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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Supplementary Materials

Topics

External Links

Volume 10 Issue 2

May 2023

Publicly Available May 16, 2023

Frontmatter

Page range: i-ii

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Editorials

Publicly Available November 10, 2022

An equation for excellence in clinical reasoning

Taro Shimizu, Mark L. Graber

Page range: 61-63

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Publicly Available November 23, 2022

Quantifying diagnostic excellence

Harry B. Burke

Page range: 64-67

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Review

December 14, 2022

A scoping review of distributed cognition in acute care clinical decision-making

Eric Wilson, Michelle Daniel, Aditi Rao, Dario Torre, Steven Durning, Clare Anderson, Nicole H. Goldhaber, Whitney Townsend, Colleen M. Seifert

Page range: 68-88

Abstract

Objectives In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error. Content This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature. Summary and outlook Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.

Opinion Papers

December 9, 2022

Context matters: toward a multilevel perspective on context in clinical reasoning and error

Justin J. Choi, Steven J. Durning

Page range: 89-95

Abstract

Context in diagnosis and management of patients is a vexing phenomenon in medicine and health professions education that can lead to unwanted variation in clinical reasoning performance and even errors that cause patient harm. Studies have examined individual-, team-, and system-level contextual factors, but the ways in which multiple contextual factors can interact, how both distracting and enabling factors can impact performance and error, and the boundaries between context and content information are not well understood. In this paper, we use a theory-based approach to enhance our understanding of context. We introduce a multilevel perspective on context that extends prior models of clinical reasoning and propose a micro-meso-macro framework to provide a more integrated understanding of how clinical reasoning is both influenced by and emerges from multiple contextual factors. The multilevel approach can also be used to study other social phenomena in medicine such as professionalism, learning, burnout, and implicit bias. We call for a new paradigm in clinical reasoning research and education that uses multilevel theory and analysis to enhance clinical reasoning performance expertise and improve the quality of patient care.

November 18, 2022

Occam’s razor and Hickam’s dictum: a dermatologic perspective

Hadassah Stein, Eve J. Lowenstein

Page range: 96-99

Abstract

Diagnostic heuristics help ease the cognitive load in our day-to-day work. Occam’s razor or the rule of diagnostic parsimony is a diagnostic heuristic often applied in dermatology. Occam’s razor dictates that all things being equal, one diagnosis (as opposed to several diagnoses) should be sought to explain a patient’s presentation. While this can often be helpful, it can also obscure the full picture. Hickam’s dictum is an aphorism expressing the opposite opinion: “patients can have as many diseases as they damn (or darn) well please.” This acknowledges that multiple simultaneous processes can be at play. This article delves into the implications of use of these approaches and offers tips through cases illustrating the limitations of Occam’s razor and when Hickam’s Dictum should be invoked.

Original Articles

Open Access November 18, 2022

Differences in clinical reasoning between female and male medical students

Inga Hege, Meike Hiedl, Karin Christine Huth, Jan Kiesewetter

Page range: 100-104

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Abstract

Objectives In undergraduate medical education virtual patients (VPs) are a suitable method to teach clinical reasoning and support the visualization of this thinking process in a safe environment. The aim of our study was to investigate differences in the clinical reasoning process and diagnostic accuracy of female and male medical students. Methods During the summer term 2020, we provided access to 15 VPs for undergraduate students enrolled in a medical school in Bavaria, Germany. All interactions of the 179 learners within the VP system CASUS were recorded, exported, and analyzed. Results We found significant differences in the clinical reasoning of female and male learners. Female students documented more findings, differential diagnoses, tests, and treatment options and more often created a summary statement about the VP. Their overall performance was higher than those of their male peers, but we did not see any significant differences in diagnostic accuracy. Conclusions The significant differences between male and female medical students should be considered when planning teaching and research activities. A future study should investigate whether these differences can also be found in physicians.

February 16, 2023

Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum

Chelsea Chang, Nevin Varghese, Michael Machiorlatti

Page range: 105-109

Abstract

Objectives Curriculum for clinical reasoning in the preclinical years is sparse and the COVID-19 pandemic heightened the need for virtual curriculums. Methods We developed, implemented and evaluated a virtual curriculum for preclinical students scaffolding key diagnostic reasoning concepts: dual process theory, diagnostic error, problem representation and illness scripts. Fifty-five second-year medical students participated in four 45-min virtual sessions led by one facilitator. Results The curriculum led to increased perceived understanding and increased confidence in diagnostic reasoning concepts and skills. Conclusions The virtual curriculum was effective in introducing diagnostic reasoning and was well-received by second-year medical students.

