Impact Factor: 3.5

Published since January 22, 2014

Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

ISSN: 2194-802X

Editors-in-chief: Mark L. Graber, Mario Plebani

About this journal

Objective
Diagnosis is a subscription journal, which focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality. Diagnosis is the official journal of the Society to Improve Diagnosis in Medicine.

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Topics

Factors that promote diagnostic quality and safety
Clinical reasoning
Diagnostic errors in medicine
The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns
Improving the value of diagnosis – eliminating waste and unnecessary testing
How culture and removing blame promote awareness of diagnostic errors
Training and education related to clinical reasoning and diagnostic skills
Advances in laboratory testing and imaging that improve diagnostic capability
Local, national and international initiatives to reduce diagnostic error

Article formats

Research Reports – Reports of original research
Short Communications – Reports of early research results and pilot studies
Reviews – Systematic, narrative, and focused reviews. Review articles are normally published by invitation, but suggestions to the Editors are welcome
Opinion Papers and Editorials
Letters to the Editor
Point/Counterpoint Papers
Guidelines and Recommendations
Innovations in diagnostic testing – Advances in laboratory testing or diagnostic imaging are appropriate subjects, or evaluations of recent innovations
Case Reports – Learning from Tragedy – Case reports of diagnostic error or dilemma discussed from a multi-stakeholder perspective; should include the facts of the case, a discussion focused on a root cause analysis, take-away points or action items resulting from the analysis, and whenever possible input from both the affected patients and their providers
Case Reports – Lessons in Clinical Reasoning: Pitfalls, Myths, and Pearls – Case reports in which a clinician discusses their diagnostic approach after clinical information is presented, focusing on a case in which a diagnostic error (or near miss = great catch) occurred
Patient-Focused Articles – Papers in this category should be written in lay language on a topic of interest to the patient stakeholder community
Diagnosis in the News – Brief reports of news-worthy advances in diagnosis, or problems involving diagnostic error

Your Benefits

Indexed in PubMed (all articles since 2014) and other abstracting and indexing services
Peer-reviewed and led by a multi-institutional editorial board
Focused on how the diagnostic process can be advanced to reduce diagnostic errors
Cutting-edge and authoritative contributions
Academic and clinical aspects of quality and safety in healthcare combination
International readership and global reach

History

founded in 2014
volumes 1 and 2 are Open Access

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Volume 10 Issue 3

August 2023

Publicly Available August 15, 2023

Frontmatter

Page range: i-ii

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Review

April 21, 2023

Cognitive biases in internal medicine: a scoping review

Michael F. Loncharich, Rachel C. Robbins, Steven J. Durning, Michael Soh, Jerusalem Merkebu

Page range: 205-214

Abstract

Background Medical errors account for up to 440,000 deaths annually, and cognitive errors outpace knowledge deficits as causes of error. Cognitive biases are predispositions to respond in predictable ways, and they don’t always result in error. We conducted a scoping review exploring which biases are most prevalent in Internal Medicine (IM), if and how they influence patient outcomes, and what, if any, debiasing strategies are effective. Content We searched PubMed, OVID, ERIC, SCOPUS, PsychINFO, and CINAHL. Search terms included variations of “bias”, “clinical reasoning”, and IM subspecialties. Inclusion criteria were: discussing bias, clinical reasoning, and physician participants. Summary Fifteen of 334 identified papers were included. Two papers looked beyond general IM: one each in Infectious Diseases and Critical Care. Nine papers distinguished bias from error, whereas four referenced error in their definition of bias. The most commonly studied outcomes were diagnosis, treatment, and physician impact in 47 % (7), 33 % (5), and 27 % (4) of studies, respectively. Three studies directly assessed patient outcomes. The most commonly cited biases were availability bias (60 %, 9), confirmation bias (40 %, 6), anchoring (40 %, 6), and premature closure (33 %, 5). Proposed contributing features were years of practice, stressors, and practice setting. One study found that years of practice negatively correlated with susceptibility to bias. Ten studies discussed debiasing; all reported weak or equivocal efficacy. Outlook We found 41 biases in IM and 22 features that may predispose physicians to bias. We found little evidence directly linking biases to error, which could account for the weak evidence of bias countermeasure efficacy. Future study clearly delineating bias from error and directly assessing clinical outcomes would be insightful.

