Diagnosis最新文献_第3页

Improving diagnosis in health care: laboratory medicine. 提高卫生保健诊断：检验医学。

IF 2

Diagnosis Pub Date : 2025-08-22 DOI: 10.1515/dx-2025-0052

Giuseppe Lippi, Brian Jackson, Mario Plebani

{"title":"Improving diagnosis in health care: laboratory medicine.","authors":"Giuseppe Lippi, Brian Jackson, Mario Plebani","doi":"10.1515/dx-2025-0052","DOIUrl":"https://doi.org/10.1515/dx-2025-0052","url":null,"abstract":"Accurate and timely diagnosis remains one of the most complex and challenging processes in medicine. Diagnostic errors pose a significant burden on patients and healthcare systems, with laboratory-related errors playing a substantial role, especially in the pre- and post-analytical phases of the testing process. However, recent innovations have mitigated some key challenges by optimizing workflows and reducing human errors. Notable advancements include automated systems for specimen check-in, preparation, aliquoting and storage for downstream analysis. Technologies such as automated interference detection, alongside sensors monitoring specimen volume and integrity, have enhanced standardization and reliability. Automated sample storage and retrieval systems have improved traceability and retrospective analyses while preserving specimen integrity. In the analytical phase, automation has facilitated real-time anomaly detection, enabling reflex or repeat testing to ensure result accuracy. The multiple integration of different analytical platforms, coupled with automated quality control features, has reduced inter-system variability, minimized manual errors and enhanced efficiency. Advancements in molecular and genetic diagnostics have enabled more precise and personalized treatments, reducing ineffective therapies and side effects. The ongoing deployment of lab-on-a-chip technology, integration of artificial intelligence, and reinforced patient safety culture highlight the vital role of continuous innovation in laboratory medicine to enhance patient safety. However, several challenges remain, including diagnostic errors from test result misinterpretation, poor sample quality, regulatory and compliance constraints, limited data sharing among laboratories, high cost of advanced diagnostic tools and shortage of trained laboratory professionals and pathologists. Addressing these barriers is essential for further safeguarding patient safety.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946525","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

Association between referral letters and diagnostic errors: a single-center, cross-sectional study in general internal medicine in Japan. 转诊信和诊断错误之间的关系：日本普通内科的单中心横断面研究。

IF 2

Diagnosis Pub Date : 2025-08-22 DOI: 10.1515/dx-2024-0197

Sakura Kamiya, Toshinori Nishizawa, Hiroki Ozawa, Yukinori Harada, Takashi Watari, Taro Shimizu, Madoka Sakurai, Yuya Suzuki, Gautam A Deshpande, Hiroko Arioka

{"title":"Association between referral letters and diagnostic errors: a single-center, cross-sectional study in general internal medicine in Japan.","authors":"Sakura Kamiya, Toshinori Nishizawa, Hiroki Ozawa, Yukinori Harada, Takashi Watari, Taro Shimizu, Madoka Sakurai, Yuya Suzuki, Gautam A Deshpande, Hiroko Arioka","doi":"10.1515/dx-2024-0197","DOIUrl":"https://doi.org/10.1515/dx-2024-0197","url":null,"abstract":"Objectives: Referral documentation may either contribute to diagnostic excellence or play a role in diagnostic errors (DEs), but its exact impact remains unclear. This study investigates the association between referral documentation and DEs among patients initially evaluated by another hospital or department and subsequently referred to the general internal medicine (GIM) outpatient clinic of an acute care tertiary hospital in Japan.Methods: This cross-sectional study analyzed outpatients who visited the GIM outpatient clinic between April 1, 2017 and March 31, 2023. Patients initially evaluated at another medical facility or department, who then visited the GIM outpatient clinic, and were subsequently readmitted unexpectedly within 14 days after GIM outpatient clinic visit were included. DEs were identified using the Revised Safer Dx Instrument. Errors were analyzed using the Diagnostic Error Evaluation and Research (DEER) taxonomy. Logistic regression analysis was performed to assess the relationship between referral letters and DEs.Results: Of 80 patients, 29 (36.3 %) experienced DEs. Referral letters were present for 52 (65.0 %) patients. The proportion of DEs was lower in the referred patients compared to non-referred patients (25.0 vs. 57.1 %; p-value=0.004). After adjusting for age, sex, race, multimorbidity, type of previous physicians, and post-graduate year of the GIM physician, the presence of a referral letter was associated with a substantially likelihood of DEs (OR=0.20, 95 % CI: 0.06-0.62, p-value=0.005).Conclusions: The presence of a referral letter facilitates accurate diagnoses while markedly reducing DEs. Healthcare systems should consider promoting the proper use of referral systems.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946560","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

