Diagnosis最新文献_第10页

Deliberate solitude for clinical reasoning. 为临床推理而故意独处。

IF 1.9

Diagnosis Pub Date : 2026-01-06 eCollection Date: 2026-08-01 DOI: 10.1515/dx-2025-0133

Eulho Jung, Feng-Chih Kuo, Steven J Durning

引用次数: 0

Performance of pulmonary physical exam skills by internal medicine interns. 内科实习生肺部体检技能的表现。

IF 1.9

Diagnosis Pub Date : 2025-11-18 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2025-0118

Shawn Y Chou, Yin Liu, Amanda K Bertram, Ariella A Stein, Timothy M Niessen, Emily Murphy, Brian T Garibaldi

{"title":"Performance of pulmonary physical exam skills by internal medicine interns.","authors":"Shawn Y Chou, Yin Liu, Amanda K Bertram, Ariella A Stein, Timothy M Niessen, Emily Murphy, Brian T Garibaldi","doi":"10.1515/dx-2025-0118","DOIUrl":"10.1515/dx-2025-0118","url":null,"abstract":"Objectives: To assess the pulmonary physical examination (PE) skills of internal medicine residents using real patients to inform pulmonary PE educational initiatives.Methods: First year medicine residents (interns) from two large academic medical centers in Maryland examined the same patient with interstitial lung disease (ILD) as part of the Assessment of Physical Examination and Communication Skills (APECS). Interns were evaluated on five clinical domains: PE technique, identifying physical signs, generating a differential diagnosis, clinical judgment, and maintaining patient welfare. Spearman's correlation test described associations between clinical domains. Preceptor comments were examined to identify errors in PE technique and identifying physical signs.Results: One-hundred and fifty-five interns examined the same patient with ILD across 33 APECS sessions. 111 interns (71.6 %) correctly identified the presence of crackles; 96 interns (61.9 %) included ILD on their differential diagnosis. There was a significant and positive correlation between PE technique and identification of PE findings (r=0.48, p<0.0001). PE technique (r=0.19, p=0.016) and identifying signs (r=0.42, p<0.0001) were both significantly associated with generating an appropriate differential diagnosis, which in turn was significantly associated with appropriate clinical management (r=0.46, p<0.0001). Common errors were not auscultating the entire lung (55 interns, 35.5 %), auscultating through the gown (20 interns, 12.9 %), not percussing the chest (15 interns, 9.7 %), and using incorrect technique for percussion (37 interns, 23.9 %).Conclusions: Medicine interns had variable skills in performing the pulmonary PE. Improving PE skills would lead to increased identification of relevant pulmonary findings, inform clinical decision making, and improve overall patient care.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"285-292"},"PeriodicalIF":1.9,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534353","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 injustice. What is it, what are its sources, and what can we do about it? 诊断不公正。它是什么，它的来源是什么，我们能做些什么？

IF 1.9

Diagnosis Pub Date : 2025-11-18 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2025-0099

Bjørn Hofmann

{"title":"Diagnostic injustice. What is it, what are its sources, and what can we do about it?","authors":"Bjørn Hofmann","doi":"10.1515/dx-2025-0099","DOIUrl":"10.1515/dx-2025-0099","url":null,"abstract":"Background: Although the issue of injustice in healthcare has been extensively discussed-particularly in relation to access to treatments-diagnostic injustice remains insufficiently addressed. Therefore, it is crucial to clarify the concept of diagnostic injustice, identify its underlying sources, and explore potential solutions to mitigate its impact.Content: An ethical analysis of diagnostics reveals that diagnostic injustice manifests in various traditional forms of injustice, including distributive, procedural, social, structural, systemic, and epistemic injustice. A subsequent narrative review identifies various sources of diagnostic injustice, such as unclear diagnostic criteria, arbitrary diagnostics, unfair taxonomic processes, biomedical (technological) dominance, uncertainty, prejudice, stereotypes, biases, as well as diagnostic hierarchies. Corresponding to these sources of diagnostic injustice, a range of measures are proposed to mitigate its effects.Summary: Diagnostic injustice is pervasive and rooted in a complex array of sources tied to social and professional norms and values, making it challenging to effectively mitigate. By clarifying the concept, pinpointing its sources, and recommending measures to manage diagnostic injustice, this article highlights the importance of promoting diagnostic justice in healthcare.Outlook: Diagnostic injustice is an understudied topic that deserves more attention. This study defines the concept, identifies its sources, and suggests measures to mitigate its effects. As such it is the first step to address diagnostic injustice and to enhance the equity in healthcare. Future work should focus on developing and implementing effective interventions that target the identified sources of injustice, ultimately striving for a more just healthcare system.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"243-254"},"PeriodicalIF":1.9,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534289","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

