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Effect of syringe underfilling on the quality of venous blood gas analysis. 注射器充气不足对静脉血气分析质量的影响。
IF 3.5 Q1 Medicine Pub Date : 2023-09-05 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0096
Giuseppe Lippi, Laura Pighi, Marco Tosi, Marco Vettori, Giovanni Celegon, Emmanuel J Favaloro, Gian Luca Salvagno

Objectives: There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis.

Methods: Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e., 1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume.

Results: The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood.

Conclusions: Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes.

目的:有关采集少量血液对血气分析质量的影响的信息十分有限。因此,本研究旨在探讨不同程度的注射器填充不足对静脉血气分析测试结果的影响:方法:通过静脉穿刺采集 19 名医护人员的静脉血,用三个 1.0 mL 注射器手动抽取不同体积的血液(即 1.0、0.5 和 0.25 mL)进行血气分析。然后立即使用 GEM Premier 5,000 进行常规血气分析。将两支未充分灌注的注射器的结果与注入适当血量的参照注射器的结果进行比较:结果:大部分检测参数的数值在两支充气不足的注射器中没有明显差异。乳酸、血细胞比容和总血红蛋白的数值随着充盈量的减少而逐渐增加,钠浓度也随着充盈量的减少而降低。在装有 0.25 毫升血液的注射器中,乳酸盐的偏差具有临床意义;在装有 0.5 毫升和 0.25 毫升血液的注射器中,血细胞比容、总血红蛋白和钠的偏差都具有临床意义:结论:采集的静脉血量少于血气分析仪规定的充盈量可能会影响某些检测结果的质量,如乳酸、血细胞比容、总血红蛋白和钠。必须给出具体说明,以规范这些注射器的采血量。
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引用次数: 0
Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. 利钠肽的诊断特性和在初级保健中检测心力衰竭的个性化阈值的机会。
IF 3.5 Q1 Medicine Pub Date : 2023-09-05 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0089
Ralf E Harskamp, Lukas De Clercq, Lieke Veelers, Martijn C Schut, Henk C P M van Weert, M Louis Handoko, Eric P Moll van Charante, Jelle C L Himmelreich

Objectives: Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds.

Methods: A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding.

Results: A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold.

Conclusions: NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.

目的:心力衰竭(HF)是一种普遍的综合征,具有相当大的疾病负担、医疗保健利用和成本。及时诊断对改善预后至关重要。本研究旨在比较b型利钠肽(BNP)和n端proBNP (NT-proBNP)在初级保健中检测HF的诊断性能。我们的第二个目标是探索个性化阈值(使用年龄、性别或其他现成的参数)是否会比通用阈值进一步提高诊断准确性。方法:在2011年1月至2021年12月期间,在阿姆斯特丹全科医生网络进行了利钠肽(NP)检测的无HF患者进行了回顾性研究。心衰发生率基于NP检测后90天的登记。通过AUROC、基于指南推荐阈值(NT-proBNP为125 ng/L, BNP为35 ng/L)的敏感性和特异性评估诊断准确性。我们使用处理权重的逆概率来调整混淆。结果:共有15234名患者接受了NP检测,6870名BNP患者(4.5% %)患有HF, 8364名NT-proBNP患者(5.7% %)患有HF。NT-proBNP比BNP更准确,AUROC为89.9% %(95 % CI: 88.4-91.2)比85.9% %(95 % CI: 83.5-88.2),灵敏度(95.3比89.7 %)和特异性(59.1比58.0 %)更高。与通用阈值相比,通过临床变量区分NP截止值可适度提高BNP和NT-proBNP的诊断准确性。结论:NT-proBNP在初级保健中检测HF优于BNP。个性化的诊断阈值而不是通用的诊断阈值导致了适度的改善。
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引用次数: 0
Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool. 在icu -病房过渡期间扩大诊断暂停:探索实施ICU-PAUSE切换工具的障碍和促进因素。
IF 3.5 Q1 Medicine Pub Date : 2023-08-21 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0046
Ella G Cornell, Emily Harris, Emma McCune, Elle Fukui, Patrick G Lyons, Juan C Rojas, Lekshmi Santhosh

