Diagnostic Competence Research Articles

18F-FDG PET/MRI in patients suffering from lymphoma: how much MRI information is really needed?

To evaluate and compare the diagnostic potential of different reading protocols, entailing non-enhanced/contrast-enhanced and diffusion-weighted 18F-FDG PET/MR imaging for lesion detection and determination of the tumor stage in lymphoma patients. A total of 101 18F-FDG PET/MRI datasets including a (1) transverse T2-w HASTE and 18F-FDG PET (PET/MRI1), (2) with an additional contrast enhanced VIBE (PET/MRI2), and (3) with additional diffusion-weighted imaging (PET/MRI3) were evaluated. Scans were performed for initial staging, restaging during treatment, or at the end of treatment and under surveillance with suspicion for tumor relapse. In all datasets lymphoma manifestations as well as tumor stage in analogy to the revised criteria of the Ann Arbor staging system were determined. Furthermore, potential changes in therapy compared to the reference standard were evaluated. Hitherto performed PET/CT and all available follow-up and prior examinations as well as histopathology served as reference standard. PET/MRI1 correctly identified 53/55 patients with active lymphoma and 190/205 lesions. Respective values were 55/55, 202/205 for PET/MRI2 and 55/55, 205/205 for PET/MRI3. PET/MRI1 determined correct tumor stage in 88 out of 101 examinations, and corresponding results for PET/MRI2 were 95 out of 101 and 96 out of 101 in PET/MRI3. Relating to the reference standard changes in treatment would occur in 11% based on PET/MRI1, in 6% based on PET/MRI2, and in 3% based on PET/MRI3. The additional application of contrast-enhanced and diffusion-weighted imaging to 18F-FDG PET/MRI resulted in higher diagnostic competence, particularly for initial staging and correct classification of the disease extent with potential impact on patient and therapy management.

Teachers’ Diagnostic Competences and Levels Pertaining to Students’ Mathematical Thinking: The Case of Three Math Teachers in Turkey

The main purpose of this research is to determine mathematics teachers’ diagnostic competency levels. Diagnostic competence, which is described as the ability to understand and analyze student thinking, has been examined in four levels through the components of teachers’ general knowledge on learning processes and their skills at considering, scrutinizing, and interpreting student thinking. The research model is based on a case study, and the participants consist of three elementary mathematics teachers. Teachers’ lessons were observed for 17 weeks, and data has been collected through (a) observation notes, (b) video recordings, (c) written documents, and (d) interviews with teachers. According to the findings, the teachers have Level-2 diagnostic competences due to their limited general knowledge on learning processes and scrutiny skills. Additional findings are as follows: (a) While teachers have been defined as having Level-2 diagnostic competences in the classroom, lower and higher levels seem able to emerge in environments that used prompts. (b) The limitations of teachers’ general knowledge on learning processes can also weaken other diagnostic competency skills. (c) Teachers care more about students’ errors and mistakes when diagnosing and do not feel the need to diagnose ideas that provide correct results.

Can teachers’ diagnostic competence be fostered through training and the use of a diary?

