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Interprofessional clinical reasoning education. 跨专业临床推理教育。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-05 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0059
Thomas Eriksen, Ismaïl Gögenur

Clinical reasoning is considered one of the most important competencies but is not included in most healthcare curricula. The number and diversity of patient encounters are the decisive factors in the development of clinical reasoning competence. Physical real patient encounters are considered optimal, but virtual patient cases also promote clinical reasoning. A high-volume, low-fidelity virtual patient library thus can support clinical reasoning training in a safe environment and can be tailored to the needs of learners from different health care professions. It may also stimulate interprofessional understanding and team shared decisions. Implementation will be challenged by tradition, the lack of educator competence and prior experience as well as the high-density curricula at medical and veterinary schools and will need explicit address from curriculum managers and education leads.

临床推理能力被认为是最重要的能力之一,但却未被纳入大多数医疗保健课程。与病人接触的次数和多样性是培养临床推理能力的决定性因素。真实病人的实际接触被认为是最佳选择,但虚拟病人案例也能促进临床推理。因此,一个高容量、低逼真度的虚拟病人资料库可以在安全的环境中支持临床推理培训,并能满足不同医疗专业学习者的需求。它还可以促进跨专业理解和团队共同决策。传统、教育者能力和经验的缺乏以及医学院和兽医学校高密度的课程设置都将给虚拟病人库的实施带来挑战,因此需要课程管理者和教育领导者明确解决这些问题。
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引用次数: 0
Typology of solutions addressing diagnostic disparities: gaps and opportunities. 解决诊断差异的解决方案类型:差距与机遇。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-03 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0026
Vadim Dukhanin, Aaron A Wiegand, Taharat Sheikh, Anushka Jajodia, Kathryn M McDonald

Objectives: Diagnostic disparities are preventable differences in diagnostic errors or opportunities to achieve diagnostic excellence. There is a need to summarize solutions with explicit considerations for addressing diagnostic disparities. We aimed to describe potential solutions to diagnostic disparities, organize them into an action-oriented typology with illustrative examples, and characterize these solutions to identify gaps for their further development.

Methods: During four human-centered design workshops composed of diverse expertise, participants ideated and clarified potential solutions to diagnostic disparities and were supported by environmental literature scan inputs. Nineteen individual semi-structured interviews with workshop participants validated identified solution examples and solution type characterizations, refining the typology.

Results: Our typology organizes 21 various types of potential diagnostic disparities solutions into four primary expertise categories needed for implementation: healthcare systems' internal expertise, educator-, multidisciplinary patient safety researcher-, and health IT-expertise. We provide descriptions of potential solution types ideated as focused on disparities and compare those to existing examples. Six types were characterized as having diagnostic-disparity-focused examples, five as having diagnostic-focused examples, and 10 as only having general healthcare examples. Only three solution types had widespread implementation. Twelve had implementation on limited scope, and six were mostly hypothetical. We describe gaps that inform the progress needed for each of the suggested solution types to specifically address diagnostic disparities and be suitable for the implementation in routine practice.

Conclusions: Numerous opportunities exist to tailor existing solutions and promote their implementation. Likely enablers include new perspectives, more evidence, multidisciplinary collaborations, system redesign, meaningful patient engagement, and action-oriented coalitions.