November 9, 2022

Bad things can happen: are medical students aware of patient centered care and safety?

Adrian Gillissen, Tonja Kochanek, Michaela Zupanic, Jan Ehlers

Page range: 110-120

Abstract

Objectives Quality and safety in healthcare are of the utmost importance, but little is known about whether undergraduate students are aware of patient safety concepts. The objectives of our study were to assess the perception of medical students of challenges in patient safety, and collect their perceptions of error management and prevention. Methods This study used an exploratory mixed method strategy. The first study phase collected data from semi-structured interviews of 28 students. Based on this, an online survey was constructed and sent to about 80,000 medical students in Germany. 1053 replies were received and analyzed for responses based on gender, curriculum type (problem based [PBC] vs. science based curriculum [SBC]) and years of training. Results Most students understand the importance of patient safety, error avoidance, and the challenges of patient safety interventions. Four themes were identified: (a) the culture of patient safety (what is a good doctor? Doctors’ responsibility), (b) the working environment (the inevitability of mistakes, high work load, hierarchy, competition, teamwork), (c) the challenges of risk reduction (error avoidance, management, skills), and (d) materialistic issue (income vs. humanistic values). Female students were more risk aware than male students. Sixteen percent of students expect negative effects (e.g. punishment) when medical errors were disclosed in a team. Regardless, >70% regard teamwork as an effective error avoidance measure. Error disclosure willingness was high (89.7%). Conclusions Although not formally part of the curriculum, students had a positive perspective concerning patient safety. The opportunities and challenges for incorporating patient safety content into the training curriculum were identified and presented.

Open Access December 9, 2022

Impact of diagnostic checklists on the interpretation of normal and abnormal electrocardiograms

Justine Staal, Robert Zegers, Jeanette Caljouw-Vos, Sílvia Mamede, Laura Zwaan

Page range: 121-129

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Abstract

Objectives Checklists that aim to support clinicians’ diagnostic reasoning processes are often recommended to prevent diagnostic errors. Evidence on checklist effectiveness is mixed and seems to depend on checklist type, case difficulty, and participants’ expertise. Existing studies primarily use abnormal cases, leaving it unclear how the diagnosis of normal cases is affected by checklist use. We investigated how content-specific and debiasing checklists impacted performance for normal and abnormal cases in electrocardiogram (ECG) diagnosis. Methods In this randomized experiment, 42 first year general practice residents interpreted normal, simple abnormal, and complex abnormal ECGs without a checklist. One week later, they were randomly assigned to diagnose the ECGs again with either a debiasing or content-specific checklist. We measured residents’ diagnostic accuracy, confidence, patient management, and time taken to diagnose. Additionally, confidence-accuracy calibration was assessed. Results Accuracy, confidence, and patient management were not significantly affected by checklist use. Time to diagnose decreased with a checklist (M=147s (77)) compared to without a checklist (M=189s (80), Z=−3.10, p=0.002). Additionally, residents’ calibration improved when using a checklist (phase 1: R 2 =0.14, phase 2: R 2 =0.40). Conclusions In both normal and abnormal cases, checklist use improved confidence-accuracy calibration, though accuracy and confidence were not significantly affected. Time to diagnose was reduced. Future research should evaluate this effect in more experienced GPs. Checklists appear promising for reducing overconfidence without negatively impacting normal or simple ECGs. Reducing overconfidence has the potential to improve diagnostic performance in the long term.

