Diagnosis最新文献_第9页

Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial. 通过游戏学习提高诊断准确性：随机对照试验。

IF 3.5

Diagnosis Pub Date : 2024-01-30 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0133

Daniel J Morgan, Laura Scherer, Lisa Pineles, Jon Baghdadi, Larry Magder, Kerri Thom, Christina Koch, Nick Wilkins, Mike LeGrand, Deborah Stevens, Renee Walker, Beth Shirrell, Anthony D Harris, Deborah Korenstein

{"title":"Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial.","authors":"Daniel J Morgan, Laura Scherer, Lisa Pineles, Jon Baghdadi, Larry Magder, Kerri Thom, Christina Koch, Nick Wilkins, Mike LeGrand, Deborah Stevens, Renee Walker, Beth Shirrell, Anthony D Harris, Deborah Korenstein","doi":"10.1515/dx-2023-0133","DOIUrl":"10.1515/dx-2023-0133","url":null,"abstract":"Objectives: Perform a pilot study of online game-based learning (GBL) using natural frequencies and feedback to teach diagnostic reasoning.Methods: We conducted a multicenter randomized-controlled trial of computer-based training. We enrolled medical students, residents, practicing physicians and nurse practitioners. The intervention was a 45 min online GBL training vs. control education with a primary outcome of score on a scale of diagnostic accuracy (composed of 10 realistic case vignettes, requesting estimates of probability of disease after a test result, 0-100 points total).Results: Of 90 participants there were 30 students, 30 residents and 30 practicing clinicians. Of these 62 % (56/90) were female and 52 % (47/90) were white. Sixty were randomized to GBL intervention and 30 to control. The primary outcome of diagnostic accuracy immediately after training was better in GBL (mean accuracy score 59.4) vs. control (37.6), p=0.0005. The GBL group was then split evenly (30, 30) into no further intervention or weekly emails with case studies. Both GBL groups performed better than control at one-month and some continued effect at three-month follow up. Scores at one-month GBL (59.2) GBL plus emails (54.2) vs. control (33.9), p=0.024; three-months GBL (56.2), GBL plus emails (42.9) vs. control (35.1), p=0.076. Most participants would recommend GBL to colleagues (73 %), believed it was enjoyable (92 %) and believed it improves test interpretation (95 %).Conclusions: In this pilot study, a single session with GBL nearly doubled score on a scale of diagnostic accuracy in medical trainees and practicing clinicians. The impact of GBL persisted after three months.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"136-141"},"PeriodicalIF":3.5,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11075046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses. 诊断管理团队对患者诊断时间和准确临床诊断百分比的影响。

IF 3.5

Diagnosis Pub Date : 2024-01-30 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0175

Jessica Brashear, Ryan Mize, Michael Laposata, Christopher Zahner

{"title":"Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses.","authors":"Jessica Brashear, Ryan Mize, Michael Laposata, Christopher Zahner","doi":"10.1515/dx-2023-0175","DOIUrl":"10.1515/dx-2023-0175","url":null,"abstract":"Objectives: Diagnostic management teams (DMT) are groups of experts with specialized knowledge to guide test selection and interpretation of results. They have been active in institutions over the past 20 years. To date, there are limited data on whether the presence of experts to advise healthcare providers on appropriate laboratory test selection and interpretation of complex test results positively impacts patient care.Methods: A retrospective study at a regional healthcare system with 257,000 patient encounters between 2011 and 2022 reviewing test interpretations provided by clinical laboratory experts on a diagnostic management team.Results: Cases reviewed by the coagulation DMT were 6 times more likely to have an established, scientifically based diagnosis compared to those without a DMT. Patients who have a coagulation DMT review were twice as likely to receive a diagnosis vs. having no diagnosis.Conclusions: This study demonstrates that for several objective clinical outcomes, specifically diagnostic conclusions and length of stay, a DMT of coagulation experts assessing patients' test results has had a major impact on outcomes and delivery of care.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"132-135"},"PeriodicalIF":3.5,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570200","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

Physiologic measurements of cognitive load in clinical reasoning. 临床推理中认知负荷的生理测量。

IF 3.5

Diagnosis Pub Date : 2024-01-29 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0143

Dolores R Mullikin, Ryan P Flanagan, Jerusalem Merkebu, Steven J Durning, Michael Soh