Objectives: The transition from the intensive care unit (ICU) to the medical ward is a high-risk period due to medical complexity, reduced patient monitoring, and diagnostic uncertainty. Standardized handoff practices reduce errors associated with transitions of care, but little work has been done to standardize the ICU to ward handoff. Further, tools that exist do not focus on preventing diagnostic error. Using Human-Centered Design methods we previously created a novel EHR-based ICU-ward handoff tool (ICU-PAUSE) that embeds a diagnostic pause at the time of transfer. This study aims to explore barriers and facilitators to implementing a diagnostic pause at the ICU-to-ward transition.

Methods: This is a multi-center qualitative study of semi-structured interviews with intensivists from ten academic medical centers. Interviews were analyzed iteratively through a grounded theory approach. The Sittig-Singh sociotechnical model was used as a unifying conceptual framework.

Results: Across the eight domains of the model, we identified major benefits and barriers to implementation. The embedded pause to address diagnostic uncertainty was recognized as a key benefit. Participants agreed that standardization of verbal and written handoff would decrease variation in communication. The main barriers fell within the domains of workflow, institutional culture, people, and assessment.

Conclusions: This study represents a novel application of the Sittig-Singh model in the assessment of a handoff tool. A unique feature of ICU-PAUSE is the explicit acknowledgement of diagnostic uncertainty, a practice that has been shown to reduce medical error and prevent premature closure. Results will be used to inform future multi-site implementation efforts.

目的:从重症监护病房(ICU)过渡到内科病房是一个高风险的时期,由于医疗复杂性,减少患者监测和诊断的不确定性。标准化的交接实践减少了与护理过渡相关的错误,但在标准化ICU病房交接方面做的工作很少。此外,现有的工具并不专注于防止诊断错误。使用以人为本的设计方法,我们之前创建了一种新颖的基于ehr的icu病房切换工具(ICU-PAUSE),该工具在转移时嵌入了诊断暂停。本研究旨在探讨在icu到病房过渡期间实施诊断暂停的障碍和促进因素。方法:采用多中心半结构化访谈法对10个学术医疗中心的重症医师进行定性研究。访谈通过扎根理论的方法进行迭代分析。Sittig-Singh社会技术模型被用作统一的概念框架。结果:在模型的八个领域中,我们确定了实现的主要好处和障碍。解决诊断不确定性的嵌入式暂停被认为是一个关键的好处。与会者一致认为,口头和书面交接的标准化将减少交流中的差异。主要的障碍落在工作流、制度文化、人员和评估的领域内。结论:本研究代表了Sittig-Singh模型在交接工具评估中的新应用。ICU-PAUSE的一个独特特点是明确承认诊断的不确定性,这种做法已被证明可以减少医疗错误并防止过早关闭。结果将用于为今后的多地点实施工作提供信息。
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引用次数: 0
Detection of fake papers in the era of artificial intelligence. 人工智能时代的假论文检测。
IF 3.5 Q1 Medicine Pub Date : 2023-08-17 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0090
Mehdi Dadkhah, Marilyn H Oermann, Mihály Hegedüs, Raghu Raman, Lóránt Dénes Dávid

Objectives: Paper mills, companies that write scientific papers and gain acceptance for them, then sell authorships of these papers, present a key challenge in medicine and other healthcare fields. This challenge is becoming more acute with artificial intelligence (AI), where AI writes the manuscripts and then the paper mills sell the authorships of these papers. The aim of the current research is to provide a method for detecting fake papers.

Methods: The method reported in this article uses a machine learning approach to create decision trees to identify fake papers. The data were collected from Web of Science and multiple journals in various fields.

