spyglass-guided and percutaneous attempts were non-diagnostic, and the clinical suspicion of malignancy persisted. Diagnostic laparoscopy and targeted incisional biopsy ultimately confirmed the diagnosis of sclerosing hemangioma. The patient underwent laparoscopic wedge resection and has remained well on follow-up for more than two years.Conclusions: This case highlights the importance of maintaining a broad differential diagnosis in the evaluation of atypical hepatic lesions, the limitations of radiological findings, and the value of a stepwise multidisciplinary approach in avoiding unnecessary major resections. A focused review of the literature supports the rarity of this entity and emphasizes the need for tissue diagnosis in ambiguous cases.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rooted in reasoning: a clinical reasoning curriculum using diagnostic RCAs. 扎根推理：临床推理课程使用诊断rca。

IF 2

Diagnosis Pub Date : 2025-10-07 DOI: 10.1515/dx-2025-0089

David Klimpl, Stacey Staudinger

{"title":"Rooted in reasoning: a clinical reasoning curriculum using diagnostic RCAs.","authors":"David Klimpl, Stacey Staudinger","doi":"10.1515/dx-2025-0089","DOIUrl":"https://doi.org/10.1515/dx-2025-0089","url":null,"abstract":"Objectives: Clinical reasoning skills are required for safe care, yet they are not consistently taught to advanced practice providers (APPs). In hospital medicine, where APPs work semi-independently, gaps in clinical reasoning can increase the likelihood of error. To address this, we developed a module that uses diagnostic root cause analysis (RCA) to teach clinical reasoning skills to hospital medicine APP fellows.Methods: The curriculum was delivered from July 2021 to March 2025. Fellows selected real-world diagnostic errors encountered during clinical rotations, created cognitive fishbone diagrams, and presented their analysis in small-group.Results: Twenty-seven fellows completed the module and pre-post assessment surveys. Statistically significant improvements were observed across all six domains of knowledge and confidence related to identifying error contributors, analyzing cases, and setting goals. Free-text responses highlighted the module's emotional safety, peer learning value, and normalization of diagnostic reflection. Two learners published their projects as academic posters, and one graduate now co-facilitates the sessions.Conclusions: This module offers a scalable, time-efficient approach to clinical reasoning education that is adaptable across learner levels and specialties. Its peer-led design fosters psychological safety, reflective practice, and creates a natural pathway for APPs to engage in microscholarship - addressing a critical gap in both education and academic inclusion.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

AHRQ's contributions to diagnostic safety: past, present, and future. AHRQ对诊断安全性的贡献：过去、现在和未来。

IF 2

Diagnosis Pub Date : 2025-09-26 DOI: 10.1515/dx-2025-0126

Heather M Hussey, Stacey H Batista, Gordon D Schiff

{"title":"AHRQ's contributions to diagnostic safety: past, present, and future.","authors":"Heather M Hussey, Stacey H Batista, Gordon D Schiff","doi":"10.1515/dx-2025-0126","DOIUrl":"https://doi.org/10.1515/dx-2025-0126","url":null,"abstract":"In the decade before and 10 years since the National Academies of Sciences, Engineering, and Medicine (NASEM) Improving Diagnosis in Health Care report, the U.S. Agency for Health Research and Quality (AHRQ) has played a major role in convening, coordinating and funding research and quality improvement efforts to learn from and prevent diagnostic errors. As part of a 10th Anniversary reflection of progress since the 2016 NASEM report, we review the historic diagnostic safety contributions of AHRQ and contemplate AHRQ's future at a critical time given recent staffing reductions and budget cuts. AHRQ contributions have included funding annual Diagnostic Error in Medicine conferences, studies on error epidemiology, projects to improve timeliness and accuracy of specific diagnoses (e.g. chest pain, dizziness), diagnosis improvement in various settings (ED, inpatient, primary care,) and disciplines (laboratory, radiology). In the past decade AHRQ has funded two major diagnosis improvement initiatives via a) its Patient Safety Learning Laboratories (PSLL) projects which take a systems engineering approach to improve clinical care processes, and b) 10 Diagnostic Centers of Excellence (DCE) working to develop systems, measures and new technologies to improve diagnostic safety and quality. Support for patient engagement has been a major strategic emphasis for AHRQ's projects, tools, and diagnosis safety information disseminated. While facing an uncertain future, federal funding and leadership is needed now more than ever given the extent of the problems that have been documented and need to build on progress to date. We project a bold vision for a bigger, better future AHRQ.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic pitfalls: how availability and anchoring biases lead to errors in dermatology. 诊断陷阱：可获得性和锚定偏差如何导致皮肤病学错误。