Global-of-care testing (GOCT): emerging challenges for laboratory medicine network. 全球保健检测：实验室医学网络面临的新挑战。

IF 2

Diagnosis Pub Date : 2025-08-22 DOI: 10.1515/dx-2025-0108

Agostino Ognibene, Giuseppe Lippi

{"title":"Global-of-care testing (GOCT): emerging challenges for laboratory medicine network.","authors":"Agostino Ognibene, Giuseppe Lippi","doi":"10.1515/dx-2025-0108","DOIUrl":"https://doi.org/10.1515/dx-2025-0108","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic has placed laboratory medicine at the forefront of public health and clinical care. Larger use of social media and official communication platforms raised public awareness of laboratory science, driving demand for rapid, accurate diagnostic information and shifting expectations around access and interpretation of testing. Laboratory medicine, rooted in accuracy, precision, reproducibility and clinical relevance, has advanced from basic diagnostics to sophisticated molecular and data-driven platforms. Yet, literature and policy on coordinated international laboratory networks, especially for surveillance and emergency response, remain limited. This opinion paper introduces the concept of \"global-of-care testing\", encompassing globally connected diagnostic infrastructures with regional adaptability, robust governance, and sustained investment in technology and workforce. Laboratory network design must account for geography and population density in allocating facilities. Integrated systems require automation capable of interfacing across multiple platforms (preanalytical processing, clinical chemistry, immunochemistry, hematology, coagulation, urinalysis and even molecular diagnostics and mass spectrometry) to optimize workflows, support real-time decision-making, facilitate remote collaboration and maintain rigorous quality assurance. A decentralized yet interconnected model allows peripheral laboratories to actively participate in clinical decision-making through shared protocols, telemedicine and integrated data, ultimately reducing turnaround times, improving responsiveness and enhancing patient-centred care. Embedding Value-Based Laboratory Medicine (VBLM) within this framework ensures that diagnostics are aligned with health outcomes in a multidisciplinary ecosystem organized around patient needs. The future of laboratory medicine will hence depend on evidence-based reforms that integrate technology, reorganize systems and reinforce governance for promoting quality, equitable access and sustainable precision healthcare.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946509","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

Managing cognitive load and enhancing metacognitive learning in postgraduate training and practice. 研究生培训与实践中的认知负荷管理与元认知学习。

IF 2

Diagnosis Pub Date : 2025-08-13 DOI: 10.1515/dx-2025-0067

Isaac K S Ng, Christine J Ko, Tow Keang Lim

{"title":"Managing cognitive load and enhancing metacognitive learning in postgraduate training and practice.","authors":"Isaac K S Ng, Christine J Ko, Tow Keang Lim","doi":"10.1515/dx-2025-0067","DOIUrl":"https://doi.org/10.1515/dx-2025-0067","url":null,"abstract":"The phase of postgraduate medical training and practice is notoriously difficult because junior physicians or medical residents find themselves stuck in a tenuous situation of having to handle newfound heavy clinical work and responsibilities while scaling a steep learning curve on the job. In recent years, increased focus on diagnostic error has led to increasing calls to re-evaluate how clinical reasoning is cultivated in medical training, with emphasis on pedagogical interventions that aim to sharpen clinical judgments while minimising cognitive errors. Against this backdrop, we herein review the concept of \"cognitive load\" in post-graduate training and clinical practice, and discuss its relevance to effective metacognitive learning amidst clinical duties and to optimisation of medical decision-making in real-world settings by reducing cognitive errors in the form of bias and noise. We then outline pedagogical and workplace-based interventions that may target the twin problem of intrinsic and extrinsic cognitive load in clinical learning and work, and specifically advocate metacognitive-based practices that promote iterative cycles of cognitive schema re-calibration and professional development.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820884","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

Advancing diagnostic stewardship in contemporary medical practice. 推进诊断管理在当代医疗实践。