Transatlantic confusion in MS diagnostic criteria: one patient, two continents, zero diagnosis. MS诊断标准的跨大西洋混淆：一个病人，两个大洲，零诊断。

IF 1.9

Diagnosis Pub Date : 2025-11-18 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2025-0103

Jagannadha Avasarala

引用次数: 0

Simple time-resolved skin-prick assays as a pharmacodynamic readout in early drug development. 简单的时间分辨皮肤点刺试验作为早期药物开发的药效学读数。

IF 1.9

Diagnosis Pub Date : 2025-11-10 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2025-0139

Ludwig Englmeier

引用次数: 0

When two truths collide: overlapping herpes zoster and leukocytoclastic vasculitis in an atypical presentation. 当两个事实相冲突：重叠带状疱疹和白细胞分裂性血管炎在一个非典型的表现。

IF 2

Diagnosis Pub Date : 2025-11-10 DOI: 10.1515/dx-2025-0134

Hunter Cohn, Jeannie Hennessy, Stephanie Cotell, Stephanie Fabbro

{"title":"When two truths collide: overlapping herpes zoster and leukocytoclastic vasculitis in an atypical presentation.","authors":"Hunter Cohn, Jeannie Hennessy, Stephanie Cotell, Stephanie Fabbro","doi":"10.1515/dx-2025-0134","DOIUrl":"https://doi.org/10.1515/dx-2025-0134","url":null,"abstract":"Objectives: Diagnostic reasoning often favors simplicity, with clinicians seeking a single unifying explanation for a patient's presentation. However, in certain cases, a narrow approach can lead to diagnostic oversight and delay. In this case, an early attribution of symptoms to leukocytoclastic vasculitis (LCV) postponed the recognition and treatment of an underlying varicella-zoster virus (VZV) infection.Case presentation: An 88-year-old woman presented with palpable purpuric macules in a linear distribution along the right pretibial region, dorsum of the foot, and toes, accompanied by severe unilateral pain radiating from the foot to the buttock. The pain preceded the rash by one day, and no vesicles were noted by the patient or clinician. Clinically, the morphology was consistent with leukocytoclastic vasculitis, but the pain followed a dermatomal distribution, raising concern for varicella-zoster virus (VZV) infection. A biopsy ultimately confirmed both leukocytoclastic vasculitis and viral cytopathic changes. The patient improved with a combination of valacyclovir, prednisone, and gabapentin.Conclusions: This case illustrates a diagnostically challenging presentation in which two distinct pathologies mimicked and masked one another. Anchoring on a unifying diagnosis led to premature closure, delaying antiviral therapy. Herpes zoster without vesicles is uncommon but documented, and VZV-induced vasculitis is rare. Together, they created a deceptive clinical picture. The case reinforces several key teaching points: the value of maintaining diagnostic flexibility, the importance of empiric antiviral treatment when herpes zoster is suspected, and the need to recognize cognitive biases that can distort clinical judgment. When findings are discordant or incomplete, clinicians should resist diagnostic simplification and remain open to diagnosing coexisting conditions.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470849","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 performance of lymphocyte transformation test and flow cytometry in the identification of culprit drugs in organ-specific serious adverse drug reactions. 淋巴细胞转化试验和流式细胞术在器官特异性严重药物不良反应元凶药物鉴别中的诊断价值。

IF 1.9

Diagnosis Pub Date : 2025-10-31 eCollection Date: 2026-08-01 DOI: 10.1515/dx-2025-0077

Carmen Ruiz-Fernández, Ibtissam Akatbach-Bousaid, Olga Rogozina, Susana Martín-López, Miguel Álvarez Montero, Ramon Pardo Puras, Zoraida Del Solar Moreno, Fiorela C Dueñas López, Mikel Urroz Elizalde, Ana Martínez Feito, Miguel González-Muñoz, Elena Ramírez

