Diagnosis最新文献

{"title":"Learning from what went right: a Safety-II application of the SIDER protocol to a case of occult breast cancer.","authors":"Takako Kamei, Yuka Shimada, Yu Shimura, Yuna Sugawara, Riko Higashihara, Masashi Yokose, Yukinori Harada, Taro Shimizu","doi":"10.1515/dx-2026-0057","DOIUrl":"https://doi.org/10.1515/dx-2026-0057","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze how diagnostic success was achieved in a challenging case of occult breast cancer using the SIDER protocol, a structured Safety-II framework for reflecting on successful diagnostic processes.</p><p><strong>Case presentation: </strong>A 56-year-old woman developed progressive pain extending from the right upper limb to the right periscapular region 8 weeks before presentation, followed by axillary pain, cutaneous changes, and lymphadenopathy. Cervical radiography, cervical magnetic resonance imaging, breast ultrasonography, and computed tomography did not identify a primary breast lesion. At presentation, the clinical team retained breast malignancy in the differential diagnosis because of the patient's sex, progressive symptoms, axillary lymphadenopathy, and unexplained clinical trajectory. Diagnostic uncertainty was explicitly discussed with the patient, supporting continued follow-up. Two weeks later, positron emission tomography-computed tomography showed intense uptake from the right neck to the supraclavicular and axillary regions. Axillary lymph node biopsy demonstrated metastatic carcinoma with immunohistochemical findings consistent with breast origin, establishing the diagnosis of occult breast cancer.</p><p><strong>Conclusions: </strong>Applying the SIDER protocol showed that diagnostic progress depended on three reproducible processes: maintaining a low-probability but high-impact diagnosis despite nondiagnostic imaging, preserving patient engagement under uncertainty, and enabling diagnostic re-entry through cross-specialty collaboration. This case extends the use of Safety-II reflection by demonstrating how structured analysis of diagnostic success can generate practical lessons for complex, evolving presentations.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315772","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":"Using generative AI to support clinical reasoning coaching: a theory-informed approach.","authors":"Avneesh Sharma, Jessica J Dreicer, Andrew S Parsons","doi":"10.1515/dx-2026-0013","DOIUrl":"https://doi.org/10.1515/dx-2026-0013","url":null,"abstract":"<p><p>Generative artificial intelligence (gen AI) can support and likely enhance clinical reasoning coaching for struggling medical learners when its use is guided by educational theory. We present a conceptual framework, grounded in deliberate practice, self-regulated learning microanalysis, and psychological safety, for integrating gen AI into clinical reasoning coaching. Each theory was selected because it addresses a distinct challenge in coaching struggling learners, from the need for structured repetition with feedback to metacognitive monitoring and the stigma that impedes engagement. We describe how each theory can guide gen AI use in coaching and include suggested prompts.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315864","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":"Impact of clinical reasoning and diagnostic error education for nurses.","authors":"Akiko Kobayashi, Taiju Miyagami, Yuji Nishizaki, Keiko Sanbe, Seiko Furusaka, Toshio Naito","doi":"10.1515/dx-2026-0053","DOIUrl":"10.1515/dx-2026-0053","url":null,"abstract":"<p><strong>Objectives: </strong>Diagnostic errors occur frequently and significantly affect patient prognosis and medical safety. Nurses, who are closest to patients, are often the first to detect abnormalities. However, owing to insufficient knowledge of medical diagnoses and diagnostic errors, they tend to hesitate in voicing concerns. This study investigated the hypothesis that clinical reasoning and diagnostic error education for nurses improve their knowledge of diagnostic errors and learning motivation.</p><p><strong>Methods: </strong>A self-administered questionnaire survey was conducted before and after a lecture among nurses working in the outpatient department of Juntendo University Hospital. Eight domains related to diagnostic errors, including knowledge, confidence, motivation, feelings of guilt, and others, were assessed using a seven-point Likert scale. Pre- and post-lecture responses were compared using paired <i>t</i>-tests. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>Valid responses were obtained from 35 of the 70 participants in this study (response rate, 50 %), and the mean years of experience among the participants was 15.0 ± 9.0 years. Knowledge of diagnostic errors significantly increased (Pre: 2.1 ± 1.1 to Post: 4.6 ± 1.3), and motivation to learn about diagnostic errors also significantly increased (Pre: 6.1 ± 1.1 to Post: 6.6 ± 0.7).</p><p><strong>Conclusions: </strong>The above findings suggest that clinical reasoning and diagnostic error education for nurses significantly improve their knowledge, confidence, and motivation to learn about diagnostic errors. Furthermore, diagnostic error education may influence nurses' perceptions and enhance their ability to participate in the diagnostic process.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"157-163"},"PeriodicalIF":1.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301214","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":"Progress in mast cell activation syndrome: the global consensus-2 diagnostic criteria at six years.","authors":"Lawrence B Afrin, Svetlana Blitshteyn, Linda S Bluestein, Tania T Dempsey, Andrew J Maxwell, Claudia S Miller, Èva Nagy, Diane J Nugent, Jill R Schofield, Leonard B Weinstock, Shijun Cindy Xi, Gerhard J Molderings","doi":"10.1515/dx-2026-0016","DOIUrl":"https://doi.org/10.1515/dx-2026-0016","url":null,"abstract":"<p><p>Since establishment in 2020 of the global consensus-2 diagnostic criteria for mast cell activation syndrome (MCAS), recognition of this prevalent disease, existing alongside rare cutaneous or systemic mastocytosis, has grown significantly. Despite this progress, some have continued using more restrictive criteria, significantly underdiagnosing this complex but treatable disorder. Consensus-2 has brought diagnosis and effective treatment in many MCAS patients previously labeled with unexplained (mostly inflammatory) syndromes or misdiagnosed as somatization or other primary psychiatric disorders. Fears that consensus-2 diagnostic criteria might bring overdiagnosis have not been realized. Appropriate therapy for MCAS can dramatically improve quality of life, sometimes after decades of morbidity and disability despite extensive past unhelpful workups and treatment. Appreciating the breadth and heterogeneity of MCAS, and achieving good management outcomes, requires understanding the complexity of mast cell biology and pathophysiology as well as the range of comorbidities the disease can drive and which can aggravate the disease. The spectrum of diseases thought possibly rooted in variants of MCAS (or to which MCAS is significantly contributing) continues expanding, calling for more research. New therapeutic options have emerged, and clinicians have gained better appreciation for use of existing treatments and mitigation of impediments to treatment. MCAS research remains in early stages, hampered by many factors including limited awareness of the disease and challenges in objective assessment of treatment response. This review examines developments in awareness, education, clinical care, and research since consensus-2 emerged, while discussing challenges and opportunities for accelerating progress.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155578","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":"Japan and the future of diagnostic research.","authors":"Taro Shimizu, Yukinori Harada, Satoshi Watanuki","doi":"10.1515/dx-2026-0079","DOIUrl":"10.1515/dx-2026-0079","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"141-145"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136947","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":"Evaluation of the analytical performance and usability of the VChemy S analyzer for decentralized multipanel testing.","authors":"Nerea Varo, Maialen Palomino, Victoria Hauke, Carmen Mugueta, María Gil-Rodríguez, José Vicente García-Villalobos, María Blázquez-Rodríguez, Débora Martínez-Espartosa, Álvaro González","doi":"10.1515/dx-2026-0035","DOIUrl":"https://doi.org/10.1515/dx-2026-0035","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the analytical performance, comparability, reference interval transference, and usability of the VChemy S point-of-care testing (POCT) analyzer for 16 biochemistry analytes using whole blood, serum and plasma. The study aimed to determine its suitability for decentralized testing and concordance with accredited central laboratory methods.