IF 2

Diagnosis Pub Date : 2025-09-25 DOI: 10.1515/dx-2025-0001

Austin S Cusick, Leo Wan, Angela S Casey, Robert Baiocchi, Stephanie K Fabbro

{"title":"Diagnostic pitfalls: how availability and anchoring biases lead to errors in dermatology.","authors":"Austin S Cusick, Leo Wan, Angela S Casey, Robert Baiocchi, Stephanie K Fabbro","doi":"10.1515/dx-2025-0001","DOIUrl":"https://doi.org/10.1515/dx-2025-0001","url":null,"abstract":"Objectives: We will explore the diagnostic similarities of spindle cell neoplasms and the attributed heuristics that lead to misdiagnosis biases. The biases explored will include availability bias and anchoring bias, with a discussion on the events leading to their formation.Case presentation: A 58-year-old African American male with a past medical history of well-controlled HIV presented to the dermatology clinic for a two-year history of several persistent skin nodules on his lower legs. One lesion on his left lateral calf, a 1.5 cm dome-shaped nodule with a centralized keratinous plug, was suspicious for squamous cell carcinoma (SCC), prompting a shave biopsy. The dermatopathology report identified the lesion as dermatofibrosarcoma protuberans (DFSP) with CD34 positivity and the patient was referred for Mohs Micrographic Surgery. Frozen sections during Mohs surgery revealed concern for an alternative diagnosis, which was then confirmed as Kaposi Sarcoma.Conclusions: This case highlights the susceptibility of dermatology to misdiagnosis. Availability bias in the clinical setting led to an inadequate biopsy method. Further anchoring bias then potentially influenced histologic interpretation and management decisions. Insufficient appreciation of Kaposi Sarcoma development in the setting of well-controlled HIV also further influenced the diagnosis rendered. Mohs Surgery evaluation allowed for de-biased clinical and histologic assessment, correcting diagnosis. Several overlying factors, such as time pressures, knowledge gaps, and technique limitations, create a reliance on cognitive heuristics. Recognizing these external pressures can help clinicians enhance diagnostic accuracy by systematically considering alternative diagnoses.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ten years on: how far have we come in patient engagement in diagnosis? 十年过去了：我们在患者参与诊断方面取得了多大进展？

IF 2

Diagnosis Pub Date : 2025-09-25 DOI: 10.1515/dx-2025-0125

Helen Haskell, Traber Giardina, Io Dolka, Kathryn M McDonald

引用次数: 0

The role of philanthropy in advancing diagnostic excellence and the legacy of the Gordon and Betty Moore Foundation. 慈善事业在推进卓越诊断和戈登和贝蒂·摩尔基金会的遗产中的作用。

IF 2

Diagnosis Pub Date : 2025-09-25 DOI: 10.1515/dx-2025-0127

Karen S Cosby, Tommy Wang, Daniel A Yang

{"title":"The role of philanthropy in advancing diagnostic excellence and the legacy of the Gordon and Betty Moore Foundation.","authors":"Karen S Cosby, Tommy Wang, Daniel A Yang","doi":"10.1515/dx-2025-0127","DOIUrl":"10.1515/dx-2025-0127","url":null,"abstract":"In America, medical research is largely driven by large investments of federal funding administered by government agencies. However, the problem of diagnostic error falls outside the usual funding categories for government-sponsored biomedical research. While federal resources are vital to support academic institutions and research teams, private funders and philanthropic organizations often contribute a significant source of support for medical research, particularly for critical gaps in funding and for high risk or innovative ideas. In 2017, the Gordon and Betty Moore Foundation launched an initial exploration into work that addressed diagnostic error and subsequently committed $85 million to their Diagnostic Excellence Initiative. Their model of strategic philanthropy proposed a pathway to improved diagnostic outcomes. Their three-pronged strategy and a summary of their portfolio of work for Diagnostic Excellence is described in this article. Lessons from their experience are worth reflection: real-world problems with diagnosis and reliable delivery of diagnostic care are complex and solutions require coordinated efforts across many disciplines; and efforts are more effective when done in partnership with like-minded organizations. We celebrate the contributions of the Moore Foundation and acknowledge their contribution to helping build a community committed to diagnostic excellence, develop infrastructure for quality improvement, and advance ideas for the use of technology to improve care.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The importance of cognition for improving diagnostic safety: Salerno redux? 认知对提高诊断安全性的重要性：Salerno redux？

