Evaluation and Reduction of Diagnostic Errors in Pathology Using an Evidence-Based Approach

2011 ◽  
pp. 235-244
Author(s):  
Raouf E. Nakhleh
Keyword(s):  
Diagnostic Errors ◽  
Evidence Based

scholarly journals ANALYSIS OF EFFICACY OF USING PLATELET-RICH PLASMA AND BETAMETHAZONE IN THE TREEATMENT OF ALOPECIA AREATA

2020 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
M. A. Aljabali ◽  
L. V. Kuts
Keyword(s):  
Alopecia Areata ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Venous Blood ◽  
Smoking Habit ◽  
Diagnostic Errors ◽  
Statistical Processing ◽  
Evidence Based ◽  
Based Medicine ◽  
Instrumental Methods

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

scholarly journals Evidence-based decision support for pediatric rheumatology reduces diagnostic errors

2016 ◽  
Vol 14 (1) ◽  
Author(s):  
Michael M. Segal ◽  
Balu Athreya ◽  
Mary Beth F. Son ◽  
Irit Tirosh ◽  
Jonathan S. Hausmann ◽  
...  
Keyword(s):  
Decision Support ◽  
Pediatric Rheumatology ◽  
Diagnostic Errors ◽  
Evidence Based

scholarly journals Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

2018 ◽  
Vol 26 (1) ◽  
pp. 106-116
Author(s):  
D. S. Pshennikov ◽  
I. B. Angotoeva
Keyword(s):  
Evidence Based Medicine ◽  
Therapeutic Approach ◽  
Bacterial Resistance ◽  
Diagnostic Errors ◽  
High Rate ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Wide Range ◽  
Acute Bacterial Rhinosinusitis ◽  
Based Medicine

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy. Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease. In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

scholarly journals Histopathologist Features Predictive of Diagnostic Concordance at Expert Level Amongst a Large International Sample of Pathologists Diagnosing Barrett’s Dysplasia Using Digital Pathology

2019 ◽  
Author(s):  
Myrtle J. van der Wel ◽  
Helen G. Coleman ◽  
Jacques JGHM Bergman ◽  
Marnix Jansen ◽  
Sybren L. Meijer ◽  
...  
Keyword(s):  
Guideline Development ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Quantitative Model ◽  
Barrett’S Oesophagus ◽  
Low Grade ◽  
Evidence Based ◽  
Online Questionnaire ◽  
Barrett's Oesophagus ◽  
P53 Immunohistochemistry

ABSTRACTObjectiveGuidelines recommend expert pathology review of Barrett’s oesophagus (BO) biopsies that reveal dysplasia, but there are no evidence-based standards to corroborate expert reviewer status. We investigated BO concordance rates and pathologist features predictive of diagnostic discordance amongst a large international cohort of gastrointestinal pathologists to develop a quantitative model of BO expert review.DesignPathologists (n=55) from over 20 countries assessed 55 digitised BO biopsies from across the diagnostic spectrum, before and after viewing matched p53 immunohistochemistry. Extensive demographic and clinical experience data were obtained via online questionnaire. We calculated discordance rates and applied multivariate regression analyses to identify predictors of concordance.ResultsWe recorded over 6,000 individual case diagnoses. Of 2,805 H&E diagnoses, we found excellent concordance (>70%) for non-dysplastic Barrett’s oesophagus (NDBO) and high-grade dysplasia (HGD), and intermediate concordance for low-grade dysplasia (LGD, 42%) and indefinite for dysplasia (IND, 23%). Major diagnostic errors (i.e. NDBO overinterpreted as LGD/HGD or vice versa) were found in 248 diagnoses (8.8%), which reduced to 8.3% after viewing p53 labelled slides. At least 5 years of professional experience was protective against major diagnostic error for H&E slide review (OR 0.48, 95%CI 0.31-0.74). Working in a district general hospital was associated with increased odds of major diagnostic error (OR 1.76, 95%CI 1.15-2.69), however this was neutralised when pathologists viewed p53 labelled slides, suggesting a beneficial impact of p53 immunohistochemistry for this group.ConclusionWe have developed an evidence-based quantitative model of BO histopathology diagnosis at expert consensus level that will inform guideline development.

