Successful Diagnosis Research Articles

Successful Early Diagnosis of Takotsubo Cardiomyopathy Induced by Status Epilepticus and Pneumonia Following the Exacerbation of Gastroesophageal Reflux Disease: A Case Report

Successful Early Diagnosis of Takotsubo Cardiomyopathy Induced by Status Epilepticus and Pneumonia Following the Exacerbation of Gastroesophageal Reflux Disease: A Case Report

Antibacterial Capabilities of Metallic Nanoparticles and Influencing Factors

ABSTRACTThe increase of antibiotic resistance in bacteria has become a major concern for successful diagnosis and treatment of infectious diseases. Over the past few decades, significant progress has been achieved on the development of nanotechnology‐based medicines for combating multidrug resistance in microorganisms. Among these, metallic nanoparticles (MNPs) hold great promise in addressing this challenge due to their broad‐spectrum and robust antimicrobial properties. This review illustrates the antibacterial activities of MNPs and further elucidates how different factors including synthesis method, size, shape, surface charge, pH, dose, type of capping or stabilizing agents of MNPs, and Gram‐type of the bacteria, impact their antibacterial activities, which are expected to promote the future development of more potent MNP‐based antibacterial agents.

7510 Use Of Tumor Markers And Surgery In The Management Of Medullary Thyroid Cancer During Pregnancy

Abstract Disclosure: M. Garver: None. C. Vaz: None. Introduction: Thyroid cancer is the second most diagnosed cancer during pregnancy, predominantly differentiated thyroid malignancies. [1] MTC during pregnancy is rare and challenging to manage due to its aggressive nature. We describe the successful diagnosis and management of MTC during pregnancy. Clinical Case: A 28 yo woman presented with a rapidly growing neck lump for 2 months with an associated unintentional 10lb weight loss and without compressive symptoms. She had no history of childhood radiation exposure or family history of thyroid cancer. Physical exam revealed a hard L lobe thyroid nodule without palpable lymphadenopathy. The patient was 5 weeks pregnant at the time. A neck US revealed a 4.2x2.7x2.0 cm L solid isoechoic thyroid nodule with punctate echogenic foci and microcalcifications. The nodule was classified as TIRADS 4 and ATA high suspicion. FNA noted Bethesda IV with positive IHC stains for chromogranin and calcitonin. Afirma MTC classifier was positive, confirming diagnosis of MTC. At 7 weeks gestation, calcitonin was markedly elevated at 3508 pg/mL (n <5 pg/mL), CEA 29.5 ng/mL (n <2.5 ng/mL) and calcium 10.3mg/dL (8.6-10.2mg/dL). Plasma normetanephrines were elevated to176 pg/mL (n <148 pg/mL) with normal metanephrines 28 pg/mL (n <57 pg/mL) and normal 24-hour urine metanephrines. CT neck revealed 3.2x2.8cm L thyroid nodule without cervical lymphadenopathy. Due to pregnancy status, additional imaging to assess for metastatic disease was deferred until after delivery. Genetic testing did not identify mutations within the thyroid cancer panel including APC, CHEK2, DICER1, MEN1, PRKAR1A, PTEN, RET, SDHB, SDHD, and TP53. The patient underwent total thyroidectomy with neck dissection at 19 weeks gestation without complication. Two weeks postoperative Calcitonin was 2 pg/mL(n <5 pg/mL) and CEA was undetectable. Conclusions: The effect of pregnancy on MTC is not well studied because of low incidence. Guidelines on the timing of surgery for MTC diagnosed during pregnancy are lacking. While evidence confirms that surgery can be safely postponed until after delivery for low risk differentiated thyroid malignancies, there is no consensus on timing of surgery for MTC. Given the aggressive nature of MTC, along with marked elevation of calcitonin and CEA in this case, surgery was performed in the 2nd trimester with excellent outcome. Data is conflicting on accuracy of calcitonin and CEA during pregnancy, with some reports suggesting falsely high levels due to pregnancy. The sharp decline in calcitonin and CEA 2 weeks postoperatively suggested these were truly elevated due to MTC and unaffected by pregnant status. We suggest that calcitonin and CEA be followed similar to non-pregnant cases with MTC. Resources: 1.Khaled, H. M., Lahloubi, N. A., & Rashad, N. (2016). A review on thyroid cancer during pregnancy: Multitasking is required. Journal of Advanced Research, 7(4), 565–570. Presentation: 6/2/2024

