Diagnosis最新文献_第4页

Learning from what goes right: a safety-II framework for improving diagnosis at the point of care. 从正确的地方学习：在护理点提高诊断的安全ii框架。

IF 2.2

Diagnosis Pub Date : 2025-07-17 DOI: 10.1515/dx-2025-0086

Taro Shimizu

{"title":"Learning from what goes right: a safety-II framework for improving diagnosis at the point of care.","authors":"Taro Shimizu","doi":"10.1515/dx-2025-0086","DOIUrl":"https://doi.org/10.1515/dx-2025-0086","url":null,"abstract":"Traditional approaches to improving diagnosis in medicine have focused mainly on identifying and analyzing errors using the Safety-I perspective. Yet, the vast majority of diagnostic encounters are successful, and structured reflection on these positive outcomes remains uncommon in current practice. In this article, I introduce SIDER (Specification, Ishikawa diagram, driver diagram, Engaging the patient and the team, Reflection), a practical protocol designed to embed Safety-II principles into routine diagnostic reflection by encouraging clinicians to learn from what goes right. SIDER guides clinicians through five clear phases: specifying a particularly challenging or instructive case, mapping contributing factors using an Ishikawa diagram, translating those findings into actionable strategies with a driver diagram, engaging the care team and patient to gather collective insights, and concluding with individual reflection to support ongoing calibration and learning. I describe how SIDER enables clinicians to extract broad and transferable lessons from successful but complex diagnostic cases, complementing traditional error analysis and supporting a culture of continuous improvement. By adopting this framework, healthcare teams can expand opportunities for experiential learning, strengthen adaptive expertise, and advance safer diagnostic practice. Future studies are warranted to evaluate the effectiveness of SIDER-guided reflection in enhancing diagnostic performance and improving patient outcomes.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641983","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

Leveraging diagnostic timeouts to foster interprofessional communication. 利用诊断超时来促进专业间的沟通。

IF 2.2

Diagnosis Pub Date : 2025-07-08 DOI: 10.1515/dx-2025-0039

James Bowen, Brenda Demeritt, Anna J Ipsaro, Amanda Combs, DeAnna Hawkins, Michaela Hoiles, Angela M Statile, Michelle Parker

{"title":"Leveraging diagnostic timeouts to foster interprofessional communication.","authors":"James Bowen, Brenda Demeritt, Anna J Ipsaro, Amanda Combs, DeAnna Hawkins, Michaela Hoiles, Angela M Statile, Michelle Parker","doi":"10.1515/dx-2025-0039","DOIUrl":"https://doi.org/10.1515/dx-2025-0039","url":null,"abstract":"Objectives: Diagnostic errors are a significant source of patient harm, often arising from cognitive biases and communication breakdowns. Diagnostic timeouts (DTOs) offer a structured opportunity to reassess diagnoses, but their implementation is inconsistent. This study aimed to evaluate a nurse-driven DTO framework designed to enhance interprofessional communication and diagnostic accuracy in a pediatric hospital setting.Methods: A multidisciplinary committee developed and piloted a DTO framework on a 48-bed pediatric acute care unit. Bedside nurses received structured education on DTOs, and standardized prompts were integrated into nursing workflows to identify patients who may benefit from a DTO. Feasibility and acceptability were assessed through voluntary surveys, post-DTO documentation, and qualitative feedback.Results: Among 90 surveyed nurses, 28 % reported that a DTO would have been beneficial for at least one patient in the eight weeks prior to the intervention period. Over six months, 13 nurse-initiated DTOs occurred, with nearly half (46 %) prompting additional workup. Two DTOs led to escalation of care. Qualitative feedback highlighted improved communication, increased psychological safety, and enhanced teamwork.Conclusions: Pilot implementation of a formalized nurse-driven DTO framework was well-received, reinforcing its role in structured diagnostic reassessment. Future efforts will expand DTO implementation and evaluate its impact on psychological safety.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575045","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

Minimizing the discard blood volume from the central venous catheter for routine laboratory testing in adult intensive care unit. 成人重症监护病房常规实验室检测中心静脉导管弃血量最小化。

IF 2.2

Diagnosis Pub Date : 2025-07-08 DOI: 10.1515/dx-2025-0065

Ivana Lapić, Josipa Kostelac, Luka Bielen, Ana Vujaklija Brajković, Ivana Rupčić Gračanin, Dunja Rogić, Radovan Radonić