IF 2

Diagnosis Pub Date : 2025-09-23 DOI: 10.1515/dx-2025-0106

Pat Croskerry, Mark L Graber

{"title":"The importance of cognition for improving diagnostic safety: Salerno redux?","authors":"Pat Croskerry, Mark L Graber","doi":"10.1515/dx-2025-0106","DOIUrl":"https://doi.org/10.1515/dx-2025-0106","url":null,"abstract":"The oldest medical school of modern civilization, in Salerno, Italy, prioritized the study of philosophy, logic, and reasoning. We first retrace the history of how clinical reasoning and its perceived importance has evolved, culminating ultimately in the 2015 National Academies report on diagnostic error in healthcare. The report clearly emphasized the fundamental role of clinical reasoning in diagnosis, and the critical need to optimize the cognitive elements of diagnosis to prevent diagnostic errors in the future. The dual processing paradigm, envisioning both intuitive and rational pathways, is central to current understandings of clinical reasoning. The importance of knowledge, the impact of cognitive biases, the influence of context, and many other 'adjacent' factors also impact the likelihood of arriving at the correct diagnosis. Medical education needs to re-prioritize cognition over content, and teach clinical reasoning interprofessionally. Emphasizing rationality and recognizing cognitive and affective bias are key. A host of interventions have been proposed: patient engagement, second opinions, reflection, improving teamwork, and using AI are all well justified and worthy of trials.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The global progress for improving diagnosis: what we've learned, what comes next. 改善诊断的全球进展：我们学到了什么，接下来会发生什么。

IF 2

Diagnosis Pub Date : 2025-09-18 DOI: 10.1515/dx-2025-0109

Taro Shimizu, Wolf E Hautz, Charlotte van Sassen, Laura Zwaan

{"title":"The global progress for improving diagnosis: what we've learned, what comes next.","authors":"Taro Shimizu, Wolf E Hautz, Charlotte van Sassen, Laura Zwaan","doi":"10.1515/dx-2025-0109","DOIUrl":"https://doi.org/10.1515/dx-2025-0109","url":null,"abstract":"Since the 2015 National Academies of Sciences, Engineering, and Medicine report on Improving Diagnosis in Health Care, global awareness of diagnostic safety has grown substantially. Progress has been most visible in high-income countries, with emerging international research networks, conferences, and educational programs. Australia and New Zealand have advanced incident reporting systems, specialty-specific diagnostic safety tools, and educational resources. European initiatives have expanded research on clinical reasoning, bias, and safety-netting, developed competency-based curricula, and investigated digital innovations including decision support systems. Japan has built on a strong tradition of clinical reasoning mastery, advancing theoretical frameworks, cultural analysis, and AI-based diagnostic support, and hosting major regional conferences. Despite these gains, engagement remains uneven, with limited data from low- and middle-income countries (LMICs). Barriers include resource constraints, underdeveloped infrastructure, and differing disease burdens that challenge the transferability of AI and other innovations. Future progress requires clear, measurable objectives across five domains: research, education, practice improvement, patient engagement, and policy. Recommendations include establishing national diagnostic error databases, promoting multicenter research in underrepresented settings, expanding standardized curricula, implementing structured audit-and-feedback systems, integrating patient perspectives, and embedding diagnostic safety indicators in policy and reimbursement frameworks. International collaboration, context-sensitive methodologies, and robust governance for emerging technologies are critical to ensure equitable improvements. By leveraging shared learning, strengthening capacity in LMICs, and aligning efforts with global policy frameworks, the diagnostic safety movement can evolve from fragmented initiatives to a cohesive, sustainable worldwide strategy, aiming for safer, more reliable diagnosis by 2035.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Society to Improve Diagnosis in Medicine's legacy: building a foundation for diagnostic excellence. 改善医学遗产诊断协会：为卓越诊断奠定基础。

