scholarly journals A comprehensive framework to estimate the frequency, duration and risk factors for diagnostic delays using simulation-based methods

2021 ◽  
Author(s):  
Aaron C Miller ◽  
Joseph E Cavanaugh ◽  
Alan T Arakkal ◽  
Scott H Koeneman ◽  
Philip M Polgreen
Keyword(s):  
Risk Factors ◽  
Signs And Symptoms ◽  
Data Sources ◽  
Simulation Algorithm ◽  
Healthcare Settings ◽  
Simulation Based ◽  
Data Generating Process ◽  
Missed Diagnostic Opportunities ◽  
Comprehensive Framework ◽  
Diagnostic Delays

The incidence of diagnostic delays is unknown for many diseases and particular healthcare settings. Many existing methods to identify diagnostic delays are resource intensive or inapplicable to various diseases or settings. In this paper we propose a comprehensive framework to estimate the frequency of missed diagnostic opportunities for a given disease using real-world longitudinal data sources. We start by providing a conceptual model of the disease-diagnostic, data-generating process. We then propose a simulation-based method to estimate measures of the frequency of missed diagnostic opportunities and duration of delays. This approach is specifically designed to identify missed diagnostic opportunities based on signs and symptoms that occur prior to an initial diagnosis, while accounting for expected patterns of healthcare that may appear as coincidental symptoms. Three different simulation algorithms are described for implementing this approach. We summarize estimation procedures that may be used to parameterize the simulation. Finally, we apply our approach to the diseases of tuberculosis, acute myocardial infarction, and stroke and evaluate the estimated frequency and duration of diagnostic delays for these diseases. Our approach can be customized to fit a range of disease and we summarize how the choice of simulation algorithm may impact the resulting estimates.

scholarly journals Incidence, duration and risk factors associated with missed opportunities to diagnose herpes simplex encephalitis: A population-based longitudinal study

2021 ◽  
Author(s):  
Aaron C Miller ◽  
Scott Koeneman ◽  
Alan T Arakkal ◽  
Joseph E Cavanaugh ◽  
Philip M Polgreen
Keyword(s):  
Risk Factors ◽  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Population Based ◽  
Missed Opportunities ◽  
Potential Risk Factors ◽  
Number Of Visits ◽  
Using Data ◽  
Missed Diagnostic Opportunities ◽  
Diagnostic Delays

Abstract Background Delays in diagnosing herpes simplex encephalitis (HSE) are associated with increased morbidity and mortality. The purpose of this paper is to determine the frequency and duration of diagnostic delays for HSE and risk factors for diagnostic delays. Methods Using data from the IBM Marketscan Databases, 2001-2017, we performed a retrospective cohort study of patients with HSE. We estimated the number of visits with HSE-related symptoms prior to diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern of visits. Next, we used a simulation-based approach to compute the number of visits representing a delay, the number of missed diagnostic opportunities per case patient and the duration of delays. We also investigated potential risk factors for delays. Results We identified 2667 patients diagnosed with HSE. We estimated 45.9% (95% CI 43.6%-48.1%) of patients experienced at least one missed opportunity; 21.9% (95% CI 17.3%-26.3%) of these patients had delays lasting >7 days. Risk factors for delays included being seen only in the emergency department, age < 65, a history of sinusitis or schizophrenia. Conclusions Many patients with HSE experience multiple missed diagnostic opportunities prior to diagnosis.

