Background: How clinicians conduct diagnostic reasoning is a major issue. Aim: To evaluate whether intuitive and analytic processes (differential diagnosis checklist, DDXC; general de-biasing checklist, GDBC) might improve diagnostic performance. Methods: We enrolled 188 medical students (4th-6th grades) who were divided into two groups and assigned the five cases scenarios. Group 1 (n ¼ 91) were instructed to provide the three most likely diagnoses immediately after reading the scenarios (intuitive diagnosis), then after reading GDBC (diagnosis by GDBC), and finally, after reading DDXC (diagnosis by DDXC). Conversely, group 2 (n ¼ 97) were instructed to provide intuitive diagnoses, by DDXC, and by GDBC. Results: Among the group 1, there was significant difference of total scores ( p ¼ 0.01 by ANOVA) between intuitive (8.25) and DDXC (8.77). Among the group 2, we noted significant difference of total scores ( p ¼ 0.001 by ANOVA) between intuitive (7.21) and DDXC (7.96). Among the difficult cases, the proportions of correct diagnosis increased after reading DDXC, although among the simple cases, the proportions of correct diagnosis decreased after reading DDXC. Conclusion: The use of DDXC, not GDBC, may improve the diagnostic performance in difficult cases, while intuitive process may still be better for simpler cases.
We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides. N. meningitidis, also called meningococcus, is a Gram-negative, aerobic, diplococcus bacterium. The various consequences of severe meningococcal sepsis include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC. The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid. Blood, CSF, and skin biopsy cultures are used for diagnosis. Meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care. Management of the systemic circulation, respiration, and intracranial pressure is vital for improving the prognosis, which has dramatically improved since the wide availability of antibiotics. This review of the literature provides an overview of current concepts on meningococcemia due to N. meningitidis infection.
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