目标:诊断差异是可预防的诊断错误差异或实现卓越诊断的机会差异。有必要总结解决方案,明确解决诊断差异的注意事项。我们的目标是描述诊断差异的潜在解决方案,将其整理成以行动为导向的类型学,并举例说明,同时描述这些解决方案的特点,以确定进一步发展的差距:方法:在四次由不同专家组成的以人为本的设计研讨会上,与会者对诊断差异的潜在解决方案进行了构思和澄清,并得到了环境文献扫描输入的支持。与工作坊参与者进行的 19 次个人半结构式访谈验证了确定的解决方案实例和解决方案类型特征,完善了类型学:我们的类型学将 21 种不同类型的潜在诊断差异解决方案归纳为实施所需的四个主要专业知识类别:医疗保健系统内部专业知识、教育工作者、多学科患者安全研究人员和医疗信息技术专家。我们描述了以差异为重点的潜在解决方案类型,并将其与现有实例进行比较。其中有六种类型以诊断差异为重点,五种类型以诊断为重点,十种类型仅以普通医疗保健为重点。只有三种解决方案得到了广泛实施。12 种解决方案的实施范围有限,6 种解决方案主要是假设性的。我们描述了差距,为每种建议的解决方案类型提供了所需的进展信息,以专门解决诊断差异并适合在常规实践中实施:结论:存在许多机会来调整现有解决方案并促进其实施。可能的推动因素包括新观点、更多证据、多学科合作、系统重新设计、有意义的患者参与以及以行动为导向的联盟。
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引用次数: 0
External Quality Assessment (EQA) scheme for serological diagnostic test for SARS-CoV-2 detection in Sicily Region (Italy), in the period 2020-2022. 2020-2022 年期间意大利西西里大区检测 SARS-CoV-2 的血清诊断测试外部质量评估 (EQA) 计划。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-03 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0048
Francesca Di Gaudio, Giuseppina Brunacci, Annamaria Cucina, Vita Giaccone, Maria Raso, Anna Lundari, Antonio Cancilleri, Vito Buffa, Eleonora Russo, Sonya Vasto, Mario La Rocca, Sergio Indelicato

Objectives: Since December 2019, worldwide public health has been exposed to a severe acute respiratory syndrome caused by Coronavirus-2. Serological testing is necessary for retrospective assessment of seroprevalence rates, and the determination of vaccine response and duration of immunity. For this reason, it was necessary to introduce a panel of tests able to identify and quantify Covid-19 antibodies.

Methods: As a Regional Reference Centre, the CRQ Laboratory (Regional Laboratory for the Quality Control) developed and conducted an External Quality Assessment (EQA) panel of assays, to evaluate the quality of various methods, that were used by 288 Sicilian laboratories, previously authorized on behalf of the Public Health Service.

Results: The performance test was based on pooled samples with different levels of concentration of antibodies. 97 , 98, and 95 % of the participating laboratories tested all samples correctly in 2020, 2021, and 2022 respectively. The best performance was observed in the test of total Ig. The general performance of laboratories improved over the years.

Conclusions: The incorrect diagnosis had and could still have important implications on vaccination cycles. Only through the effort of laboratory professionals, and the extension of the EQA scheme, a better harmonization of methods, protocols, and thus results, to guarantee a better healthcare system, will be possible.

目标:自 2019 年 12 月以来,全球公共卫生受到了由冠状病毒-2 引起的严重急性呼吸系统综合征的威胁。血清学检测是回顾性评估血清流行率、确定疫苗反应和免疫持续时间所必需的。因此,有必要引入一套能够识别和量化 Covid-19 抗体的检测方法:作为地区参考中心,CRQ 实验室(地区质量控制实验室)开发并实施了一套外部质量评估(EQA)检测方法,以评估各种方法的质量:性能测试基于不同抗体浓度水平的集合样本。2020年、2021年和2022年,分别有97%、98%和95%的参与实验室正确检测了所有样本。总 Ig 的检测结果最佳。多年来,实验室的总体表现有所改善:错误的诊断曾经并可能继续对疫苗接种周期产生重要影响。只有通过实验室专业人员的努力和 EQA 计划的扩展,才能更好地协调方法、规程和结果,从而保证更好的医疗保健系统。
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引用次数: 0
Masquerade of authority: hijacked journals are gaining more credibility than original ones. 伪装权威:被劫持的期刊比原创期刊更有公信力。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-03 eCollection Date: 2024-08-01 DOI: 10.1515/dx-2024-0082
Mihály Hegedűs, Mehdi Dadkhah, Lóránt D Dávid

At the moment, the academic world is faced with various challenges that negatively impact science integrity. One is hijacked journals, a second, inauthentic website for indexed legitimate journals, managed by cybercriminals. These journals publish any manuscript by charging authors and pose a risk to scientific integrity. This piece compares a journal's original and hijacked versions regarding authority in search engines. A list of 16 medical journals, along with their hijacked versions, has been collected. The MOZ Domain Authority has been used to check the authority of both original and hijacked journals, and the results have been discussed. It indicates that hijacked journals are gaining more credibility than original ones. This should alarm academia and highlights a need for serious action against hijacked journals. The related policies should be planned, and tools should be developed to support easy detection of hijacked journals. On the publishers' side, the visibility of journals' websites must be enhanced to address this issue.