IF 2

Diagnosis Pub Date : 2025-09-18 DOI: 10.1515/dx-2025-0120

Laura J Chien, Janice L Kwan, Christina Cifra, Ava L Liberman, Helen Haskell, Kathy McDonald, Suz Schrandt, Rebecca Jones, Andrew P J Olson, Eliana Bonifacino, Leslie Tucker, Mark L Graber, Maria R Dahm

{"title":"The Society to Improve Diagnosis in Medicine's legacy: building a foundation for diagnostic excellence.","authors":"Laura J Chien, Janice L Kwan, Christina Cifra, Ava L Liberman, Helen Haskell, Kathy McDonald, Suz Schrandt, Rebecca Jones, Andrew P J Olson, Eliana Bonifacino, Leslie Tucker, Mark L Graber, Maria R Dahm","doi":"10.1515/dx-2025-0120","DOIUrl":"https://doi.org/10.1515/dx-2025-0120","url":null,"abstract":"The Society to Improve Diagnosis in Medicine (SIDM) played a pivotal role in elevating diagnostic error from an overlooked aspect of patient safety to a recognized healthcare priority during its thirteen-year history (2011-2024). Through strategic advocacy, coalition building, and engagement with policymakers, SIDM secured dedicated federal funding for diagnostic safety research and promoted diagnostic excellence as a critical healthcare imperative. This article examines the organization's establishment, evolution and lasting impact on the field of diagnostic safety across research, education, practice improvement, and patient engagement. A crowning achievement was SIDM's success in stimulating the Institute of Medicine to study the problem, resulting in the landmark 2015 report Improving Diagnosis in Health Care (1). Despite the transformative impact of this report, substantial challenges remain in reducing harm from diagnostic error. We conclude with a call to address gaps in three critical areas: awareness, measurement, and implementation.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic errors in older patients: a secondary analysis of case reports. 老年患者的诊断错误：病例报告的二次分析。

IF 2

Diagnosis Pub Date : 2025-09-16 DOI: 10.1515/dx-2025-0073

Kotaro Kunitomo, Yukinori Harada, Takashi Watari, Taku Harada, Taro Shimizu

{"title":"Diagnostic errors in older patients: a secondary analysis of case reports.","authors":"Kotaro Kunitomo, Yukinori Harada, Takashi Watari, Taku Harada, Taro Shimizu","doi":"10.1515/dx-2025-0073","DOIUrl":"https://doi.org/10.1515/dx-2025-0073","url":null,"abstract":"Objectives: Diagnostic errors are a significant source of patient harm and occur more frequently in older adults due to comorbidities, symptom ambiguity, and communication barriers. However, how these errors differ between older and younger patients remains unclear. The aim of this study was to examine the characteristics of diagnostic errors in older patients using published case reports.Methods: We performed a secondary analysis of 534 case reports from a systematic review. Cases were divided into older (≥65 years, n=115) and younger (<65 years, n=419) groups. Data were extracted and coded using the diagnostic error evaluation and research (DEER), reliable diagnosis challenges (RDC), and generic diagnostic pitfalls (GDP) frameworks.Results: Older patients had significantly more DEER codes per case than younger patients (2.5 vs. 2.0; p=0.01). Key DEER codes were more frequent in older adults, including \"Physical examination: Failure in weighing\" (7.8 vs. 2.9 %), \"Assessment: Failure/delay in considering the diagnosis\" (74.8 vs. 64.0 %), and \"Assessment: Failure/delay to recognise/weigh urgency\" (7.8 vs. 2.9 %). In RDC, \"Diagnosis of complications\" was also more common in older patients (11.3 vs. 5.3 %). No significant differences were found in GDP coding.Conclusions: Diagnostic errors involving failure to consider the correct diagnosis, recognize urgency, and identify complications were more common in older patients. Understanding these mechanisms is essential to develop diagnostic strategies specific to older patients.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosis最新文献