IF 2

Diagnosis Pub Date : 2025-08-12 DOI: 10.1515/dx-2025-0071

Isaac K S Ng, Zhen Jonathan Liang, Wilson G W Goh, Adrian C L Kee, Tow Keang Lim

{"title":"Advancing diagnostic stewardship in contemporary medical practice.","authors":"Isaac K S Ng, Zhen Jonathan Liang, Wilson G W Goh, Adrian C L Kee, Tow Keang Lim","doi":"10.1515/dx-2025-0071","DOIUrl":"https://doi.org/10.1515/dx-2025-0071","url":null,"abstract":"Over-testing, or the inappropriate use of diagnostic tests, is a highly prevalent phenomenon in modern medical practice, driven by a variety of physician, patient/disease, practice environment and system-related factors. Most of the time, physician proclivities to over-investigate fundamentally reflects a flawed clinical reasoning process under real-world practice conditions. Over the years, various educational campaigns and interventions such as the Choosing Wisely programme have been attempted to varying success, without clear evidence of a sustained reduction in the excessive/inappropriate use of diagnostic tests in clinical practice. Therefore, in this article, we hope to provide fresh perspectives on the concept of \"diagnostic stewardship\", which has hitherto been largely confined to the realm of infectious diseases to govern responsible clinical use of antimicrobials, by explaining its role in the delivery of patient-centered and sustainable healthcare. We further explore the underlying contributors to over-testing and how it relates to flaws in clinical reasoning in real-world settings. Lastly, we discuss multi-level educational and practice-based interventions that may help to curb the tide of profligate diagnostic testing behaviors.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816007","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

Incivility in the context of diagnostic safety: a theoretical analysis. 诊断安全背景下的不文明行为：一个理论分析。

IF 2

Diagnosis Pub Date : 2025-08-12 DOI: 10.1515/dx-2025-0060

Ana Lorena Hermosilla

{"title":"Incivility in the context of diagnostic safety: a theoretical analysis.","authors":"Ana Lorena Hermosilla","doi":"10.1515/dx-2025-0060","DOIUrl":"https://doi.org/10.1515/dx-2025-0060","url":null,"abstract":"Objectives: To analyze a theoretical framework that incorporates incivility among healthcare teams in relation to diagnostic safety, and to assess its potential utility for advancing research and practice.Methods: A structured literature review was conducted across PubMed, Web of Science, and CINAHL using search terms such as \"diagnostic safety,\" \"team dynamics,\" \"theoretical framework,\" \"incivility,\" and \"diagnostic framework\". A theoretical framework was selected for analysis. Walker and Avant's six-step theory analysis method was applied to assess the framework's origins, meaning, logical adequacy, usefulness, generalizability, parsimony, and testability.Results: The literature review yielded 144 articles after screening and applying inclusion criteria. Ten articles were reviewed, and the Model of Ward Team Dynamics in Diagnosis by Choi et al. was selected for analysis, as it was the only framework that explicitly addressed unacceptable behaviors (i.e., incivility) in diagnostic team settings. The Choi et al. framework uniquely integrates unacceptable behaviors as a mediating factor in diagnostic team performance, distinguishing it from other diagnostic models. The analysis found the framework to be conceptually well-grounded, with several constructs operationally defined and empirically measurable. However, gaps were identified in parsimony and the clarity of relational statements, indicating opportunities for refinement and empirical testing.Conclusions: The framework offers a valuable theoretical foundation for studying the impact of incivility on diagnostic safety. Its integration of behavioral constructs supports its relevance for empirical research and intervention development aimed at improving team dynamics and diagnostic outcomes.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816008","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

Appendicitis: common and commonly missed - the story of Alice Tapper. 阑尾炎：常见和常被忽视——爱丽丝·塔珀的故事。

IF 2

Diagnosis Pub Date : 2025-08-01 DOI: 10.1515/dx-2023-0142

Antonio J Dajer, Andrew P J Olson

引用次数: 0

Misdiagnosis in carpal tunnel syndrome: amyloidosis and other red flags. A narrative review. 腕管综合征的误诊：淀粉样变和其他危险信号。叙述性评论

IF 2

Diagnosis Pub Date : 2025-08-01 DOI: 10.1515/dx-2025-0063

Jorge Menéndez-Cámara, David Cecilia-López, Lorena García-Lamas, Celia Castillo-Fernández, Luis Matesanz-García, Josué Fernández-Carnero

引用次数: 0

The poverty of diagnostic essentialism: reimagining diagnosis in the age of artificial intelligence. 诊断本质论的贫乏：人工智能时代对诊断的重新构想。