CODEX Digest - 8.6.26

1) Racial disparities in medical errors among women: a systematic review and meta-analysis.

Batubo VI, Elasha FHM, Adeniyi-Ibrahim BF, et al. J Patient Saf. Epub 2026 Jul 14.

Medical errors remain a major source of preventable harm globally, disproportionately affecting women and racial minorities, though evidence on racial disparities among women has been inconsistent. This meta-analysis quantifies the disparities between Black and White women receiving unsafe care. While overall error rates were similar, Black women more often experienced underdiagnosis and safety events, whereas White women more frequently experienced overdiagnosis.

2) Deep learning in the early diagnosis of acute aortic dissection.

Eggleton S, Ryan J, Gallego B. Front Cardiovasc Med. 2026;13:1828870.

Acute aortic dissection (AAD) diagnosis remains perilously delayed, with fatal consequences. This review examines the ability of deep learning (DL) to enhance early detection using routine clinical data, guiding the use of advanced imaging triage. The review discusses diagnostic pitfalls, current decision pathways, and emerging DL models, while addressing critical barriers—data scarcity, class imbalance, and explainability—that must be overcome for safe, effective clinical integration of AI into the AAD diagnostic pathway.

3) Generative AI-assisted simulation training is associated with higher post-intervention diagnostic communication scores across Type 2 diabetes, obesity, and breast cancer scenarios.

García-García BM, N’guessan-Sánchez BJ, Romero-Guevara MF, et al. Healthcare (Basel). 2026;14(13):1883.

Diagnostic communication directly impacts patient outcomes. This pre-post study evaluates a generative AI-assisted simulation with medical students in Mexico. Across scenarios, students practiced core diagnostic communication skills, including rapport, diagnosis delivery, empathy, and management planning. While the results situate AI as a possible support mechanism to improve communication skills, more trials are needed to validate this educational approach.

4) Effects and use of a computerized diagnostic decision support system during the diagnostic process in emergency medicine. A mixed-methods study.

Hautz SC, Epprecht TP, Marcin T, et al. Diagnosis (Berl). Epub 2026 Jul 14.

Despite the potential for decision support to inform action, clinicians don't reliably use the tools. This Swiss emergency study finds that mandatory computerized diagnostic decision support systems use reduced senior consultations across 1,204 cases, yet physicians rated it supportive in only 23% of cases. Users cited broader differentials and diagnostic confirmation, revealing benefits and risks —aiding deliberation while potentially reinforcing confirmatory biases and altering team dynamics.

5) When emergency physicians meet patients displaying irritable behaviours: a randomised vignette-based experiment investigating physicians’ emotions and clinical reasoning. 

Isbell LM, Huff NR, Liu G, et al. BMJ Qual Saf. Epub 2026 Jul 12.

Emergency department sessions with "challenging" patients are common and can heighten physicians' negative emotions. In this study of 134 experienced emergency physicians with computer simulated vignettes, "irritable" (versus "calm") patient behavior increased anger, anxiety, and fatigue while reducing empathy, happiness, and engagement. The results find that these emotional reactions to unsettled patients did not compromise diagnostic accuracy, decision-making, or other measures of care quality.

6) Informing the measurement of timely follow-up on inconclusive or abnormal screening mammograms: an environmental scan.

Marceau M, Nafaa O, Mita C, et al. Jt Comm J Qual Patient Saf. Epub 2026 Jun 1.

Lack of follow-up to abnormal mammogram screening can contribute to diagnostic delay. This environmental scan finds that society guidelines and existing literature lack a standard definition for timely follow-up after inconclusive or abnormal mammograms. Longer wait times worsened morbidity and mortality outcomes, yet evidence was insufficient to establish an optimal follow-up time frame, requiring discussions with experts to fill this gap. Patients who were non-white, non-English speakers, with lower educational attainment and socioeconomic status, and/or not living in urban settings had a higher risk of missed or delayed follow-up.

7) Informal peer diagnostic second opinion: hospitalist practices and perspectives.

Miyagami T, Auerbach A, Schnipper JL, et al. J Hosp Med. Epub 2026 Jul 6.

Team-based care and communication improve diagnosis for in-patients. This cross-sectional survey of 338 hospitalists and Advanced Practice Providers across 13 hospitals examines peer second-opinion practices addressing diagnostic uncertainty. The results find half of the participating clinicians regularly sought second opinions, and nearly all felt psychologically safe doing so and believed it improved accuracy. The main obstacles highlighted were time constraints and averseness to inconvenience colleagues; less experienced clinicians more often cited feeling vulnerable. Strengthening peer consultation systems could improve diagnostic teamwork. 

**UCSF CODEX’s director Sumant Ranji, MD, is an author for this publication. 

8) Visual representation of clinical conditions across skin tones in nursing textbooks: a quantitative image analysis.

Pusey-Reid E, Wong J. Am J Nurs. 2026;126(5):22-29.

Nursing textbooks frequently omit clinical examples on darker skin tones, failing to show how conditions manifest across diverse populations. This limits students' assessment and diagnostic skills and reinforces healthcare inequities. This analysis of nursing textbook imagery reveals a widespread visual bias favoring lighter skin as the clinical default, perpetuating structural gaps in health education and weakening nurses' ability to identify conditions in all patients. Notably, only 2% of graphic illustrations showed dark skin.

9) Smartphone applications in dermatology with special focus on AI: a European-continent-based review.

Sangers T, Shifai AN, Pasqualini DGJ, et al. Int J Dermatol. Epub 2026 Jul 15.

Dermatology smartphone apps are widely accessible, but proof of their reliability and regulatory adherence remains scarce. This review analyzed 420 apps sold in Europe, including skin cancer tools, mostly aimed at laypersons for teledermatology, education, and self-assessment. It finds substantial gaps in regulatory compliance, clinical validation, and transparency, raising patient safety concerns and highlighting the need for stronger quality assurance and diverse skin-type representation.

10) Evaluation of nurse-led triage in the emergency department: a retrospective observational study.

Selva-Medrano D, Laredo-Aguilera JA, Serrano-Fernández V, et al. J Clin Nurs. 2026;35(8):3441-3451.

Appropriate triage of patients relies on teamwork and accurate documentation to support timely diagnosis and treatment. This large single-center six-year Spanish study analyzed 493,211 emergency department visits to benchmark nurse-led structured triage. The findings reveal documentation gaps: higher-acuity patients had faster recorded physician contact but lowest target-time compliance, likely since urgent care preceded charting. The authors share a practical risk profile to guide re-evaluation and prioritization.

11) Saving Lives and Reducing Health Care Waste by Improving Diagnosis in Medicine Act.

HR 9696, 119th Cong, 2nd Sess (2026).

This proposed US legislation seeks to advance diagnostic excellence through research, quality measurement, workforce development, patient engagement, and improved implementation of diagnostic safety practices. If enacted, it could strengthen national efforts to reduce diagnostic error and support healthcare organizations in adopting evidence-based approaches to improve timely, accurate diagnosis while reducing avoidable costs.

12) Prostate-specific antigen screening patterns and metastatic prostate cancer in US veterans.

Siavoshi M, Frochen S, Fakunle M, et al. JAMA Netw Open. 2026;9(7):e2621741.

Effective screening is a core element for early cancer detection. In this cohort study of more than 103,000 men, researchers find that earlier and more frequent prostate-specific antigen (PSA) testing was associated with a lower likelihood of prostate cancer being metastatic at diagnosis. Men first screened before age 50 and tested regularly had substantially lower rates of advanced cancer, highlighting how screening timing and frequency may influence early detection outcomes.