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

Unscattering the burden of disease landscape: supporting interaction between existing burden of disease efforts

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Haagsma ◽  
M Majdan ◽  
S M Pires ◽  
R Assunção
Keyword(s):  
Risk Factors ◽  
Infectious Diseases ◽  
Burden Of Disease ◽  
Methodological Approach ◽  
Data Sources ◽  
Global Burden ◽  
Disease Network ◽  
Non Communicable Diseases ◽  
Cost Action ◽  
The Eu

Abstract The burden of disease landscape in Europe is currently scattered with experts from diverse professional backgrounds, ranging from experts in infectious diseases, non-communicable diseases, injuries and risk factors, to experts in more comprehensive national, regional and global burden of disease studies. Currently there is little interaction between these experts and existing burden of disease efforts. The European burden of disease network (burden-eu) COST Action aims to bring together expertise across different domains and professional backgrounds. During the course of the burden-eu COST Action, several steps will be taken to facilitate interaction between existing burden of disease efforts. First, a survey has been sent around to all members of the EU burden of disease network to map burden of disease studies that have been carried out in their country. Apart from general details about the year of the study and cause of disease categories, items of the survey included data sources, methodological approach and collaborations with institutes of other countries. In the first month, the survey has been completed for over 70 studies that have been carried out in twelve countries. Second, comparison of existing burden of disease initiatives allows for the identification of the various domains for which burden of disease has been assessed, highlight methodological differences as well as similarities, and facilitate improvements and harmonization of methods and approaches. Furthermore, the data collected from the survey will be included in a continuously updated burden of disease database that lists all past and current burden of disease activities. Lastly, burden-eu will facilitate regular meetings and workshops. Each of these steps will make it possible to move beyond the currently scattered burden of disease landscape and increase interaction between professionals and burden of disease efforts.

scholarly journals Risk factors for antibiotic resistance development in healthcare settings in China: A systematic review

2021 ◽  
pp. 1-30
Author(s):  
Qi Chen ◽  
Duguang Li ◽  
Claudia Beiersmann ◽  
Florian Neuhann ◽  
Babak Moazen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antibiotic Resistance ◽  
Resistance Development ◽  
Healthcare Settings

scholarly journals The mortal cause of sudden ECG changes in patients with chronic aortic insufficiency: Aortic dissection

2019 ◽  
Vol 11 (1) ◽  
pp. 68-70
Author(s):  
Mahmut Yesin ◽  
Turgut Karabağ ◽  
Macit Kalçık ◽  
Süleyman Karakoyun ◽  
Metin Çağdaş ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Signs And Symptoms ◽  
Aortic Insufficiency ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
High Index Of Suspicion

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

Fatigue: Has It Affected Your Compassion?

2017 ◽  
Vol 36 (5) ◽  
pp. 289-293
Author(s):  
Bobbi S. Greiner ◽  
Gail A. Poskey
Keyword(s):  
Risk Factors ◽  
Compassion Fatigue ◽  
Work Productivity ◽  
Signs And Symptoms ◽  
Poor Quality ◽  
Job Dissatisfaction ◽  
Job Turnover ◽  
Additional Stress ◽  
Increased Risk

AbstractCompassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment.

scholarly journals Vocal signs and symptoms related to COVID-19 and risk factors for their persistence

2021 ◽  
Author(s):  
Ana Paula Dassie-Leite ◽  
Tatiane Prestes Gueths ◽  
Vanessa Veis Ribeiro ◽  
Eliane Cristina Pereira ◽  
Perla do Nascimento Martins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Signs And Symptoms

Abstract TP199: Stroke Awareness in Argentina, the Sifhon Population Survey

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Daiana E Dossi ◽  
Maximiliano A Hawkes ◽  
Mauricio F Farez ◽  
Maia M Gomez Schneider ◽  
Nicolas A Torres ◽  
...  
Keyword(s):  
Risk Factors ◽  
Distribution System ◽  
Population Survey ◽  
Large Population ◽  
Family Doctor ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Warning Signs ◽  
Public Media ◽  
Stroke Awareness

