Diagnosis最新文献

{"title":"Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula.","authors":"Katherine Gavinski, Deborah DiNardo, Scott D Rothenberger, Eliana Bonifacino","doi":"10.1515/dx-2024-0181","DOIUrl":"https://doi.org/10.1515/dx-2024-0181","url":null,"abstract":"<p><strong>Objectives: </strong>Published clinical reasoning curricula are limited, and measuring curricular impact has proven difficult. This study aims to evaluate the impact of a broad-reaching, multi-level reasoning curricula by measuring utilization of clinical reasoning terminology in published abstracts.</p><p><strong>Methods: </strong>In 2014, the University of Pittsburgh Medical Center (UPMC) created a clinical reasoning curriculum with interventions at the student, resident, and faculty levels with the goal of bringing reasoning education to the forefront. This study was a retrospective analysis of published clinical vignettes of the Society of General Internal Medicine prior to local curricular intervention (2014), post-curricular intervention (2018), and on follow-up (2022). UPMC-affiliated abstracts were compared to abstracts containing reasoning terms from all other institutions, at each time point.</p><p><strong>Results: </strong>There was a statistically significant increase in the use of clinical reasoning terms by UPMC-affiliated participants from 2014 to 2018. Non-UPMC submissions, saw a smaller, but still significant increase in the use of clinical reasoning terms. There was a decline in clinical reasoning term use from 2018 to 2022, both at UPMC and nationally.</p><p><strong>Conclusions: </strong>This study demonstrates that widespread clinical reasoning curricula can increase interest in and use of clinical reasoning terminology. Further work is needed to develop creative assessment tools for reasoning curricula.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926523","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":"Reviewer Acknowledgment.","authors":"","doi":"10.1515/dx-2024-2001","DOIUrl":"https://doi.org/10.1515/dx-2024-2001","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906673","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":"Reviewer Acknowledgment.","authors":"","doi":"10.1515/dx-2024-2001","DOIUrl":"https://doi.org/10.1515/dx-2024-2001","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":"12 1","pages":"144"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457305","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":"Diagnostic errors in patients admitted directly from new outpatient visits.","authors":"Yu Watanabe, Taiju Miyagami, Taro Shimizu, Yuji Nishizaki, Sho Ukishima, Koichiro Santo, Seiko Furusaka Kushiro, Nozomi Aoki, Mayu Suzuki, Akio Kanazawa, Toshio Naito","doi":"10.1515/dx-2024-0088","DOIUrl":"10.1515/dx-2024-0088","url":null,"abstract":"<p><strong>Objectives: </strong>Diagnostic errors frequently represent significant adverse events that can occur in any medical setting, particularly in rushed handovers and constrained timing. Cases that result in emergency hospitalization at the time of the initial outpatient visit are more likely to have complex or serious patient conditions and more detrimental diagnostic errors. Our study investigated diagnostic errors in these under reported situations.</p><p><strong>Methods: </strong>We conducted a retrospective study using electronic medical record data on patients who were directly admitted to a newly established outpatient clinic at a single university hospital in Japan. Diagnostic errors were assessed independently by two physicians using the Revised Safer Dx instrument. We analyzed patient demographics, symptoms, referrals, and resident doctor (postgraduate-year-1) involvement using logistic regression to compare groups with and without diagnostic error. Additionally, we employed the Diagnostic Error Evaluation and Research (DEER) taxonomy and Generic Diagnostic Pitfalls (GDP) to examine the factors associated with diagnostic errors.</p><p><strong>Results: </strong>The study included 321 patients, with diagnostic errors identified in 39 cases (12.1 %). Factors contributing to diagnostic errors included the involvement of young residents, male patients, the number of symptoms, and atypical presentation. The most common causes of diagnostic errors were \"too much weight given to competing/coexisting diagnosis\" as indicated by DEER and \"atypical presentation\" by GDP.</p><p><strong>Conclusions: </strong>The frequency of diagnostic errors in this study was higher than those in previous studies of new outpatient visits, underscoring the imperative for heightened scrutiny in cases involving medical residents especially when patients present with multiple or atypical symptoms. This vigilance is crucial to mitigating the risk of diagnostic inaccuracies in these settings. Cases that result in emergency hospitalization at the time of the initial outpatient visit are more likely to have complex or serious patient conditions and more detrimental diagnostic errors.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"223-231"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973894","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":"The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study.","authors":"Cody Clary, Adam Cohen, Shelley Kumar, Moushumi Sur, Brian Rissmiller, Geeta Singhal, Satid Thammasitboon","doi":"10.1515/dx-2024-0097","DOIUrl":"10.1515/dx-2024-0097","url":null,"abstract":"<p><strong>Objectives: </strong>Competency in diagnostic reasoning is integral to medical training and patient safety. Situativity theory highlights the importance of contextual factors on learning and performance, such as being informed of a provisional diagnosis prior to a patient encounter. This study aims to determine how being informed of a provisional diagnosis affects an intern's approach to diagnostic reasoning.