Diagnosis最新文献_第4页

Should APTT become part of thrombophilia screening? APTT 是否应成为血栓性疾病筛查的一部分？

IF 2.2

Diagnosis Pub Date : 2024-05-24 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0086

Giuseppe Lippi, Emmanuel J Favaloro

引用次数: 0

Recent mortality rates due to complications of medical and surgical care in the US. 美国医疗和外科护理并发症导致的最新死亡率。

IF 2.2

Diagnosis Pub Date : 2024-05-20 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0071

Camilla Mattiuzzi, Mario Plebani, Giuseppe Lippi

{"title":"Recent mortality rates due to complications of medical and surgical care in the US.","authors":"Camilla Mattiuzzi, Mario Plebani, Giuseppe Lippi","doi":"10.1515/dx-2024-0071","DOIUrl":"10.1515/dx-2024-0071","url":null,"abstract":"Objectives: Medical errors and complications pose a major threat to the safety of healthcare systems worldwide. This article was hence aimed at determining the current burden of complications of medical and surgical care in the US.Methods: We searched the latest version of the US Centers for Disease Control and Prevention (CDC) WONDER online database (years 2018-2022) using ICD-10 codes Y40-Y84 (complications of medical and surgical care).Results: The age-adjusted death rate for complications of medical and surgical care increased from 1.17 × 100,000 in 2018 to 1.49 × 100,000 in 2021, but then declined to 0.85 × 100,000 in 2022. The gender-specific analysis showed a similar trend, with the age-adjusted death rate values always being higher in men than in women. A clear age-dependent relationship was also found in the crude mortality rate for complications of medical and surgical care, as higher death rates were observed in older patients.Conclusions: This analysis reveals that the burden of complications of medical and surgical care has increased over time, especially during the COVID-19 pandemic, but has then considerably declined in 2022. However, root cause analysis and actions are still needed for preventing the still noticeable consequences of medical complications.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"443-445"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955507","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

Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area. 初级医疗中心力衰竭登记的质量：从阿姆斯特丹大都会区 100 万份电子健康记录中观察到的结果。

IF 2.2

Diagnosis Pub Date : 2024-05-14 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0009

Lukas De Clercq, Jelle C L Himmelreich, Ralf E Harskamp

{"title":"Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area.","authors":"Lukas De Clercq, Jelle C L Himmelreich, Ralf E Harskamp","doi":"10.1515/dx-2024-0009","DOIUrl":"10.1515/dx-2024-0009","url":null,"abstract":"Objectives: Proper coding of heart failure (HF) in electronic health records (EHRs) is an important prerequisite for adequate care and research towards this vulnerable patient population. We set out to evaluate the accuracy of registration of HF diagnoses in primary care EHRs.Methods: In a routine primary care database covering the Amsterdam Metropolitan Area, we identified all episodes of care with International Classification of Primary Care (ICPC) codes K77 (decompensatio cordis) or K84.03 (cardiomyopathy) up to 31/12/2021. We also performed two text-based searches to identify HF episodes without an appropriate ICPC-code. An expert panel evaluated all ICPC and text matches for congruence between the assigned codes and notes.Results: From a database of 968,433 records we identified 19,106 patients (2.0 %) with a total of 24,011 ICPC-coded HF episodes. Removal of 1,324 episodes found to concern other or uncertain diagnoses and inclusion of 4,582 validated HF episodes identified through text search led to exclusion of 909 (overregistration: 4.8 %) and inclusion of 2,266 additional patients (underregistration: 11.1 %). The inclusion of miscoded HF episodes advanced the first known date of HF diagnosis in 3.9 % of records, with a median shift of 3.45 years. Episode-level underregistration decreased significantly over time, from 23.8 % in 2006 to 10.0 % in 2021.Conclusions: While there is improvement over time, there are still substantial levels of over- and underregistration of HF, emphasizing the need for cautious interpretation of ICPC-coded data. The findings contribute to the understanding of HF registration issues in primary care and provide insights for improving registration practices.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"380-388"},"PeriodicalIF":2.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916190","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