CLASSIFICATION OF X-RAY AND CT IMAGES IN DIFFERENT COLOR SPACES USING ROBUST CNN

Since deep learning models have been successfully used in many fields, they have been used to identify sick and healthy people in X-ray or Computed Tomography (CT) chest radiology images. In this study, Covid-19 and pneumonia classification is performed on both X-ray and CT images using the robust Convolutional Neural Network (CNN). BGR, HSV, and CIE LAB color space transformations are applied to X-ray and CT images to show that the model performs a successful classification independent of dataset characteristics. The binary classification accuracy rates of Covid-19 and pneumonia for X-ray images and CT images are 98.7% and 98.4%, 97.6% and 99.4%, respectively. Precision, Recall, Specificity, F1 score, and Mean Squared Error metrics are calculated for each X-ray and CT dataset. In addition, 5-fold cross-validation proved accuracy of the model. Although X-ray and CT chest radiology images are transformed into different color spaces, the proposed model performed a successful classification. Thus, even if the image characteristics of the radiology device brands change, the computer-based system will be able to make successful disease diagnoses at low cost where expert personnel are insufficient.

Tuberculosis-Induced Immune-Mediated Necrotizing Myopathy: A Challenging Case Scenario in a Non-Endemic Country

Background: Tuberculosis (TB) poses a significant global health challenge; although low–middle income countries carry the heaviest burden, its diagnosis and treatment can be challenging in any country. The clinical picture can be complex and vary from person to person, with autoimmune complications that can hinder TB diagnosis and treatment. Case Presentation: We report the case of a 38-year-old man from Bangladesh who had recently arrived in Italy through the Balkan route. He presented with TB in the cervical lymph nodes and long-standing chronic myalgias. While a wide range of TB-triggered autoimmune entities can be found in the literature, this case is the first to describe immune-mediated necrotizing myopathy (IMNM) triggered by active TB. Conclusions: IMNM has been previously associated only with other infections like SARS-CoV-2 and Dengue. The successful diagnosis and management of TB-induced IMNM was achieved through a collaborative, multidisciplinary approach involving rheumatologists, immunologists, and infectious diseases specialists, showcasing an innovative treatment strategy and adding new insights into the complexities of TB and IMNM.

Cancer detection with various classification models: A comprehensive feature analysis using HMM to extract a nucleotide pattern

This work presents a novel feature extraction method for identifying complex patterns in genomic sequences by employing the Hidden Markov Model (HMM). In this study, we use HMM to identify gene nucleotide patterns that are specific to malignant and non-malignant cells. Crucial genetic components DNA and RNA are involved in many biological processes that impact both healthy and malignant cells. Early patient identification is essential to successful cancer diagnosis and therapy. Varying nucleotide patterns indicate different cellular responses, which are important to understanding the molecular causes of cancer and associated disorders. We present a detailed study of nucleotide patterns in whole raw nucleotide sequences with variations in both protein sequence (CDS) and non-protein sequence (NCDS) in both malignant and non-malignant cells. Nucleotide prediction has been achieved while computational expenses are reduced by using the proposed HMM for feature extraction and selection. The classification models implemented in this work for cancer detection are Gradient-Boosted Decision Trees (GBDT), Random Forests (RF), Decision Trees (DT), and Support Vector Machines (SVM) with kernels. The suggested classification model's accuracy and 10-fold cross-validation have been validated via comprehensive case studies. The results reveal that DT and ensemble learning techniques significantly differentiate between malignant and non-malignant DNA sequences. SVM with suitable kernels improves cancer detection accuracy significantly. Combining feature reduction approaches with nucleotide pattern classifiers based on Hidden Markov models improves performance and ensures reliable cancer detection.

Diagnosis of botulism in mammals aided by toxin ELISA and C and D gene RT-PCRs with an emphasis on farm animals.

Animal welfare and ethical considerations limit the use of the mouse lethality bioassay for the detection of botulinum toxins. This study assessed an ELISA and RT-PCRs to detect toxin types C and D in samples from mammals with flaccid paralysis or weakness. DNA/RNA tightly bound to the toxin molecules were used as surrogates for the presence of toxin. In total 391 diverse samples from 101 clinical cases from cattle and 9 other species were examined. Botulism was confirmed by ELISA in samples from 16 cases. Toxin type C or D was identified by RT-PCR in 10 cases, five of which were among the cases confirmed by ELISA. Among the 80 cases with negative samples, sampling was not comprehensive enough in 66 cases (botulism therefore not excluded) but was adequate in 14 cases (no indication of botulism). The last two categories included 16 cases with other laboratory findings explaining the clinical signs. The ELISA that detects botulinum C and D toxins was superior in identifying cases with positive samples compared to the RT-PCRs but the latter were able to identify the toxin type present when positive. Furthermore, the RT-PCRs are available to any laboratory with molecular testing capability. Both laboratory assays can screen a comprehensive range and a large number of samples which is crucial for a successful diagnosis of botulism.

