Diagnosis最新文献_第8页

The physical exam and telehealth: between past and future. 身体检查和远程医疗:介于过去和未来之间。

IF 3.5

Diagnosis Pub Date : 2023-12-01 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0154

Jorge A Restrepo, Richard Henriquez, Dario Torre, Mark L Graber

引用次数: 0

Factors influencing diagnostic accuracy among intensive care unit clinicians - an observational study. 影响重症监护病房临床医生诊断准确性的因素-一项观察性研究。

IF 3.5

Diagnosis Pub Date : 2023-11-30 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0026

Paul A Bergl, Neehal Shukla, Jatan Shah, Marium Khan, Jayshil J Patel, Rahul S Nanchal

{"title":"Factors influencing diagnostic accuracy among intensive care unit clinicians - an observational study.","authors":"Paul A Bergl, Neehal Shukla, Jatan Shah, Marium Khan, Jayshil J Patel, Rahul S Nanchal","doi":"10.1515/dx-2023-0026","DOIUrl":"10.1515/dx-2023-0026","url":null,"abstract":"Objectives: Diagnostic errors are a source of morbidity and mortality in intensive care unit (ICU) patients. However, contextual factors influencing clinicians' diagnostic performance have not been studied in authentic ICU settings. We sought to determine the accuracy of ICU clinicians' diagnostic impressions and to characterize how various contextual factors, including self-reported stress levels and perceptions about the patient's prognosis and complexity, impact diagnostic accuracy. We also explored diagnostic calibration, i.e. the balance of accuracy and confidence, among ICU clinicians.Methods: We conducted an observational cohort study in an academic medical ICU. Between June and August 2019, we interviewed ICU clinicians during routine care about their patients' diagnoses, their confidence, and other contextual factors. Subsequently, using adjudicated final diagnoses as the reference standard, two investigators independently rated clinicians' diagnostic accuracy and on each patient on a given day (\"patient-day\") using 5-point Likert scales. We conducted analyses using both restrictive and conservative definitions of clinicians' accuracy based on the two reviewers' ratings of accuracy.Results: We reviewed clinicians' responses for 464 unique patient-days, which included 255 total patients. Attending physicians had the greatest diagnostic accuracy (77-90 %, rated as three or higher on 5-point Likert scale) followed by the team's primary fellow (73-88 %). Attending physician and fellows were also least affected by contextual factors. Diagnostic calibration was greatest among ICU fellows.Conclusions: Additional studies are needed to better understand how contextual factors influence different clinicians' diagnostic reasoning in the ICU.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"31-39"},"PeriodicalIF":3.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451152","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

Updated statistics on Influenza mortality. 流感死亡率最新统计数字。

IF 3.5

Diagnosis Pub Date : 2023-11-29 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0158

Camilla Mattiuzzi, Brandon M Henry, Giuseppe Lippi

引用次数: 0

Convicting a wrong molecule? 判定分子错误？

IF 3.5

Diagnosis Pub Date : 2023-11-01 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0129

Sok-Ja Janket, Jukka H Meurman, Eleftherios P Diamandis

引用次数: 0

Improving communication of diagnostic uncertainty to families of hospitalized children. 简要报告:改善对住院儿童家属诊断不确定性的沟通。

IF 3.5

Diagnosis Pub Date : 2023-10-26 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0088

Eleanor E Young, Joelle Kane, Kristen Timmons, Jodi Kelley, Philip A Hagedorn, Patrick W Brady, Trisha L Marshall

{"title":"Improving communication of diagnostic uncertainty to families of hospitalized children.","authors":"Eleanor E Young, Joelle Kane, Kristen Timmons, Jodi Kelley, Philip A Hagedorn, Patrick W Brady, Trisha L Marshall","doi":"10.1515/dx-2023-0088","DOIUrl":"10.1515/dx-2023-0088","url":null,"abstract":"Objectives: Diagnostic uncertainty is not reliably communicated to patients and caregivers. This study aims to identify barriers and facilitators to effective communication of diagnostic uncertainty, including development of potential tools and strategies for improvement, as perceived by healthcare professionals and caregivers.Methods: We completed structured interviews with providers and caregivers of hospitalized children with uncertain diagnoses (UD). The interview guides addressed barriers to communication, key components for communication of uncertainty, and qualities of effective communication. The interviews concluded with respondents prioritizing potential interventions to improve communication of uncertainty. Interviews were audio recorded, transcribed, and independently analyzed by two team members to identify common themes.Results: Ten provider and five caregiver interviews were conducted. Common barriers to communication of uncertainty included time constraints, language barriers, and lack of clear definition of UD. Caregiver suggestions for improvement included sharing expectations of the diagnostic process and use of both written and visual communication tools. Interview respondents favored interventions of a sign summarizing the key components of diagnostic uncertainty for display in patient rooms and a structured diagnostic pause during daily rounds.Conclusions: We identified several potential interventions that may enhance communication of diagnostic uncertainty and better engage patients and caregivers in the diagnostic process.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"186-191"},"PeriodicalIF":3.5,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157299","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