Diagnostizieren zahlt zu den zentralsten Kompetenzen von Lehrkraften. Bisher wurde die diagnostische Kompetenz meist als Urteilsgenauigkeit operationalisiert. Kurzlich wurde ein Prozessmodell entwickelt und empirisch uberpruft, das den Diagnoseprozess beschreibt, den Lehrkrafte zum Ziel der Diagnostik und Forderung durchlaufen. Es konnte gezeigt werden, dass es noch grosen Forderbedarf gibt. Zum Ziel der Forderung nahmen 47 Gymnasiallehrkrafte an der vorliegenden Studie teil, die drei quasi-experimentellen Bedingungen zugeteilt waren: Einer Wartekontrollgruppe ( n = 17), die nicht am Trainingsprogramm, aber wie die anderen beiden Gruppen auch am Pra- und Posttest teilnahm, Versuchsgruppe 1 ( n = 15), die das Trainingsprogramm bekam und Versuchsgruppe 2 ( n = 15), die zusatzlich uber vier Wochen halbstandardisierte Tagebucher bearbeitete, um die Umsetzung ihrer diagnostischen Handlungen im Unterricht zu uberwachen. Zur Evaluation wurden sowohl Pra-Post- als auch Zeitreihenanalysen durchgefuhrt. Die Ergebnisse zeigen, dass durch das Trainingsprogram insbesondere die Kompetenzen von Lehrkraften vor und wahrend des Diagnostizierens gesteigert werden konnten. Das Tagebuch erwies sich als hilfreiches Instrument um den Transfer in den Unterricht zu messen. Allerdings zeigte sich kein zusatzlicher Interventionseffekt, der uber den des Trainingsprogramms hinausgeht. Trainingsprogramms und Tagebuch konnen als hilfreiche Tools in der Lehrkrafteaus- und -weiterbildung verwendet werden.

A Dual Processing Theory Based Approach to Instruction and Assessment of Diagnostic Competencies

Evidence suggests that diagnostic error plays a major role in America’s suboptimal patient care. Evidence also suggests that generalizable problem solving or clinical reasoning skills are not the primary determinant of diagnostic accuracy. Rather, knowledge-based constructs likely play a greater role in diagnostic performance. Dual processing theory (DPT) posits how knowledge-based constructs and information processing (problem solving or reasoning) mechanisms work together to enable categorization tasks such as differential diagnosis. This manuscript describes how medical educators might use DPT to create training and testing methods to improve the diagnostic capabilities of tomorrow’s practitioners and subsequently patient care outcomes.

The role of endobronchial ultrasonography for mediastinal lymphadenopathy in cases with extrathoracic malignancy.

Many extrathoracic malignancies can metastasize to lungs and mediastinal lymph nodes. Whether mediastinal lesions are metastasis in these patients changes staging, prognosis, and treatment strategy. In this study, we aimed to find out the contribution of EBUS-TBNA to the diagnosis in cases with extrathoracic malignancy. Patients who had been previously diagnosed as extrapulmonary solid organ malignancy and in whom mediastinal or hilar lymphadenopathy developed during their follow-up and EBUS-TBNA was applied for diagnostic purposes were retrospectively included in this study. A total of 91 patients consisting of 35 females (38.5%) and 56 males (61.5%) were included in the study. The mean age of the patients was 60.5 (±11.4). Malignancy was not observed in 54 (59.3%) patients; primary malignancy metastasis was detected in 33 (36.3%) patients, and primary lung cancer was detected in 4 (4.4%) patients with EBUS-TBNA. The sensitivity of EBUS-TBNA in extrathoracic malignancies was determined as 90.2%; its specificity was determined as 100%, its negative predictive value as 92.5%, its positive predictive value as 100%, and its diagnostic accuracy as 95.6%. The highest rate was determined in the left lower paratracheal lymph node when they were examined in terms of malignancy detection rate in lymph node stations. EBUS-TBNA is a minimally invasive method with quite a low complication rate that does not require general anesthesia. It should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies since it has high diagnostic accuracy, sensitivity, and specificity. EBUS-TBNA significantly reduces the need for surgical intervention. Further surgical interventions can be planned in patients in whom diagnostic competence is not ensured.

Standardized Checklist for Otoscopy Performance Evaluation: A Validation Study of a Tool to Assess Pediatric Otoscopy Skills.