</p><p><strong>Methods: </strong>Adult outpatients were recruited to assess precision following CLSI EP15 and method comparison following CLSI EP09. Measurements were performed using VChemy S cartridges in whole blood, serum, and plasma and compared with results obtained in Roche Cobas^® Pro. Analytical performance was evaluated through Passing-Bablok regression, Bland-Altman analysis and comparison with EFLM minimum analytical quality specifications. Reference interval transference was examined according to CLSI EP28 using healthy volunteers. Usability was assessed through a 15-item Likert-scale questionnaire completed by users.</p><p><strong>Results: </strong>All analytes showed acceptable repeatability and within-laboratory imprecision, meeting manufacturer specifications and EFLM analytical performance targets, except glucose, which exceeded its APS. Fourteen of the sixteen analytes demonstrated analytical comparability across all matrices, with mean relative differences within total allowable error. Chloride and alkaline phosphatase exhibited method-dependent biases, preventing interchangeability and reference interval transference for chloride. Reference intervals were verified for all remaining analytes. Usability evaluation demonstrated a high satisfaction score (above 90 %).</p><p><strong>Conclusions: </strong>VChemy S provides analytically reliable results in whole blood, serum, and plasma for most routine biochemistry analytes, demonstrating strong alignment with central laboratory methods. Its portability, concordance with central laboratory methods, and user acceptance support its implementation in decentralized clinical settings, enabling faster decision-making and reduced preanalytical complexity.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980866","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":"Albumin decline corroborates physiological prothrombin time prolongation in the elderly.","authors":"Fabio Del Ben, Giuseppe Lippi","doi":"10.1515/dx-2026-0071","DOIUrl":"https://doi.org/10.1515/dx-2026-0071","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971378","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":"Cognitive mechanisms underlying anchoring bias in diagnosis: a randomized controlled experiment.","authors":"Sílvia Mamede, Henk G Schmidt, Francisco Carlos Specian Junior, LigiaCayres Ribeiro, Marco Antonio de Carvalho Filho, Bruno Augusto Goulart Campos, Dario Cecilio Fernandes","doi":"10.1515/dx-2025-0181","DOIUrl":"https://doi.org/10.1515/dx-2025-0181","url":null,"abstract":"<p><strong>Objectives: </strong>Anchoring bias occurs when physicians fail to revise an incorrect diagnosis triggered by salient distracting features (SDFs) despite contradictory evidence. The cognitive mechanisms underlying anchoring bias are unclear. We examined differences in processing of biasing (SDFs) and critical diagnostic information (discriminating features, DFs), when physicians give an SDF-related-diagnosis or an accurate diagnosis.</p><p><strong>Methods: </strong>Randomized, crossover experiment with medical residents in Brazil. Each participant diagnosed six clinical vignettes while eye movements were tracked and subsequently recalled each vignette's clinical findings. Each vignette had three versions: without SDFs, with SDFs at the beginning, with SDFs at the end. Each participant diagnosed two vignettes in each version in counterbalanced manner.</p><p><strong>Results: </strong>Fixations on DFs did not significantly differ between SDF-related-diagnoses and accurate diagnoses nor with the position of SDFs. Fixations on SDFs did not significantly differ with diagnostic accuracy. However, SDFs at the end of the vignette received fewer fixations than when at the beginning. Regardless of the SDFs position, physicians recalled more DFs and fewer SDFs when they gave an accurate diagnosis than an SDF-related-diagnosis (respectively, DFs: 0.47; 95 % CI, 0.40-0.53 vs. 0.20; 95 % CI, 0.06-0.33; SDFs: 0.16; 95 % CI, 0.08-0.24 vs. 0.37; 95 % CI, 0.24-0.50).</p><p><strong>Conclusions: </strong>DFs and SDFs attracted physicians' attention similarly extensively, but the recall suggests different cognitive processes were taking place. Overcoming anchoring bias apparently required engaging in inhibiting the SDFs while corroborating the diagnostic value of DFs. Clinical teaching should strengthen knowledge of DFs. Digital diagnostic support could possibly be optimized by directing physicians' attention to DFs during diagnosis.