Unclassified green dots on nucleated red blood cells (nRBC) plot in DxH900 from a patient with hyperviscosity syndrome. 一位高粘度综合征患者的 DxH900 中有核红细胞（nRBC）图上的未分类绿点。

IF 3.5

Diagnosis Pub Date : 2024-05-10 DOI: 10.1515/dx-2024-0038

Rafael José García Martínez, José Carlos Garrido Gomez, Enrique María Ocio San Miguel, María Josefa Muruzábal Sitges

引用次数: 0

n-3 fatty acids and the risk of atrial fibrillation, review. n-3 脂肪酸与心房颤动风险，综述。

IF 2.2

Diagnosis Pub Date : 2024-05-09 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0077

Wolfgang Herrmann, Markus Herrmann

{"title":"n-3 fatty acids and the risk of atrial fibrillation, review.","authors":"Wolfgang Herrmann, Markus Herrmann","doi":"10.1515/dx-2024-0077","DOIUrl":"10.1515/dx-2024-0077","url":null,"abstract":"Atrial fibrillation (AF) is the most frequent type of cardiac arrhythmia that affects over six million individuals in Europe. The incidence and prevalence of AF rises with age, and often occurs after cardiac surgery. Other risk factors correlated with AF comprise high blood pressure, diabetes mellitus, left atrial enlargement, ischemic heart disease, and congestive heart failure. Considering the high prevalence of AF in aging societies, strategies to prevent serious complications, such as stroke or heart failure, are important because they are correlated with high morbidity and mortality. The supplementation of sea-derived n-3 polyunsaturated fatty acids (PUFA) is widely discussed in this context, but the results of experimental and observational studies are in contrast to randomized placebo-controlled intervention trials (RCTs). Specifically, larger placebo-controlled n-3 PUFA supplementation studies with long follow-up showed a dose-dependent rise in incident AF. Daily n-3 PUFA doses of ≥1 g/d are correlated with a 50 % increase in AF risk, whereas a daily intake of <1 g/d causes AF in only 12 %. Individuals with a high cardiovascular risk (CVD) risk and high plasma-triglycerides seem particularly prone to develop AF upon n-3 PUFA supplementation. Therefore, we should exercise caution with n-3 PUFA supplementation especially in patients with higher age, CVD, hypertriglyceridemia or diabetes. In summary, existing data argue against the additive intake of n-3 PUFA for preventative purposes because of an incremental AF risk and lacking CVD benefits. However, more clinical studies are required to disentangle the discrepancy between n-3 PUFA RCTs and observational studies showing a lower CVD risk in individuals who regularly consume n-3 PUFA-rich fish.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"345-352"},"PeriodicalIF":2.2,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876066","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

Computerized diagnostic decision support systems - a comparative performance study of Isabel Pro vs. ChatGPT4. 计算机诊断决策支持系统--伊莎贝尔专业版与 ChatGPT4 的性能比较研究。

IF 2.2

Diagnosis Pub Date : 2024-05-07 eCollection Date: 2024-08-01 DOI: 10.1515/dx-2024-0033

Joe M Bridges

{"title":"Computerized diagnostic decision support systems - a comparative performance study of Isabel Pro vs. ChatGPT4.","authors":"Joe M Bridges","doi":"10.1515/dx-2024-0033","DOIUrl":"10.1515/dx-2024-0033","url":null,"abstract":"Objectives: Validate the diagnostic accuracy of the Artificial Intelligence Large Language Model ChatGPT4 by comparing diagnosis lists produced by ChatGPT4 to Isabel Pro.Methods: This study used 201 cases, comparing ChatGPT4 to Isabel Pro. Systems inputs were identical. Mean Reciprocal Rank (MRR) compares the correct diagnosis's rank between systems. Isabel Pro ranks by the frequency with which the symptoms appear in the reference dataset. The mechanism ChatGPT4 uses to rank the diagnoses is unknown. A Wilcoxon Signed Rank Sum test failed to reject the null hypothesis.Results: Both systems produced comprehensive differential diagnosis lists. Isabel Pro's list appears immediately upon submission, while ChatGPT4 takes several minutes. Isabel Pro produced 175 (87.1 %) correct diagnoses and ChatGPT4 165 (82.1 %). The MRR for ChatGPT4 was 0.428 (rank 2.31), and Isabel Pro was 0.389 (rank 2.57), an average rank of three for each. ChatGPT4 outperformed on Recall at Rank 1, 5, and 10, with Isabel Pro outperforming at 20, 30, and 40. The Wilcoxon Signed Rank Sum Test confirmed that the sample size was inadequate to conclude that the systems are equivalent. ChatGPT4 fabricated citations and DOIs, producing 145 correct references (87.9 %) but only 52 correct DOIs (31.5 %).Conclusions: This study validates the promise of Clinical Diagnostic Decision Support Systems, including the Large Language Model form of artificial intelligence (AI). Until the issue of hallucination of references and, perhaps diagnoses, is resolved in favor of absolute accuracy, clinicians will make cautious use of Large Language Model systems in diagnosis, if at all.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"250-258"},"PeriodicalIF":2.2,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848080","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