Opinion Papers

February 14, 2023

“Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template

Taro Shimizu, Tow Keang Lim

Page range: 215-217

Abstract

Pivot and cluster strategy (PCS) is a cognitive forcing strategy designed to achieve diagnostic accuracy through the analytical deployment of a cluster of differential diagnoses (Cluster) specific to the initial most likely diagnosis (Pivot) recalled by a clinical diagnostician. This approach has been widely implemented and has effectively decreased diagnostic errors. Kahneman et al. have introduced innovative notions of noise and decision hygiene. Noise refers to the variance of errors, with numerous individuals’ errors in judgment pointing in different directions. They suggest a “Decision Hygiene” (DH) template, w preventative technique meant to reduce noise in decision-making. This paper introduced an interpretation of the existing strategy of PCS from new perspectives of noise and DH, which would allow us to further understand the usefulness of PCS, thereby contributing to a positive effect on the quality of diagnosis.

Open Access February 20, 2023

Developing a European longitudinal and interprofessional curriculum for clinical reasoning

Inga Hege, Martin Adler, Daniel Donath, Steven J. Durning, Samuel Edelbring, Maria Elvén, Ada Bogusz, Carina Georg, Sören Huwendiek, Melina Körner, Andrzej A. Kononowicz, Ioannis Parodis, Ulrika Södergren, Felicitas L. Wagner, Desiree Wiegleb Edström

Page range: 218-224

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Abstract

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

April 5, 2023

Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity

Ava L. Liberman, Zheyu Wang, Yuxin Zhu, Ahmed Hassoon, Justin Choi, J. Matthew Austin, Michelle C. Johansen, David E. Newman-Toker

Page range: 225-234

Abstract

Diagnostic errors in medicine represent a significant public health problem but continue to be challenging to measure accurately, reliably, and efficiently. The recently developed Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach measures misdiagnosis related harms using electronic health records or administrative claims data. The approach is clinically valid, methodologically sound, statistically robust, and operationally viable without the requirement for manual chart review. This paper clarifies aspects of the SPADE analysis to assure that researchers apply this method to yield valid results with a particular emphasis on defining appropriate comparator groups and analytical strategies for balancing differences between these groups. We discuss four distinct types of comparators (intra-group and inter-group for both look-back and look-forward analyses), detailing the rationale for choosing one over the other and inferences that can be drawn from these comparative analyses. Our aim is that these additional analytical practices will improve the validity of SPADE and related approaches to quantify diagnostic error in medicine.

July 4, 2023

Reframing context specificity in team diagnosis using the theory of distributed cognition

James G. Boyle, Matthew R. Walters, Susan Jamieson, Steven J. Durning

Page range: 235-241

Abstract

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.

Original Articles

July 13, 2023

Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship

Harisa Spahic, Dana Goplerud, Carly Blatt, Megan Murphy, William Christopher Golden, Amit Pahwa

Page range: 242-248

Abstract

Objectives Clinical reasoning with generation and prioritization of differential diagnoses (DDx) is a key skill for medical students, but no consensus exists on the best method to teach these skills. Meta-memory techniques (MMTs) may be useful, but the efficacy of individual MMTs is unclear. Methods We designed a 3-part curriculum for pediatric clerkship students to teach one of 3 MMTs and provide practice in DDx generation through case-based sessions. Students submitted DDx lists during two sessions and completed pre- and post-curriculum surveys assessing self-reported confidence and perceived helpfulness of the curriculum. Results were analyzed using ANOVA with multiple linear regression. Results A total of 130 students participated in the curriculum, with 96 % (125/130) completing at least one DDx session, and 44 % (57/130) completing the post-curriculum survey. On average, 66 % of students rated all three sessions as “quite helpful” (4/5 on 5-point Likert scale) or “extremely helpful” (5/5) without difference between MMT groups. Students generated an average of 8.8, 7.1 and 6.4 diagnoses using the VINDICATES, Mental CT, and Constellations methods, respectively. When controlling for case, case order, and number of prior rotations, students using VINDICATES produced 2.8 more diagnoses than those using Constellations (95 % CI [1.1,4.5], p<0.001). There was no significant difference between VINDICATES and Mental CT (Δ=1.6, 95 % CI [−0.2,3.4], p=0.11) or Mental CT and Constellations (Δ=1.2, 95 % CI [−0.7,3.1], p=0.36). Conclusions Medical education should include curricula focused on enhancing DDx development. Although VINDICATES helped students produce the most DDx, further research is needed to identify which MMT generates more accurate DDx.