December 8, 2022

Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis

Sérgio Monteiro de Almeida, Gislene B. Kussen, Laura L. Cogo, Keite Nogueira

Page range: 130-139

Abstract

Objectives The definitive diagnosis of tuberculous meningitis (TBM) is achieved by identifying Mycobacterium tuberculosis (MTb) in cerebrospinal fluid (CSF); however, diagnostic confirmation is difficult due to the inability of current tests for an effective diagnosis. Our objective was to retrospectively assess the characteristics of CSF lactate (CSF-LA) as an adjunct biomarker in the diagnosis of TBM. Methods 608 CSF laboratory reports were assessed. Of these, 560 had clinically suspected TBM. These were classified as definite (n=36), probable (23), possible (278), or non-TBM (223) according to the international consensus TBM case definitions. An additional 48 CSF samples were negative controls with normal CSF. Results Against a reference standard of definite TBM, the cut-off value for CSF-LA was 4.0 mmol/L, the area under the ROC curve was 0.88 (95% CI, 0.82–0.94; p=0.0001), sensitivity was 69%, specificity 90%, negative predictive value 98%. These diagnostic parameters decreased when calculated against those of the other categories of TBM. CSF-LA exhibited high specificity, efficiency, negative predictive value, and clinical utility index in all the groups studied. Conclusions CSF-LA is a useful diagnostic marker to rule out TBM when associated with conventional microbiology tests, nucleic acid amplification assays, and clinical algorithms, particularly in endemic areas.

December 22, 2022

Empowering quality data – the Gordian knot of bringing real innovation into healthcare system

Denis Horgan, Yosr Hamdi, Jonathan A. Lal, Teresia Nyawira, Salomé Meyer, Dominique Kondji, Ngiambudulu M. Francisco, Roselle De Guzman, Anupriya Paul, Krishna Reddy Nallamalla, Woong-Yang Park, Vijay Triapthi, Ravikant Tripathi, Amber Johns, Mohan P. Singh, Maude E. Phipps, France Dube, Hadi Mohamad Abu Rasheed, Marta Kozaric, Joseph A. Pinto, Stephen Doral Stefani, Maria Eugenia Aponte Rueda, Ricardo Fujita Alarcon, Hugo A. Barrera-Saldana

Page range: 140-157

Abstract

Objectives The introduction of Personalised Medicine (PM) into healthcare systems could benefit from a clearer understanding of the distinct national and regional frameworks around the world. Recent engagement by international regulators on maximising the use of real-world evidence (RWE) has highlighted the scope for improving the exploitation of the treasure-trove of health data that is currently largely neglected in many countries. The European Alliance for Personalised Medicine (EAPM) led an international study aimed at identifying the current status of conditions. Methods A literature review examined how far such frameworks exist, with a view to identifying conducive factors – and crucial gaps. This extensive review of key factors across 22 countries and 5 regions revealed a wide variety of attitudes, approaches, provisions and conditions, and permitted the construction of a comprehensive overview of the current status of PM. Based on seven key pillars identified from the literature review and expert panels, the data was quantified, and on the basis of further analysis, an index was developed to allow comparison country by country and region by region. Results The results show that United States of America is leading according to overall outcome whereas Kenya scored the least in the overall outcome. Conclusions Still, common approaches exist that could help accelerate take-up of opportunities even in the less prosperous parts of the world.

February 20, 2023

Collective intelligence improves probabilistic diagnostic assessments

Nathan R. Stehouwer, Keith W. Torrey, Michael S. Dell

Page range: 158-163

Abstract

Objectives Collective intelligence, the “wisdom of the crowd,” seeks to improve the quality of judgments by aggregating multiple individual inputs. Here, we evaluate the success of collective intelligence strategies applied to probabilistic diagnostic judgments. Methods We compared the performance of individual and collective intelligence judgments on two series of clinical cases requiring probabilistic diagnostic assessments, or “forecasts”. We assessed the quality of forecasts using Brier scores, which compare forecasts to observed outcomes. Results On both sets of cases, the collective intelligence answers outperformed nearly every individual forecaster or team. The improved performance by collective intelligence was mediated by both improved resolution and calibration of probabilistic assessments. In a secondary analysis looking at the effect of varying number of individual inputs in collective intelligence answers from two different data sources, nearly identical curves were found in the two data sets showing 11–12% improvement when averaging two independent inputs, 15% improvement averaging four independent inputs, and small incremental improvements with further increases in number of individual inputs. Conclusions Our results suggest that the application of collective intelligence strategies to probabilistic diagnostic forecasts is a promising approach to improve diagnostic accuracy and reduce diagnostic error.