{"title":"Physiologic measurements of cognitive load in clinical reasoning.","authors":"Dolores R Mullikin, Ryan P Flanagan, Jerusalem Merkebu, Steven J Durning, Michael Soh","doi":"10.1515/dx-2023-0143","DOIUrl":"10.1515/dx-2023-0143","url":null,"abstract":"Objectives: Cognitive load is postulated to be a significant factor in clinical reasoning performance. Monitoring physiologic measures, such as heart rate variability (HRV) may serve as a way to monitor changes in cognitive load. The pathophysiology of why HRV has a relationship to cognitive load is unclear, but it may be related to blood pressure changes that occur in a response to mental stress.Methods: Fourteen residents and ten attendings from Internal Medicine wore Holter monitors and watched a video depicting a medical encounter before completing a post encounter form used to evaluate their clinical reasoning and standard psychometric measures of cognitive load. Blood pressure was obtained before and after the encounter. Correlation analysis was used to investigate the relationship between HRV, blood pressure, self-reported cognitive load measures, clinical reasoning performance scores, and experience level.Results: Strong positive correlations were found between increasing HRV and increasing mean arterial pressure (MAP) (p=0.01, Cohen's d=1.41). There was a strong positive correlation with increasing MAP and increasing cognitive load (Pearson correlation 0.763; 95 % CI [; 95 % CI [-0.364, 0.983]). Clinical reasoning performance was negatively correlated with increasing MAP (Pearson correlation -0.446; 95 % CI [-0.720, -0.052]). Subjects with increased HRV, MAP and cognitive load were more likely to be a resident (Pearson correlation -0.845; 95 % CI [-0.990, 0.147]).Conclusions: Evaluating HRV and MAP can help us to understand cognitive load and its implications on trainee and physician clinical reasoning performance, with the intent to utilize this information to improve patient care.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"125-131"},"PeriodicalIF":3.5,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570202","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

Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area. 常规初级保健中的肌钙蛋白检测：阿姆斯特丹市区动态队列研究观察结果。

IF 3.5

Diagnosis Pub Date : 2024-01-29 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0183

Ralf E Harskamp, Indra M Melessen, Amy Manten, Lukas De Clercq, Wendy P J den Elzen, Jelle C L Himmelreich

{"title":"Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area.","authors":"Ralf E Harskamp, Indra M Melessen, Amy Manten, Lukas De Clercq, Wendy P J den Elzen, Jelle C L Himmelreich","doi":"10.1515/dx-2023-0183","DOIUrl":"10.1515/dx-2023-0183","url":null,"abstract":"Objectives: Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponin testing in routine primary care; a setting that is understudied.Methods: Routine data were used from the academic primary care network in the Amsterdam metropolitan area (968,433 patient records). The study population included adult patients who underwent high-sensitivity troponin I or T (hs-TnI/T) testing between 2011 and 2021. The primary outcome was the reported diagnosis and the secondary outcome was the diagnostic accuracy measured by death or ACS at 30 days.Results: 3,184 patients underwent hs-troponin testing, either with hsTNT (n=2,333) or hsTNI (n=851). Median patients' age was 55 (44-65) years, and 62.3 % were female. Predominant symptoms were chest pain and dyspnea (56.7 %). Additional diagnostic laboratory tests were commonly performed (CRP: 47.7 %, natriuretic peptides: 25.6 %, d-dimer: 21.5 %). Most common diagnoses were musculoskeletal symptoms (21.6 %) and coronary heart disease (7.1 %; 1.1 % ACS). Troponin testing showed sensitivity and specificity of 77.8 % (60.9-89.9) and 94.3 % (93.5-95.1), respectively. Negative and positive predictive values were 99.7 (99.5-99.9) and 13.5 (11.1-16.4), and positive and negative likelihood ratios were 13.7 (10.9-17.1) and 0.24 (0.13-0.43).Conclusions: GPs occasionally use troponin testing in very low-risk patients, often as part of a multi-marker rule-out strategy. The diagnostic characteristics of troponin tests, while promising, warrant prospective validation and implementation to facilitate appropriate use.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"171-177"},"PeriodicalIF":3.5,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570207","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

How case reports can be used to improve diagnosis. 如何利用病例报告改进诊断。

IF 2.2

Diagnosis Pub Date : 2024-01-19 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0181

Kosuke Ishizuka, Shun Yamashita, Yuichiro Mine, Yukichika Yamamoto, Hiroki Kojima, Hidehiro Someko, Taiju Miyagami