March 15, 2023

Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations

Pedro Grilo Diogo, Vítor Hugo Pereira, Frank Papa, Cees van der Vleuten, Steven J. Durning, Nuno Sousa

Page range: 249-256

Abstract

Objectives The organization of medical knowledge is reflected in language and can be studied from the viewpoints of semantics and prototype theory. The purpose of this study is to analyze student verbalizations during an Objective Structured Clinical Examination (OSCE) and correlate them with test scores and final medical degree (MD) scores. We hypothesize that students whose verbalizations are semantically richer and closer to the disease prototype will show better academic performance. Methods We conducted a single-center study during a year 6 (Y6) high-stakes OSCE where one probing intervention was included at the end of the exam to capture students’ reasoning about one of the clinical cases. Verbalizations were transcribed and coded. An assessment panel categorized verbalizations regarding their semantic value (Weak, Good, Strong). Semantic categories and prototypical elements were compared with OSCE, case-based exam and global MD scores. Results Students with Semantic ‘Strong’ verbalizations displayed higher OSCE, case-based exam and MD scores, while the use of prototypical elements was associated with higher OSCE and MD scores. Conclusions Semantic competence and verbalizations matching the disease prototype may identify students with better organization of medical knowledge. This work provides empirical groundwork for future research on language analysis to support assessment decisions.

April 27, 2023

Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment

Linda M. Isbell, Mark L. Graber, Daniel R. Rovenpor, Guanyu Liu

Page range: 257-266

Abstract

Objectives Patients with mental illness are less likely to receive the same physical healthcare as those without mental illness and are less likely to be treated in accordance with established guidelines. This study employed a randomized experiment to investigate the influence of comorbid depression on diagnostic accuracy. Methods Physicians were presented with an interactive vignette describing a patient with a complex presentation of pernicious anemia. They were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. Results Fifty-nine physicians completed the study. The patient with comorbid depression was less likeable than the control patient (p=0.03, 95 % CI [0.09, 1.53]). Diagnostic accuracy was lower in the depression compared to control condition (59.4 % vs. 40.7 %), however this difference was not statistically significant χ 2 (1)=2.035, p=0.15. Exploratory analyses revealed that patient condition (depression vs. control) interacted with the number of diagnostic tests ordered to predict diagnostic accuracy (OR=2.401, p=0.038). Accuracy was lower in the depression condition (vs. control) when physicians ordered fewer tests (1 SD below mean; OR=0.103, p=0.028), but there was no difference for physicians who ordered more tests (1 SD above mean; OR=2.042, p=0.396). Conclusions Comorbid depression and related behaviors lowered diagnostic accuracy when physicians ordered fewer tests – a time when more possibilities should have been considered. These findings underscore the critical need to develop interventions to reduce diagnostic error when treating vulnerable populations such as those with depression.