{"title":"Minimizing the discard blood volume from the central venous catheter for routine laboratory testing in adult intensive care unit.","authors":"Ivana Lapić, Josipa Kostelac, Luka Bielen, Ana Vujaklija Brajković, Ivana Rupčić Gračanin, Dunja Rogić, Radovan Radonić","doi":"10.1515/dx-2025-0065","DOIUrl":"https://doi.org/10.1515/dx-2025-0065","url":null,"abstract":"Objectives: The aim was to reduce blood loss related to laboratory blood sampling by decreasing the discard blood volume from the central venous catheter (CVC) from 10 to 3 mL, and replacing the 3 mL tube for complete blood count (CBC) with a 2 mL tube. A comparison study was performed, and after introduction of this modified protocol the decrease in withdrawn blood was calculated.Methods: In 52 adult inpatients at the ICU 3 mL of blood was discarded from the CVC, and blood was drawn in a 5 mL serum tube and a 2 mL EDTA tube (test samples), followed by subsequent sampling for routine laboratory testing using the same blood tubes (routine samples). In paired test and routine samples, clinical chemistry testing and CBC were performed.Results: High correlations (ρ>0.90) were obtained for the majority of parameters. Small constant difference was obtained for hemoglobin. Small significant biases were observed for hemoglobin, MCHC, albumin, ALT, calcium, chlorides, MCV and glucose, however, being below the biases of the analytical methods. No statistically significant differences between test and routine samples were found for any of the assessed tests (p>0.05). Implementation of the 3 mL discard blood volume protocol and transition to a smaller volume tube for CBC reduced the amount of withdrawn blood by almost half (46 %).Conclusions: The 3 mL discard blood volume from the CVC can be safely used for routine hematology and clinical chemistry testing. The dual approach assessed herein can contribute to reduction of iatrogenic blood loss.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575046","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 use of the hemolysis index as an indirect indicator of whole blood sample quality. 使用溶血指数作为全血样本质量的间接指标。

IF 2.2

Diagnosis Pub Date : 2025-07-02 DOI: 10.1515/dx-2025-0066

Stefano Pastori, Vincenzo Roccaforte, Rossella Panella, Erika Jani, Alberto Ponzoni, Marta Spreafico, Giuseppe Lippi, Ruggero Buonocore, Massimo Daves

{"title":"The use of the hemolysis index as an indirect indicator of whole blood sample quality.","authors":"Stefano Pastori, Vincenzo Roccaforte, Rossella Panella, Erika Jani, Alberto Ponzoni, Marta Spreafico, Giuseppe Lippi, Ruggero Buonocore, Massimo Daves","doi":"10.1515/dx-2025-0066","DOIUrl":"https://doi.org/10.1515/dx-2025-0066","url":null,"abstract":"Objectives: The aim of this study is to assess the discrepancies between potassium values obtained from point-of-care testing and laboratory analyzers, and to propose a straightforward method to indirectly assess the likelihood of hemolysis in whole blood samples.Methods: The data were collected from 409 hospitalized patients (199 males, 210 females; median age 78 years, interquartile range 55-87) in whom were simultaneously requested the blood gas profile, including electrolytes (Na, K, Cl and Ca2+) on the GEM Premier 5000 blood gas analyzer and K in plasma samples on the Cobas analytical system.Results: The Wilcoxon test showed a significant difference (p<0.0001) for K measurements, with a number of positive differences between Cobas and GEM Premier 5,000 of 110 and negative differences of 293. The median value of the hemolysis index was 7 (95 % CI for the median 6 to 8). The differences between the two K measurements obtained from plasma and whole blood samples showed a lowest and highest differences of -1.7 and 4.6 mmol/L. The median difference was 0.63 (95 % CI for the median: 0.54-0.73) and the interquartile range (IQR) was 0.48-0.9. Overall, 89 samples (21 %) displayed a difference larger than the relative change value.Conclusions: The presence of hemolysis in plasma samples should alert laboratory professionals to carefully evaluate the corresponding whole blood results. Concordant values indicate the presence of hemolysis in the whole blood sample, while discordant values suggest that hemolysis only affects one of the two samples.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526852","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

Myelin water imaging as a quantitative diagnostic tool for neurodegenerative diseases: a systematic review. 髓鞘水显像作为神经退行性疾病的定量诊断工具：系统综述。

IF 2.2

Diagnosis Pub Date : 2025-06-16 DOI: 10.1515/dx-2025-0055

Aswathi Puliyakkara, Abhijith Shirlal, Saikiran Pendem, Priyanka, Rajagopal Kadavigere, Thejas S Marike