Introduction: Stroke awareness in Latin America is scant. We conducted a large population survey in 13 provinces in Argentina to assess knowledge of cerebrovascular disease. Methods: We distributed 110,000 multiple-choice anonymous questionnaires using the house distribution system of a bottled water dispensing company, assessing information regards age, gender, educational level, general stroke information, attitude towards symptoms and treatment. Percentages of each choice were recorded for every question and a multivariate analysis was performed. Results: A total of 12,710 surveys were returned, age 51±17 years, 69% women. Almost 95% reported prior knowledge of the disease, 50% through public media, 37% through a relative/friend that had a stroke and 8% through their family doctor. The Spanish acronym for accidente cerebrovascular , ACV, was the most frequently identified name for stroke (79%), the Spanish equivalent to cerebral attack was used by 7% and 0,4% used the term “ictus”. Only 29% knew about TIA but 69% identified stroke risk factors. Although 73% recognized their signs and symptoms, 11% misinterpreted them as a heart attack and 34% ignored that stroke can present with severe headache. Although 73% considered the disease potentially disabling/fatal, 40% ignored its frequency. If symptoms, 25% would call 911 and 50% would go to an emergency room by own means. Only 63% knew the existence of a specific treatment. Lowest degree of knowledge was seen in young, single, non-university men. Conclusion: This study represents the largest general public stroke awareness survey in Spanish speaking populations. Respondents showed excellent recognition of risk factors, warning signs and need of a rapid response. The population had little knowledge of prevalence, severity, TIA, and acute treatment. Public media appear to have an essential role in education.

scholarly journals Audit of the management of patients at high risk of carbapenemase-producing enterobacteriaceae (CPE): Are we ready?

2017 ◽  
Vol 18 (6) ◽  
pp. 296-300 ◽  
Author(s):  
Lasantha Ratnayake ◽  
Amy Harris ◽  
Doreen Ko ◽  
Linda Hawtin
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
High Risk ◽  
Individual Risk ◽  
Risk Status ◽  
Healthcare Settings ◽  
The Uk ◽  
Individual Risk Factors ◽  
Routine Assessment ◽  
Relevant Section

Background: Incidence of carbapenemase-producing enterobacteriaceae (CPE) in the UK is increasing. In 2013, Public Health England (PHE) published a toolkit to control spread of CPE within healthcare settings. Aim: To assess compliance to hospital CPE policy (adapted from PHE) in the identification, isolation and screening of suspected CPE patients. Methods: Admission booklets of 150 patients were evaluated to see whether the relevant section had been completed to identify high-risk CPE patients. Where necessary, patients were interviewed or their GPs were contacted to assess their CPE risk. Additionally, 28 patients screened for CPE were audited to assess compliance to screening and isolation. Findings: Only 23 patients out of 147 (15.6%) were risk assessed on admission. Risk status of 27 (18.4%) patients could not be assessed due to lack of data. Fifteen patients out of 28 (54%) screened for CPE were identified and isolated on admission. Ten out of 19 patients (53%) had three screens 48 h apart. Discussion: This audit highlights difficulties in screening based on individual risk factors as the majority of patients were not screened on admission and documentation on isolation and screening was poor. More needs to be done to raise awareness of the requirements for routine assessment, isolation and screening.

Comparison of Stopping Modes for Pod-Driven Ships by Simulation Based on Model Testing

2005 ◽  
Vol 219 (2) ◽  
pp. 47-64 ◽  
Author(s):  
M D Woodward ◽  
M Atlar ◽  
D Clarke
Keyword(s):  
Load Condition ◽  
Open Water ◽  
Water Model ◽  
Simulation Algorithm ◽  
Time Domain Simulation ◽  
Dynamic Effects ◽  
Study Results ◽  
Simulation Based ◽  
Fluid Damping

Conventionally, the stopping of a ship is achieved by direct reversal of propeller rotation. However, the introduction of azimuthing pods presents other options. The following study examines the various modes that may be employed to stop a pod-driven ship. A continuous function is derived describing the hydrodynamic forces on both the propeller and the pod body for any load condition and helm angle, including fluid damping and added mass effects. The proposed function is validated through comparison with comprehensive open water model tests. Next, a time domain simulation algorithm is proposed to examine the dynamic effects including the mass inertia on both the propeller shaft and slewing stock. Finally, a simulation study for the proposed stopping modes is performed using a known design as a case study. Results and discussion are presented.

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