目前,学术界面临着对科学诚信产生负面影响的各种挑战。其一是被劫持的期刊,其二是由网络犯罪分子管理的被收录合法期刊的不真实网站。这些期刊发表任何收费作者的稿件,对科学诚信构成威胁。这篇文章比较了期刊的原始版本和劫持版本在搜索引擎中的权威性。我们收集了 16 种医学期刊及其劫持版本。使用 MOZ 域名授权来检查原始期刊和被劫持期刊的权威性,并对结果进行了讨论。结果表明,被劫持的期刊比原始期刊获得了更高的可信度。这应该给学术界敲响警钟,并强调有必要对劫持期刊采取严肃行动。应规划相关政策,开发相关工具,以支持轻松检测被劫持期刊。在出版商方面,必须提高期刊网站的能见度,以解决这一问题。
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引用次数: 0
The growing threat of hijacked journals. 期刊被劫持的威胁日益严重。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-27 eCollection Date: 2024-08-01 DOI: 10.1515/dx-2024-0103
Mark L Graber, Mario Plebani
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引用次数: 0
Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study. 导致糖尿病酮症酸中毒的新发儿童糖尿病延迟诊断:一项回顾性队列研究。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-27 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0024
Stephanie M Hadley, Kenneth A Michelson

Objectives: Patients with a delayed diagnosis of diabetes are more likely to present in diabetic ketoacidosis (DKA). The objective of this study was to assess the prevalence, risk factors, and consequences of missed pediatric diabetes diagnoses in emergency departments (EDs) potentially leading to DKA.

Methods: Cases of children under 19 years old with a first-time diagnosis of diabetes mellitus presenting to EDs in DKA were drawn from the Healthcare Cost and Utilization Project database. A total of 11,716 cases were included. A delayed diagnosis of diabetes leading to DKA was defined by an ED discharge in the 14 days prior to the DKA diagnosis. The delayed diagnosis cases were analyzed using multivariate analysis to identify risk factors associated with delay, with the primary exposure being child opportunity index (COI) and secondary exposure being race/ethnicity. Rates of complications were compared across groups.

Results: Delayed diagnosis of new onset diabetes leading to DKA occurred in 2.9 %. Delayed diagnosis was associated with COI, with 4.5 , 3.5, 1.9, and 1.5 % occurring by increasing COI quartile (p<0.001). Delays were also associated with younger age and non-Hispanic Black race. Patients with a delayed diagnosis were more likely to experience complications (4.4 vs. 2.2 %, p=0.01) including mechanical ventilation, as well as more frequent intensive care unit admissions and longer length of stays.

Conclusions: Among children with new-onset DKA, 2.9 % had a delayed diagnosis. Delays were associated with complications. Children living in areas with lower child opportunity and non-Hispanic Black children were at higher risk of delays.

目的:糖尿病诊断延迟的患者更有可能出现糖尿病酮症酸中毒(DKA)。本研究旨在评估急诊科(ED)漏诊儿童糖尿病可能导致 DKA 的发生率、风险因素和后果:方法:研究人员从 "医疗成本与利用项目"(Healthcare Cost and Utilization Project)数据库中抽取了首次诊断为糖尿病并在急诊科就诊时出现 DKA 的 19 岁以下儿童病例。共纳入 11,716 个病例。糖尿病延迟诊断导致 DKA 的定义是在诊断 DKA 前 14 天内急诊室出院。采用多变量分析方法对延迟诊断病例进行了分析,以确定与延迟诊断相关的风险因素,主要风险因素是儿童机会指数(COI),次要风险因素是种族/民族。比较了各组的并发症发生率:结果:2.9%的新发糖尿病患者因诊断延误而导致DKA。延迟诊断与 COI 有关,COI 四分位数越高,发生率分别为 4.5%、3.5%、1.9% 和 1.5%(p 结论:在新发糖尿病患儿中,并发症的发生率与 COI 有关:在新发 DKA 患儿中,2.9% 的患儿诊断延误。延误与并发症有关。生活在儿童机会较少地区的儿童和非西班牙裔黑人儿童发生延误的风险较高。
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引用次数: 0
What is diagnostic safety? A review of safety science paradigms and rethinking paths to improving diagnosis. 什么是诊断安全?回顾安全科学范例,重新思考改进诊断的途径。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-27 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0008
Justin J Choi