Results: The article presents a method to identify fake papers based on the results of decision trees. Use of this method in a case study indicated its effectiveness in identifying a fake paper.

Conclusions: This method to identify fake papers is applicable for authors, editors, and publishers across fields to investigate a single paper or to conduct an analysis of a group of manuscripts. Clinicians and others can use this method to evaluate articles they find in a search to ensure they are not fake articles and instead report actual research that was peer reviewed prior to publication in a journal.

目标:造纸厂,撰写科学论文并获得认可,然后出售这些论文的作者身份的公司,在医学和其他医疗保健领域提出了一个关键挑战。随着人工智能(AI)的出现,这一挑战变得更加严峻,人工智能撰写手稿,然后造纸厂出售这些论文的作者身份。目前研究的目的是提供一种检测假论文的方法。方法:本文报告的方法使用机器学习方法创建决策树来识别假论文。数据收集自Web of Science和多个领域的期刊。结果:本文提出了一种基于决策树结果的伪论文识别方法。在一个案例研究中使用这种方法表明了它在识别假论文方面的有效性。结论:这种识别假论文的方法适用于跨领域的作者、编辑和出版商调查一篇论文或对一组手稿进行分析。临床医生和其他人可以使用这种方法来评估他们在搜索中找到的文章,以确保它们不是假文章,而是报告在期刊上发表之前经过同行评审的实际研究。
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引用次数: 2
Learned cautions regarding antibody testing in mast cell activation syndrome. 学习了肥大细胞活化综合征抗体检测的注意事项。
IF 3.5 Q1 Medicine Pub Date : 2023-08-14 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0032
Lawrence B Afrin, Tania T Dempsey, Gerhard J Molderings

Objectives: To describe patterns observed in antibody titer trendlines in patients with mast cell activation syndrome (MCAS, a prevalent but underrecognized chronic multisystem inflammatory disorder of great clinical heterogeneity) and offer clinical lessons learned from such pattern recognition.

Methods: The available records of 104 MCAS patients drawn from the authors' practices were reviewed, including all antibody tests therein.

Results: All patients had positive/elevated antibodies of various sorts at various points, but for most of the antibodies which were found to be positive at least some points, the diseases classically associated with those antibodies were not present, marking such antibodies as clinically insignificant mimickers (likely consequent to inflammatory effects of MCAS on the immune system itself driving spurious/random antibody production) rather than "on-target" and pathogenic antibodies reflecting true disease warranting treatment. We also observed two distinct patterns in trendlines of the titers of the mimickers vs. the trendline pattern expected in a true case of an antibody-associated disease (AAD).

Conclusions: Our observations suggest most positive antibody tests in MCAS patients represent detection of clinically insignificant mimicking antibodies. As such, to reduce incorrect diagnoses of AADs and inappropriate treatment in MCAS patients, caution is warranted in interpreting positive antibody tests in these patients. Except in clinically urgent/emergent situations, patience in determining the trendline of a positive antibody in an MCAS patient, and more carefully assessing whether the AAD is truly present, is to be preferred.