Retraction of: Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population. 收回：建立一个稳定的平台，用于测量透析人群中的血液内毒素水平。

IF 3.5

Diagnosis Pub Date : 2023-10-26 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0136

Shyam Dheda, Hongjin Min, David Vesey, Carmel Hawley, David W Johnson, Magid Fahim

引用次数: 0

Tumor heterogeneity: how could we use it to achieve better clinical outcomes? 肿瘤异质性：我们如何利用它来获得更好的临床结果？

IF 3.5

Diagnosis Pub Date : 2023-10-12 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0108

Arsani Yousef, Lucianna Ghobrial, Eleftherios P Diamandis

{"title":"Tumor heterogeneity: how could we use it to achieve better clinical outcomes?","authors":"Arsani Yousef, Lucianna Ghobrial, Eleftherios P Diamandis","doi":"10.1515/dx-2023-0108","DOIUrl":"10.1515/dx-2023-0108","url":null,"abstract":"Differences in tumors related to location, tissue type, and histological subtype have been well documented for decades. Tumors are also molecularly very diverse. In this short review we describe the current classification schemes for tumor heterogeneity. We enlist the various drivers of tumor heterogeneity generation and comment on their clinical significance. New molecular techniques promise to assess tumor heterogeneity at affordable cost, so that these techniques can soon enter the clinic. While tumor heterogeneity currently represents a major unfavorable barrier in the field of oncology, it may also be a key in revolutionizing cancer diagnosis and treatment. Information regarding tumor heterogeneity has the potential to provide more thorough prognostic information, guide more efficacious combination treatment regimens, and lead to the development of novel therapeutic strategies and identification of new targets. For these gains to be realized, assessment of tumor heterogeneity needs to be incorporated into current diagnostic protocols but standardized and reproducible assessment methods are required. Fortunately, when these advances are realized, tumor heterogeneity has the potential to improve clinical outcomes.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"25-30"},"PeriodicalIF":3.5,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41194515","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

Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study. 日本医学生诊断错误教育与识别频率的相关性：一项全国性的横断面研究。

IF 2.2

Diagnosis Pub Date : 2023-10-09 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0105

Taiju Miyagami, Takashi Watari, Yuji Nishizaki, Taro Shimizu, Yasuharu Tokuda

{"title":"Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study.","authors":"Taiju Miyagami, Takashi Watari, Yuji Nishizaki, Taro Shimizu, Yasuharu Tokuda","doi":"10.1515/dx-2023-0105","DOIUrl":"10.1515/dx-2023-0105","url":null,"abstract":"Objectives: Diagnostic errors pose a significant risk to patient safety and have substantial medical and economic consequences. Despite their importance, diagnostic error education is currently lacking in standard pre-graduate curricula. This study aimed to investigate the incidence of diagnostic errors and the frequency of recognition among medical students in Japan.Methods: A pilot survey was conducted immediately after the General Medicine In-Training Examination (GM-ITE), a comprehensive post-graduation test, administered to new residents right after graduation from medical school. The survey assessed whether they received education on diagnostic errors during their formal undergraduate medical education and whether they recognized diagnostic errors during their clinical training.Results: Of the 564 examinees, 421 participated in the study. The majority of participants (63.9 %) reported receiving education on diagnostic errors, and 15.7 % recognized diagnostic errors during their clinical training. Significantly, those who received education on diagnostic errors had a higher rate of recognizing such errors compared to those who did not (19.7 vs. 8.6 %; p=0.0017).Conclusions: These findings suggest that the recognition rate of diagnostic errors increases with improved literacy in diagnostic error education. This highlights the importance of incorporating diagnostic error education into medical curricula to develop effective strategies to prevent and manage diagnostic errors, and thereby enhance medical and patient safety. However, this study did not examine the specific educational content of the errors or the details of the recognition, necessitating further investigation in the future.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"192-194"},"PeriodicalIF":2.2,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178260","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

