Diagnosis最新文献

{"title":"Translating Japan's diagnostic science into frontline implementation.","authors":"Shotaro Kinoshita, Taishiro Kishimoto","doi":"10.1515/dx-2026-0170","DOIUrl":"https://doi.org/10.1515/dx-2026-0170","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955059","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}

{"title":"The enduring value of the physical exam to achieve diagnostic excellence.","authors":"Brian T Garibaldi, Stephen W Russell","doi":"10.1515/dx-2026-0145","DOIUrl":"https://doi.org/10.1515/dx-2026-0145","url":null,"abstract":"<p><p>Physical examination remains a cornerstone of diagnostic excellence, even in an era dominated by advanced technology. Evidence shows that a well-performed physical exam not only improves diagnostic accuracy but also reduces medical errors, lowers healthcare costs, and strengthens the patient-physician relationship. This article highlights how the physical exam often provides pivotal findings that technology cannot replace. Strengthening bedside skills through intentional practice, evidence-based techniques, and integration of supportive technologies is essential to enhance diagnostic reasoning, mitigate uncertainty, and restore professional fulfillment. This article offers practical, modern strategies to reinvigorate the physical exam, integrating evidence, education, and technology, critical for achieving safer, more effective, and patient-centered care.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955080","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}

{"title":"The AI arc and interpretive drift.","authors":"Alan P Feren","doi":"10.1515/dx-2026-0162","DOIUrl":"https://doi.org/10.1515/dx-2026-0162","url":null,"abstract":"<p><p>Artificial intelligence now enters the clinical encounter at three points: before the visit, during clinical reasoning, and after it, when ambient tools generate the note. AI has the potential to adversely influence the diagnostic process at each of these steps. This opinion piece names interpretive drift, the subtle shift in meaning that occurs as a patient's account moves through an AI-generated summary and into the medical record. It argues that reviewing AI-generated documentation is a diagnostic safety practice, not clerical proofreading, and proposes clinical authorship and review as the standard clinicians should apply: active verification that a summary preserved the patient's central concern, distinguished observation from interpretation, and retained meaningful uncertainty. An interpretive frame inherited from a note shapes every subsequent decision, testing, referrals, and treatment, even when the frame itself began with a small distortion. The safeguard is not avoiding AI documentation tools but insisting that the clinician, not the tool, remains the author of the note's clinical meaning. As ambient AI adoption accelerates, training clinicians to critically read AI-generated documentation for interpretive drift should become an explicit, taught skill in clinical education rather than an assumed default.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900213","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}

{"title":"When an AI-generated diagnosis begins to matter: the AI consequence point.","authors":"Haruki Saito, Tetsuya Ohira","doi":"10.1515/dx-2026-0153","DOIUrl":"https://doi.org/10.1515/dx-2026-0153","url":null,"abstract":"<p><p>A patient can arrive at a consultation already organised around an AI-generated disease name. When does that use become relevant to diagnostic quality and safety - not merely to AI adoption? We define the AI consequence point: the first identifiable moment at which a patient's previsit use of diagnostic AI materially changes what happens next in care. This change may involve whether or when the patient seeks care, how the problem is presented, which explanations are considered credible, or how diagnostic decisions are negotiated. The concept refers not to AI use itself, but to the point at which that use becomes consequential for the diagnostic process. Curiosity, momentary surprise, and a label that leaves no durable trace do not qualify. AI exposure is not the AI consequence point; an AI label is not a diagnosis. Benefits and harms are both possible: earlier appropriate care and better preparation, or delay, fixation, narrowed attention, and authority conflict. Diagnostic safety research should measure previsit framing, prespecify observable material changes in the three domains, and examine how clinical responses amplify or correct them.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900261","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}

{"title":"History taking: the foundation of diagnostic excellence.","authors":"Stephen W Russell, Brian T Garibaldi, Doug Salvador","doi":"10.1515/dx-2026-0144","DOIUrl":"https://doi.org/10.1515/dx-2026-0144","url":null,"abstract":"<p><p>Medical history taking serves a critical role in improving diagnostic safety and patient outcomes. Despite advances in technology, a patient's medical history remains the cornerstone of accurate diagnosis, often yielding diagnoses before tests are performed. This article explores how patient-centered communication, contextual awareness, and evidence-based strategies reduce diagnostic errors, which often stem from miscommunication during the clinical encounter. It highlights practical tools for clinicians and patients, addresses systemic challenges, and examines how innovations like AI and digital platforms can augment, not replace, the human connection essential to care. By reinforcing the value of thorough, empathetic history taking, this resource advocates for a future where technology and human expertise work hand-in-hand to achieve diagnostic excellence.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879664","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}

