Diagnosis最新文献

{"title":"Interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein for optimal immunometabolic profiling of the lifestyle-related cardiorenal risk.","authors":"Georgina Noel Marchiori, María Daniela Defagó, María Lucía Baraquet, Sebastián Del Rosso, Nilda Raquel Perovic, Elio Andrés Soria","doi":"10.1515/dx-2023-0159","DOIUrl":"10.1515/dx-2023-0159","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aimed to identify optimal inflammatory biomarkers involved in cardiorenal risk in response to major lifestyle factors.</p><p><strong>Methods: </strong>One hundred and twenty-nine adults aged 35-77 years participated voluntarily from 2017 to 2019 (Córdoba, Argentina) in a cross-sectional study to collect sociodemographic, clinical, and lifestyle data. Blood biomarkers (different cytokines, monocyte chemoattractant protein-1 [MCP-1], and high-sensitivity C-reactive protein [hs-CRP]) were measured using standard methods and then evaluated by principal component analysis and structural equation modeling (SEM) according to Mediterranean diet adherence, physical activity level, and waist circumference, while cardiorenal risk involved blood diastolic pressure, HDL-cholesterol, triacylglycerols, creatinine, and glycosylated hemoglobin.</p><p><strong>Results: </strong>A principal component included TNF-α (tumor necrosis factor-alpha), IL-8 (interleukin-8), IL-6 (interleukin-6), hs-CRP, and MCP-1, with absolute rotated factor loadings >0.10. SEM showed that IL-6 (β=0.38, 95 % IC=0.08-0.68), hs-CRP (β=0.33, 95 % IC=0.17-0.48), and TNF-α (β=0.22, 95 % IC=0.11-0.32) were the mediators that better explained an inflammatory profile positively related to waist circumference (β=0.77, 95 % IC=0.61-0.94). Moreover, this profile was associated with an increased cardiorenal risk (β=0.78, 95 % IC=0.61-0.94), which was well-defined by the variable used.</p><p><strong>Conclusions: </strong>Immune mediators are key elements in profiling the cardiorenal risk associated with lifestyle factors, for which the combination of hs-CRP, IL-6, and TNF-α has emerged as a robust indicator. This work reaffirms the need for biomarker optimization for early diagnosis and risk assessment.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"82-90"},"PeriodicalIF":3.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058215","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":"Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease.","authors":"Qi Zhou, Fang Chen, Yan Wang, Wenjie Qu, Yingxin Gong, Yuankui Cao, Hongwei Zhang, Qing Wang, Limei Chen, Qing Cong, Lin Lin, Jiayin Mo, Tianyi Bi, Jingxin Ding, Long Sui, Yanyun Li","doi":"10.1515/dx-2023-0146","DOIUrl":"10.1515/dx-2023-0146","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of this retrospective study were to evaluate the clinical applicability of the latest International Society for the Study of Vulvovaginal Disease (ISSVD) and International Federation for Cervical Pathology and Colposcopy (IFCPC) terminology for vulvar diseases, and to explore a new evaluation flow to optimize decision-making on diagnosis.</p><p><strong>Methods: </strong>A total of 1,068 patients with 5,340 qualified vulvar images were evaluated by observers using 2011 ISSVD and 2011 IFCPC terminology systems. The sensitivity, specificity, positive predictive value, negative predictive value, Youden Index and Overall Diagnostic Value (ODV) were calculated for each finding in the two systems. Then the disease diagnosis order and a diagnosis flow draft (DFD) were obtained.</p><p><strong>Results: </strong>A total of 15 kinds of vulvar diseases were diagnosed. The proportion of patients accompanied with cervical or vaginal intraepithelial neoplasia was highest (83.3 %) in vulvar Paget's disease group (p<0.001). Total area of lesions was larger in vulvar Paget's disease, lichen simplex chronicus and lichen sclerosus group (p<0.001). Among the top five findings of ODV, some findings inferred several (≥6) kinds of diseases, while some findings only exist in a certain disease. When the DFD was used, the agreement between the initial impression and histopathology diagnosis was 68.8 %, higher than those when ISSVD an IFCPC terminology systems used (p=0.028), and it didn't change with the experience of the observer (p=0.178).</p><p><strong>Conclusions: </strong>Based on the findings in ISSVD and IFCPC terminology systems, we explored a DFD for observers with different experience on the detection of vulvar disease.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"151-163"},"PeriodicalIF":3.5,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032127","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's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.","authors":"Stephen K Liu, Fabienne Bourgeois, Joe Dong, Kendall Harcourt, Elizabeth Lowe, Liz Salmi, Eric J Thomas, Natalie Riblet, Sigall K Bell","doi":"10.1515/dx-2023-0075","DOIUrl":"10.1515/dx-2023-0075","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a \"good\" diagnostic process (DxP).</p><p><strong>Methods: </strong>We evaluated patient/family feedback on \"what's going well\" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words.</p><p><strong>Results: </strong>In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %).</p><p><strong>Conclusions: </strong>Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"63-72"},"PeriodicalIF":3.5,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10875277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800992","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}