Preferred language and diagnostic errors in the pediatric emergency department. 儿科急诊科的首选语言和诊断错误。

IF 3.5

Diagnosis Pub Date : 2023-10-06 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0079

Jeremiah T Lowe, Jan Leonard, Fidelity Dominguez, Kaitlin Widmer, Sara J Deakyne Davies, Alexandria J Wiersma, Marcela Mendenhall, Joseph A Grubenhoff

{"title":"Preferred language and diagnostic errors in the pediatric emergency department.","authors":"Jeremiah T Lowe, Jan Leonard, Fidelity Dominguez, Kaitlin Widmer, Sara J Deakyne Davies, Alexandria J Wiersma, Marcela Mendenhall, Joseph A Grubenhoff","doi":"10.1515/dx-2023-0079","DOIUrl":"10.1515/dx-2023-0079","url":null,"abstract":"Objectives: To investigate the relationship between language and diagnostic errors (DxE) in the pediatric emergency department (ED).Methods: Electronic trigger identified ED encounters resulting in unplanned hospital admission that occurred within 10 days of an index visit from January 2018 through February 2022. Manual screening of each triggered encounter identified cases where the index visit diagnosis and hospitalization discharge diagnosis differed, and these were screened in for review using the Revised Safer Dx instrument to determine if a diagnostic error (DxE) occurred. Non-English primary language (NEPL) and English-proficient (EP) groups were established based on caregiver language. The primary outcome was the proportion of DxE each group. Data were analyzed using univariate analysis and multivariable logistic regression to identify independent predictors of DxE.Results: Electronic trigger identified 3,551 patients, of which 806 (22.7 %) screened in for Safer Dx review. 172 (21.3 %) experienced DxE. The proportion of DxE was similar between EP and NEPL groups (21.5 vs. 21.7 %; p=0.97). Age≥12 years and fewer prior admissions in the preceding 6 months predicted higher odds of DxE. NEPL did not predict higher odds of DxE.Conclusions: NEPL was not associated with increased odds DxE resulting in unplanned admission.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"49-53"},"PeriodicalIF":3.5,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157160","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 PRIDx framework to engage payers in reducing diagnostic errors in healthcare. PRIDx框架使支付方参与减少医疗保健中的诊断错误。

IF 3.5

Diagnosis Pub Date : 2023-10-05 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0042

Kisha J Ali, Christine A Goeschel, Derek M DeLia, Leah M Blackall, Hardeep Singh

{"title":"The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.","authors":"Kisha J Ali, Christine A Goeschel, Derek M DeLia, Leah M Blackall, Hardeep Singh","doi":"10.1515/dx-2023-0042","DOIUrl":"10.1515/dx-2023-0042","url":null,"abstract":"Objectives: No framework currently exists to guide how payers and providers can collaboratively develop and implement incentives to improve diagnostic safety. We conducted a literature review and interviews with subject matter experts to develop a multi-component 'Payer Relationships for Improving Diagnoses (PRIDx)' framework, that could be used to engage payers in diagnostic safety efforts.Content: The PRIDx framework, 1) conceptualizes diagnostic safety links to care provision, 2) illustrates ways to promote payer and provider engagement in the design and adoption of accountability mechanisms, and 3) explicates the use of data analytics. Certain approaches suggested by PRIDx were refined by subject matter expert interviewee perspectives.Summary: The PRIDx framework can catalyze public and private payers to take specific actions to improve diagnostic safety.Outlook: Implementation of the PRIDx framework requires new types of partnerships, including external support from public and private payer organizations, and requires creation of strong provider incentives without undermining providers' sense of professionalism and autonomy. PRIDx could help facilitate collaborative payer-provider approaches to improve diagnostic safety and generate research concepts, policy ideas, and potential innovations for engaging payers in diagnostic safety improvement activities.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"17-24"},"PeriodicalIF":3.5,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41120880","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