April 21, 2023

Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care

Goutham Rao, Kelsey Ufholz, Paola Saroufim, Harry Menegay, Mark Beno

Page range: 267-274

Abstract

Objectives Identify the incidence, rate of physician recognition, diagnostic practices and cancer outcomes for unintentional weight loss (UWL). Methods We completed a secondary analysis of structured and unstructured EHR data collected from adult patients between January 1, 2020 and December 31, 2021. We used four common definitions to define UWL, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy. Unstructured physicians’ notes were used to identify both intentional weight loss (e.g. dieting) as well as physician recognition of UWL. Cancer outcomes were identified within 12 months of UWL using diagnostic codes. Physician actions (lab tests, etc.) in response to UWL were identified through manual chart review. Results Among 29,494 established primary care patients with a minimum of two weight measurements in 2020 and in 2021, we identified 290 patients who met one or more criteria for UWL (1 %). UWL was recognized by physicians in only 60 (21 %). UWL was more common and more likely to be recognized among older patients. Diagnostic practices were quite variable. A complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the three most common tests ordered in response to UWL. Five patients were diagnosed with cancer within 12 months of UWL (3 in whom UWL was recognized; two in whom it was not.) Conclusions Unintentional weight loss is poorly recognized across a diverse range of patients. A lack of research-informed guidance may explain both low rates of recognition and variability in diagnostic practices.

February 15, 2023

Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay

Antigona Ulndreaj, Dorsa Sohaei, Simon Thebault, Oscar D. Pons-Belda, Amaia Fernandez-Uriarte, Christopher Campbell, David Cheo, Martin Stengelin, George Sigal, Mark S. Freedman, Isobel A. Scarisbrick, Ioannis Prassas, Eleftherios P. Diamandis

Page range: 275-280

Abstract

Objectives Neurofilament light (NfL) chain is a marker of neuroaxonal damage in various neurological diseases. Here we quantitated NfL levels in the cerebrospinal fluid (CSF) and serum from patients with multiple sclerosis (MS) and controls, using the R-PLEX NfL assay, which employs advanced Meso Scale Discovery ® (MSD) electrochemiluminescence (ECL)-based detection technology. Methods NfL was quantitated in samples from 116 individuals from two sites (Ottawa Hospital Research Institute and Mayo Clinic), consisting of patients with MS (n=71) and age- and sex-matched inflammatory neurological controls (n=13) and non-inflammatory controls (n=32). Correlation of NfL levels between CSF and serum was assessed in paired samples in a subset of MS patients and controls (n=61). Additionally, we assessed the correlation between NfL levels obtained with MSD’s R-PLEX ® and Quanterix’s single molecule array (Simoa ® ) assays in CSF and serum (n=32). Results Using the R-PLEX, NfL was quantitated in 99% of the samples tested, and showed a broad range in the CSF (82–500,000 ng/L) and serum (8.84–2,014 ng/L). Nf-L levels in both biofluids correlated strongly (r=0.81, p<0.0001). Lastly, Nf-L measured by MSD’s R-PLEX and Quanterix’s Simoa assays were highly correlated for both biofluids (CSF: r=0.94, p<0.0001; serum: r=0.95, p<0.0001). Conclusions We show that MSD’s R-PLEX NfL assay can reliably quantitate levels of NfL in the CSF and serum from patients with MS and controls, where levels correlate strongly with Simoa.

March 7, 2023

Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood

Julia Maroto-García, Sara Deza, Patricia Fuentes-Bullejos, Patricia Fernández-Tomás, Débora Martínez-Espartosa, María Marcos-Jubilar, Nerea Varo, Álvaro González

Page range: 281-297

Abstract

Objectives Remote self-collected capillary blood samples have been proposed as alternative to venous blood samples as an aid in telemedicine. The aim of this work is to compare the preanalytical and analytical performance of these two types of samples and to study the stability of common measurands in capillary blood. Methods Capillary and venous blood samples were collected in parallel from 296 patients in serum tubes to analyze 22 common biochemistry magnitudes after centrifugation and in EDTA tubes to analyze 15 hematologic magnitudes. Quality of the preanalytical process was assessed applying the model of quality indicator. 24 h stability at room temperature was studied by obtaining paired capillary samples. A questionnaire of assessment was conducted. Results Mean hemolysis index was higher in capillary samples compared to venous blood samples (p<0.001). Regression analysis and difference analysis showed no bias for all studied biochemistry parameters and hematologic parameters, except mean corpuscular volume (MCV), between capillary and venous blood samples. Regarding sample stability, percentage deviation was higher than the corresponding minimum analytical performance specification for ferritin, vitamin D, hematocrit, MCV, mean corpuscular hemoglobin concentration, platelets distribution wide, mean platelet volume and basophils. Finger pricking was perceived as less painful (p<0.05) than venipuncture in participants who undergo more than one blood test per year. Conclusions Capillary blood can be used as an alternative to venous blood for the studied parameters in automated common clinical analyzers. Cautious should be taken if samples are not analyzed within 24 h from the collection.