Acute otitis media (AOM) is the most frequently diagnosed pediatric illness in the United States and the most common indication for antibiotic prescription. Skill in pediatric otoscopy is essential to correctly identify children with AOM. However, studies have found diagnostic inconsistency and significant overdiagnosis among practitioners. Given the potential public and individual health consequences, there has been a call for improved education regarding the diagnostic certainty of AOM. Yet educational efforts continue to be limited, particularly in regard to competency assessment. The lack of a validated tool to assess otoscopy skill attainment objectively diminishes the instructor's ability to provide useful feedback and direction to the learner. We have undertaken an educational intervention with the goal of developing a validated Standardized Checklist for Otoscopy Performance Evaluation (SCOPE), building on key principles of the general pediatric ear exam. The SCOPE was developed with the input of process and content experts with attention to specific domains of validity. Our analysis provides important validity evidence for the SCOPE assessment tool. The instrument was piloted and successfully implemented with medical students and varying levels of residents in pediatrics and emergency medicine over a 5-year period in varied settings: urgent care, large and small pediatric clinics, and the emergency departments at two institutions. It has been used for both instruction and assessment purposes. Because the SCOPE can be used in teaching demonstration purposes, in formative and summative assessment settings, and across the continuum of learners, this instrument offers the potential for more educational efforts in the field of assessment in direct patient care. We anticipate that the SCOPE will foster an environment of efficient yet high-yield review and discussion of otoscopy and diagnostic competency.

Tvorba a struktura elektronického nástroje Videoweb tělesné výchovy

Our paper describes creation and structure of electronic and research tool called Videoweb Physical Education (Videoweb PE – in Czech Videoweb TV), which is based on the videorecordings analysis. Videoweb PE is used to identify and to develop diagnostic competence of future physical education teachers in secondary education. This paper is also concerned with the evaluation research survey focused on feedback from students of the Faculty of Sports Studies (FSpS MU), who had the opportunity to work with Videoweb PE. During the evaluation research, we found out that students rated Videoweb PE as a very useful teaching study material. Based on the data obtained from the results of the evaluation survey there were outlined recommendations on the basis of which it is possible to optimize the Videoweb PE for its future use.

Diagnostic performance of smartphone reading of the coronary CT angiography in patients with acute chest pain at ED

PurposeThe aims of this study were to simulate mobile consultation for the coronary computed tomography angiography (CCTA) at the emergency department (ED) and to measure the diagnostic performance of the mobile reading. Materials and methodsA total of 107 patients with acute chest pain who underwent CCTA and coronary angiography (CAG) were included. The CCTA images were reviewed by a cardiac radiologist using a smartphone. The degree of stenosis at each coronary segment was scored with 4-point scale (score 1, <50%; score 2, 51%-70%; score 3, 71%-90%; score 4, >90%). The degree of stenosis at each coronary segments were also scored with preliminary CCTA report by on-call residents, final CCTA reports by in-house attending cardiac radiologists, and CAG. Interobserver agreement was measured using κ statistics. The areas under the receiver operating characteristic curves (AUCs) for diagnosing segments with obstructive stenosis were compared between each reader and CAG. ResultsThe smartphone reader's reading was more similar to the CAG results and in-house radiologists' reports than reading of on-call residents. The diagnostic performance of smartphone reading for detection of obstructive stenosis was significantly greater than that of on-call residents (AUC, 0.89 vs 0.75; P<.001) and did not significantly differ from that of the in-house radiologists (AUC, 0.89 vs 0.90; P=.05). ConclusionSmartphone reading by the cardiac radiologist was superior to the on-call residents' reading. Further study with real-time mobile consultation needs to be investigated to evaluate whether improvement in diagnostic competency can make a difference in the outcome of patients.

L'ecocardioscopia nella stratificazione cardiovascolare delle malattie renali croniche: il Nefrologo Protagonista

Abstract non disponibile (Cardionephrology)

Diagnostic competence of primary school mathematics teachers during classroom situations

One of the main challenges for teachers during teaching in class is the diagnosis of students’ learning and thinking processes. For this purpose, teachers must perceive relevant information, they need to interpret this information and finally, they need to respond and select suitable opportunities to learn. In this paper, diagnostic processes in classroom situations are analyzed on the basis of a video test that was used in a follow-up study of the Teacher Education Development the so-called TEDS-FU Study dealing with early career primary teachers. The results point out that teachers cope with diagnostic tasks during teaching very differently. Varying perspectives in perceiving and solving diagnostic situations can be reconstructed such as a content-related mathematical perspective on the one hand and a student-related, more pedagogical perspective on the other hand.