{"title":"Myelin water imaging as a quantitative diagnostic tool for neurodegenerative diseases: a systematic review.","authors":"Aswathi Puliyakkara, Abhijith Shirlal, Saikiran Pendem, Priyanka, Rajagopal Kadavigere, Thejas S Marike","doi":"10.1515/dx-2025-0055","DOIUrl":"https://doi.org/10.1515/dx-2025-0055","url":null,"abstract":"Introduction: Neurodegenerative diseases such as multiple Sclerosis (MS), Alzheimer's disease (AD), and Parkinson's disease (PD) share overlapping clinical and pathological features, complicating early diagnosis and management. Demyelination, a key pathological hallmark, underscores the importance of accurately assessing white matter (WM) integrity.Content: Myelin water imaging (MWI), an advanced non-invasive MRI technique, quantifies the myelin water fraction (MWF) and offers high specificity for detecting myelin abnormalities. This systematic review explores the feasibility and diagnostic utility of MWI across MS, AD, and PD by analyzing 21 high-quality studies from major databases, following PRISMA guidelines.Summary: MWI consistently revealed reduced MWF in MS patients across various WM regions, lesion types, and disease stages, including responsiveness to early treatment. In AD, MWF decline correlated with disease progression and apolipoprotein E4 (APOE4) genotype, supporting its potential in early diagnosis. Findings in PD were inconsistent, reflecting secondary or minimal myelin involvement in its pathology.Outlook: MWI shows strong promise as a non-invasive imaging biomarker, particularly in MS and AD. Standardization of acquisition protocols, integration with multimodal imaging, and further longitudinal studies are essential to establish its clinical utility and support broader implementation in neurodegenerative disease diagnostics.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526851","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

Exploring the role of glial fibrillary acid protein and neurofilament light chains in patients with hereditary transthyretin amyloidosis with polyneuropathy. 探讨神经胶质原纤维酸蛋白和神经丝轻链在遗传性甲状腺转蛋白淀粉样变性合并多发性神经病患者中的作用。

IF 2.2

Diagnosis Pub Date : 2025-06-10 DOI: 10.1515/dx-2025-0042

Caterina Maria Gambino, Luisa Agnello, Vincenzo Di Stefano, Fabio Del Ben, Anna Masucci, Martina Tamburello, Roberta Vassallo, Concetta Scazzone, Anna Maria Ciaccio, Filippo Brighina, Marcello Ciaccio

{"title":"Exploring the role of glial fibrillary acid protein and neurofilament light chains in patients with hereditary transthyretin amyloidosis with polyneuropathy.","authors":"Caterina Maria Gambino, Luisa Agnello, Vincenzo Di Stefano, Fabio Del Ben, Anna Masucci, Martina Tamburello, Roberta Vassallo, Concetta Scazzone, Anna Maria Ciaccio, Filippo Brighina, Marcello Ciaccio","doi":"10.1515/dx-2025-0042","DOIUrl":"https://doi.org/10.1515/dx-2025-0042","url":null,"abstract":"Objectives: Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN) is a rare, progressive neurodegenerative disorder caused by mutations in the transthyretin (TTR) gene. The disease leads to systemic amyloid deposition, primarily affecting the nervous system and, in some cases, the heart. Early diagnosis and monitoring are critical for effective management, yet reliable biomarkers remain limited. This study aimed to investigate the role of serum glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) as biomarkers in ATTRv-PN.Methods: A retrospective observational study was conducted at the University Hospital Paolo Giaccone, enrolling ATTRv-PN patients, asymptomatic TTR mutation carriers, and healthy blood donors. Serum GFAP and NfL levels were measured using a fully automated immunoassay (Lumipulse G1200).Results: A total of 119 participants were included: ATTRv-PN (n=23), carriers (n=27), and healthy controls (n=69). GFAP levels were significantly elevated in ATTRv-PN patients compared to carriers and healthy controls (p<0.001), with the highest levels observed in individuals with the V122I mutation. The median NfL levels were also significantly elevated in ATTRv-PN patients (30.74 pg/mL) compared to carriers (11.59 pg/mL) and healthy controls (12.86 pg/mL) (p<0.001). Additionally, a significant negative correlation was observed between NfL levels and clinical severity scores, indicating its association with disease severity.Conclusions: These findings support the usefulness of serum NfL as a prognostic tool in ATTRv-PN and highlight the potential involvement of astrocyte activation in disease pathology. Further longitudinal studies are needed to validate these biomarkers for clinical application.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246898","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

