Diagnosis最新文献

{"title":"Associative thinking as a lever for diagnostic creativity.","authors":"Sho Isoda, Taro Shimizu, Masasi Hattori","doi":"10.1515/dx-2025-0169","DOIUrl":"10.1515/dx-2025-0169","url":null,"abstract":"<p><p>Creativity plays an important role in diagnostic reasoning, particularly in supporting calibration and insights. However, the cognitive mechanisms underlying creativity have not yet been clearly articulated in this context. This study focused on associative thinking, an essential component of creativity, and conducted a systematic examination in the context of diagnostic reasoning. To the best of our knowledge, this is the first such study. Specifically, this study explored how the four types of associative thinking-remote, chained, radial, and dissociative-contribute to the generation of diagnostic hypotheses by examining clinical cases. This article presents a theoretical reinterpretation, grounded in the cognitive perspectives of sophisticated reasoning processes routinely employed by expert clinicians. By illuminating the role of associative thinking in diagnostic hypothesis generation, this study provides a novel conceptual perspective that aims to enhance both creativity and diagnostic accuracy, ultimately contributing to improved quality of patient care.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"193-199"},"PeriodicalIF":1.9,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376439","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":"Tuberculosis-induced arthritis (Poncet's disease): diagnostic challenges and a workflow for clinical decision-making.","authors":"Rahma Isti Kusyadi, Lita Diah Rahmawati, Prastuti Asta Wulaningrum","doi":"10.1515/dx-2025-0177","DOIUrl":"10.1515/dx-2025-0177","url":null,"abstract":"<p><strong>Introduction: </strong>Poncet's disease (PD) is a rare form of TB-associated reactive arthritis, presents a major diagnostic challenge due to its close resemblance to rheumatoid arthritis and tuberculous septic arthritis. A clear diagnostic workflow is essential to support clinical decision-making to prevent misdiagnosis and inappropriate immunosuppressive treatment. This review synthesizes current evidence on the diagnostic characteristics of PD and propose a structured diagnostic workflow to improve clinical decision-making and reduce misdiagnosis.</p><p><strong>Content: </strong>A narrative review was conducted using major databases, focusing on publications between 2010 and 2025. Eligible studies included clinical descriptions, diagnostic criteria, differential diagnosis, and outcomes related to PD and TB-associated arthritis. PD is characterized by acute or subacute, non-erosive polyarthritis occurring concurrently with active TB at an extra-articular site. Laboratory tests typically reveal elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) but negative autoantibodies, although low-titer RF or anti-CCP may occur. Synovial fluid is inflammatory but sterile, and imaging reveals no erosive changes - features that help differentiate PD from tuberculous arthritis and rheumatoid arthritis. The most reliable diagnostic indicator is rapid and complete resolution of arthritis following anti-tuberculosis therapy (ATT). A diagnostic workflow integrating clinical screening, TB confirmation, exclusion of mimicking conditions, and therapeutic response assessment is proposed.</p><p><strong>Summary: </strong>Poncet's disease remains a diagnosis of exclusion that requires a high index of clinical suspicion. Distinct clinical, laboratory, and imaging features, combined with a favorable response to ATT, are central to establishing the diagnosis.</p><p><strong>Outlook: </strong>Implementation of a standardized diagnostic workflow may minimize misdiagnosis, avoid unnecessary immunosuppression, and support timely initiation of ATT. Greater recognition of PD within diagnostic pathways is essential for improving outcomes.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"359-367"},"PeriodicalIF":1.9,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364400","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 Bence Jones protein in refrigerated urine samples over five days: a preanalytical evaluation.","authors":"Maria Rita Cozzi, Fabio Del Ben, Martina Amato, Romina Boschian, Claudio Buciol, Chiara Corso, Cinzia Crepaldi, Tamara Damian, Riccardo De Appollonia, Katya Gaspardo, Fabiana Giordari, Matteo Turetta, Francesco Volpi, Agostino Steffan","doi":"10.1515/dx-2025-0183","DOIUrl":"10.1515/dx-2025-0183","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the short-term stability of Bence Jones protein (BJP) in refrigerated urine samples stored over a period of 5 days. The aim was to evaluate whether BJP concentrations remain consistent when urine specimens are refrigerated and analyzed over time.</p><p><strong>Methods: </strong>Urine samples were collected from 20 plasma cell dyscrasia patients with BJP for a total of 30 independent time-series and 83 data-points. Measurements were performed at five time points: Day 0 (baseline), and Days 1 through 4. Percentage difference (PD%) from baseline was used to quantify temporal change.