The dynamics of the development of clínical resoaning (system 1 and 2) and diagnostic competence in medical training

The dynamics of the development of clínical resoaning (system 1 and 2) and diagnostic competence in medical training

Evaluation of Serum Pregnancy Associated Plasma Protein-A & Plasma D-Dimer in Acute Coronary Syndrome.

Acute coronary syndrome (ACS), a spectrum comprising unstable angina pectoris, ST Elevated Myocardial Infarction (STEMI) & Non ST Elevated Myocardial Infarction (NSTEMI) is the major cause of presentation in Emergency Department today. Though ECG and cardiac enzymes are used for diagnosis, they mislead the diagnosis sometimes and delay in treatment initiation. This leads us to search certain new parameters which reflect the pathophysiology of ACS. Markers of plaque stability like Pregnancy Associated Plasma Protein-A and D-Dimer, a marker of ongoing thrombosis are found to be better markers in early diagnosis. To evaluate the diagnostic competence of PAPP-A and D-Dimer in acute coronary syndrome over CK-MB and to compare with the inflammatory marker High Sensitive C-Reactive Protein (hs-CRP) which is associated with atherosclerosis. Fifty patients presenting with acute onset of chest pain to Emergency Department with or without ECG changes served as cases and 50 healthy people served as controls. Serum PAPP-A is measured by Enzyme Linked Immunosorbent Assay (ELISA), D-Dimer and hs-CRP by using Latex Turbidimetry method. A statistical significant difference of PAPP-A and D-Dimer was noted between the ACS and controls (p < 0.001) whereas CK-MB shows no much difference (p 0.09). Statistically significant positive correlation is noted between parameters. PAPP-A marker of plaque instability and D-Dimer marker of ongoing thrombosis are raised in acute coronary syndrome and thus can be considered as one of the marker in ACS for diagnosis.

Which variables predict teachers diagnostic competence when diagnosing students’ learning behavior at different stages of a teacher’s career?

Diagnosing is one of teachers’ key competences. Lately, a new model of teachers’ diagnostic competence and therewith a new measurement method focusing on diagnosing students’ learning behavior in an interdisciplinary approach have been developed. They can build a basis for promoting teachers’ diagnostic competence. However, some questions relevant to promoting teachers’ diagnostic competence concerning students’ learning behavior still remain unanswered: Which values do teachers-on-the-job in contrast to preservice teachers with or without teaching experience gain through experience and which are the relevant variables that lead to a high level of diagnostic competence focused on learning behavior? Thus, this study aims at enlightening these issues. In a sample of 293 participants (93 German grammar school teachers, 107 German teacher students in their second phase of teacher education, and 93 German preservice students in their first phase of teacher education), teachers’ diagnostic competence concerning learning behavior as well as teachers’ motivation, attitude, self-efficacy, knowledge, and reflection on experience concerning diagnosing was measured. Motivation, attitude, and knowledge were found to be substantial positive predictors of diagnostic competence concerning learning behavior, with differentiated predictions for teachers’ experience. Reflection on experience and self-efficacy unexpectedly was not found to be relevant. Teachers-on-the-job were generally better at diagnosing their students’ learning behavior than were preservice teachers without teaching experience. However, the diagnostic work of preservice teachers with teaching experience was as credible as that of the in-service teachers.

Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.

In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. A prospective observational study was carried out over a 2-month period, with one HEMS station covering six ambulance regions. Provider registration was recorded, supplemented by interviews of ambulance nurses and HEMS physicians. Competencies were categorized depending on whether the competency was specific for the nurse or physician, mutual or mutual with a qualitative difference. A total of 225 HEMS dispatches resulted in 117 cases with HEMS on-scene in the study region and 78 patients were included. In 35 (45%) patients, the HEMS physician provided additional treatment: in 19 (24%) patients, a physician-specific therapeutic competency, in nine (12%) patients, a mutual competency with a qualitative difference and in seven (9%) patients, both categories. The presence of the HEMS physician was considered more useful by both ambulance nurses (89 vs. 60%) and HEMS physicians (97 vs. 81%) when additional treatment was provided by the HEMS physician. HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.