April 6, 2023

Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis

Sérgio Monteiro de Almeida, Juliane Rosa Castoldi, Salomão Cury Riechi

Page range: 298-308

Abstract

Objectives Given the difficulty in the differential diagnosis of acute bacterial meningitis (BM) and viral meningitis (VM), we aimed to compare the ability of cerebrospinal fluid (CSF) biomarkers, such as lactate, glucose, lactate dehydrogenase (LDH), C-reactive protein (CRP), total white blood cell count, and predominance of neutrophils, as single tests to differentiate microbiologically defined acute BM and VM. Methods CSF samples were divided into three groups: BM (n=17), VM (n=14) (both with the etiological agent identified), and normal control groups (n=26). Results All the biomarkers studied were significantly higher in the BM group than in the VM or control groups (p>0.05). CSF lactate showed the best diagnostic clinical performance characteristics: sensitivity (94.12%), specificity (100%), positive and negative predictive value (100 and 97.56%, respectively), positive and negative likelihood ratio (38.59 and 0.06, respectively), accuracy (98.25%), and AUC (0.97). CSF CRP is excellent for screening BM and VM, as its best feature is its specificity (100%). CSF LDH is not recommended for screening or case-finding. LDH levels were higher in Gram-negative diplococcus than in Gram-positive diplococcus. Other biomarkers were not different between Gram-positive and negative bacteria. The highest level of agreement between the CSF biomarkers was between CSF lactate and CRP [kappa coefficient, 0.91 (0.79; 1.00)]. Conclusions All markers showed significant differences between the studied groups and were increased in acute BM. CSF lactate is better than the other biomarkers studied for screening acute BM due to its high specificity.

Short Communications

March 7, 2023

Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes

Erin E. Sullivan, Maram Khazen, Sophia D. Arabadjis, Maria Mirica, Jason M. Ramos, Andrew P.J. Olson, Mark Linzer, Gordon D. Schiff

Page range: 309-312

Abstract

Objectives To understand the relationship between stressful work environments and patient care by assessing work conditions, burnout, and elements of the diagnostic process. Methods Notes and transcripts of audiotaped encounters were assessed for verbal and written documentation related to psychosocial data, differential diagnosis, acknowledgement of uncertainty, and other diagnosis-relevant contextual elements using 5-point Likert scales in seven primary care physicians (PCPs) and 28 patients in urgent care settings. Encounter time spent vs time needed (time pressure) was collected from time stamps and clinician surveys. Study physicians completed surveys on stress, burnout, and work conditions using the Mini-Z survey. Results Physicians with high stress or burnout were less likely to record psychosocial information in transcripts and notes (psychosocial information noted in 0% of encounters in 4 high stress/burned-out physicians), whereas low stress physicians (n=3) recorded psychosocial information consistently in 67% of encounters. Burned-out physicians discussed a differential diagnosis in only 31% of encounters (low counts concentrated in two physicians) vs. in 73% of non-burned-out doctors’ encounters. Burned-out and non-burned-out doctors spent comparable amounts of time with patients (about 25 min). Conclusions Key diagnostic elements were seen less often in encounter transcripts and notes in burned-out urgent care physicians.

April 21, 2023

Development of a student-created internal medicine frameworks website for healthcare trainees

H. Moses Murdock, Jarrod Ehrie, Nadia L. Bennett, Jennifer R. Kogan

Page range: 313-315

Abstract

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.

Case Report - Lessons in Clinical Reasoning

July 14, 2023

Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain

Denslow Allerton Trumbull, Erica L. Braschi, Ankur Jain, Frederick S. Southwick, Andrew S. Parsons, Nila S. Radhakrishnan

Page range: 316-321

Abstract

Objectives Diagnostic error is not uncommon and diagnostic accuracy can be improved with the use of problem representation, pre-test probability, and Bayesian analysis for improved clinical reasoning. Case presentation A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient’s discharge. The patient presented to the ED 10 days later with an anterior ST-elevation myocardial infarction. Conclusions An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors.