</p><p><strong>Results: </strong>The median baseline BJP M-spike percentage was 54 % (range: 17-87 %), covering a wide range of total urinary protein (median 296 mg/L, range 64-3,094 mg/L). PD% ranged from -2 % on Day 3 to +7 % on Day 1, with no statistically significant trend over time. The derived instability equation, PD%=0.33 × time (days), yielded r= -0.03 and p=0.77, indicated negligible instability.</p><p><strong>Conclusions: </strong>These findings demonstrate acceptable short-term stability of BJP in refrigerated urine over 5 days, supporting its use in routine laboratory workflows involving delayed analysis.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"485-491"},"PeriodicalIF":1.9,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376447","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":"Information structure in clinical reasoning.","authors":"Taro Shimizu, Zhongqi Wang, Marie Shihara, Satoshi Yoshida","doi":"10.1515/dx-2025-0182","DOIUrl":"10.1515/dx-2025-0182","url":null,"abstract":"<p><p>Clinical reasoning in diagnosis is often described using dual-process theory (DPT), which distinguishes between intuitive and analytical modes of thinking. In contemporary clinical practice, however, differences in diagnostic performance are not always explained solely by cognitive mode. This paper examines how the structure of diagnostic information, specifically whether information is held in a more integrated or more modular form, is related to how dual process reasoning is expressed in practice. Information structure is considered within the situational context through which clinicians assemble, interpret, and use clinical data as cases unfold. Building on work in cognitive psychology, human factors, and systems design, the analysis describes how variations in information structure interact with intuitive and analytical processing during clinical work. This focus helps account for why clinicians may reason differently as a case evolves, how reframing information can alter the speed and flexibility of judgment, and how vulnerability to bias may vary across situations. Focusing on how information is structured underscores implications for safety and education by supporting reflection on reasoning approaches, alignment between task demands and cognitive processes, and adaptive shifts as clinical situations change.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"187-192"},"PeriodicalIF":1.9,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364430","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 <i>in vitro</i> acidosis on leukocyte cell population data measured by automated hemocytometry.","authors":"Debora Olioso, Nicole Nori, Nicola Baratto, Giuseppe Lippi","doi":"10.1515/dx-2026-0014","DOIUrl":"10.1515/dx-2026-0014","url":null,"abstract":"<p><strong>Objectives: </strong>Acidosis is a frequent and clinically significant abnormality in critically ill patients, known also to affect leukocyte metabolism, morphology, and immune function. Cell population data (CPD), generated by modern hematological analyzers, provide quantitative information on leukocyte size, complexity, and nucleic acid content, but their sensitivity to acidosis has not been fully characterized.</p><p><strong>Methods: </strong>Thirty-five whole blood samples collected in K₂EDTA, referred for routine hematological testing, were divided into paired aliquots and subjected to <i>in vitro</i> acidification with hydrochloric acid or an equivalent volume of saline, serving as control condition (hereafter referred to as \"untreated\"). Samples were analyzed at baseline and after 30 min on Sysmex XN-10.</p><p><strong>Results: </strong>Acidification induced rapid and sustained reduction in pH, from a median value of 7.30 to 6.90. After 30 min of incubation, compared to the untreated aliquots, acidified samples displayed increased monocyte and lymphocyte size indices (MO-Z, LY-Z) and lymphocyte complexity (LY-X), along with reduced neutrophil complexity and fluorescence (NE-SSC, NE-SFL), reduced neutrophil size (NE-FSC), and decreased DNA/RNA-related fluorescence in monocytes and lymphocytes (MO-Y, LY-Y). LY-Y showed the highest accuracy (area under the curve [AUC=0.93]), followed by MO-Y (AUC=0.84) and LY-Z (AUC=0.82) for discriminating acidosis.</p><p><strong>Conclusions: </strong><i>In vitro</i> acidosis induces consistent and biologically plausible alterations in leukocyte CPD, reflecting changes in cell size, granularity, and nucleic acid content, mostly indicative of leukocyte dysfunction. These findings support the hypothesis that CPD could be used as sensitive markers of acid-base-related leukocyte dysregulation, with clinical significance in conditions characterized by severe acidosis.