scholarly journals The COVID-19 Diagnostic Dilemma: a Clinician's Perspective

2020 ◽  
Vol 58 (8) ◽  
Author(s):  
Ralph Rogers ◽  
Thomas O’Brien ◽  
Jad Aridi ◽  
Curt G. Beckwith
Keyword(s):  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Dilemma ◽  
Serologic Testing ◽  
Made In ◽  
Broad Overview

ABSTRACT In this commentary, we provide a broad overview of how the rapidly evolving coronavirus disease 2019 (COVID-19) diagnostic landscape has impacted clinical care during the COVID-19 pandemic. We review aspects of both molecular and serologic testing and discuss the logistical challenges faced with each. We also highlight the progress that has been made in the development and implementation of these assays as well as the need for ongoing improvement in diagnostic testing capabilities.

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

2011 ◽  
Vol 21 (3) ◽  
pp. 89-99
Author(s):  
Michael F. Vaezi
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Best Practice ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Tools ◽  
Swallowing Function ◽  
Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

Children’s assent within clinical care: A concept analysis

2020 ◽  
pp. 136749352097630
Author(s):  
Marjorie Montreuil ◽  
Justine Fortin ◽  
Eric Racine
Keyword(s):  
Clinical Care ◽  
Concept Analysis ◽  
Process Of Care ◽  
Deliberative Process ◽  
Ethical Implications ◽  
Rights Of The Child ◽  
Healthcare Decision Making ◽  
Psychological Harm ◽  
Practical Implications ◽  
Made In

Seeking children’s assent has been put forward as a way to foster children’s involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children’s capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children’s refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.

scholarly journals Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

2021 ◽  
pp. bmjqs-2020-011593
Author(s):  
Traber D Giardina ◽  
Saritha Korukonda ◽  
Umber Shahid ◽  
Viralkumar Vaghani ◽  
Divvy K Upadhyay ◽  
...  
Keyword(s):  
Medical Record ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Healthcare Organisation ◽  
Safety Concerns ◽  
Patient Complaints ◽  
Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

scholarly journals Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Paibul Suriyawongpaisal ◽  
Samrit Srithamrongsawad ◽  
Pongsakorn Atiksawedparit ◽  
Khanisthar Phooseemungkun ◽  
Krongkan Bunchaiyai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Patient Outcomes ◽  
Prehospital Care ◽  
Clinical Care ◽  
Mixed Methods Approach ◽  
Time Flow ◽  
Care Systems ◽  
Pay System ◽  
Made In

Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

scholarly journals Progress and Opportunities for Exsolution in Electrochemistry

Electrochem ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 32-43 ◽  
Author(s):  
Brian A. Rosen
Keyword(s):  
New Materials ◽  
Electrochemical Applications ◽  
Electrochemical Devices ◽  
Made In ◽  
Broad Overview

This perspective gives the reader a broad overview of the progress that has been made in understanding the physics of the exsolution process and its exploitation in electrochemical devices in the last five years. On the basis of this progress, the community is encouraged to pursue unreported and under-reported opportunities for the advancement of exsolution in electrochemical applications through new materials discovery.

scholarly journals Clinical approach to obscure GI bleeding - Diagnostic testing and management

2013 ◽  
Vol 04 (03) ◽  
pp. 061-070 ◽  
Author(s):  
Prashanth Prabakaran ◽  
Nalini Guda ◽  
Jacob Thomas ◽  
Charles Heise ◽  
Deepak Gopal
Keyword(s):  
Small Bowel ◽  
Diagnostic Testing ◽  
Radiographic Evaluation ◽  
Clinical Approach ◽  
Gi Bleeding ◽  
Diagnostic Dilemma ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Entire Small Bowel ◽  
Single Balloon

AbstractObscure gastrointestinal bleeding (OGIB) can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE), balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE)], and overtube-assisted deep enteroscopy (spiral enteroscopy), are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

Polyarticular disease

2016 ◽  
Author(s):  
Ade Adebajo ◽  
Lisa Dunkley
Keyword(s):  
Lupus Erythematosus ◽  
Definitive Diagnosis ◽  
Systemic Lupus ◽  
Musculoskeletal Problem ◽  
Diagnostic Dilemma ◽  
General Management ◽  
Wide Range ◽  
Seronegative Spondyloarthropathies ◽  
Polyarticular Disease ◽  
Made In