</p><p><strong>Methods: </strong>This mixed methods study was conducted in a real-time workplace learning environment at a large teaching hospital. Interns were randomized to the Chief Complaint (CC) only or chief complaint with Provisional Diagnosis (PD) group. One blinded researcher assessed intern diagnostic reasoning using a validated tool. Mean group scores were compared using the two-sample t-test. The researcher was unblinded for think aloud interviews analyzed via thematic analysis.</p><p><strong>Results: </strong>There was no difference in performance between the CC and PD groups (mean ± SD): 47.8 ± 8.1 vs. 43.9 ± 10.9, p=0.24. Thematic analysis identified that interns aware of the provisional diagnosis 1) invested less effort in diagnostic reasoning, 2) formulated a differential through a narrowly focused frame, 3) accepted a provisional diagnosis as definitive, and 4) sought to confirm rather than refute the provisional diagnosis.</p><p><strong>Conclusions: </strong>Our discordant results highlight the complex interplay between a provisional diagnosis and diagnostic reasoning performance in early learners. Though an accurate provisional diagnosis may enhance diagnostic reasoning outcomes, our qualitative results suggest that it may pose certain risks to the diagnostic reasoning process. Metacognitive strategies may be a ripe field for exploration to optimize this complex interplay.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"208-216"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914009","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":"Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study.","authors":"Kotaro Kunitomo, Takahiro Tsuji, Yanosuke Kouzaki, Fumitaka Yoshimura, Jyunko Kubosaki, Taro Shimizu","doi":"10.1515/dx-2024-0183","DOIUrl":"10.1515/dx-2024-0183","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis.</p><p><strong>Methods: </strong>This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases.</p><p><strong>Results: </strong>This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy.</p><p><strong>Conclusions: </strong>Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"250-255"},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691143","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":"Challenges and barriers for the adoption of personalized medicine in Europe: the case of Oncotype DX Breast Recurrence Score^® test.","authors":"Denis Horgan, Paul Hofman, Patrizio Giacomini, France Dube, Jaya Singh, Daniel Schneider, Tanya Hills, Jennifer Faikish, Marc Van Den Bulcke, Umberto Malapelle, Maciej Gajewski, Vivek Subbiah","doi":"10.1515/dx-2024-0127","DOIUrl":"10.1515/dx-2024-0127","url":null,"abstract":"<p><p>Personalized medicine, aiming to tailor treatments based on individual patient characteristics, holds immense potential in oncology. However, its widespread adoption in Europe faces numerous challenges, as illustrated by the case study of the Oncotype DX Breast Recurrence Score^® assay, a genomic test for breast cancer. This manuscript delineates the multifaceted obstacles encountered during the introduction of the Oncotype DX^®test (Oncotype DX Breast Recurrence Score test) in Europe from 2004 to 2018. In June 2018, the TAILORx results were published in the <i>New England Journal of Medicine</i> (Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med 2018;379:111-21, Sparano JA, Gray RJ, Ravdin PM, Makower DF, Pritchard KI, Albain KS, et al. Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med 2019;380:2395-405), and reported that among 6,711 women with hormone-receptor-positive, HER2-negative, node-negative breast cancer and a midrange recurrence score of 11-25 on the Oncotype DX assay, endocrine therapy was not inferior to chemoendocrine therapy, which provides evidence that adjuvant chemotherapy was not beneficial in these patients. Through a comprehensive analysis of clinical evidence, commercial presence, reimbursement mechanisms, guideline recommendations, regulatory pathways, and local experiences, this study sheds light on the intricate dynamics influencing the adoption of personalized medicine technologies. This article examines the various obstacles encountered during the introduction of the Oncotype DX Breast Cancer Assay in Europe from 2004 to 2018. By analyzing clinical evidence, commercial presence, reimbursement mechanisms, guideline recommendations, regulatory pathways, and local experiences, this study reveals the complex factors that influence the adoption of personalized medicine technologies. By highlighting these challenges, this article offers valuable insights into strategies to facilitate the integration of innovative diagnostic tools into clinical practice across Europe, ultimately leading to improved treatment decision-making for cancer patients.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"175-181"},"PeriodicalIF":2.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834578","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":"Three-way comparison of different ESR measurement methods and analytical performance assessment of TEST1 automated ESR analyzer.","authors":"Kwanlada Chaiwong, Rujira Naksith, Waroonkarn Laiklang, Manissara Yeekaday, Suppakorn Wongkamchai, Orakan Limpornpukdee, Chutitorn Ketloy, Eakachai Prompetchara","doi":"10.1515/dx-2024-0158","DOIUrl":"10.1515/dx-2024-0158","url":null,"abstract":"<p><strong>Objectives: </strong>Validation and performance assessment of novel ESR analyzer is required before implementation. The objective of this study was to assess the correlation between three ESR measurement methods. Full validation and performance assessment of an alternate method (TEST1) were also evaluated.