Healthcare service quality: what really matters to the female patient?

Purpose– This paper aims to develop a model that encompasses the constructs and sub-constructs consumers use in evaluating healthcare service quality (HSQ) in Egypt.Design/methodology/approach– Factor analysis was performed on 40 variables to identify the constructs. Ordinal logistic regression was also used to identify the sub-constructs and examine the effect of each sub-construct on patients’ overall perception of service quality.Findings– Factor analysis confirmed an eight-construct framework: hospital premises and employees; doctor medical service; nursing medical service; diagnostic medical service; admission; discharge; rooms and housekeeping; and meals. Ordinal logistic regression established 17 sub-constructs – physician reliability; physician assurance; physician interaction; physician’s competence; nursing tangibles; nursing reliability; nursing assurance; nursing interaction; nursing responsiveness; diagnostic service competence; diagnostic service reliability; hospital premises and employees tangibles; admission responsiveness; admission knowledge and courtesy; meals tangibles; rooms tangibles and housekeeping courtesy; and discharge knowledge and courtesy – that have significant effect on HSQ. Some sub-constructs had a significantly greater impact on overall perception of service quality than others.Practical implications– Healthcare providers will be able to pinpoint areas of service quality shortfall and better satisfy their patients. This will ultimately lead to repeat patronage and positive recommendation behavior.Originality/value– The model is the first comprehensive model in the Middle East that takes into account all constructs and sub-constructs patients use for evaluation of HSQ.

A Categorical Competence Model on the Development of Diagnostic Competences of Mathematics Teachers in the Field of Functions

Bisherige Erfassungsinstrumente fur diagnostische Kompetenzen und Professionswissen von Lehrkraften eignen sich nur bedingt fur die Evaluation von Fortbildungen, da sie nicht themenspezifisch genug angelegt sind. Es wurde daher ein Instrument entwickelt, welches diagnostische Kompetenz von Lehrkraften fur den Themenbereich Funktionen erfassen kann. Im Rahmen einer Interventionsstudie (N = 26) wurde dazu ein Erhebungsinstrument mit offenen Frageformaten und ein dazugehoriges Auswertungsverfahren entwickelt, welches eine qualitative Untersuchung von Lehrerurteilen zu Schulerlernstanden ermoglichte. Die Kompetenzfacette Beurteilung von Schulerlernstanden wird anhand von vier Diagnoseurteilen zu drei unterschiedlichen Schuleraufgabenbearbeitungen pro Lehrkraft erfasst. Durch einen Kodierungszyklus und ein anschliesendes Rating mit zwei unabhangigen Ratern konnte jeweils ein Diagnoseprofil pro Lehrkraft rekonstruiert werden. Die Ergebnisse einer Clusteranalyse weisen auf vier Diagnosetypen hin, die sich in Bezug auf die Merkmalsbereiche Konkretheit, diagnostische Aktivitaten, Fokus der Diagnose, Qualitatsmerkmale und Korrektheit bzw. Verstandlichkeit unterscheiden. Das hier vorgestellte kategoriale Modell fur diagnostische Kompetenzen im fokussierten Bereich kann zur Nachzeichnung von Kompetenzentwicklungsverlaufen durch Fortbildungen und als Basis fur weitere Instrumententwicklungen genutzt werden.

Enhancing diagnostic competence with self-explanation prompts and adaptable feedback.