Computable phenotype for diagnostic error: developing the data schema for application of symptom-disease pair analysis of diagnostic error (SPADE). 诊断错误的可计算表型：为诊断错误的症状-疾病配对分析 (SPADE) 应用开发数据模式。

IF 2.2

Diagnosis Pub Date : 2024-05-03 eCollection Date: 2024-08-01 DOI: 10.1515/dx-2023-0138

Ahmed Hassoon, Charles Ng, Harold Lehmann, Hetal Rupani, Susan Peterson, Michael A Horberg, Ava L Liberman, Adam L Sharp, Michelle C Johansen, Kathy McDonald, J Mathrew Austin, David E Newman-Toker

{"title":"Computable phenotype for diagnostic error: developing the data schema for application of symptom-disease pair analysis of diagnostic error (SPADE).","authors":"Ahmed Hassoon, Charles Ng, Harold Lehmann, Hetal Rupani, Susan Peterson, Michael A Horberg, Ava L Liberman, Adam L Sharp, Michelle C Johansen, Kathy McDonald, J Mathrew Austin, David E Newman-Toker","doi":"10.1515/dx-2023-0138","DOIUrl":"10.1515/dx-2023-0138","url":null,"abstract":"Objectives: Diagnostic errors are the leading cause of preventable harm in clinical practice. Implementable tools to quantify and target this problem are needed. To address this gap, we aimed to generalize the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) framework by developing its computable phenotype and then demonstrated how that schema could be applied in multiple clinical contexts.Methods: We created an information model for the SPADE processes, then mapped data fields from electronic health records (EHR) and claims data in use to that model to create the SPADE information model (intention) and the SPADE computable phenotype (extension). Later we validated the computable phenotype and tested it in four case studies in three different health systems to demonstrate its utility.Results: We mapped and tested the SPADE computable phenotype in three different sites using four different case studies. We showed that data fields to compute an SPADE base measure are fully available in the EHR Data Warehouse for extraction and can operationalize the SPADE framework from provider and/or insurer perspective, and they could be implemented on numerous health systems for future work in monitor misdiagnosis-related harms.Conclusions: Data for the SPADE base measure is readily available in EHR and administrative claims. The method of data extraction is potentially universally applicable, and the data extracted is conveniently available within a network system. Further study is needed to validate the computable phenotype across different settings with different data infrastructures.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"295-302"},"PeriodicalIF":2.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848588","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

Are shortened aPTT values always to be attributed only to preanalytical problems? 缩短的 aPTT 值是否总是只能归因于分析前的问题？

IF 2.2

Diagnosis Pub Date : 2024-05-03 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0050