December 22, 2022

Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS)

Matt C. Howard

Page range: 164-174

Abstract

Objectives Many studies show that most people, even at-risk individuals, do not undergo routine clinical skin cancer screening, and many questions remain unanswered regarding the participation (or lack thereof) in annual skin cancer screening. Perhaps the largest unanswered question is the most essential: why do people fail to undergo annual skin cancer screening? We provide an avenue to answer this question by creating the Perceptions of Annual Skin Cancer Screening Scale (PASCSS). Methods In Study 1, we conduct a qualitative investigation to identify potential scale dimensions and items (n=233). In Study 2, we test the validity and psychometric properties of our initial item list via exploratory factor analysis (n=406). In Study 3, we further test the psychometric properties of our item list via confirmatory factor analysis (n=587). Results These three studies provide strong support for the validity and psychometric properties of our item list, resulting in the PASCSS. The PASCSS includes 48 items and 12 dimensions that each represent unique perceptions regarding annual skin cancer screening. Conclusions We encourage future authors to utilize the PASCSS to identify those most at risk for failing to participate in annual skin cancer screening as well as develop adaptive interventions that can target these participants.

February 10, 2023

Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters

Nélia S.V. Andrade, Sinead N. Curtin, Ashiq Masih, Brid Fitzgibbon, Katie Herbert, Mary Gowen, Margaret Lehane, Seán J. Costelloe

Page range: 175-182

Abstract

Objectives This study investigated the effect of appropriate pre-phlebotomy instructions on patients’ awareness of the need to fast, their fasting status at phlebotomy, and the measurement of specific biochemical analytes and indices. Methods While booking their phlebotomy appointments, two-hundred outpatients, with a wide range of pre-existing medical conditions, were recruited and randomly assigned to either control or intervention groups. The control group received no instructions while the intervention group was verbally instructed to fast for precisely 12 h prior to their appointment. Serum samples were collected from participants to quantify common biochemical analytes and serum indices, some of which were known to be influenced by fasting status, such as triglyceride and the lipaemic index. At the same appointment, participants completed a survey assessing their perception of, and adherence to, fasting requirements. Results In the intervention group, 99% responded that they had fasted before phlebotomy vs. 16% of controls. Subjects stated they fasted for 12 h in 51% of the intervention group and 7% of the controls. Median concentrations for potassium and total bilirubin were statistically, but not clinically, significantly different. In the study, a single patient in the intervention group was found to have a lipaemic sample. Conclusions Without instruction, it appears few patients will fast appropriately prior to blood collection. This study suggests that most patients recall and adhere to verbal instructions regarding fasting. Though many in the control group stated they did not fast, triglyceride concentration and lipaemia were not significantly different from the intervention group, and biochemical analyses appear unaffected by fasting status.

December 12, 2022

Clinician factors associated with delayed diagnosis of appendicitis

Kenneth A. Michelson, Finn L.E. McGarghan, Emma E. Patterson, Mark L. Waltzman, Margaret E. Samuels-Kalow, Kimberly F. Greco

Page range: 183-186

Abstract

Objectives To evaluate the association of clinician demographics and practice patterns with delayed diagnosis of appendicitis. Methods We included children with appendicitis at 13 regional emergency departments (EDs). We screened patients with a previous ED visit within 7 days for delayed diagnosis by chart review. We evaluated the association of clinician characteristics using logistic regression with random intercepts for site and clinician and delay as the outcome. Results Among 7,452 children with appendicitis, 105 (1.4%) had delayed diagnosis. Clinicians in the lowest quartile of obtaining blood in their general practice were more likely to have delayed diagnosis (odds ratio 4.9 compared to highest quartile, 95% confidence interval 1.8, 13.8). Clinicians’ imaging rates, specialty, sex, and experience were not associated with delayed diagnosis. Conclusions Clinicians who used more blood tests in their general practice had a lower risk of delayed diagnosis of appendicitis, possible evidence that lower risk tolerance has benefits.

