Diagnosis最新文献

Objectives: Physicians rarely receive formal training on communicating diagnostic uncertainty to patients. Best practices in timing and educational strategies are not established. We aimed to develop, implement and assess a curriculum on communicating uncertainty for medical students.

Methods: This was a pseudorandomized and controlled study. Students on their Internal Medicine Clerkship during the study period from February to August 2023 were invited to participate and separated into control and intervention groups based on assigned rotation site. Students in the intervention group received a curriculum on communicating diagnostic uncertainty. All students completed a subscale of the Physicians' Reaction to Uncertainty Scale (PRUS) at the beginning of their clerkship and at the end of week 4 and an Objective Structured Clinical Examination (OSCE) at the end of week 4.

Results: Fifty-four students participated in the curriculum (29 intervention, 25 control). Intervention group students scored 2.13 points higher than control group students on their skills assessment (mean OSCE for intervention group=14.3, control group=12.17, p<0.001). PRUS increased in both groups, indicating improved tolerance of uncertainty, with no significant difference in change in PRUS between groups (mean change in PRUS for intervention group=2.68, control group=4.82, p=0.33). 97.7 % of students agreed that a curriculum on uncertainty should be included in their medical training.

Conclusions: Students who participated in a curriculum on communication of uncertainty demonstrated superior skills in communicating uncertainty during their OSCE. There was a significant increase in PRUS indicating decreased stress associated with uncertainty for all students. This may reflect high levels of baseline stress associated with starting a clerkship, maturation, exposure to cases, or role-modeling by the clinical team.

Objectives: Interpreting skin findings can be challenging for both laypersons and clinicians. Large language models (LLMs) offer accessible decision support, yet their diagnostic capabilities for dermatological images remain underexplored. This study evaluated the diagnostic performance of LLMs based on image interpretation of common dermatological diseases.

Methods: A total of 500 dermatological images, encompassing four prevalent skin conditions (psoriasis, vitiligo, erysipelas and rosacea), were used to compare seven multimodal LLMs (GPT-4o, GPT-4o mini, Gemini 1.5 Pro, Gemini 1.5 Flash, Claude 3.5 Sonnet, Llama3.2 90B and 11B). A standardized prompt was used to generate one top diagnosis.

Results: The highest overall accuracy was achieved by GPT-4o (67.8 %), followed by GPT-4o mini (63.8 %) and Llama3.2 11B (61.4 %). Accuracy varied considerably across conditions, with psoriasis with the highest mean LLM accuracy of 59.2 % and erysipelas demonstrating the lowest accuracy (33.4 %). 11.0 % of all images were misdiagnosed by all LLMs, whereas 11.6 % were correctly diagnosed by all models. Correct diagnoses by all LLMs were linked to clear, disease-specific features, such as sharply demarcated erythematous plaques in psoriasis. Llama3.2 90B was the only LLM to decline diagnosing images, particularly those involving intimate areas of the body.

Conclusions: LLM performance varied significantly, emphasizing the need for cautious usage. Notably, a free, locally hostable model correctly identified the top diagnosis for approximately two-thirds of all images, demonstrating the potential for safer, locally deployed LLMs. Advancements in model accuracy and the integration of clinical metadata could further enhance accessible and reliable clinical decision support systems.

Objectives: Scandinavian evaluation of laboratory equipment for point of care testing (SKUP) provides objective and supplier-independent information about analytical quality and user-friendliness of point-of-care (POC) measuring systems. The evaluation reports are freely available online and are valuable tools when selecting fit-for-purpose POC equipment. In this study, we present an overview of the performance of four POC measuring systems for monitoring prothrombin time international normalized ratio (INR) assessed against updated analytical performance specifications (APSs).

Methods: Primary healthcare centres (PHCCs) in Sweden and Norway did the practical work under real-life conditions. In each evaluation, 2-4 PHCCs participated with at least 40 patients on Warfarin treatment per site. Capillary samples were measured on the POC INR systems (qLabs Q3 Plus PT-INR Owren, Xprecia Stride, microINR or ProTime InRhythm), with venous samples analysed at hospital laboratories for comparison (STA-R Evolution or Sysmex CS5100). In the current study, APSs from SKUP, ISO 17593:2022, and CLSI POCT14-Ed2 were used. User-friendliness was assessed by addressing operational facilities, user-manual, time factors, and quality control.