Diagnostic errors in health care are a global threat to patient safety. Researchers have traditionally focused diagnostic safety efforts on identifying errors and their causes with the goal of reducing diagnostic error rates. More recently, complementary approaches to diagnostic errors have focused on improving diagnostic performance drawn from the safety sciences. These approaches have been called Safety-II and Safety-III, which apply resilience engineering and system safety principles, respectively. This review explores the safety science paradigms and their implications for analyzing diagnostic errors, highlighting their distinct yet complementary perspectives. The integration of Safety-I, Safety-II, and Safety-III paradigms presents a promising pathway for improving diagnosis. Diagnostic researchers not yet familiar with the various approaches and potential paradigm shift in diagnostic safety research may use this review as a starting point for considering Safety-I, Safety-II, and Safety-III in their efforts to both reduce diagnostic errors and improve diagnostic performance.

医疗诊断错误是对患者安全的全球性威胁。传统上,研究人员将诊断安全工作的重点放在识别错误及其原因上,目的是降低诊断错误率。最近,针对诊断错误的补充方法则侧重于从安全科学中汲取营养,提高诊断性能。这些方法被称为 Safety-II 和 Safety-III,分别应用了弹性工程和系统安全原则。本综述探讨了安全科学范式及其对分析诊断错误的影响,强调了它们不同但互补的观点。安全-I、安全-II 和安全-III 范式的整合为改进诊断提供了一条大有可为的途径。尚未熟悉诊断安全研究中的各种方法和潜在范式转变的诊断研究人员可将本综述作为起点,在努力减少诊断错误和提高诊断绩效的过程中考虑安全-I、安全-II 和安全-III 范式。
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引用次数: 0
Should APTT become part of thrombophilia screening? APTT 是否应成为血栓性疾病筛查的一部分?
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-24 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0086
Giuseppe Lippi, Emmanuel J Favaloro
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引用次数: 0
Recent mortality rates due to complications of medical and surgical care in the US. 美国医疗和外科护理并发症导致的最新死亡率。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-20 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0071
Camilla Mattiuzzi, Mario Plebani, Giuseppe Lippi

Objectives: Medical errors and complications pose a major threat to the safety of healthcare systems worldwide. This article was hence aimed at determining the current burden of complications of medical and surgical care in the US.

Methods: We searched the latest version of the US Centers for Disease Control and Prevention (CDC) WONDER online database (years 2018-2022) using ICD-10 codes Y40-Y84 (complications of medical and surgical care).

Results: The age-adjusted death rate for complications of medical and surgical care increased from 1.17 × 100,000 in 2018 to 1.49 × 100,000 in 2021, but then declined to 0.85 × 100,000 in 2022. The gender-specific analysis showed a similar trend, with the age-adjusted death rate values always being higher in men than in women. A clear age-dependent relationship was also found in the crude mortality rate for complications of medical and surgical care, as higher death rates were observed in older patients.

Conclusions: This analysis reveals that the burden of complications of medical and surgical care has increased over time, especially during the COVID-19 pandemic, but has then considerably declined in 2022. However, root cause analysis and actions are still needed for preventing the still noticeable consequences of medical complications.

