CODEX Digest - 11.13.25

1) Atypical presentations at risk for diagnostic errors in internal medicine: a scoping review.

Harada Y, Kawamura R, Yokose M, et al. J Gen Intern Med. Epub 2025 Oct 14. 

Lack of consistent language and definitions degrade the applicability of diagnostic science. This review examines atypical presentation studies discussing diagnostic errors in internal medicine and finds a pronounced lack of commonality in how they are described. The authors share a framework anchored on four disease patterns that they found to be associated with atypical presentations aligning with diagnostic error.     

2) The global patient perspective on uncontrolled moderate-to-severe asthma: reducing delays in diagnosis and treatment.

Rance K, Young B, McCreary G, et al. Adv Ther. Epub 2025 Oct 6. 

Delays in diagnosis of adult asthma contribute to poor care. This study reports on the results of an international survey finding that over half of patients surveyed experienced delays in getting tests needed to confirm asthma diagnosis and visiting emergency rooms to get needed care. 

3) The role of artificial intelligence in improving diagnostic accuracy in medical imaging: a review.

Sabri O, Al-Shargabi B, Abuarqoub A. Computers, Materials & Continua. 2025, 85(2), 2443-2486.  

AI is widely considered to have the potential to impact image analysis accuracy and process improvement. This introductory literature survey summarizes deep learning and machine learning (ML) in radiology diagnostic performance and pattern recognition. The authors discuss identified trends and research gaps to highlight needed areas of exploration in the field.

4) Feelings behind words: a systematic review on how effective is NLP-based assessment for mental health diagnosis in human studies.

Yulianti EP, Eka Putri YS, Keliat BA, et al. Int J Med Inform. 2025;205:106129.

The use of AI for mental health assessment is controversial. This systematic review discusses evidence on natural language processing (NLP)-powered tools to diagnose mental illness and identifies several cultural, language, and ethical limitations.  

5) Exploring the dark side of the moon: diagnostic errors in critically ill patients.

Valentin A, Flaatten H, Dünser MW. Intensive Care Med. Epub 2025 Oct 6. 

This introductory commentary summarizes key points on understanding why diagnostic errors happen in critical care. The authors provide an informative graphic illustrating systemic and individual tactics to mitigate errors at various points in the diagnostic process, such as history taking and test ordering, and points across the diagnostic process where AI may have the biggest impact. 

6) Stroke alert: examining demographic disparities in prehospital stroke care. (subscription required) 

McGlynn E, Nickel LB, Colella MR, et al. Am J Emerg Med. 2025;96:116-121. 

Unequal prehospital stroke care can be catastrophic for patients and their communities. This retrospective study finds that Black and Hispanic patients experienced gaps in emergency medical services record keeping and time spent with the patient upon assessment initiation. 

7) Less is more for patients, practitioners, public and planet: a taxonomy for the harms of too much medicine. (subscription required)

Gram EG, Haas R, Niklasson A, et al for the  Preventing Overdiagnosis Research Day group. BMJ Evid Based Med. Epub 2025 Oct 5. 

Low value healthcare is connected to overdiagnosis and over testing. This commentary discusses the negative impact of overuse on care excellence, patients, clinicians, and the environment. The authors submit a framework to assess all types of harm to more effectively represent harms and benefits of overuse on diagnosis and treatment to inform optimization efforts.   

8) Adherence to breast screening guidelines and breast cancer mortality: a population cohort study.

Christensen RAG, Anderson GM, Kim SJ, et al. Breast Cancer Res Treat. 2025;213(1):63-69. 

Guidelines provide evidence-based recommendations to achieve excellence in treatment, diagnosis, and screening. This large Canadian study examines the impact screening program alignment with published guidelines and deaths from breast cancer. The research finds that patients screened in compliance with published recommendations had a lower morbidity rate than non-screened patients. 

9) Rooted in reasoning: a clinical reasoning curriculum using diagnostic RCAs. (subscription required)

Klimpl D, Staudinger S. Diagnosis (Berl). Epub 2025 Oct 7.

Explicit illustrations of clinical reasoning gaps can be powerful learning tools if delivered in a psychologically safe environment. This commentary outlines how frontline diagnostic error examples were used as content for an advanced practice provider root cause analysis clinical reasoning educational program.  

10) Echocardiographic diagnosis of rheumatic heart disease: substantial agreement, inter-rater reliability and accuracy between cardiac sonographers and paediatric cardiologists.

Williamson JM, Whalley GA, Morris PS, et al. Heart Lung Circ. 2025;34(9):900-907. 

Efficiencies may be realized if a broader range of clinicians can provide equally safe services to improve access to diagnostic care. This Australian study compares the accuracy of cardiac sonographers and cardiologists in determining rheumatic heart disease (RHD). While only 11 clinicians participated in the analysis of 210 echocardiograms, the results indicate the potential of this role assignment to improve timely diagnosis of RHD. 

11) No time for waste! Co-producing practice guidelines and research recommendations to promote earlier diagnosis of colorectal cancer in community pharmacies: a qualitative analysis.

Brunsdon E, Hollyfield S, Venkat SC, et al. Health Expect. 2025;28(5):e70411.  

Strategies to decrease workload while improving access to diagnostic services are challenging to design and implement. This multidisciplinary study describes an effort to understand effective processes for engaging community pharmacists in efforts to improve the timeliness of colon cancer diagnosis. 

12) Optimizing electronic health records: Integration of human factors engineering for enhanced pathology report display and accessibility. (subscription required)

Larsen EP, Jalloul M, Larsen MP. Am J Clin Pathol. 2025;164(2):174-181. 

Human factors engineering (HFE) principles can be applied to design technology interfaces to reduce error potential and improve efficiency. This improvement report describes an effort to engage clinicians, EHR technologists, and design experts to improve the usefulness of pathology reports.