{"title":"Diagnostic performance of lymphocyte transformation test and flow cytometry in the identification of culprit drugs in organ-specific serious adverse drug reactions.","authors":"Carmen Ruiz-Fernández, Ibtissam Akatbach-Bousaid, Olga Rogozina, Susana Martín-López, Miguel Álvarez Montero, Ramon Pardo Puras, Zoraida Del Solar Moreno, Fiorela C Dueñas López, Mikel Urroz Elizalde, Ana Martínez Feito, Miguel González-Muñoz, Elena Ramírez","doi":"10.1515/dx-2025-0077","DOIUrl":"10.1515/dx-2025-0077","url":null,"abstract":"Objectives: Serious adverse drug reactions (SADRs) require robust causality assessment methods. Identifying the culprit drug relies on clinical history, causality algorithms, and in vitro tests. The lymphocyte transformation test (LTT) is widely used, but flow cytometry has been proposed as an alternative due to LTT's limitations. This study evaluated the diagnostic performance of LTT and CD69 upregulation on T lymphocytes by flow cytometry.Methods: A total of 148 patients (150 SADRs) with at least a \"possible\" algorithmic causality score (≥4) were assessed using LTT and flow cytometry. Twenty-five healthy individuals served as negative controls. Over 98 % of cases were organ-specific reactions, with drug-induced liver injury being most frequent (52.6 %), and systemic antibiotics the most implicated drug group (29.7 %).Results: 400 suspected drugs were analyzed. LTT and flow cytometry were positive in 43 and 30 % of patients, respectively. For cases with an algorithmic score≥6, sensitivity increased to 50 % for LTT and 33 % for flow cytometry. Sensitivity varied by reaction type (LTT: 17-47 %; flow cytometry: 20-38 %) and drug group (LTT: 17-86 %; flow cytometry: 18-50 %). Combining both tests improved sensitivity to 50-63 % by reaction type and 50-100 % by drug group. An algorithmic score≥6 combined with both tests further increased overall sensitivity to 70 %.Conclusions: These findings show the added value of integrating multiple in vitro diagnostic approaches with causality algorithms to improve culprit drug identification in organ-specific SADRs. Future studies are needed to validate these findings.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"492-501"},"PeriodicalIF":1.9,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408482","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

A framework for defining diagnostically challenging conditions identifiable through electronic algorithms. 用于定义通过电子算法可识别的诊断挑战性条件的框架。

IF 1.9

Diagnosis Pub Date : 2025-10-27 eCollection Date: 2026-08-01 DOI: 10.1515/dx-2025-0034

Andrew P J Olson, Jennifer Sloane, Andrew Zimolzak, Bhavika Kaul, Viralkumar Vaghani, Roni Matin, Rosann T Cholankeril, Hardeep Singh

{"title":"A framework for defining diagnostically challenging conditions identifiable through electronic algorithms.","authors":"Andrew P J Olson, Jennifer Sloane, Andrew Zimolzak, Bhavika Kaul, Viralkumar Vaghani, Roni Matin, Rosann T Cholankeril, Hardeep Singh","doi":"10.1515/dx-2025-0034","DOIUrl":"10.1515/dx-2025-0034","url":null,"abstract":"Diagnostic delays and errors are serious and costly, affecting approximately 5 % of US adults in the outpatient setting annually. Patients with difficult-to-diagnose conditions may spend months or years undergoing diagnostic evaluation in search of a correct diagnosis. Methods are needed to identify patients with diagnostically challenging conditions (DCCs) who are experiencing diagnostic odysseys and, as a result, potential missed opportunities in their diagnosis. Given the increasing availability of longitudinal EHR data to map a patient's journey, we propose a new framework to proactively identify patients with DCCs using electronic data. These patients are at risk for missed opportunities in diagnosis, and a timelier diagnosis can improve their outcomes. We propose criteria for identifying specific DCCs where the diagnostic process for that condition makes them amenable to detection using EHR-based algorithms. We discuss the application of the proposed framework to an exemplary case study of fibrotic interstitial lung disease and provide examples of algorithms that could be implemented in the future. This work can help identify patients earlier in their diagnostic journeys, resulting in adequate follow-up and fewer missed or delayed diagnoses. Our proposed framework can inform research and potential solutions that are more real-time to potentially mitigate and avoid delays in care and resulting harm.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"378-383"},"PeriodicalIF":1.9,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12633116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surveying patients to assess timeliness of cancer diagnosis. 调查患者以评估癌症诊断的及时性。

IF 1.9

Diagnosis Pub Date : 2025-10-27 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2024-0203

Claire E O'Hanlon, Carl Berdahl, Feifei Ye, Elie Ohana, Anagha Tolpadi, Melissa A Bradley, Elizabeth Marsolais, Maxim Ptacek, Andrew J Henreid, Rebecca Anhang Price