January 20, 2023

Real-world assessment of the clinical performance of COVID-VIRO ALL IN rapid SARS-CoV-2 antigen test

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

Page range: 187-192

Abstract

Objectives Since the external validation of severe acute respiratory syndrome coronavirus 2 antigen rapid diagnostic tests (SARS-CoV-2 RDT-Ags) is a necessary requisite before they can be introduced into routine clinical practice, this study reports the results of a real-world assessment of the clinical performance of the new COVID-VIRO ALL IN device. Methods The study population consisted in 165 outpatients (median age: 43 years, range: 14–68 years; 66.1% females) who had paired nasal and nasopharyngeal samples collected upon hospital presentation. The samples were concomitantly tested with the AAZ-LMB COVID-VIRO ALL IN SARS-CoV-2 RDT-Ag and with Cepheid Xpert Xpress SARS-CoV-2 real-time reverse transcription polymerase chain reaction (RT-PCR). Results The number of subjects with positive RT-PCR results (i.e., mean Ct value <45) was 116 (70.3%), 109 (66.1%) and 86 (52.1%) with mean Ct values <37 and <30, respectively. In all RT-PCR positive samples, COVID-VIRO ALL IN displayed 78.8% agreement, 0.698 sensitivity, 1.000 specificity, 0.583 negative predictive value (NPV) and 1.000 positive predictive value (PPV) compared to RT-PCR. The median Ct value of samples testing positive with COVID-VIRO ALL IN was significantly lower than those testing negative (22.8 vs. 32.2; p<0.001). In samples with high viral load (i.e., Ct value <30), COVID-VIRO ALL IN displayed 92.1% agreement, 0.895 sensitivity, 0.949 specificity, 0.983 NPV and 0.951 PPV compared to RT-PCR. Conclusions Although the diagnostic performance of COVID-VIRO ALL IN do not exactly match those of the manufacturer, its high NPV in high viral load samples would enable fast-track and rapid identification of highly contagious subjects.

Publicly Available December 26, 2022

Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience

Daniele Moratto, Elda Mimiola, Federico Serana, Martina Garuti, Viviana Giustini, Aldo M. Roccaro, Salvatore Casari, Massimiliano Beccaria, Duilio Brugnoni, Marco Chiarini, Massimo Franchini

Page range: 193-199

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Abstract

Objectives Being COVID-19 convalescent plasma (CCP) a therapeutic option that can have a potential impact on the normalization of immunological parameters of COVID-19 affected patients, a detailed analysis of post-infusion immunological changes was conducted in CCP treated patients, aiming to identify possible predictive hallmarks of disease prognosis. Methods This prospective observational study describes a cohort of 28 patients who received CCP shortly after being hospitalized for COVID-19 and diagnosed for Acute Respiratory Distress Syndrome. All patients were subjected to a detailed flow cytometry based evaluation of immunological markers at baseline and on days +3 and +7 after transfusion. Results At baseline almost all patients suffered from lymphopenia (25/28 on T-cells and 16/28 on B-cells) coupled with neutrophil-lymphocyte ratio exceeding normal values (26/28). Lymphocyte subsets were generally characterized by increased percentages of CD19+CD20-CD38hiCD27+ plasmablasts and reduction of CD4+CD45RA+CCR7+CD31+ recent thymic emigrants, while monocytes presented a limited expression of CD4 and HLA-DR molecules. Amelioration of immunological parameters began to be evident from day +3 and became more significant at day +7 post-CCP transfusion in 18 patients who recovered within 30 days from hospitalization. Conversely, baseline immunological characteristics generally persisted in ten critical patients who eventually progressed to death (6) or long-term care (4). Conclusions This study demonstrates that proper immunophenotyping panels can be potentially useful for monitoring CCP treated patients from the first days after infusion in order to presume higher risk of medical complications.

Letter to the Editors

Publicly Available December 7, 2022

Uncontrolled confounding in COVID-19 epidemiology

Giuseppe Lippi, Camilla Mattiuzzi, Brandon M. Henry

Page range: 200-202

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January 19, 2023

VAPES: a new mnemonic for considering paroxysmal disorders

Kosuke Ishizuka, Yoshiyuki Ohira, Takanori Uehara, Kazutaka Noda, Tomoko Tsukamoto, Kiyoshi Shikino, Daiki Yokokawa, Masatomi Ikusaka

Page range: 203-204

Congress Abstracts

Publicly Available April 7, 2023

SIDM2022 15th Annual International Conference

Page range: A1-A77

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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)

CiteScore	4.6
Journal Citation Indicator	1.20
SCImago Journal Rank	0.817
Source Normalized Impact per Paper	1.261

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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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E-mail: diagnosis.editorial@degruyter.com

(Deutsch)

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