The fostering of diagnostic competence is an important goal of medical education. Worked-example cases with integrated errors represent a promising method of doing so. This study investigates whether the provision of self-explanation prompts and adaptable feedback fosters diagnostic competence in a computer-supported learning environment based on worked-example cases with integrated errors. A total of 103 medical students participated in the study. After a test of prior diagnostic competence, learners studied worked examples with integrated errors for cases of heart failure of different causes in a computer-based learning environment. The worked examples started with the description of a clinical situation in which a student apprentice diagnoses a patient and commits errors in the conclusions he draws from the information presented. Participants were randomly assigned to four learning conditions that varied in two factors: self-explanation prompts and adaptable feedback. In the self-explanation prompts condition, students were prompted to reflect on the errors. Independently of the condition, the student apprentice in the worked example receives feedback on his diagnosis. In the adaptable feedback condition, students were able to adjust the level of elaboration of the feedback. A post-test of diagnostic competence was administered. Adaptable feedback had a positive effect on important aspects of diagnostic competence (strategic knowledge: F(1,93) =4.15, p<0.05, partial η(2) =0.04; decision-oriented practical knowledge: F(1,93) =4.41, p<0.05, partial η(2) =0.05), whereas self-explanation prompts did not further improve the effectiveness of the learning environment. In the use of worked examples with integrated errors, the provision of adaptable feedback whereby learners have control over the amount of feedback they receive seems to be advantageous to the development of important decision-oriented aspects of diagnostic competence. Additional help to stimulate reflection about the error by self-explanation prompts does not seem to be critical.

Teachers' diagnostic competences and their practical relevance. Special Issue Editorial

“Studies and their results about teachers’ diagnostic accuracy are very heterogeneous. While some papers focus on motivational and self-related learning outcomes, most studies investigate the accuracy of teachers judging students’ performance.” This editorial provides a short introduction of the articles in this journal according to teacher diagnostic competencies. (DIPF/Orig.)

Evaluation of CT capability for the detection of thin bone structures

Abstract Evaluation of CT capability for the detection of thin bone structures by means of modeling small bone structures and comparing with quantitative measurements. Knowledge of how thin bone structures can be or of what low density to be detectable in clinical CT images can increase the diagnostic competence to diagnose various diseases. Correlation between size and density of detectable bone structures is the key for many diagnosis purposes. This paper describes the use of clinical 64 detector scanner to image the skeletons of codfish and salmon species. Fish skeletons, such as codfish and salmon, have petite structures and lower bone density than humans. Bone structures were segmented out of the image data and 3D models of their skeletons developed. Evaluation was done by means of comparing quantitative measurements of selected bones to parameters observed from the model. Results show the limits where thin bones and of low density disappear from the clinical CT. It shows ability to reconstruct closely the diameter of the codfish bones but to a less extent the small bones of the salmon.

Implementation of FAST-PET/MRI for whole-body staging of female patients with recurrent pelvic malignancies: A comparison to PET/CT

ObjectivesTo compare the diagnostic competence of FAST-PET/MRI and PET/CT for whole-body staging of female patients suspect for a recurrence of a pelvic malignancy. Methods24 female patients with a suspected tumor recurrence underwent a PET/CT and subsequent PET/MRI examination. For PET/MRI readings a whole-body FAST-protocol was implemented. Two readers separately evaluated the PET/CT and FAST PET/MRI datasets regarding identification of all tumor lesions and qualitative assessment of visual lesion-to-background contrast (4-point ordinal scale). ResultsTumor relapse was present in 21 of the 24 patients. Both, PET/CT and PET/MRI allowed for correct identification of tumor recurrence in 20 of 21 cases. Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of malignant lesions were 82%, 91%, 97%, 58% and 84% for PET/CT and 85%, 87%, 96%, 63% and 86% for PET/MRI, lacking significant differences. Furthermore, no significant difference for lesion-to-background contrast of malignant and benign lesions was found. ConclusionFAST-PET/MRI provides a comparably high diagnostic performance for restaging gynecological cancer patients compared to PET/CT with slightly prolonged scan duration, yet enabling a markedly reduced radiation exposure.