目的:描述肥大细胞激活综合征(MCAS,一种普遍存在但未被充分认识的慢性多系统炎症性疾病,具有很大的临床异质性)患者抗体滴度趋势线的模式,并从这种模式识别中提供临床经验教训。方法:回顾104例MCAS患者的现有记录,包括其中的所有抗体检测。结果:所有的病人在不同的时间点都有不同种类的抗体呈阳性或升高,但对于大多数被发现呈阳性的抗体,至少在某些时间点,与这些抗体相关的疾病并不存在,将这些抗体标记为临床无关紧要的模仿物(可能是由于MCAS对免疫系统本身的炎症作用导致虚假/随机抗体的产生),而不是反映真正需要治疗的疾病的“靶标”和致病抗体。我们还观察到模拟者滴度的趋势线与抗体相关疾病(AAD)真实病例中预期的趋势线模式的两种不同模式。结论:我们的观察表明,在MCAS患者中,大多数阳性抗体检测代表检测到临床无关紧要的模拟抗体。因此,为了减少对MCAS患者aad的错误诊断和不适当的治疗,在解释这些患者的阳性抗体检测时需要谨慎。除了在临床紧急/紧急情况下,在确定MCAS患者抗体阳性的趋势时,更仔细地评估AAD是否真的存在,最好是耐心。
{"title":"Learned cautions regarding antibody testing in mast cell activation syndrome.","authors":"Lawrence B Afrin, Tania T Dempsey, Gerhard J Molderings","doi":"10.1515/dx-2023-0032","DOIUrl":"10.1515/dx-2023-0032","url":null,"abstract":"<p><strong>Objectives: </strong>To describe patterns observed in antibody titer trendlines in patients with mast cell activation syndrome (MCAS, a prevalent but underrecognized chronic multisystem inflammatory disorder of great clinical heterogeneity) and offer clinical lessons learned from such pattern recognition.</p><p><strong>Methods: </strong>The available records of 104 MCAS patients drawn from the authors' practices were reviewed, including all antibody tests therein.</p><p><strong>Results: </strong>All patients had positive/elevated antibodies of various sorts at various points, but for most of the antibodies which were found to be positive at least some points, the diseases classically associated with those antibodies were not present, marking such antibodies as clinically insignificant mimickers (likely consequent to inflammatory effects of MCAS on the immune system itself driving spurious/random antibody production) rather than \"on-target\" and pathogenic antibodies reflecting true disease warranting treatment. We also observed two distinct patterns in trendlines of the titers of the mimickers vs. the trendline pattern expected in a true case of an antibody-associated disease (AAD).</p><p><strong>Conclusions: </strong>Our observations suggest most positive antibody tests in MCAS patients represent detection of clinically insignificant mimicking antibodies. As such, to reduce incorrect diagnoses of AADs and inappropriate treatment in MCAS patients, caution is warranted in interpreting positive antibody tests in these patients. Except in clinically urgent/emergent situations, patience in determining the trendline of a positive antibody in an MCAS patient, and more carefully assessing whether the AAD is truly present, is to be preferred.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10405731","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
Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process. 迈向学术病房团队的卓越诊断:建立诊断过程中团队动态的概念模型。
IF 3.5 Q1 Medicine Pub Date : 2023-08-11 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0065
Justin J Choi, Michael A Rosen, Martin F Shapiro, Monika M Safford

Objectives: Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions.

Methods: We used mixed-methods to develop and refine a conceptual model of how ward team dynamics in an academic medical center influence the diagnostic process. First, we systematically searched existing literature for conceptual models and empirical studies of team dynamics. Then, we conducted field observations with thematic analysis to refine our model.

Results: We present a conceptual model of how medical ward team dynamics influence the diagnostic process, which serves as a roadmap for future research and interventions in this area. We identified three underexplored areas of team dynamics that are relevant to diagnostic excellence and that merit future investigation (1): ward team structures (e.g., team roles, responsibilities) (2); contextual factors (e.g., time constraints, location of team members, culture, diversity); and (3) emergent states (shared mental models, psychological safety, team trust, and team emotions).

Conclusions: Optimizing the diagnostic process to achieve diagnostic excellence is likely to depend on addressing all of the potential barriers and facilitators to ward team dynamics presented in our model.