{"title":"Surveying patients to assess timeliness of cancer diagnosis.","authors":"Claire E O'Hanlon, Carl Berdahl, Feifei Ye, Elie Ohana, Anagha Tolpadi, Melissa A Bradley, Elizabeth Marsolais, Maxim Ptacek, Andrew J Henreid, Rebecca Anhang Price","doi":"10.1515/dx-2024-0203","DOIUrl":"10.1515/dx-2024-0203","url":null,"abstract":"Objectives: To develop and test feasibility of patient survey-based quality measures to assess timeliness of cancer diagnosis.Methods: We developed a 39-item survey through review of literature and measures, input from experts, and cognitive testing. We field-tested it in an urban health system among patients with new cancer diagnoses (prior 3-9 months); surveys were administered by web and mail September-October 2023. We calculated top-box scores and conducted confirmatory factor analysis for evaluative items and assessed construct validity through correlations to the diagnostic interval, number of health care visits, and overall assessments of care quality.Results: The overall response rate was 23.9 %. The 276 respondents primarily spoke English (89 %), were non-Hispanic white (66 %), age 65+ (68 %), and college graduates (67 %). More than a quarter believed their cancer could have been diagnosed much sooner. Better communication with health care professionals, timely receipt of usual and specialty care, and ease of receipt and follow-up of tests, X-rays, and scans were positively associated with patients reporting that health care professionals could not have diagnosed the cancer much sooner. Patients reporting it was always easy to receive needed tests, X-rays, and scans and that they always received follow-up results were more than three times more likely to report a diagnostic interval less than or equal to 30 days (p<0.001).Conclusions: Patients can report on barriers to timely diagnosis associated with the length of their cancer diagnostic interval. Surveys are a promising source of information regarding opportunities to improve timeliness of cancer diagnosis.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"300-311"},"PeriodicalIF":1.9,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Salivary protein biomarkers for the diagnosis of oral squamous cell carcinoma: a systematic review and meta-analysis. 唾液蛋白生物标志物诊断口腔鳞状细胞癌：系统回顾和荟萃分析。

IF 1.9

Diagnosis Pub Date : 2025-10-27 eCollection Date: 2026-05-01 DOI: 10.1515/dx-2025-0058

Jayesh Beladiya, Dhruvi Mehta, Yashi Patel, Sandip Patel, Dharmistha Parmar, Sandip Dholakia, Devang Sheth, B Mahalakshmi, Chirag A Patel, Sai H S Boddu

{"title":"Salivary protein biomarkers for the diagnosis of oral squamous cell carcinoma: a systematic review and meta-analysis.","authors":"Jayesh Beladiya, Dhruvi Mehta, Yashi Patel, Sandip Patel, Dharmistha Parmar, Sandip Dholakia, Devang Sheth, B Mahalakshmi, Chirag A Patel, Sai H S Boddu","doi":"10.1515/dx-2025-0058","DOIUrl":"10.1515/dx-2025-0058","url":null,"abstract":"Identifying and assessing salivary protein biomarkers for the noninvasive diagnosis of oral squamous cell carcinoma (OSCC) could significantly enhance early detection, guide timely intervention, and ultimately improve patient survival and quality of life. A comprehensive search of PubMed, Google Scholar, and EMBASE databases was conducted to identify studies that assessed the potential of salivary protein biomarkers for screening OSCC. To assess the validity of the studies, two reviewers independently extracted data on sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), and diagnostic odds ratios (DOR). Owing to the expected variation between studies, a random effects model was used to combine the extracted data. The meta-analysis included 28 studies including 3,507 patients with OSCC and 3,501 control subjects that evaluated 37 salivary protein biomarkers. Pooled analysis across all biomarkers revealed a sensitivity of 0.71 (95 % CI 0.690-0.720), specificity of 0.69 (95 % CI 0.68-0.71), PLR of 3.04 (95 % CI 2.56-3.60), NLR of 0.37 (95 % CI 0.33-0.43), and DOR of 11.7 (95 % CI 8.02-15.29). Further analysis compared five specific biomarkers: interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP9), and cytokeratin 19 fragment 21-1 (CYFRA21-1). Notably, MMP9 and CYFRA21-1 demonstrated sensitivity of 1.00 and 0.81, respectively, with specificities of 0.58 and 0.91, respectively, and high area under the curve (AUC) values of 0.9932 and 0.9447, respectively. Despite promising results, heterogeneity across studies warrants cautious interpretation. Focusing on promising candidates, this meta-analysis explored the potential of salivary protein biomarkers for diagnosing OSCC. Notably, MMP9 and CYFRA21-1 demonstrated good sensitivity, suggesting their strong potential for further development as noninvasive diagnostic tools.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"255-267"},"PeriodicalIF":1.9,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367842","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