CODEX Digest - 2.19.26

1) Does LLM Assistance Improve Healthcare Delivery? An Evaluation Using On-site Physicians and Laboratory Tests.

Abaluck J, Pless R, Ravi N, et al. National Bureau of Economic Research; 2026.

LLMs have potential to provide second opinions for diagnosis and care plans. This non-peer reviewed working paper compares real-world LLM use for clinical decision support in two Nigerian outpatient clinics. Findings show that community health workers valued LLM feedback while physicians reviewing patient records found little improvement in diagnosis or test use.

2) The role of general practitioners in dementia diagnosis: a scoping review of clinical practice guidelines.

Cronin M, Jennings A, Cornally N, et al. Fam Pract. 2025;43(1):cmaf103.

Early diagnosis of dementia is challenging but important for directing care, improving quality of life, and reducing financial costs. This scoping review examines international guidance outlining general practitioner actions for timely dementia diagnosis and identifies gaps in current recommendations for their practical use.

3) Overdiagnosis in low-dose CT lung cancer screening: a systematic review and meta-analysis of overall magnitude and subgroup variations. (subscription required) 

Du Y, Yuan C, Ni X, et al. Int J Cancer. 2025;157(11):2269-2282.

Overdiagnosis is a concern in low-dose computed tomography lung cancer screening. This meta-analysis quantifies overdiagnosis and examines its variation by different factors. Results show that long-term follow-up reduces overdiagnosis rates.

4) Vision-language models in diagnostic imaging: review of technical advances, clinical validation, and practical deployment. (subscription required) 

Dutta N, Bose K, Syailendra E, et al. Int J Med Inform. 2026;208:106227.

Radiology is experiencing a workload crisis, and vision-language models (VLMs) may help by enhancing radiologists' workflows rather than providing autonomous support. This narrative review discusses limitations of use of VLMs in direct care. The authors call for industry robust validation, error reduction, and seamless workflow integration processes to maintain quality and safety.

5) Prostate cancer screening practices among high-risk patients: a retrospective analysis.

Ghosh AK, Sivasubramanian BP, Asif RH, et al. Am J Mens Health. 2025;19(6):15579883251392440.

Prostate cancer screening in primary care is challenging, with risk of overdiagnosis among low risk groups and under-screening in high-risk groups. This retrospective analysis finds that while more risk factors led to increased testing, African American and low-income patients were still tested less often. Improving clinician education and decision-support tools use could improve adherence to guidelines and promote equitable testing.

6) Difficult conversation case: missed testicular cancer.

Ginsburg J, Zamamiri S, Howell M, et al. J Educ Teach Emerg Med. 2025;10(5):CE1-CE13.

Diagnostic error transparency requires distinct communication skills to be patient-centered and empathetic. This study evaluates an emergency medicine resident's effectiveness in disclosing a missed testicular cancer diagnosis. The results show the case approach to be effective and adaptable for other error disclosure assessments.

7) Pilot investigation into the influence of racial implicit bias on physician clinical reasoning.

Gonzalez CM, Deno ML, Ark TK, et al. Diagnosis (Berl). Epub 2026 Jan 26.

Clarifying implicit bias in care encounters is crucial for developing effective mitigation strategies. This study uses simulation with Black and White standardized patients to introduce cognitive stressors typical in clinical settings. Results show a moderate link between physicians' racial bias scores and diagnostic accuracy in acute coronary syndrome only for Black patients and not for White patients.

8) Identifying missed diagnostic opportunities in maternal stroke. (subscription required)

Haghighi N, Bourscheid RM, Shang C, et al. Stroke. 2026;57(2):292-300.

Pregnancy-related stroke can present with general neurological symptoms, resulting in missed diagnoses. This retrospective cohort study using the Safer Stroke-Dx tool finds that 27% of pregnant or postpartum acute stroke patients experienced missed diagnostic opportunities.

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9) Importance of diagnosis in chronic pain: patient's perspective.

Javed M, MacDonncha C, Harmon D. Pain Stud Treatment. 2026;14(01):1-9.

Accurate diagnosis is crucial for chronic pain, as mistakes can reduce care quality and patient trust. This Irish survey-based study shows that uncertainty and lack of respect during the diagnostic journey negatively affects patients. The authors highlight the need for empathetic, patient-focused approaches to validate the patient experience and improve clinical outcomes.

10) Care team model and diagnostic error risk in medical patients who transferred to the ICU or died. (subscription required)

Knees M, Hubbard C, Burden M, et al. J Gen Intern Med. Epub 2026 Jan 26.

Diagnostic errors are known to cause harm for hospitalized patients. This retrospective study finds that medical team structure can affect diagnostic safety, with care models under a direct attending showing higher risk of diagnostic error than care models with residents teams. Teaching services may reduce error risk by encouraging teamwork, collective decision-making, and balanced workloads.

11) Infant outcomes, risk factors, and diagnostic yield after a brief resolved unexplained event: a systematic review and meta-analysis. (subscription required)

Nama N, Liebert S, Abaji M, et al. JAMA Pediatr. Epub 2026 Jan 26. 

"Brief unexplained medical events" have clinical uncertainty in pediatrics. This review assesses serious underlying diagnoses and mortality associated with events. Routine tests yielded few benefits, often causing false positives. The authors suggest that existing guidelines should shift toward targeted, risk-based evaluations using reliable high-risk markers.

12) Physician perspectives on diagnostic uncertainty in radiographic imaging reports for pulmonary embolism: a qualitative study. (subscription required)

Westafer LM, Walsh P, Helderman R, et al. Ann Emerg Med. Epub 2025 Dec 5.

The effect of diagnostic uncertainty on physician behavior has both cognitive and process workload ramifications. This interview study explores hospital physicians' responses to uncertainty in pulmonary embolism imaging reports. Themes include lack of standard approach, use of precautionary anticoagulation, dependence on downstream decision makers for follow-up, and hesitation to repeat tests due to time and practice constraints.