Acellular Dermal Matrix: Imaging Features With Histopathology Correlation.

Acellular dermal matrix (ADM) is an immunologically inert graft, typically from cadaveric skin, often used in postmastectomy breast reconstruction. Created from decellularized dermal tissues that have been treated to remove DNA and antigenic donor cells (leaving extracellular matrix), ADM is often used as a structural scaffold or sling to reinforce and support the structure and position of a breast implant during postoperative integration in implant-based breast reconstruction; ADM can also be used to fill cosmetic defects. Advantages of ADM use include improved cosmesis and reduced capsular contracture rates. On US, ADM can be seen as a subtle band with variable echogenicity adjacent to the implant. When folded on itself or redundant, ADM may present as a palpable oval mass with indistinct or circumscribed margins and variable echogenicity. On mammography, ADM can be seen as a circumscribed oval equal density mass when redundant and folded on itself; a layered appearance may be evident on tomosynthesis. On MRI, presence and absence of enhancement have been documented. Imaging findings likely vary depending on the degree of host tissue remodeling and incorporation, and when biopsied, histopathologically, ADM may be difficult to distinguish from scarring. Successful imaging diagnosis of ADM is aided by clinical knowledge of the intraoperative use and configuration of ADM, which may help differentiate ADM from new or recurrent malignancy and avoid unnecessary biopsy.

Ai-Driven Prediction Models For Medical Image Enhancement And Analysis Using Deep Learning

Thyroid diseases, including cancer, demand for accurate medical imaging for diagnosis and treatment direction. Important MRI imaging of the thyroid occasionally suffers with poor resolution and noise. Conventional imaging enhancement techniques may not be able to effectively solve noise or capture small features required for a successful diagnosis, therefore lowering the image quality and diagnostic accuracy. For feature extraction and classification, we provide an artificial intelligence prediction model on multi-scale deep convolutional neural network (CNN). Our method reduces noise and solves resolution enhancement, hence improving thyroid MRI images. For this work we used a bespoke CNN architecture and a 500 thyroid MRI image collection. Not only considerably outperforming current techniques, our model generated a Structural Similarity Index (SSIM) of 0.89 and a Peak Signal-to---- Noise Ratio (PSNR) of 32.5 dB. The improvements brought diagnosis accuracy 15% above more traditional techniques.

Successful Diagnosis and Surgical Treatment of Zygomatic Salivary Gland Rupture Following Enucleation in a Brachycephalic Dog

Successful Diagnosis and Surgical Treatment of Zygomatic Salivary Gland Rupture Following Enucleation in a Brachycephalic Dog

Popliteal Vein Entrapment as a Rare Form of Popliteal Entrapment Syndrome.

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment.

Successful treatment of acute promyelocytic leukemia with initial hyperleukocytosis, differentiated syndrome and massive intracranial hemorrhage in a child

Introduction. The development of hemorrhagic syndrome at the onset of the disease in patients with acute promyelocytic leukemia (APL) is one of the main causes of therapy failures and the most common cause of death in the early stages of remission induction. The risk of severe hemorrhagic complications increases in patients with the microgranular APL variant, often accompanied with hyperleukocytosis.Aim — to present a clinical case of successful diagnosis and treatment of primary APL with initial hyperleukocytosis in a patient with massive intracranial hemorrhage and differentiated syndrome.Main findings. A clinical observation of the diagnosis and treatment of APL in a 13-year-old patient with initial hyperleukocytosis, massive intracranial hemorrhage and differentiation syndrome is presented. Data on the variable manifestations of hemorrhagic syndrome in patients with APL and its effect on survival outcomes are also given. Diagnostic criteria and approaches in the treatment of differentiation syndrome are presented on the example of a clinical observation, when early clinical diagnosis and timely initiation of special antitumor treatment in the intensive care unit made it possible to achieve clinical, hematological and molecular remission, avoiding the fatal consequences of massive intracranial hemorrhage.