引用次数: 0

The Future of Diagnosis: Navigating Uncertainty. 诊断的未来：驾驭不确定性。

IF 2.2

Diagnosis Pub Date : 2024-01-19 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0178

引用次数: 0

Clinical assessment of Ortho VITROS SARS-CoV-2 antigen chemiluminescence immunoassay. Ortho VITROS SARS-CoV-2 抗原化学发光免疫测定的临床评估。

IF 3.5

Diagnosis Pub Date : 2024-01-19 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0182

Laura Pighi, Gian Luca Salvagno, Nicole Bertoldi, Brandon M Henry, Giuseppe Lippi

引用次数: 0

The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation. 对接受自体造血干细胞移植的多发性硬化症患者进行延迟诊断和治疗的后果。

IF 3.5

Diagnosis Pub Date : 2024-01-18 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0157

María de Lourdes Pastelín-Martínez, Moisés Manuel Gallardo-Pérez, Andrés Gómez-de-León, Juan Carlos Olivares-Gazca, Edgar Jared Hernández-Flores, Daniela Sánchez-Bonilla, Merittzel Montes-Robles, Max Robles-Nasta, Guillermo Ocaña-Ramm, Silvia Soto-Olvera, David Gómez-Almaguer, Guillermo J Ruiz-Delgado, Guillermo J Ruiz-Argüelles

{"title":"The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation.","authors":"María de Lourdes Pastelín-Martínez, Moisés Manuel Gallardo-Pérez, Andrés Gómez-de-León, Juan Carlos Olivares-Gazca, Edgar Jared Hernández-Flores, Daniela Sánchez-Bonilla, Merittzel Montes-Robles, Max Robles-Nasta, Guillermo Ocaña-Ramm, Silvia Soto-Olvera, David Gómez-Almaguer, Guillermo J Ruiz-Delgado, Guillermo J Ruiz-Argüelles","doi":"10.1515/dx-2023-0157","DOIUrl":"10.1515/dx-2023-0157","url":null,"abstract":"Objectives: We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given autologous hematopoietic stem cell transplantation (aHSCT).Methods: Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS).Results: The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group.Conclusions: These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"164-170"},"PeriodicalIF":3.5,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478116","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

Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat. 利用基于唾液的 qPCR 诊断技术，准确、快速、低成本地检测链球菌咽喉炎。

IF 3.5

Diagnosis Pub Date : 2024-01-05 eCollection Date: 2024-05-01 DOI: 10.1515/dx-2023-0134

Madeline H Peachey, Kristopher E Kubow, Kristina B Blyer, Julia A Halterman

{"title":"Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat.","authors":"Madeline H Peachey, Kristopher E Kubow, Kristina B Blyer, Julia A Halterman","doi":"10.1515/dx-2023-0134","DOIUrl":"10.1515/dx-2023-0134","url":null,"abstract":"Objectives: Outpatient health care facilities are essential for quickly diagnosing common infectious diseases such as bacterial and viral pharyngitis. The only form of pharyngitis requiring antibiotics is strep throat (ST); however, antibiotic prescription rates are much higher than ST prevalence, suggesting antibiotics are being inappropriately prescribed. Current rapid ST diagnostics may be contributing to this problem due to the low sensitivity and variable specificity of these tests. It is best practice to verify a negative ST diagnosis with a group A Streptococcus (GAS) culture, but many clinics do not perform this test due to the additional cost and 24-72 h required to obtain results. This indicates there is great need for more accurate rapid diagnostic tools in outpatient facilities. We hypothesized that next generation qPCR technology could be adapted to detect GAS DNA from saliva samples (instead of the traditional throat swab) by creating a simple, fast, and inexpensive protocol.Methods: Saliva specimens collected from patients at James Madison University Health Center were used to test the effectiveness of our Chelex 100-based rapid DNA extraction method, followed by a fast protocol developed for the Open qPCR machine to accurately detect ST.Results: Our final saliva processing and qPCR protocol required no specialized training to perform and was able to detect ST with 100 % sensitivity and 100 % specificity (n=102) in 22-26 min, costing only $1.12 per sample.Conclusions: Saliva can be rapidly analyzed via qPCR for the accurate and inexpensive detection of ST.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"178-185"},"PeriodicalIF":3.5,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097547","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

Journal Reputation Factor. 期刊声誉因子。

IF 3.5

Diagnosis Pub Date : 2024-01-01 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0165

Eleftherios P Diamandis

引用次数: 0