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"469-474"},"PeriodicalIF":1.9,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368947","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":"Pilot demonstration for physician compensation incentives to improve diagnostic specificity in clinical documentation.","authors":"David S Burstein, Nathaniel Schwartz, Abhiroop Ganguly, Michael A Hanak, Laura J Zimmermann, Ali Keshavarzian","doi":"10.1515/dx-2025-0088","DOIUrl":"10.1515/dx-2025-0088","url":null,"abstract":"<p><strong>Objectives: </strong>Omissions in clinical documentation hinder diagnosis by obscuring important information and delaying communication among clinicians. Additionally, carefully implemented incentives can improve health care processes such as clinical documentation. Therefore, we created a pilot using $20,000 in compensation incentives to improve free text documentation for six common outpatient diagnoses (cerebrovascular accidents, chronic kidney disease, congestive heart failure, deep vein thrombosis and pulmonary embolism, chronic obstructive pulmonary disease, and smoking) in an urban health system.</p><p><strong>Methods: </strong>For each diagnosis, we asked clinicians to document 2-3 pre-specified clinically significant, evidence-based details that influence diagnosis or management. We compared baseline documentation (Aug 15th-Sep 25th, 2022) with an incentivized period (Sep 26th-Dec 16th, 2022) using an unadjusted signed rank test and an adjusted generalized linear mixed model. All 32 eligible physicians and advanced practice providers participated.</p><p><strong>Results: </strong>Among 693 baseline and 1,494 intervention opportunities when a diagnosis was assessed, documentation that included all clinically significant details improved from mean 32.2 % (SD 20.7) to mean 47.1 % (SD 23.6; p=0.01) and in our adjusted analysis from 35.6 to 48.2 % (p<0.001). Seven participants' documentation improved by ≥1.6 diagnoses per week.</p><p><strong>Conclusions: </strong>In conclusion, compensation incentives improved free text documentation of clinically significant information to improve the diagnostic process.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"419-429"},"PeriodicalIF":1.9,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353846","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":"Clinical prediction models: from foundational concepts to practical application.","authors":"Javier Arredondo Montero","doi":"10.1515/dx-2025-0152","DOIUrl":"https://doi.org/10.1515/dx-2025-0152","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical prediction requires formalizing uncertainty into a statistical model. However, persistent confusion between prediction and inference, and between traditional (stepwise) and modern (penalized) development strategies, leads to unstable, poorly calibrated, and overfit models. A structured statistical framework is essential.</p><p><strong>Methods: </strong>This article is a structured, didactic tutorial that explains the core concepts of clinical prediction models. It covers the definition of a prediction model, the fundamental strategies for its construction, and the essential framework for its evaluation, illustrated through an applied example using real-world clinical data.</p><p><strong>Results: </strong>The tutorial illustrates model development using the GUSTO-I dataset (<i>N</i> = 40,830). Penalized methods (LASSO and Elastic Net) successfully identified clinical signals while eliminating engineered noise variables. The LASSO model (λ_1se) achieved excellent discrimination (AUC 0.818; 95 % CI: 0.803-0.832) and overall accuracy (Brier score 0.058). Calibration analysis revealed a slope of 1.28 and intercept of 0.63, identifying conservative bias and systematic risk underestimation inherent to λ_1se selection. Decision curve analysis confirmed significant clinical utility across relevant probability thresholds.</p><p><strong>Conclusions: </strong>This guide equips clinicians with a rigorous methodological framework for the critical appraisal and interpretation of modern clinical prediction models.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316744","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":"What is a medical expert? Response to Letter by Remy Rickers.","authors":"Narinder Kapur","doi":"10.1515/dx-2026-0019","DOIUrl":"10.1515/dx-2026-0019","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"533"},"PeriodicalIF":1.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270137","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":"What is a medical expert? A reply to Kapur (2024).","authors":"Remy M J P Rikers","doi":"10.1515/dx-2026-0011","DOIUrl":"10.1515/dx-2026-0011","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"531-532"},"PeriodicalIF":1.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270117","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":"Cardiovascular medicine in 2026: emerging technologies as a lever to reduce gaps and inequalities.","authors":"Damien Gruson, Tuğba Kemaloğlu Öz","doi":"10.1515/dx-2026-0004","DOIUrl":"10.1515/dx-2026-0004","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"344-346"},"PeriodicalIF":1.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200318","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}