{"title":"Methods to measure clinicians' diagnostic calibration: an appraisal for real world application.","authors":"Andrea Bradford, Umber Shahid, Rosann Cholankeril, Gopi Astik, Andrew P J Olson, Hardeep Singh, Ashley N D Meyer","doi":"10.1515/dx-2026-0039","DOIUrl":"https://doi.org/10.1515/dx-2026-0039","url":null,"abstract":"<p><strong>Objectives: </strong>Many, if not most, diagnostic errors go unrecognized by clinicians unless they cause significant patient harm. Reducing the gap between clinicians' perceived and actual diagnostic performance (i.e., improving calibration) may improve patient outcomes. However, existing approaches to measuring calibration were developed for use in experimental settings rather than realistic practice environments. We reviewed the scientific literature and solicited expert field input to improve approaches for assessing calibration in clinical practice.</p><p><strong>Methods: </strong>We performed a targeted literature review to identify studies that compared clinicians' diagnostic performance or accuracy to perceived accuracy or confidence. Key findings from the review were provided to 10 subject matter experts in clinical reasoning and diagnostic excellence. We then interviewed these subject matter experts in a series of four small-group teleconferences. Transcripts of group discussions were analyzed for thematic content relevant to improving the measurement of calibration in real-world care settings.</p><p><strong>Results: </strong>Discussions with experts highlighted that, while calibration reflects skill and expertise relevant to the task at hand, it is also fluctuating and context-dependent. Experts recommended that measurement of calibration should focus on clinically meaningful decisions that may be upstream of a final, correct diagnosis. Experts also recommended assessment of contextual factors that shape diagnostic decision-making and self-assessment.</p><p><strong>Conclusions: </strong>Measures of calibration should focus not only on outcomes but also on processes, which are often more actionable and proximal to clinical decision-making. In response to expert input, we propose a measure of real-world calibration that builds upon a previous measure to include several contextual variables.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863768","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}

{"title":"Discrepancies in plasma alkaline phosphatase reruns on Cobas c503 Roche analysers: a retrospective analysis and impact of dilution.","authors":"Denis Monneret, Caroline Richet, Marc Chévrier, Frédérique Jandot, Audrey Frugier, Chadia Mekki, Sabine Zaepfel, Julien Rouquié, Laurence Chardon","doi":"10.1515/dx-2026-0133","DOIUrl":"https://doi.org/10.1515/dx-2026-0133","url":null,"abstract":"<p><strong>Objectives: </strong>Discrepancies have been observed in the rerun results of plasma alkaline phosphatases (ALP) on Cobas c503 Roche analysers. The aims were to 1) determine the percentage of discrepancies in ALP reruns and 2) evaluate the effect of an automatic dilution on discrepancies.</p><p><strong>Methods: </strong>1) Raw plasma ALP results from patients were extracted from Cobas pro c503 analysers over a 2.7-year period. Reruns were triggered for any ALP above 200 U/L with no history or with a previous normal ALP, and those with a variation exceeding the total allowable error (±15 U/L if ≤150 U/L or ±10 % if >150 U/L) were classified as discrepancies. 2) During five weeks, a systematic 1:5 dilution was triggered on the analysers for all pure tests, concomitantly.</p><p><strong>Results: </strong>1) Among 9,574 reruns, 677 (7.1 %) were discordant (5.8 %, 1.2 % and 0.1 % after one, two and three reruns, respectively), and 90 % of which were decreases. 2) 9,062 pairs of concomitant pure and diluted ALP were measured, with respective medians (2.5th-97.5th percentiles) of 94 (43-559) and 90 (41-528) U/L (median of differences -4.4 %). Of these, 274 were retested, of which 16 pure reruns (5.8 %) were discordant, compared to only two diluted reruns (0.7 %). There were greater negative variations in ALP reruns as the leukocyte count increased (p<0.001).</p><p><strong>Conclusions: </strong>A substantial rate of discrepancies was observed when elevated ALP were retested on Cobas c503 analysers. This issue was almost eliminated by applying a first-line 1:5 dilution. A modification of the assay method is eagerly awaited from the manufacturer.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863451","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}