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927472","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":"Stability of whole blood samples at different temperatures: a systematic review.","authors":"Rie Harboe Nygaard, Josefine Freyberg Justesen, Ida Marie Nørum Wigh, Mads Nybo, Eline Sandvig Andersen","doi":"10.1515/dx-2025-0180","DOIUrl":"https://doi.org/10.1515/dx-2025-0180","url":null,"abstract":"<p><p>Blood samples collected outside the hospitals are primarily transported as whole blood. During this transportation, blood sample integrity is highly dependent on conditions such as ambient temperature and mode of transportation, and these conditions are not always sufficiently controlled. Thus, samples may be exposed to time and temperature combinations outside the typically studied and recommended conditions. For laboratories to make recommendations regarding transportation and handle samples that exceed these recommendations correctly, an overview of analyte stability outside the recommended storage conditions is warranted. The objective of this systematic review was to investigate and summarize studies on the effects of temperature and storage time on stability of analytes commonly requested by general practitioners in Denmark. A systematic search of Embase and PubMed was performed on in July 2024 identifying 4,006 potential sources. 60 original studies were included in the review. Twenty-eight out of 32 investigated analytes were stable at 20-23 °C for up to 8 h and many analytes were stable for 8 h at temperatures above and/or below 20-23 °C. Results for stability of lactate dehydrogenase and potassium were conflicting. No data were found for methylmalonic acid, total thyroxine, and total triiodothyronine. In conclusion, this systematic review provides comprehensive data for clinical laboratories to use when evaluating criteria for transportation of whole blood samples. Most analytes were stable after prolonged transportation even after failure to maintain room temperature during transportation; however, attention should be paid to lactate dehydrogenase and potassium, where data were conflicting even under typically recommended conditions.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867156","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":"Multicenter reference limits of hs-cTnI and NT-proBNP in a Chinese cohort.","authors":"Yuxin Xu, Qianjin Li, Huabin Xie, Li Hou, Poshi Xu, Huijun Cui, Xiaobo Chen, Xiaoyu Zhang, Ziyuan Peng, Houqing Zhou, Lixin Wang","doi":"10.1515/dx-2026-0045","DOIUrl":"https://doi.org/10.1515/dx-2026-0045","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to validate the analytical performance of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) assays, and to establish age- and sex-specific reference intervals (RIs) using a large multicenter Chinese cohort.</p><p><strong>Methods: </strong>hs-cTnI and NT-proBNP were measured on a fully automated chemiluminescence platform (Maglumi X8, Snibe, China). Analytical performance was validated following Clinical and Laboratory Standards Institute guidelines. Sex- and age-specific RIs for hs-cTnI (n=2,323) and NT-proBNP (n=2,333) were determined nonparametrically from IFCC-compliant cohorts across six Chinese provinces.</p><p><strong>Results: </strong>Analytical validation confirmed high sensitivity, specificity, satisfactory linearity, and strong interference resistance of hs-cTnI and NT-proBNP. hs-cTnI demonstrated 3.19 % total imprecision near 99th percentile URLs and >99.5 % detectable rates (>LoD) in healthy individuals, meeting third-generation hs-cTn criteria. RIs were established stratified by age and sex. In plasma, RIs of hs-cTnI were 11.97 ng/L for males and 11.61 ng/L for females, while 97.5th percentile URLs of NT-proBNP were 145.00 ng/L overall, 113.63 ng/L for males, and 160.75 ng/L for females. Elevated hs-cTnI levels were observed in residents of Ningxia and in women with central obesity.</p><p><strong>Conclusions: </strong>The Snibe hs-cTnI assay fulfills IFCC high-sensitivity criteria. Age- and sex-specific RIs of hs-cTnI and NT-proBNP were established from a large multicenter Chinese cohort, confirming their essential role in accurate cardiovascular risk stratification.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812333","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}