目标:在病房实现卓越诊断需要团队合作和有效的团队动力。然而,教学医院对病房团队动态的研究相对欠发达。我们的目标是加强对病房团队成员在诊断过程中如何互动以及驱动团队互动的潜在行为,心理和认知机制的理解。方法:我们使用混合方法来开发和完善一个概念模型,以了解学术医疗中心的病房团队动态如何影响诊断过程。首先,我们系统地检索了现有文献,寻找团队动力学的概念模型和实证研究。然后,我们进行了实地观察和专题分析,以完善我们的模型。结果:我们提出了一个关于病房团队动态如何影响诊断过程的概念模型,该模型可作为该领域未来研究和干预的路线图。我们确定了与卓越诊断相关的三个未被充分探索的团队动态领域,值得未来研究(1):病房团队结构(例如,团队角色,责任)(2);环境因素(例如,时间限制、团队成员的位置、文化、多样性);(3)突发状态(共享心理模型、心理安全、团队信任和团队情绪)。结论:优化诊断过程以实现卓越诊断可能取决于解决我们模型中呈现的所有潜在障碍和促进因素。
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引用次数: 0
Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors. 罕见情况下的诊断错误:对诊断错误病例报告的系统回顾。
IF 3.5 Q1 Medicine Pub Date : 2023-08-10 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0030
Yukinori Harada, Takashi Watari, Hiroyuki Nagano, Tomoharu Suzuki, Kotaro Kunitomo, Taiju Miyagami, Tetsuro Aita, Kosuke Ishizuka, Mika Maebashi, Taku Harada, Tetsu Sakamoto, Shusaku Tomiyama, Taro Shimizu

Objectives: To assess the usefulness of case reports as sources for research on diagnostic errors in uncommon diseases and atypical presentations.

Content: We reviewed 563 case reports of diagnostic error. The commonality of the final diagnoses was classified based on the description in the articles, Orphanet, or epidemiological data on available references; the typicality of presentation was classified based on the description in the articles and the judgment of the physician researchers. Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC), and Generic Diagnostic Pitfalls (GDP) taxonomies were used to assess the factors contributing to diagnostic errors.

Summary and outlook: Excluding three cases in that commonality could not be classified, 560 cases were classified into four categories: typical presentations of common diseases (60, 10.7 %), atypical presentations of common diseases (35, 6.2 %), typical presentations of uncommon diseases (276, 49.3 %), and atypical presentations of uncommon diseases (189, 33.8 %). The most important DEER taxonomy was "Failure/delay in considering the diagnosis" among the four categories, whereas the most important RDC and GDP taxonomies varied with the categories. Case reports can be a useful data source for research on the diagnostic errors of uncommon diseases with or without atypical presentations.

目的:评估病例报告作为研究罕见疾病和非典型表现诊断错误的来源的有用性。内容:我们回顾了563例诊断错误报告。最终诊断的共性根据文献描述、孤儿院或现有参考文献的流行病学数据进行分类;根据文献的描述和医师研究者的判断,对表现的典型性进行分类。诊断错误评估与研究(DEER)、可靠诊断挑战(RDC)和通用诊断缺陷(GDP)分类法用于评估导致诊断错误的因素。总结与展望:560例病例除3例共性不能分的病例外,共分为典型常见病(60例,10.7 %)、不典型常见病(35例,6.2 %)、典型不常见病(276例,49.3 %)、不典型不常见病(189例,33.8 %)四类。在4个分类中,最重要的分类是“失败/延迟考虑诊断”,而最重要的RDC和GDP分类因类别而异。病例报告可作为研究具有或不具有非典型表现的罕见疾病的诊断错误的有用数据源。
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引用次数: 0
How to overcome hurdles in holding mortality and morbidity conferences on diagnostic error cases in Japan. 如何克服在日本召开诊断错误病例死亡率和发病率会议的障碍。
IF 3.5 Q1 Medicine Pub Date : 2023-08-08 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0073
Yuto Unoki, Kosuke Ishizuka, Takuma Hata, Fumitaka Yoshimura, Toshihiko Oshita, Kotaro Kunitomo
{"title":"How to overcome hurdles in holding mortality and morbidity conferences on diagnostic error cases in Japan.","authors":"Yuto Unoki, Kosuke Ishizuka, Takuma Hata, Fumitaka Yoshimura, Toshihiko Oshita, Kotaro Kunitomo","doi":"10.1515/dx-2023-0073","DOIUrl":"10.1515/dx-2023-0073","url":null,"abstract":"","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947040","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
Reframing context specificity in team diagnosis using the theory of distributed cognition. 运用分布式认知理论重构团队诊断中的情境特异性。
IF 3.5 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1515/dx-2022-0100
James G Boyle, Matthew R Walters, Susan Jamieson, Steven J Durning