{"title":"Effects of case revisitation during deliberate reflection on medical students' diagnostic accuracy: a randomized experiment.","authors":"Francisco Carlos Specian Junior, Julia Beatriz Aliscantes Silva Brito, Silvia Mamede, Bruno Augusto Goulart Campos, Thiago Martins Santos, Alessandra Mazzo, Dario Cecilio-Fernandes","doi":"10.1515/dx-2026-0061","DOIUrl":"https://doi.org/10.1515/dx-2026-0061","url":null,"abstract":"<p><strong>Objectives: </strong>Deliberate reflection (DR) is an instructional strategy that enhances clinical reasoning by prompting learners to systematically compare diagnostic hypotheses with case findings. DR protocols often allow learners to revisit the written case during reflection, which may reduce cognitive effort but limit the benefits of effortful retrieval for long-term retention. This study examined whether allowing or restricting case revisitation during DR affects medical students' diagnostic performance.</p><p><strong>Methods: </strong>We conducted a randomized, two-arm experimental study with 67 third- and fourth-year medical students enrolled in a six-year undergraduate medical program in Brazil. During the intervention phase, after providing an initial diagnosis, students engaged in DR either with or without access to the case description. After a 15-day interval, participants diagnosed four cases of previously studied diseases and four cases of adjacent diseases. Outcomes included diagnostic accuracy, confidence, and recall of correct propositions, analyzed using a generalized linear mixed model.</p><p><strong>Results: </strong>No overall group differences were found in diagnostic accuracy. However, a significant interaction emerged between group and disease type (χ² (1)=7.68, p=0.006). For previously studied diseases, students in the without-access-DR group performed better (OR=1.77, 95 % CI [0.76, 2.78], p=0.050), whereas for adjacent diseases, those in the with-access-DR group performed better (OR=0.56, 95 % CI [0.24, 0.89], p=0.050). Diagnostic accuracy was positively associated with confidence (OR=1.12, 95 % CI [1.01, 1.24], p=0.028) and recall (OR=1.06, 95 % CI [1.01, 1.12], p=0.027).</p><p><strong>Conclusions: </strong>Restricting case revisitation enhanced accuracy for previously studied diseases, consistent with retrieval effort theory, whereas allowing revisitation supported transfer to adjacent diseases.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817792","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}

{"title":"When seeing is not believing: a scope mistaken for a foreign body.","authors":"İbrahim Üntan, Sultan Üntan","doi":"10.1515/dx-2026-0150","DOIUrl":"https://doi.org/10.1515/dx-2026-0150","url":null,"abstract":"<p><strong>Objectives: </strong>A convincing endoscopic image can prove false when the observer's expectation supplies a conclusion before evidence is tested. We describe how a flexible ureteroscope can mimic a retained intraluminal foreign body, and how anchoring and diagnostic momentum can drive an operator to an unnecessary and hazardous retrieval.</p><p><strong>Case presentation: </strong>During an elective flexible ureteroscopy as a planned second-look procedure, a linear, smooth, metallic-appearing structure within a dilated calyx was taken for a retained intraluminal foreign body, consistent with the residual hardware anticipated in the referring operative note. It was followed for approximately 3 cm before clinical doubt prompted reassessment. Two equipment-free manoeuvres established the truth: releasing tip deflection made the apparent foreign body move with the scope and disappear, and a guidewire passed retrogradely through a ureteric catheter emerged from the supposed forward opening, showing that the line of sight ran back along the instrument's own axis. The \"foreign body\" was the distal shaft of the ureteroscope, brought into view by passive buckling within the dilated collecting system. Had it been grasped, the deflected shaft would have been seized against the urothelium, exposing the patient to complications for no benefit.</p><p><strong>Conclusions: </strong>The near miss arose not from faulty optics but from anchoring and diagnostic momentum: a handover narrative primed the operator to expect retained hardware, and a high-fidelity image confirmed the expectation before it was verified. Before acting on a striking image that confirms what one was told to expect, ask what simple independent test would distinguish it from its most likely imitator.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808298","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}

{"title":"Laboratory testing in acute care settings: a personal perspective.","authors":"Giuseppe Lippi, Brandon M Henry, Camilla Mattiuzzi","doi":"10.1515/dx-2026-0132","DOIUrl":"https://doi.org/10.1515/dx-2026-0132","url":null,"abstract":"<p><p>Laboratory Medicine plays a central role in the management of acute conditions in the emergency department (ED), yet its clinical impact is often under-recognized and variably implemented across healthcare systems. This opinion paper aims to describe the conceptual, operational, and evidence-based foundations of urgent laboratory diagnostics in acute care settings (especially in the emergency department), emphasizing the need for structured and standardized approaches. The lack of a single universal guideline for urgent laboratory testing has led to development of several national and international consensus documents. These frameworks, including those from SIBioC-AcEMC, DGKL/DIVI, and EFLM TF-PLE, consistently highlight the importance of prioritizing clinically meaningful tests and aligning laboratory workflows with emergency care demands. Across these initiatives, core parameters such as hemoglobin, electrolytes, blood gases, lactate, creatinine, and coagulation markers emerge as essential components of emergency diagnostic pathways. Operationally, urgent laboratory testing can be structured according to clinical urgency and turnaround time (TAT), and further categorized into essential, critical and supportive panels. This stratification enables optimized resource allocation, improves laboratory efficiency, and supports clinical decision-making in time-sensitive scenarios.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789362","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}