Case 22-2022: A 34-Year-Old Woman with Cavitary Lung Lesions

Restrepo, Daniel; Haramati, Adina; McCluskey, Suzanne M.; Branda, John A.

doi:10.1056/nejmcpc2201238

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Eighteen cases of culture-confirmed blastomycosis were identified. Ten were excluded because of residence in or travel to other areas endemic for blastomycosis in the past 5 years, 2 were excluded due to inadequate documentation of travel history, and 1 was excluded as having been previously reported [ 7 ]. In the remaining patients, it was not clear why the record had been tagged with an ICD code or LMR code for blastomycosis.…”

Section: Resultsmentioning

confidence: 99%

Blastomycosis in New England: 5 Cases and a Review

Ross

Koo

Zuckerman

2023

Open Forum Infectious Diseases

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The geographic range of blastomycosis is thought to include New England, but documentation is sparse. We report five cases of infection with Blastomyces dermatitidis which were likely acquired in New England between 2011 and 2021. Our experience suggests that chart coding for the diagnosis of blastomycosis is imprecise, and that mandatory reporting might help resolve uncertainties about the prevalence and extent of blastomycosis.

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Section: Resultsmentioning

confidence: 99%

Blastomycosis in New England: 5 Cases and a Review

Ross

Koo

Zuckerman

2023

Open Forum Infectious Diseases

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“…It is critical for clinicians to decompose complex diagnostic problems into elements to extract the essential elements properly (D and E= isolate assessment items in the decision hygiene template) and then to sequentially explore the similarities and differences in the differential diagnoses derived from these elements. 10 Meanwhile, the additional distinctive features of DECLARE lie in the R and CL parts. A valid problem-solving hypothesis is formed by not merely dividing complex problems but by clearly considering causal relationships between clinical information (CL= Causal inference), assessing the relationship in order to satisfy accountabilities to the patient (A), and by reconstructing them appropriately (R).…”

Section: Discussionmentioning

confidence: 99%

DECLARE: A Comprehensive, Multifaceted Cognitive Forcing Strategy to Confront Complex Cases

Shimizu¹

2023

IJGM

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Diagnostic excellence is an important goal in medicine. The enhancement of clinical reasoning skills of physicians, which is at the core of this concept, is a significant challenge. To achieve this improvement, it is necessary to enhance the ability to collect patient history information and to integrate the information. Additionally, the complexity of diagnosis is confounded by biases, noise, uncertainty, and contextual factors, and the impact of these factors is particularly prominent in complex cases. In such cases, the dual process theory, which is a classical reasoning measure, alone is insufficient to cope with these challenges, and a multifaceted and comprehensive approach is required to supplement its limitations. Therefore, the author presents six concrete steps, represented by the acronym DECLARE (Decomposition, Extraction, Causation Link, Assessing Accountability, Recomposition, Explanation and Exploration), that implement the concept of cognitive forcing strategy that has been shown to be effective in bias control, and include reflection, meta-cognition, and the recently popularized decision hygiene procedure. DECLARE is a strategy that should be deployed when faced with more complex diagnostic scenarios. By examining each of the six steps that comprise DECLARE individually, cognitive load can be reduced. Furthermore, by verifying causation and accountability when constructing diagnostic hypotheses, biases can be mitigated, which can also help to address noise and uncertainty, leading to an improvement in the quality of diagnosis and effectiveness in medical education.

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