{"title":"Assessing clinical reasoning skills following a virtual patient dizziness curriculum","authors":"Susrutha Kotwal, Amteshwar Singh, Sean Tackett, Anand Bery, Rodney Omron, Daniel Gold, David E. Newman-Toker, Scott M Wright","doi":"10.1515/dx-2023-0099","DOIUrl":"https://doi.org/10.1515/dx-2023-0099","url":null,"abstract":"Abstract Objectives Dizziness is a common medical symptom that is frequently misdiagnosed. While virtual patient (VP) education has been shown to improve diagnostic accuracy for dizziness as assessed by VPs, trainee performance has not been assessed on human subjects. The study aimed to assess whether internal medicine (IM) interns after training on a VP-based dizziness curriculum using a deliberate practice framework would demonstrate improved clinical reasoning when assessed in an objective structured clinical examination (OSCE). Methods All available interns volunteered and were randomized 2:1 to intervention (VP education) vs. control (standard clinical teaching) groups. This quasi-experimental study was conducted at one academic medical center from January to May 2021. Both groups completed pre-posttest VP case assessments (scored as correct diagnosis across six VP cases) and participated in an OSCE done 6 weeks later. The OSCEs were recorded and assessed using a rubric that was systematically developed and validated. Results Out of 21 available interns, 20 participated. Between intervention (n=13) and control (n=7), mean pretest VP diagnostic accuracy scores did not differ; the posttest VP scores improved for the intervention group (3.5 [SD 1.3] vs. 1.6 [SD 0.8], p=0.007). On the OSCE, the means scores were higher in the intervention (n=11) compared to control group (n=4) for physical exam (8.4 [SD 4.6] vs. 3.9 [SD 4.0], p=0.003) and total rubric score (43.4 [SD 12.2] vs. 32.6 [SD 11.3], p=0.04). Conclusions The VP-based dizziness curriculum resulted in improved diagnostic accuracy among IM interns with enhanced physical exam skills retained at 6 weeks post-intervention.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":"28 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138632927","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":"Prevalence of atypical presentations among outpatients and associations with diagnostic error.","authors":"Yukinori Harada, Yumi Otaka, Shinichi Katsukura, Taro Shimizu","doi":"10.1515/dx-2023-0060","DOIUrl":"10.1515/dx-2023-0060","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the prevalence of atypical presentations and their association with diagnostic errors in various diseases.</p><p><strong>Methods: </strong>This retrospective observational study was conducted using cohort data between January 1 and December 31, 2019. Consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine at a university hospital in Japan were included. Patients for whom the final diagnosis was not confirmed were excluded. Primary outcomes were the prevalence of atypical presentations, and the prevalence of diagnostic errors in groups with typical and atypical presentations. Diagnostic errors and atypical presentations were assessed using the Revised Safer Dx Instrument. We performed primary analyses using a criterion; the average score of less than five to item 12 of two independent reviewers was an atypical presentation (liberal criterion). We also performed additional analyses using another criterion; the average score of three or less to item 12 was an atypical presentation (conservative criterion).</p><p><strong>Results: </strong>A total of 930 patients were included out of a total of 2022 eligible. The prevalence of atypical presentation was 21.7 and 6.7 % when using liberal and conservative criteria for atypical presentation, respectively. Diagnostic errors (2.8 %) were most commonly observed in the cases with slight to moderate atypical presentation. Atypical presentation was associated with diagnostic errors with the liberal criterion for atypical presentation; however, this diminished with the conservative criterion.</p><p><strong>Conclusions: </strong>An atypical presentation was observed in up to 20 % of outpatients with a confirmed diagnosis, and slight to moderate atypical presentation may be the highest risk population for diagnostic errors.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"40-48"},"PeriodicalIF":3.5,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138498025","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 physical exam and telehealth: between past and future.","authors":"Jorge A Restrepo, Richard Henriquez, Dario Torre, Mark L Graber","doi":"10.1515/dx-2023-0154","DOIUrl":"10.1515/dx-2023-0154","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"1-3"},"PeriodicalIF":3.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458567","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 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":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Additional studies are needed to better understand how contextual factors influence different clinicians' diagnostic reasoning in the ICU.</p>","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}

{"title":"Updated statistics on Influenza mortality.","authors":"Camilla Mattiuzzi, Brandon M Henry, Giuseppe Lippi","doi":"10.1515/dx-2023-0158","DOIUrl":"10.1515/dx-2023-0158","url":null,"abstract":"<p><p>We have planned this analysis to provide current statistics on mortality directly caused by Influenza viruses in recent years in the US. We performed an electronic search in the online database CDC WONDER to obtain current statistics on direct mortality caused by Influenza viruses in the US. Mortality data are derived from information on all death certificates issued in the 50 states and the District of Columbia, excluding deaths of nonresidents. Our basic query criteria included Influenza-specific ICD-10 codes. Influenza caused an average of 7,670 deaths per year from 2018 to 2020 based on Influenza-specific ICD-10 codes, with a corresponding mean death rate of 2.3 × 100,000. The death rate increased in parallel with the age of the US resident population, from 0.2 × 100,000 in the 5-24 age group to 37.4 × 100,000 in US residents aged 85 years or older. No substantial differences were observed in males vs. females. The results of this analysis show that Influenza remains a significant clinical burden in the general population, with a cumulative mortality rate of approximately 2.3 × 100,000, but increasing more than tenfold (to over 37 × 100,000) in older persons.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"195-197"},"PeriodicalIF":3.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444252","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":"Convicting a wrong molecule?","authors":"Sok-Ja Janket, Jukka H Meurman, Eleftherios P Diamandis","doi":"10.1515/dx-2023-0129","DOIUrl":"10.1515/dx-2023-0129","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"203-204"},"PeriodicalIF":3.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71411131","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":"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":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>We identified several potential interventions that may enhance communication of diagnostic uncertainty and better engage patients and caregivers in the diagnostic process.</p>","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}