Experience of successful diagnosis and first-stage treatment of a patient with Moschcowitz syndrome

Experience of successful diagnosis and first-stage treatment of a patient with Moschcowitz syndrome

Diagnostic Yield of Trio Whole-Genome Sequencing in Children with Undiagnosed Developmental Delay or Congenital Anomaly: A Prospective Cohort Study.

Developmental delays (DD) and congenital anomalies (CA) are prevalent yet often remain undiagnosed despite comprehensive genetic testing. This study aims to investigate the diagnostic yield of trio whole-genome sequencing (WGS) in children presenting with DD or CA who remained undiagnosed after previous genetic testing. A prospective cohort study was conducted on children with undiagnosed DD or CA at a single tertiary hospital. All participants suspected of genetic conditions had undergone chromosome analysis, chromosome microarray analysis (CMA), and clinical exome sequencing (CES); however, a subset remained undiagnosed. The WGS test was administered to both the affected children and their parents. A total of 52 children were included, and 10 (19.2%) had undergone a genetic diagnosis through WGS. Eight of these cases were associated with autosomal dominant and de novo variants. WGS led to successful diagnosis due to several factors, including small structural variants, genes not covered in the CES panel, the discovery of newly implicated genes, issues related to coverage depth, low variant allele frequency, challenges in variant interpretation, and differences in the interpretation of variants of unknown significance among clinicians. This study highlights the clinical value of trio WGS testing in undiagnosed children with DD or CA. Notably, an additional 19.2% of affected children were diagnosed through this method.

Therapeutic Recommendations for the Treatment of Acne Vulgaris in the US

Introduction: Acne vulgaris and related sequelae negatively impact quality of life and are associated with increased rates of anxiety and depression. However, treatment of acne can be difficult due to its long time course, chronicity, and low patient adherence. While national acne guidelines have been recently updated, there is a need for practical, easy-to-use guidance for healthcare practitioners who treat patients with acne. Methods: A roundtable discussion with a panel of eight clinicians and dermatologists was held to provide recommendations for the diagnosis and treatment of acne, including appropriate pharmaceutical treatments based on clinical presentation and patient population, patient discussion points, and advice for clinicians regarding acne treatment. Results: The consensus was that successful acne treatment is contingent upon meeting three core goals: 1) correct diagnosis; 2) proper treatment regimen; and 3) patient adherence and education. 1: Acne should be diagnosed using both quantitative and qualitative assessments, taking into consideration the patient’s lived experience with acne. Quantitative assessments include acne duration; lesion type and location; inflammation; acne-related sequelae; and family history of scarring. Qualitative assessments determine how bothersome acne and/or sequelae are to patients and how much they impact quality of life. Differential diagnoses should be performed to rule out acneiform lesions, genetic disorders, infections, and certain types of medications. 2: For most patients, a combination topical treatment containing benzoyl peroxide and a retinoid and/or an antibiotic is recommended to address the multiple acne pathological processes, though sequelae and patient characteristics should be considered (eg, post-inflammatory hyperpigmentation in patients with skin of color). Fixed-dose combinations are preferred to ensure proper skin coverage, simplify treatment complexity, and improve adherence. 3: For optimal outcomes, patients should be educated about their treatments and consequences of non-adherence; realistic treatment goals should be established to manage patient expectations. A patient handout on skin care best practices can be used to detail their overall skin care regimen, treatments, and subsequent visits. Conclusions: This practical guidance aims to assist clinicians in the successful diagnosis and treatment of acne as well as patient management/education.

A Surgical Case of Lipomatous Hypertrophy of the Atrial Septum

We present a rare case of lipomatous hypertrophy of the atrial septum (LHAS) characterized by the abnormal accumulation of adipose tissue within the interatrial septum, forming a tumor-like mass. The reported incidence of LHAS is 2.2–8%, with advancements in imaging techniques expanding diagnostic opportunities. A 75-year-old female with a history of meningioma, right breast cancer, cholecystolithiasis, and ovarian cyst; comorbidities, including diabetes, hypertension, and hyperlipidemia; and a body mass index of 33 kg/m2 underwent resection for an enlarging interatrial septal tumor, ultimately leading to the diagnosis of LHAS. Imaging revealed a 36 mm × 28 mm tumor extending from the atrial septum into the right atrium, with a computed tomography value of –76 HU. Histopathologically, the tumor was mainly composed of mature adipocytes along with hypertrophied myocardial fibers and scattered brown adipocytes, confirming the diagnosis of LHAS. Although LHAS is often managed with observation following diagnosis, our report on surgical intervention presents a rare and noteworthy occurrence. This case highlights the importance of recognizing and addressing the rare occurrence of LHAS, which often requires surgical intervention in cases of tumor enlargement. The successful resection and diagnosis of LHAS in this patient underscore the importance of considering this condition in the differential diagnosis of cardiac tumors.