Results: Only microINR coagulometer met the APS for accuracy, while qLabs Q3 Plus PT-INR Owren and ProTime InRhythm met the repeatability criteria. Xprecia Stride scored highest on user-friendliness, whereas the other systems faced challenges with sample application and unclear error messages on the devices.

Conclusions: This study highlights the potential for improvements in POC INR measuring systems and underscores the importance of performing objective evaluations under real-life conditions.

Objectives: The challenges posed by questionable journals to academia are very real, and being able to detect hijacked journals would be valuable to the research community. Using an artificial intelligence (AI) chatbot may be a promising approach to early detection. The purpose of this research is to analyze and benchmark the performance of different AI chatbots in identifying hijacked medical journals.

Methods: This study utilized a dataset comprising 21 previously identified hijacked journals and 10 newly detected hijacked journals, alongside their respective legitimate versions. ChatGPT, Gemini, Copilot, DeepSeek, Qwen, Perplexity, and Claude were selected for benchmarking. Three question types were developed to assess AI chatbots' performance in providing information about hijacked journals, identifying hijacked websites, and verifying legitimate ones.

Results: The results show that current AI chatbots can provide general information about hijacked journals, but cannot reliably identify either real or hijacked journal titles. While Copilot performed better than others, it was not error-free.

Conclusions: Current AI chatbots are not yet reliable for detecting hijacked journals and may inadvertently promote them.

Creativity is an important component of diagnostic reasoning, enabling the generation of novel and effective diagnostic hypotheses, in collaboration with abduction. The creative process not only fosters insight - critical for overcoming diagnostic challenges - but also enhances calibration by encouraging the exploration of alternative hypotheses. Insight, a key component of creativity, emerges when clinicians reconsider problems from fresh perspectives, breaking through diagnostic impasses. Similarly, calibration, essential for mitigating cognitive biases, promotes the generation and evaluation of alternative hypotheses. By fostering insight and calibration, creativity enhances precision and effectiveness of diagnostic reasoning. Leveraging insights from cognitive psychology to promote creativity can further elevate diagnostic reasoning, driving innovation and excellence in diagnosis. This article explores the pivotal role of creativity in diagnostic reasoning, its applications in diagnosis, approaches to nurture it, and its limitations, ultimately aiming to inspire innovation and excellence in the pursuit of diagnostic accuracy and patient care.

Prenatal screening (PNS) can be a very effective strategy for identifying the individuals at-risk of genetic disorders. In contrast to prenatal genetic tests, which are very expensive, require special set-ups and expertise, PNS can be of great help in reducing the burden of genetic disorders, especially in the Indian context. During the last 10 years, several advanced PNS tests utilizing new platforms, with comparatively more sensitivity and specificity, have emerged. PNS tests for chromosomal aneuploidies, microdeletion syndromes, hemoglobinopathies, neural tube defects etc. are available. However, primary health care providers need to be made more aware about the availability of different tests, the time point at which these need to be used, appropriateness of these tests to various presentations and interpretation of the result. They need to be periodically informed about the availability, limitations, sensitivity and specificity of different platforms for PNS. Further, there is a need to develop uniform, updated and practical guidelines on PNS and disseminate these to health care providers so as to benefit the mass population. This article compiles information on different types of PNS and prenatal diagnostic tests, commonly required for different genetic conditions. These recommendations may help clinicians and primary healthcare providers in PNS.

Enhancing the resolution of patient history is crucial for accurate diagnosis and improving patient outcomes. This paper introduces the "GREAT PRISM" strategy, a framework to eliminate barriers to reconstructing comprehensive patient history. Grounded in Grid analysis, the analysis organizes patient information along temporal and symptomatic axes to achieve high-resolution narratives for reaching an accurate diagnosis. Techniques such as identifying missing information, uncovering hidden histories, and dissecting temporal patterns are explored. While emphasizing cognitive forcing strategies and practical applications, this method bridges the gap between traditional practices and modern diagnostic approaches, fostering precision in diagnostic excellence from the point-of-care perspective.

Introduction: The differential diagnosis of fever of unknown origin (FUO) resembles that of inflammation of unknown origin (IUO), but the concept and differential diagnosis of FUO with no inflammatory laboratory evidence (FUO-NIL) are unknown. The aim was to propose the concept of FUO-NIL and explore its differential diagnosis.