Letters to the Editor

April 5, 2023

Ample room for cognitive bias in diagnosing accidental hypothermia

Robert Blasco Mariño, Steven Roy, Maria Martin Orejas, Iñigo Soteras Martínez, Peter Paal

Page range: 322-324

March 6, 2023

Auscultation order of lung and heart sounds and autonomous noise cancellation

Keisuke Matsuda, Yuki Otsuka

Page range: 325-325

Publicly Available February 20, 2023

Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection

Laura Pighi, Brandon M. Henry, Simone De Nitto, Gian Luca Salvagno, Giuseppe Lippi

Page range: 326-327

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Ahead of Print / Just Accepted

Ahead of Print / Just Accepted

Volume 10 (2023)

Volume 9 (2022)

Volume 8 (2021)

Volume 7 (2020)

Volume 6 (2019)

Volume 5 (2018)

Volume 4 (2017)

Volume 3 (2016)

Volume 2 (2015)

Volume 1 (2014)

Journal Impact Factor	3.5	2022, Journal Citation Reports (Clarivate, 2023)
5-year Journal Impact Factor	3.2	2022, Journal Citation Reports (Clarivate, 2023)
Journal Citation Indicator	0.95	2022, Journal Citation Reports (Clarivate, 2023)
CiteScore	6.9	2022, Scopus (Elsevier B.V., 2023)
SCImago Journal Rank	1.172	2022, SJR (Scimago Lab, 2023; Data Source: Scopus)
Source Normalized Impact per Paper	1.215	2022, CWTS Journal Indicators (CWTS B.V., 2023; Data Source: Scopus)

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Editorial

Co-Editors
Mark L. Graber, Society to Improve Diagnosis in Medicine (SIDM), Plymouth, MA
Mario Plebani, University Hospital, Padova, Italy

Associate Editors
Christina L. Cifra, Boston Children's Hospital, MA
Giuseppe Lippi, University Hospital of Verona, Verona, Italy
Andrew Olson, University of Minnesota Medical School, Minneapolis, MN
Satid Thammasitboon, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Dario Torre, Primary Uniformed Services, University of Medicine, Bethesda, MD
Laura Zwaan, Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, Rotterdam, Netherlands

Section Editors – Case Reports
Andrew Parsons, University of Virginia, Charlottesviille, VA
Melissa Plesac, University of Minnesota Medical Center, Minneapolis, MN
Verity Schaye, New York University School of Medicine, New York, NY

Editorial Board
Daniela Basso, University Hospital of Padova, Padova, Italy
Carmel Crock, Melbourne, Royal Victorian Eye and Ear Hospital, Australia
Pat Croskerry, Dalhousie University, Halifax, Canada
Gurpreet Dhaliwal, San Francisco VA Medical Center, San Francisco, CA
John Ely, University of Iowa Carver College of Medicine, Iowa City, IA
Evangelos Giannitsis, University of Heidelberg, Heidelberg, Germany
Michael Laposata, University of Texas Medical Branch, Galveston, TX
Yoryos Lyratzopoulos, University of Cambridge, Cambridge, United Kingdom
Jason Maude, Isabel Healthcare, Surrey, United Kingdom
David Newman-Toker, Johns Hopkins Hospital, Baltimore, MD
Joseph J. Rencic, Boston University School of Medicine, Boston, MA
Taro Shimizu, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
Geeta Singhal, Baylor College of Medicine, Pediatrics, Houston, TX
Dean F. Sittig, University of Texas Health Science Center, Houston, TX
Alexander von Meyer, Weiden, Germany

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Online ISSN: 2194-802X
Type: Journal
Language: English
Publisher: De Gruyter
First published: January 22, 2014
Publication Frequency: 4 Issues per Year
Audience: academics, physicians, educators, healthcare managers and leaders, patients, the diagnostic industry, and policy makers