P-504 Examining the success rates following a second embryo biopsy for inconclusive results in preimplantation genetic testing for monogenic diseases (PGT-M): a matched case-control study

Abstract Study question Can an embryo re-biopsy for a previous inconclusive result influence clinical pregnancy compared to a successful PGT-M diagnosis from the first biopsy? Summary answer The embryo re-biopsy intervention for PGT-M seems to reduce the implantation potential of a blastocyst. What is known already PGT-M allows embryo genetic profiling prior to transfer in couples with hereditary genetic disorders, as part of in vitro fertilization process. The need of a trophectoderm biopsy for the retrieval of a fragment of about 8-10 blastomeres is generally sufficient for optimal DNA amplification and molecular analysis. However, a proportion of embryos (approximately 10-12%) fails to be properly diagnosed after PGT-M testing due to inconclusive results. Therefore, as an attempt to obtain a genetic diagnosis, the embryo biopsy can be repeated on the same embryos although retesting involves a second round of biopsy and a second round of vitrification. Study design, size, duration Twenty-seven embryos from women undergoing PGT-M at an infertility center and transferred after two biopsies for genetic analysis were matched for age, fertility status, and study period, to embryos transferred after a conclusive PGT-M result after the first biopsy. The main outcome was the clinical pregnancy rate following embryo transfers in cases in whom embryos had a single biopsy, and when a re-biopsy was performed. The secondary outcome was the live birth rate. Participants/materials, setting, methods Ovarian stimulation, oocyte collection and fertilization were performed according to standard protocols. Embryos were cultured to blastocyst stage in groups of up to five, using one-step media. Blastocysts were biopsied on day 5, 6, or 7, employing either the pulling or flicking method based on their appearance. Biopsied cells were stored at -20 °C for genetic analysis. Vitrification was performed using Kitazato protocol. If results were inconclusive, a second biopsy was performed in surviving blastocysts. Main results and the role of chance The median [interquartile range] number of retrieved and injected oocytes was similar between the two groups, as well as fertilization rate and number of blastocysts obtained. No difference between the two groups was also observed pertaining to the day of embryo culture in which the first biopsy was performed. Conversely, the number of non-diagnosticated and transferable blastocysts was lower in patients whose blastocysts were re-biopsied. In 90% of the re-biopsies an informative result was obtained. Clinical pregnancy rate was 52% (95% CI: 34-69) following the transfer of a single-biopsy blastocyst and 30% (95% CI: 16-48) following the transfer of a re-biopsied blastocyst. The likelihood to have a healthy baby was 33% (95% CI: 19-52) following the transfer of a blastocyst biopsied once and 22% (95% CI: 11-41) following the transfer of a re-biopsied blastocyst. Limitations, reasons for caution The matching design, which aligns women’s age and fertility status in the two groups, allowed the assessment of pregnancy rates while avoiding potential confounding factors associated with retrospective analysis. Given that it is the first study with this design, a larger sample size is necessary to further elucidate these findings. Wider implications of the findings Despite the limited sample size, these results are of extreme clinical relevance. They offer valuable insights for guiding decisions about embryos with unclear results, contributing to the improvement of strategies for selecting those with the highest probability of pregnancy. Trial registration number not applicable

Expert System for Diagnosing Covid-19 Disease Using Method Forward Chaining

December 2019 was the beginning of cases that hit the Wuhan area, increasing cases of Covid-19 in China every day and increasing from January to February 2020. Initially reports came from the Hubei area and surrounding provinces, and the reports that came increased to the provinces around China, there were 86 other cases reported from various parts of the country, including Indonesia. Indonesia's first Covid-19 disease reportedly entered on March 2, 2020, there were two cases. The latest information is published on the official WHO website (World Health Organization) it was recorded that from January 3, 2020 to March 18, 2022 in Indonesia, there were 5,948,610 people who were recorded as positive for Covid-19 and 153,411 people were confirmed to have died. Diagnosing Covid-19 is the job of experts or specialists who have experience and knowledge in this field. An alternative that can help people who are not experts in diagnosing Covid-19 is an expert system. The forward chaining method was chosen because it is a forward tracking technique that is sorted according to the number of facts and ends with a conclusion. Forward Chaining is a method inference engine where this method compares facts and statements and will start from the left first (IF). Where, reasoning will start from the facts and then test the validation of the hypothesis (THEN). This research was conducted to make it easier for non-experts to diagnose Covid-19 with this expert system, and to be able to provide solutions after a successful diagnosis.