Content: The present study is a scoping review of FUO-NIL, defined as FUO with normal serum C-reactive protein (CRP). The PubMed, Embase, CENTRAL, Web of Science, and Google Scholar databases were searched for relevant information. A study was considered eligible for enrolment if the final diagnosis was definitive and the CRP value was clearly noted as normal in each case. The data extracted included the patients' clinical information, final diagnosis, diagnostic tests performed, treatments, and outcomes.

Summary and outlook: The full text of 342 of 3,084 articles were reviewed, and 17 articles met the inclusion criteria. The review identified 19 cases that were eligible for quantitative analysis. The disease categories were infection (n=10, 52.6 %), malignancy (n=3, 15.8 %), non-infectious, inflammatory disease (n=4, 21.1 %), and miscellaneous (n=2, 10.5 %). A more specific differential diagnosis included intracellular fungal infection, tuberculosis, malignancy, systemic lupus erythematosus, granulomatous diseases, Fabry disease, hemophagocytic lymphohistiocytosis, and functional hyperthermia. FUO-NIL may have a unique differential diagnosis and have a different etiology from that of inflammatory FUO. In addition to the standard diagnostic work-up for FUO, tailored diagnostic strategies, including checking for a history of animal contact, the presence of hypohidrosis, and psychosocial stressors may be warranted in cases of FUO-NIL.

Objectives: Cellulitis shares several clinical features with fulminant deep soft tissue infections, creating a diagnostic dilemma for which clinicians are increasingly using cross-sectional diagnostic imaging to resolve. However, the role of imaging in apparent cellulitis is poorly defined. In particular, the clinical utility of CT in extremity cellulitis is underexplored. The purpose of this study was to determine patient and clinical factors that increase likelihood for finding of deep infection on CT among patients with extremity cellulitis.

Methods: A retrospective observational study was performed of patients with cellulitis of the extremities who were examined with computed tomography from January 1, 2012 to December 31, 2021. Demographics, medical history, and clinical and laboratory characteristics were collected. The presence of positive findings on CT report was recorded. Repeated measures logistic regression was used to evaluate significant predictors of positive CT.

Results: There were 496 eligible patient encounters, and CT was positive for deep infection in 39 cases (7.9 %). Median patient age was 56 years of age, 58.1 % were male, and most patients had a history of diabetes mellitus, history of tobacco use, and/or obesity. Significant predictors for positive CT on multivariable analysis included gas on pre-CT radiographs, febrile leukopenic state, injection drug use, purulence on exam, and white blood cell count extremes. Elevated CRP was also a significant positive predictor on bivariate analysis.

Conclusions: Finding a deep infection on CT in a patient with extremity cellulitis is uncommon and is predominantly associated with a high-risk clinical picture, and/or with high index of suspicion based on pre-CT plain films. In the absence of these patient factors or compelling findings on radiographs, CT does not typically provide clinically actionable information for extremity cellulitis and should not be used as part of standard evaluation.

Objectives: Autopsy plays an essential role in detecting diagnostic errors and the findings from autopsies have the potential to reduce future errors. However, there are few reports from Japan on diagnostic errors based on autopsy diagnoses. This study aimed to detail diagnostic errors in autopsy reports in Japan.

Methods: This descriptive study utilized the case report abstract database of the Japanese Society of Internal Medicine chapter meetings. Autopsy cases from 2002 to 2022 were included. We defined diagnostic errors as discrepancies in the primary cause of death between autopsy and clinical diagnosis. Diagnostic error cases were also categorized according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). To observe trends, a chi-square test was conducted by dividing the 20 years of data into four groups.

Results: Among 1,213 autopsied cases, diagnostic errors occurred in 435 cases (35.9 %; 95 % confidence interval, 33.2-38.6 %). The most frequent category of autopsy-detected diagnostic error cases was neoplasms (147, 33.8 %), followed by infections (131, 30.1 %), and cardiovascular diseases (49, 11.3 %). Over the 20 years, the incidence of diagnostic errors neither increased nor decreased.

Conclusions: Diagnostic errors detected in 35.8 % of autopsy cases in Japan. Autopsy is an important quality indicator for identifying diagnostic error.