scholarly journals Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

2018 ◽  
Vol 26 (1) ◽  
pp. 106-116
Author(s):  
D. S. Pshennikov ◽  
I. B. Angotoeva
Keyword(s):  
Evidence Based Medicine ◽  
Therapeutic Approach ◽  
Bacterial Resistance ◽  
Diagnostic Errors ◽  
High Rate ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Wide Range ◽  
Acute Bacterial Rhinosinusitis ◽  
Based Medicine

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy. Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease. In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

scholarly journals Histopathologist features predictive of diagnostic concordance at expert level among a large international sample of pathologists diagnosing Barrett’s dysplasia using digital pathology

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 811-822 ◽  
Author(s):  
Myrtle J van der Wel ◽  
Helen G Coleman ◽  
Jacques J G H M Bergman ◽  
Marnix Jansen ◽  
Sybren L Meijer
Keyword(s):  
Demographic Data ◽  
Digital Pathology ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Low Grade ◽  
Evidence Based ◽  
Online Questionnaire ◽  
Case Volume ◽  
Before And After ◽  
Diagnostic Concordance

ObjectiveGuidelines mandate expert pathology review of Barrett’s oesophagus (BO) biopsies that reveal dysplasia, but there are no evidence-based standards to corroborate expert reviewer status. We investigated BO concordance rates and pathologist features predictive of diagnostic discordance.DesignPathologists (n=51) from over 20 countries assessed 55 digitised BO biopsies from across the diagnostic spectrum, before and after viewing matched p53 labelling. Extensive demographic and clinical experience data were obtained via online questionnaire. Reference diagnoses were obtained from a review panel (n=4) of experienced Barrett’s pathologists.ResultsWe recorded over 6000 case diagnoses with matched demographic data. Of 2805 H&E diagnoses, we found excellent concordance (>70%) for non-dysplastic BO and high-grade dysplasia, and intermediate concordance for low-grade dysplasia (42%) and indefinite for dysplasia (23%). Major diagnostic errors were found in 248 diagnoses (8.8%), which reduced to 232 (8.3%) after viewing p53 labelled slides. Demographic variables correlating with diagnostic proficiency were analysed in multivariate analysis, which revealed that at least 5 years of professional experience was protective against major diagnostic error for H&E slide review (OR 0.48, 95% CI 0.31 to 0.74). Working in a non-teaching hospital was associated with increased odds of major diagnostic error (OR 1.76, 95% CI 1.15 to 2.69); however, this was neutralised when pathologists viewed p53 labelled slides. Notably, neither case volume nor self-identifying as an expert predicted diagnostic proficiency. Extrapolating our data to real-world case prevalence suggests that 92.3% of major diagnostic errors are due to overinterpreting non-dysplastic BO.ConclusionOur data provide evidence-based criteria for diagnostic proficiency in Barrett’s histopathology.

Abstraction: An alternative neurocognitive account of recognition, prediction, and decision making

2020 ◽  
Vol 43 ◽  
Author(s):  
Valerie F. Reyna ◽  
David A. Broniatowski
Keyword(s):  
Decision Making ◽  
Software Engineering ◽  
Systems Engineering ◽  
Evidence Based ◽  
Extensive Literature ◽  
Trace Theory ◽  
Fuzzy Trace Theory ◽  
Abstract Representations ◽  
Technical Systems

Abstract Gilead et al. offer a thoughtful and much-needed treatment of abstraction. However, it fails to build on an extensive literature on abstraction, representational diversity, neurocognition, and psychopathology that provides important constraints and alternative evidence-based conceptions. We draw on conceptions in software engineering, socio-technical systems engineering, and a neurocognitive theory with abstract representations of gist at its core, fuzzy-trace theory.

Misophonia: An Evidence-Based Case Report

2020 ◽  
Vol 29 (4) ◽  
pp. 685-690
Author(s):  
C. S. Vanaja ◽  
Miriam Soni Abigail
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Case History ◽  
Pure Tone ◽  
Physiological Responses ◽  
Evidence Based ◽  
Management Option ◽  
Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Sign in / Sign up

Export Citation Format

Share Document