Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper...Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.展开更多
Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impo...Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlow<sup>TM</sup> STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.展开更多
BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on t...BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on the immune response capacity of the host and the type of Leishmania.In East Asia,leishmaniasis is relatively rare and prone to misdiagnosis and underdiagnosis.CASE SUMMARY We report a case of a 36-year-old male with cutaneous leishmaniasis.The patient had been misdiagnosed with a bacterial skin infection and was given a dressing change and oral levofloxacin,which proved ineffective.Histopathological examination revealed amastigote(Leishman-Donovan body)in the histocytes,and nucleic acid sequencing proved that the pathogen was Leishmania major.The patient was treated successfully by regional injection of sodium gluconate(600 mg)three times.The ulcer healed and did not recur at 1.5-year follow-up.CONCLUSION Skin ulcers caused by leishmaniasis are easily misdiagnosed in non-epidemic countries,yet it should not be overlooked.展开更多
Background: Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identi...Background: Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression.Methods: The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression.Results: Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression.Conclusions: Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.展开更多
OBJECTIVE: To establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE. METHODS: From December 1995 to July 2001, 45 patients with acu...OBJECTIVE: To establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE. METHODS: From December 1995 to July 2001, 45 patients with acute PE were hospitalized, of which 33 received intravenous thrombolytic therapy or interventional treatment. RESULTS: Misdiagnostic rate in the 45 patients with acute PE during first visit was 62.2% and mortality rate was 28.9%. Misdiagnostic rate in acute PE patients who had undergone surgery was 82% and mortality rate was 73%. The effective rate of thrombolytic therapy was 77.7%. Clinical symptoms rapidly disappeared in massive PE patients treated with interventional therapies. CONCLUSIONS: Intravenous thrombolytic therapy is one of the most effective methods for treating acute PE. Application of interventional therapy for severe acute PE is also promising.展开更多
A61-year-old woman was admitted to the Department of Vasculocardiology,First Affiliated Hospital of Zhengzhou University presented with recurrent respiratory distress for 2 weeks without fever,cough,phlegm,chest pain ...A61-year-old woman was admitted to the Department of Vasculocardiology,First Affiliated Hospital of Zhengzhou University presented with recurrent respiratory distress for 2 weeks without fever,cough,phlegm,chest pain or hemoptysis.Her symptom had generally worsened at night when she lying supine,and that could be partly alleviated when she had a seat or stand for a few minutes.Two weeks ago,the patient was admitted to the local hospital with diagnosis of ＂coronary disease;chronic hepatitis B;stage Ⅱ hypertension＂.After administered with conservative treatment,her symptoms were not significantly alleviated.The patient was then referred to our hospital in September 2012 for further evaluation and treatment.The patient had a past medical history of hypertension with regular medications of compound kendir lenves （one tablet daily） and reserpine （one tablet daily）.Her family history was negative.展开更多
文摘Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.
文摘Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlow<sup>TM</sup> STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.
基金Supported by Shandong Provincial Natural Science Foundation,No.ZR2020QH138
文摘BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on the immune response capacity of the host and the type of Leishmania.In East Asia,leishmaniasis is relatively rare and prone to misdiagnosis and underdiagnosis.CASE SUMMARY We report a case of a 36-year-old male with cutaneous leishmaniasis.The patient had been misdiagnosed with a bacterial skin infection and was given a dressing change and oral levofloxacin,which proved ineffective.Histopathological examination revealed amastigote(Leishman-Donovan body)in the histocytes,and nucleic acid sequencing proved that the pathogen was Leishmania major.The patient was treated successfully by regional injection of sodium gluconate(600 mg)three times.The ulcer healed and did not recur at 1.5-year follow-up.CONCLUSION Skin ulcers caused by leishmaniasis are easily misdiagnosed in non-epidemic countries,yet it should not be overlooked.
基金This work was supported by grants from the Beijing Municipal Science and Technology Program(No.Z181100001618013)the National Key Research and Development Program of China(No.2016YFC1302802)。
文摘Background: Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression.Methods: The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression.Results: Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression.Conclusions: Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.
文摘OBJECTIVE: To establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE. METHODS: From December 1995 to July 2001, 45 patients with acute PE were hospitalized, of which 33 received intravenous thrombolytic therapy or interventional treatment. RESULTS: Misdiagnostic rate in the 45 patients with acute PE during first visit was 62.2% and mortality rate was 28.9%. Misdiagnostic rate in acute PE patients who had undergone surgery was 82% and mortality rate was 73%. The effective rate of thrombolytic therapy was 77.7%. Clinical symptoms rapidly disappeared in massive PE patients treated with interventional therapies. CONCLUSIONS: Intravenous thrombolytic therapy is one of the most effective methods for treating acute PE. Application of interventional therapy for severe acute PE is also promising.
文摘A61-year-old woman was admitted to the Department of Vasculocardiology,First Affiliated Hospital of Zhengzhou University presented with recurrent respiratory distress for 2 weeks without fever,cough,phlegm,chest pain or hemoptysis.Her symptom had generally worsened at night when she lying supine,and that could be partly alleviated when she had a seat or stand for a few minutes.Two weeks ago,the patient was admitted to the local hospital with diagnosis of ＂coronary disease;chronic hepatitis B;stage Ⅱ hypertension＂.After administered with conservative treatment,her symptoms were not significantly alleviated.The patient was then referred to our hospital in September 2012 for further evaluation and treatment.The patient had a past medical history of hypertension with regular medications of compound kendir lenves （one tablet daily） and reserpine （one tablet daily）.Her family history was negative.