Extended Computed Tomography Angiography for the Successful Diagnosis of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA: Study Protocol for a Randomized Controlled Trial.

Cardiac imaging is one of the main components of the etiological investigation of ischemic strokes. However, basic and advanced cardiac imaging remain underused in most stroke centers globally. Computed tomography angiography (CTA) of the supra-aortic and intracranial arteries is the most frequent imaging modality applied during the evaluation of patients with acute ischemic stroke to identify the presence of a large vessel occlusion. Recent evidence from retrospective observational studies has shown a high detection of cardiac thrombi, ranging from 6.6 to 17.4%, by extending a CTA a few cm below the carina to capture cardiac images. However, this approach has never been prospectively compared against usual care in a randomized controlled trial. The Extended Computed Tomography Angiography for the Successful Screening of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA (DAYLIGHT) prospective, randomized, controlled trial evaluates whether an extended CTA (eCTA) + standard-of-care stroke workup results in higher detection rates of cardiac and aortic source of embolism compared to standard-of-care CTA (sCTA) + standard-of-care stroke workup. DAYLIGHT is a single-center, prospective, randomized, open-blinded endpoint trial, aiming to recruit 830 patients with suspected acute ischemic stroke or transient ischemic attack (TIA) being assessed under acute code stroke at the emergency department or at a dedicated urgent stroke prevention clinic. Patients are randomized 1:1 to eCTA versus sCTA. The eCTA expands image acquisition caudally, 6 cm below the carina. All patients receive standard-of-care cardiac imaging and diagnostic stroke workup. The primary efficacy endpoint is the diagnosis of a cardioaortic thrombus after at least 30 days of follow-up. The primary safety endpoint is door-to-CTA completion time. The diagnosis of a qualifying ischemic stroke or TIA is independently adjudicated by a stroke neurologist, blinded to the study arm allocation. Patients without an adjudicated ischemic stroke or TIA are excluded from the analysis. The primary outcome events are adjudicated by a board-certified radiologist with subspecialty training in cardiothoracic radiology and a cardiologist with formal training in cardiac imaging. The primary analysis is performed according to the modified intention-to-diagnose principle and without adjustment by logistic regression models. Results are presented with odds ratios and 95% confidence intervals. The DAYLIGHT trial will provide evidence on whether extending a CTA to include the heart results in an increased detection of cardioaortic thrombi compared to standard-of-care stroke workup.

Collaborative Problem-Solving in Knowledge-Rich Domains: A Multi-Study Structural Equation Model

Collaborative skills are crucial in knowledge-rich domains, such as medical diagnosing. The Collaborative Diagnostic Reasoning (CDR) model emphasizes the importance of high-quality collaborative diagnostic activities (CDAs; e.g., evidence elicitation and sharing), influenced by content and collaboration knowledge as well as more general social skills, to achieve accurate, justified, and efficient diagnostic outcomes (Radkowitsch et al., 2022). However, it has not yet been empirically tested, and the relationships between individual characteristics, CDAs, and diagnostic outcomes remain largely unexplored. The aim of this study was to test the CDR model by analyzing data from three studies in a simulation-based environment and to better understand the construct and the processes involved (N = 504 intermediate medical students) using a structural equation model including indirect effects. We found various stable relationships between individual characteristics and CDAs, and between CDAs and diagnostic outcome, highlighting the multidimensional nature of CDR. While both content and collaboration knowledge were important for CDAs, none of the individual characteristics directly related to diagnostic outcome. The study suggests that CDAs are important factors in achieving successful diagnoses in collaborative contexts, particularly in simulation-based settings. CDAs are influenced by content and collaboration knowledge, highlighting the importance of understanding collaboration partners’ knowledge. We propose revising the CDR model by assigning higher priority to collaboration knowledge compared with social skills, and dividing the CDAs into information elicitation and sharing, with sharing being more transactive. Training should focus on the development of CDAs to improve CDR skills.