目的:医疗事故和并发症对全球医疗系统的安全构成了重大威胁。因此,本文旨在确定当前美国医疗和外科护理并发症的负担:我们使用ICD-10代码Y40-Y84(内外科护理并发症)检索了美国疾病控制和预防中心(CDC)WONDER在线数据库的最新版本(2018-2022年):经年龄调整后的内外科护理并发症死亡率从2018年的1.17×100,000上升至2021年的1.49×100,000,但随后下降至2022年的0.85×100,000。性别分析显示了类似的趋势,男性的年龄调整后死亡率值始终高于女性。在内科和外科护理并发症的粗死亡率方面,也发现了明显的年龄依赖关系,因为年龄较大的患者死亡率较高:这项分析表明,医疗和外科护理并发症的负担随着时间的推移而增加,尤其是在 COVID-19 大流行期间,但随后在 2022 年大幅下降。然而,仍需对根本原因进行分析并采取行动,以预防医疗并发症带来的明显后果。
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引用次数: 0
Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area. 初级医疗中心力衰竭登记的质量:从阿姆斯特丹大都会区 100 万份电子健康记录中观察到的结果。
IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-14 eCollection Date: 2024-11-01 DOI: 10.1515/dx-2024-0009
Lukas De Clercq, Jelle C L Himmelreich, Ralf E Harskamp

Objectives: Proper coding of heart failure (HF) in electronic health records (EHRs) is an important prerequisite for adequate care and research towards this vulnerable patient population. We set out to evaluate the accuracy of registration of HF diagnoses in primary care EHRs.

Methods: In a routine primary care database covering the Amsterdam Metropolitan Area, we identified all episodes of care with International Classification of Primary Care (ICPC) codes K77 (decompensatio cordis) or K84.03 (cardiomyopathy) up to 31/12/2021. We also performed two text-based searches to identify HF episodes without an appropriate ICPC-code. An expert panel evaluated all ICPC and text matches for congruence between the assigned codes and notes.

Results: From a database of 968,433 records we identified 19,106 patients (2.0 %) with a total of 24,011 ICPC-coded HF episodes. Removal of 1,324 episodes found to concern other or uncertain diagnoses and inclusion of 4,582 validated HF episodes identified through text search led to exclusion of 909 (overregistration: 4.8 %) and inclusion of 2,266 additional patients (underregistration: 11.1 %). The inclusion of miscoded HF episodes advanced the first known date of HF diagnosis in 3.9 % of records, with a median shift of 3.45 years. Episode-level underregistration decreased significantly over time, from 23.8 % in 2006 to 10.0 % in 2021.

Conclusions: While there is improvement over time, there are still substantial levels of over- and underregistration of HF, emphasizing the need for cautious interpretation of ICPC-coded data. The findings contribute to the understanding of HF registration issues in primary care and provide insights for improving registration practices.

目的:在电子健康记录(EHR)中对心力衰竭(HF)进行正确编码是对这一弱势患者群体进行充分护理和研究的重要前提。我们着手评估基层医疗电子病历中心力衰竭诊断登记的准确性:方法:在覆盖阿姆斯特丹大都会区的常规初级医疗数据库中,我们确定了截至 2021 年 12 月 31 日所有带有国际初级医疗分类 (ICPC) 代码 K77(心肌减压)或 K84.03(心肌病)的医疗事件。我们还进行了两次文本检索,以识别没有相应 ICPC 代码的高频病例。专家小组对所有 ICPC 和文本匹配进行了评估,以确定分配的代码与注释之间是否一致:从 968,433 条记录的数据库中,我们发现了 19,106 名患者(2.0%)共 24,011 次 ICPC 编码的高血压病程。删除了 1324 个涉及其他诊断或不确定诊断的病例,并纳入了 4582 个通过文本搜索确定的有效高血压病例,结果排除了 909 个病例(登记过多:4.8%),纳入了 2266 个额外的病人(登记不足:11.1%)。在 3.9% 的记录中,由于纳入了编码错误的高血压病例,首次确诊高血压的日期提前了,中位数提前了 3.45 年。随着时间的推移,病程水平的登记不足率明显下降,从2006年的23.8%降至2021年的10.0%:虽然随着时间的推移情况有所改善,但仍存在大量的高血压登记过度和登记不足的情况,这强调了谨慎解释 ICPC 编码数据的必要性。研究结果有助于了解基层医疗机构的高血压登记问题,并为改进登记实践提供了启示。
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引用次数: 0
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Diagnosis
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