</p><p><strong>Methods: </strong>Three-way correlation assessment for the Westergren (WG), modified Westregren (Mixrate), and alternate (TEST1) methods were performed. Analytical performance of TEST1 including precision, carryover, sample stability, potential interferences as well as effect of hematocrit (Hct) and mean corpuscular volume (MCV) were also determined.</p><p><strong>Results: </strong>Strong correlation between three ESR measurement methods were observed. Correlation coefficient (r) was 0.902, 0.977, and 0.949 for WG vs. TEST1, WG vs. Mixrate, and TEST1 vs. Mixrate, respectively with absolute bias <5 mm. For TEST1, precision and carryover were within the manufacturer's claim. Samples were stable upto 24 h and 48 h when they were stored at room temperature or 2-8 °C, respectively. No effect of trigyceride and cholesterol was observed. In low Hct samples, no significant different between the results obtained from Fabry's formula corrected WG values and from TEST1.</p><p><strong>Conclusions: </strong>Three-way comparison study yielded a strong correlation between methods. As part of the method validation before implementing a new analyzer, full validation of TEST1 showed that all validated parameters met the manufacturer's specifications. A negative bias was observed but remains within the acceptable criteria. Difference in values for samples with low hematocrit were noted, but these can be corrected by Fabry's formula applied to the values from WG method.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"268-276"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812334","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":"Medical language matters: impact of clinical summary composition on a generative artificial intelligence's diagnostic accuracy.","authors":"Cassandra Skittle, Eliana Bonifacino, Casey N McQuade","doi":"10.1515/dx-2024-0167","DOIUrl":"10.1515/dx-2024-0167","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the impact of problem representation (PR) characteristics on Generative Artificial Intelligence (GAI) diagnostic accuracy.</p><p><strong>Methods: </strong>Internal medicine attendings and residents from two academic medical centers were given a clinical vignette and instructed to write a PR. Deductive content analysis described the characteristics comprising each PR. Individual PRs were input into ChatGPT-4 (OpenAI, September 2023) which was prompted to generate a ranked three-item differential. The ranked differential and the top-ranked diagnosis were scored on a 3-part scale, ranging from incorrect, partially correct, to correct. Logistic regression evaluated individual PR characteristic's impact on ChatGPT accuracy.</p><p><strong>Results: </strong>For a three-item differential, accuracy was associated with including fewer comorbidities (OR 0.57, p=0.010), fewer past historical items (OR 0.60, p=0.019), and more physical examination items (OR 1.66, p=0.015). For ChatGPT's ability to rank the true diagnosis as the single-best diagnosis, utilizing temporal semantic qualifiers, more semantic qualifiers overall, and adhering to a typical 3-part PR format all correlated with diagnostic accuracy: OR 3.447, p=0.046; OR 1.300, p=0.005; OR 3.577, p=0.020, respectively.</p><p><strong>Conclusions: </strong>Several distinct PR factors improved ChatGPT diagnostic accuracy. These factors have previously been associated with expertise in creating PR. Future studies should explore how clinical input qualities affect GAI diagnostic accuracy prospectively.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"277-281"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812324","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":"Harbingers of sepsis misdiagnosis among pediatric emergency department patients.","authors":"Jonathan G Sawicki, Jessica Graham, Gitte Larsen, Jennifer K Workman","doi":"10.1515/dx-2024-0119","DOIUrl":"10.1515/dx-2024-0119","url":null,"abstract":"<p><strong>Objectives: </strong>To identify clinical presentations that acted as harbingers for future sepsis hospitalizations in pediatric patients evaluated in the emergency department (ED) using the Symptom Disease Pair Analysis of Diagnostic Error (SPADE) methodology.</p><p><strong>Methods: </strong>We identified patients in the Pediatric Health Information Systems (PHIS) database admitted for sepsis between January 1, 2004 and December 31, 2023 and limited the study cohort to those patients who had an ED treat-and-release visit in the 30 days prior to admission. Using the look-back approach of the SPADE methodology, we identified the most common clinical presentations at the initial ED visit and used an observed to expected (O:E) analysis to determine which presentations were overrepresented. We then employed a graphical, temporal analysis with a comparison group to identify which overrepresented presentations most likely represented harbingers for future sepsis hospitalization.</p><p><strong>Results: </strong>We identified 184,157 inpatient admissions for sepsis, of which 15,331 hospitalizations (8.3 %) were preceded by a treat-and-release ED visit in the prior 30 days. Based on the O:E and temporal analyses, the presentations of fever and dehydration were both overrepresented in the study cohort and temporally clustered close to sepsis hospitalization. ED treat-and-release visits for fever or dehydration preceded 1.2 % of all sepsis admissions.</p><p><strong>Conclusions: </strong>In pediatric patients presenting to the ED, fever and dehydration may represent harbingers for future sepsis hospitalization. The SPADE methodology could be applied to the PHIS database to develop diagnostic performance measures across a wide range of pediatric hospitals.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"241-249"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812320","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}