Polyarticular disease is a commonly encountered musculoskeletal problem which regularly confronts clinicians as a diagnostic dilemma. Polyarticular disease is a musculoskeletal presentation in which more than four joints are affected by the disease. The classical rheumatological condition which presents as polyarticular disease is rheumatoid arthritis, although even this condition can very occasionally present with a mono- or oligoarticular onset. Polyarticular disease includes a wide range of musculoskeletal conditions including such disorders as polyarticular gout, the seronegative spondyloarthropathies, rheumatic fever, and systemic lupus erythematosus. This chapter emphasizes how through a careful history, thorough clinical examination and appropriate investigations, a definitive diagnosis can be made in a patient presenting clinically with polyarticular disease. General management principles for patients with polyarticular disease are also provided.

scholarly journals Infectious Diseases Society of America Guidelines on the Diagnosis of Coronavirus Disease 2019 (COVID-19): Serologic Testing

2020 ◽  
Author(s):  
Kimberly E Hanson ◽  
Angela M Caliendo ◽  
Cesar A Arias ◽  
Janet A Englund ◽  
Mary K Hayden ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Best Practice ◽  
Vaccine Development ◽  
Clinical Performance ◽  
Diagnostic Testing ◽  
Molecular Diagnostic ◽  
Past Infection ◽  
Serologic Tests ◽  
Serologic Testing ◽  
Grade Methodology

Abstract Background The availability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic testing has rapidly increased. Current assays use a variety of technologies, measure different classes of immunoglobulin or immunoglobulin combinations, and detect antibodies directed against different portions of the virus. The overall accuracy of these tests, however, has not been well defined. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct best-practice guidance related to SARS-CoV-2 serologic testing. This guideline is the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. Objective IDSA’s goal was to develop evidence-based recommendations that assist clinicians, clinical laboratories, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 serologic tests in a variety of settings. We also highlight important unmet research needs pertaining to the use of anti–SARS-CoV-2 antibody tests for diagnosis, public health surveillance, vaccine development, and the selection of convalescent plasma donors. Methods A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. Results The panel agreed on 8 diagnostic recommendations. Conclusions Information on the clinical performance and utility of SARS-CoV-2 serologic tests is rapidly emerging. Based on available evidence, detection of anti–SARS-CoV-2 antibodies may be useful for confirming the presence of current or past infection in selected situations. The panel identified 3 potential indications for serologic testing, including (1) evaluation of patients with a high clinical suspicion for COVID-19 when molecular diagnostic testing is negative and ≥2 weeks have passed since symptom onset, (2) assessment of multisystem inflammatory syndrome in children, and (3) conducting serosurveillance studies. The certainty of available evidence supporting the use of serology for either diagnosis or epidemiology was, however, graded as very low to moderate. For the most updated version of these guidelines, please go to https://www.idsociety.org/covid19guidelines.

scholarly journals Use of the Optum Labs Data Warehouse To Assess Test Ordering Patterns for Diagnosis of Helicobacter pylori Infection in the United States: TABLE 1

2015 ◽  
Vol 53 (4) ◽  
pp. 1358-1360 ◽  
Author(s):  
Elitza S. Theel ◽  
Ryan D. Johnson ◽  
Elizabeth Plumhoff ◽  
Curtis A. Hanson
Keyword(s):  
Helicobacter Pylori ◽  
Diagnostic Testing ◽  
The United States ◽  
Content Type ◽  
Medical Claims ◽  
Serologic Testing ◽  
Testing Practices ◽  
H Pylori ◽  
Test Ordering ◽  
Expert Recommendations

We surveyed nationalHelicobacter pyloridiagnostic testing practices and diagnoses using commercial and Medicare medical claims data from Optum Labs (Cambridge, MA). Serologic testing for antibodies toH. pyloriremains the most commonly ordered diagnostic test despite recent expert recommendations. Changes in reimbursement for serologic testing will likely drive future provider ordering practices.

scholarly journals Rapid growth in the COVID-19 era

MRS Bulletin ◽  
2021 ◽  
Author(s):  
Yerim Lee ◽  
Michelle Ng ◽  
Kristin Daniel ◽  
Elizabeth Wayne
Keyword(s):  
World War Ii ◽  
Large Scale ◽  
Technological Development ◽  
Diagnostic Testing ◽  
Drug Repurposing ◽  
Antibody Engineering ◽  
World War ◽  
Rapid Diagnostic Testing ◽  
The Future ◽  
Broad Overview

Abstract From Operation Warp Speed to the lipid mRNA vaccine, the COVID-19 pandemic has been a watershed moment for technological development, production, and implementation. The scale and pace of innovation and global collaboration has likely not been experienced since World War II. This article highlights some of the engineering accomplishments that occurred during the pandemic. We provide a broad overview of the technological achievements in vaccine design, antibody engineering, drug repurposing, and rapid diagnostic testing. We also discuss what the future of these technologies and the future of large-scale collaborations might look like moving forward. Graphic abstract

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