Clinical implications of conjugated vs. direct bilirubin testing: analytical limits and clinical consequences. 结合胆红素与直接胆红素检测的临床意义：分析限度和临床后果。

IF 2.2

Diagnosis Pub Date : 2025-06-02 DOI: 10.1515/dx-2025-0068

Oswald Sonntag, Giuseppe Lippi

引用次数: 0

Prognostic role of previous syncope spells in ED patients with syncope. 既往晕厥对ED晕厥患者预后的影响。

IF 2.2

Diagnosis Pub Date : 2025-05-30 DOI: 10.1515/dx-2025-0045

Filippo Numeroso, Ivo Casagranda

{"title":"Prognostic role of previous syncope spells in ED patients with syncope.","authors":"Filippo Numeroso, Ivo Casagranda","doi":"10.1515/dx-2025-0045","DOIUrl":"https://doi.org/10.1515/dx-2025-0045","url":null,"abstract":"Objectives: In the prognostic evaluation of syncopal patients, previous episodes have a somewhat ambivalent role, as they are usually associated to reflex syncope, with a benign prognosis, but according to some authors when frequent require further investigations even in case of a negative ED workup.Methods: Retrospective observational study in a cohort of 378 ED syncopal patients to investigated the presence of previous episodes and their prognostic significance, in predicting cardiac syncope, syncope associated to underlying acute diseases and syncope severe due to consequential risk.Results: We found previous syncopal episodes in over half of patients (57.4 %); mostly few (up to two episodes in total in 63.8 %), with a trends over time very rare or occasional, in a small minority complicated by major injuries. As regards the prognostic role of syncopal recurrences, we found: 1. no association between their total number in life with any outcome considered; 2. a close association between presence of acute principal diseases and absence of previous episodes; 3. a close association between severe syncope due to consequential risk and a frequent or recurrent time course of previous spells and previous episodes worsened by major injuries.Conclusions: Previous episodes, although frequent, don't correlate with adverse outcomes so don't help to identify high risk patients. Conversely, a first syncopal episode, especially in elderly patients, requires careful evaluation to rule out any underlying acute condition. Additionally, attention should be also paid to patients with previous episodes clustered in the last period or complicated by severe injuries, as they negatively impact quality of life.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207989","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

Optimizing use of illness script builder templates in medical education. 优化医学教育中疾病脚本构建器模板的使用。

IF 2.2

Diagnosis Pub Date : 2025-05-29 DOI: 10.1515/dx-2025-0005

Erin H Yang, Joseph Rencic, Alec B Rezigh, Prathit A Kulkarni

{"title":"Optimizing use of illness script builder templates in medical education.","authors":"Erin H Yang, Joseph Rencic, Alec B Rezigh, Prathit A Kulkarni","doi":"10.1515/dx-2025-0005","DOIUrl":"https://doi.org/10.1515/dx-2025-0005","url":null,"abstract":"Illness scripts are mental networks of information about medical diseases and are used by clinicians to efficiently make diagnostic and treatment decisions. The traditional components of an illness script include the epidemiologic risk factors, pathophysiology, and clinical findings of a disease [Feltovich PJ, Barrows HS. Issues of generality in medical problem solving. In: Schmidt HG, De Volder ML, editors. Tutorials in problem-based learning. Assen/Maastricht: Van Gorcum; 1984:128-42 pp]. Here, we coin the term illness script builder templates (ISBTs), which are educational tools to help learners develop their illness scripts. While the actual concept of ISBTs is not new, we aim to explicitly distinguish these discrete learning tools from illness scripts themselves, which are mental frameworks. ISBTs have significant pedagogic value. They are being more widely adopted in clinical curricula in medical school, as they have been well-received by students and educationally effective. ISBTs allow the integration of new knowledge to be intuitive, as they take advantage of our predilection toward story-based learning. Limitations to ISBTs also exist, especially when considering their optimal length and structure as well as complexity for different levels of learners. We additionally explore the specific strengths and limitations of ISBTs and propose strategies to maximize their use in education and clinical practice.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180954","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

Does ANA positivity alone lead to microcirculatory alterations detectable by capillaroscopy? 单纯ANA阳性是否会导致毛细血管镜检查检测到的微循环改变？

IF 2.2

Diagnosis Pub Date : 2025-05-29 DOI: 10.1515/dx-2025-0020

Angelo Nigro

引用次数: 0