Vanja Radišić Biljak, Matea Tomas, Ivana Lapić, Andrea Saračević

{"title":"Are shortened aPTT values always to be attributed only to preanalytical problems?","authors":"Vanja Radišić Biljak, Matea Tomas, Ivana Lapić, Andrea Saračević","doi":"10.1515/dx-2024-0050","DOIUrl":"10.1515/dx-2024-0050","url":null,"abstract":"Objectives: It has been recognized that shortened activated partial thromboplastin time (aPTT) may be caused by various preanalytical conditions. As coagulation Factor VIII is included in the in vitro intrinsic coagulation cascade measured by aPTT, we hypothesized that the shortened aPTT could be a result of elevated FVIII activity. We aimed to inspect the connection of elevated FVIII with shortened aPTT, and the possible effect inflammation has on routine laboratory parameters.Methods: 40 patients from various hospital departments with aPTT measurement below the lower limit of the reference interval (<23.0 s) were included in the study. To compare the obtained results with aPTT measurements in the non-inflammatory state, samples from 25 volunteers (laboratory personnel) were collected. White blood cell count, C-reactive protein, aPTT, and FVIII values were measured in the control group.Results: Only two samples among 40 patients with shortened aPTT (5 %) were clotted. Out of the remaining 38, 26 had FVIII activity above 150 % (upper limit of a reference interval), median value of 194 % (IQR: 143-243 %). Seven samples in the control group had shortened aPTT results (36 %). However, all coagulation samples were clot and hemolysis-free. Multiple regression identified only FVIII activity as an independent variable in predicting aPTT values (p=0.001).Conclusions: Our results support the thesis that shortened aPTT is rarely a consequence of preanalytical problems. Elevated FVIII activity causes shortened aPTT, not only in the inflammatory state but also in individuals with concentration of inflammatory markers within reference intervals.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"430-434"},"PeriodicalIF":2.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853391","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

Comparative analysis of diagnostic accuracy in endodontic assessments: dental students vs. artificial intelligence. 牙髓病评估中诊断准确性的比较分析：牙科学生与人工智能。

IF 2.2

Diagnosis Pub Date : 2024-05-03 eCollection Date: 2024-08-01 DOI: 10.1515/dx-2024-0034

Abubaker Qutieshat, Alreem Al Rusheidi, Samiya Al Ghammari, Abdulghani Alarabi, Abdurahman Salem, Maja Zelihic

{"title":"Comparative analysis of diagnostic accuracy in endodontic assessments: dental students vs. artificial intelligence.","authors":"Abubaker Qutieshat, Alreem Al Rusheidi, Samiya Al Ghammari, Abdulghani Alarabi, Abdurahman Salem, Maja Zelihic","doi":"10.1515/dx-2024-0034","DOIUrl":"10.1515/dx-2024-0034","url":null,"abstract":"Objectives: This study evaluates the comparative diagnostic accuracy of dental students and artificial intelligence (AI), specifically a modified ChatGPT 4, in endodontic assessments related to pulpal and apical conditions. The findings are intended to offer insights into the potential role of AI in augmenting dental education.Methods: Involving 109 dental students divided into junior (54) and senior (55) groups, the study compared their diagnostic accuracy against ChatGPT's across seven clinical scenarios. Juniors had the American Association of Endodontists (AEE) terminology assistance, while seniors relied on prior knowledge. Accuracy was measured against a gold standard by experienced endodontists, using statistical analysis including Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner tests.Results: ChatGPT achieved significantly higher accuracy (99.0 %) compared to seniors (79.7 %) and juniors (77.0 %). Median accuracy was 100.0 % for ChatGPT, 85.7 % for seniors, and 82.1 % for juniors. Statistical tests indicated significant differences between ChatGPT and both student groups (p<0.001), with no notable difference between the student cohorts.Conclusions: The study reveals AI's capability to outperform dental students in diagnostic accuracy regarding endodontic assessments. This underscores AIs potential as a reference tool that students could utilize to enhance their understanding and diagnostic skills. Nevertheless, the potential for overreliance on AI, which may affect the development of critical analytical and decision-making abilities, necessitates a balanced integration of AI with human expertise and clinical judgement in dental education. Future research is essential to navigate the ethical and legal frameworks for incorporating AI tools such as ChatGPT into dental education and clinical practices effectively.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"259-265"},"PeriodicalIF":2.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856356","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 'curse of knowledge': when medical expertise can sometimes be a liability. 知识的诅咒"：医学知识有时会成为一种负担。

IF 2.2

Diagnosis Pub Date : 2024-04-29 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0064

Narinder Kapur

引用次数: 0