Context specificity refers to the vexing phenomenon whereby a physician can see two patients with the same presenting complaint, identical history and physical examination findings, but due to specific situational (contextual) factors arrives at two different diagnostic labels. Context specificity remains incompletely understood and undoubtedly leads to unwanted variance in diagnostic outcomes. Previous empirical work has demonstrated that a variety of contextual factors impacts clinical reasoning. These findings, however, have largely focused on the individual clinician; here we broaden this work to reframe context specificity in relation to clinical reasoning by an internal medicine rounding team through the lens of Distributed Cognition (DCog). In this model, we see how meaning is distributed amongst the different members of a rounding team in a dynamic fashion that evolves over time. We describe four different ways in which context specificity plays out differently in team-based clinical care than for a single clinician. While we use examples from internal medicine, we believe that the concepts we present apply equally to other specialties and fields in health care.

情境特异性指的是一种令人烦恼的现象,即医生可以看到两个具有相同主诉、相同病史和体格检查结果的患者,但由于特定的情境(语境)因素而得出两种不同的诊断标签。背景特异性仍然不完全了解,无疑会导致诊断结果出现不必要的差异。以往的实证研究表明,多种背景因素影响临床推理。然而,这些发现主要集中在个体临床医生身上;在这里,我们扩大了这项工作,通过分布式认知(DCog)的镜头,重新构建与临床推理相关的上下文特异性。在这个模型中,我们看到意义是如何在一个四舍五入的团队的不同成员之间以一种随时间演变的动态方式分布的。我们描述了四种不同的方式,其中情境特异性在基于团队的临床护理中发挥不同于单个临床医生的作用。虽然我们使用内科的例子,但我们认为,我们提出的概念同样适用于医疗保健的其他专业和领域。
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引用次数: 1
Development of a student-created internal medicine frameworks website for healthcare trainees. 为医疗保健培训生开发一个由学生创建的内科框架网站。
IF 3.5 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1515/dx-2023-0020
H Moses Murdock, Jarrod Ehrie, Nadia L Bennett, Jennifer R Kogan

Objectives: Describe medical student perspectives on framework learning and develop a free, online, mobile-friendly framework website.

Methods: Internal medicine clerkship students were surveyed at a single U.S. medical school regarding how they learn frameworks. We used Draw.io to create frameworks, which were edited by expert clinicians. Frameworks were hosted online through an academic server, and Google analytics was used to track website activity.

Results: Most medical students report learning frameworks from attending clinicians. We developed 87 frameworks on the "Penn Frameworks'' website, which was visited by 9,539 unique users from 124 countries over three years.

Conclusions: Most medical students perceive that they learn frameworks during clinical rotations from attending clinicians. We found that it is feasible to develop a low-cost, expert-curated, mobile-friendly resource to supplement in-person learning.

目的:描述医学生对框架学习的看法,并开发一个免费、在线、移动友好的框架网站。方法:对一所美国医学院的内科实习学生进行调查,了解他们如何学习框架。我们使用Draw。创建框架,由专家临床医生编辑。框架通过学术服务器在线托管,并使用谷歌分析来跟踪网站活动。结果:大多数医学生报告主治医生的学习框架。我们在“佩恩框架”网站上开发了87个框架,三年来有来自124个国家的9539个独立用户访问了该网站。结论:大多数医学生认为他们在临床轮转期间从主治医生那里学习了框架。我们发现开发一个低成本的、专家策划的、移动友好的资源来补充面对面的学习是可行的。
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引用次数: 0
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Diagnosis
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