Diagnosis最新文献_第4页

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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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

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":null,"pages":null},"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

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":null,"pages":null},"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

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

Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit. 监测重症监护室败血症的单核细胞分布宽度（MDW）动力学。

IF 3.5

Diagnosis Pub Date : 2024-04-22 DOI: 10.1515/dx-2024-0019

L. Agnello, A. M. Ciaccio, Fabio Del Ben, B. Lo Sasso, G. Biundo, Aurora Giglia, R. V. Giglio, Andrea Cortegiani, C. Gambino, M. Ciaccio

{"title":"Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit.","authors":"L. Agnello, A. M. Ciaccio, Fabio Del Ben, B. Lo Sasso, G. Biundo, Aurora Giglia, R. V. Giglio, Andrea Cortegiani, C. Gambino, M. Ciaccio","doi":"10.1515/dx-2024-0019","DOIUrl":"https://doi.org/10.1515/dx-2024-0019","url":null,"abstract":"OBJECTIVES\u0000Monocyte distribution width (MDW) is a measure of monocyte anisocytosis. In this study, we assessed the role of MDW, in comparison to C-reactive protein (CRP), procalcitonin (PCT), and lactate, as a screening and prognostic biomarker of sepsis in intensive care unit (ICU) by longitudinally measuring it in the first 5 days of hospital stay.\u0000\u0000\u0000METHODS\u0000We considered all consecutive patients admitted to the ICU. At admission, patients were classified as septic or not according to Sepsis-3 criteria. MDW, CRP, PCT, and lactate were measured daily in the first 5 days of hospitalization. ICU mortality was also recorded.\u0000\u0000\u0000RESULTS\u0000We included 193 patients, 62 with sepsis and 131 without sepsis (controls). 58% and 26 % of the patients, with and without sepsis respectively, died during ICU stay. MDW showed the highest accuracy for sepsis detection, superior to CRP, PCT, and lactate (AUC of 0.840, 0.755, 0.708, 0.622, respectively). At admission, no biomarker predicts ICU mortality in patients with sepsis. The kinetic of all biomarkers during the first 5 days of hospitalization was associated with ICU mortality. Noteworthy, above all, the kinetic of MDW showed the best accuracy. Specifically, an increase or decrease in MDW from day 1-4 and 5 was significantly associated with mortality or survival, respectively.\u0000\u0000\u0000CONCLUSIONS\u0000MDW is a reliable diagnostic and prognostic sepsis biomarker, better than traditional biomarkers.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674673","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

Development of a disease-based hospital-level diagnostic intensity index. 制定基于疾病的医院诊断强度指数。

IF 3.5

Diagnosis Pub Date : 2024-04-22 DOI: 10.1515/dx-2023-0184

M. Ellenbogen, Leonard S Feldman, Laura Prichett, Junyi Zhou, Daniel J Brotman

{"title":"Development of a disease-based hospital-level diagnostic intensity index.","authors":"M. Ellenbogen, Leonard S Feldman, Laura Prichett, Junyi Zhou, Daniel J Brotman","doi":"10.1515/dx-2023-0184","DOIUrl":"https://doi.org/10.1515/dx-2023-0184","url":null,"abstract":"OBJECTIVES\u0000Low-value care is associated with increased healthcare costs and direct harm to patients. We sought to develop and validate a simple diagnostic intensity index (DII) to quantify hospital-level diagnostic intensity, defined by the prevalence of advanced imaging among patients with selected clinical diagnoses that may not require imaging, and to describe hospital characteristics associated with high diagnostic intensity.\u0000\u0000\u0000METHODS\u0000We utilized State Inpatient Database data for inpatient hospitalizations with one or more pre-defined discharge diagnoses at acute care hospitals. We measured receipt of advanced imaging for an associated diagnosis. Candidate metrics were defined by the proportion of inpatients at a hospital with a given diagnosis who underwent associated imaging. Candidate metrics exhibiting temporal stability and internal consistency were included in the final DII. Hospitals were stratified according to the DII, and the relationship between hospital characteristics and DII score was described. Multilevel regression was used to externally validate the index using pre-specified Medicare county-level cost measures, a Dartmouth Atlas measure, and a previously developed hospital-level utilization index.\u0000\u0000\u0000RESULTS\u0000This novel DII, comprised of eight metrics, correlated in a dose-dependent fashion with four of these five measures. The strongest relationship was with imaging costs (odds ratio of 3.41 of being in a higher DII tertile when comparing tertiles three and one of imaging costs (95 % CI 2.02-5.75)).\u0000\u0000\u0000CONCLUSIONS\u0000A small set of medical conditions and related imaging can be used to draw meaningful inferences more broadly on hospital diagnostic intensity. This could be used to better understand hospital characteristics associated with low-value care.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676698","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

Analysis of thicknesses of blood collection needle by scanning electron microscopy reveals wide heterogeneity. 通过扫描电子显微镜对采血针的厚度进行分析，可以发现存在很大的异质性。

IF 3.5

Diagnosis Pub Date : 2024-04-10 DOI: 10.1515/dx-2023-0171

Giuseppe Lippi, Maksim Harbatsevich, Vera Zayats

{"title":"Analysis of thicknesses of blood collection needle by scanning electron microscopy reveals wide heterogeneity.","authors":"Giuseppe Lippi, Maksim Harbatsevich, Vera Zayats","doi":"10.1515/dx-2023-0171","DOIUrl":"https://doi.org/10.1515/dx-2023-0171","url":null,"abstract":"OBJECTIVES\u0000The preanalytical phase in clinical laboratory diagnostics is currently receiving more and more attention. This term describes one part of actions and aspects of the \"brain-to-brain cycle\" of the medical laboratory diagnostic procedure that take place before the analytical phase. However, the preanalytical activities, the handling of unsuitable samples and the reporting procedures are neither fully standardized nor harmonized worldwide. The influence of the properties of the blood collection needle must be acknowledged. In this work, we focused on the investigation of the internal structure and size of standardized 21G blood collection needles.\u0000\u0000\u0000METHODS\u0000All parameters were measured with a scanning electron microscope using a Jeol model JSM-6000PLUS. Our.\u0000\u0000\u0000RESULTS\u0000The obtained data shows that the internal surfaces of the needles vary greatly from manufacturer to manufacturer (by around 35 %), and this may play an important role in influencing blood flow and even the risk of blood cell injury (especially hemolysis) during blood drawing.\u0000\u0000\u0000CONCLUSIONS\u0000The differential actual needle diameters can vary greatly between needle manufactures and this variety may have a significant impact on laboratory values and may also lead to specimen rejection.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718119","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 Japanese universal health insurance system in the context of diagnostic equity. 诊断公平背景下的日本全民医疗保险制度。

IF 3.5

Diagnosis Pub Date : 2024-04-10 DOI: 10.1515/dx-2024-0047

Keisuke Iida, Takashi Watari, Satoshi Watanuki

引用次数: 0