scholarly journals Tuberculosis Unseen - Missed Opportunities in Diagnosis

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Aaron C. Miller ◽  
Linnea A. Polgreen ◽  
Philip M. Polgreen
Keyword(s):  
Emergency Department ◽  
Correct Diagnosis ◽  
The State ◽  
Missed Opportunities ◽  
Respiratory Illnesses ◽  
Tuberculosis Patients ◽  
Tuberculosis Diagnosis ◽  
To Receive

This study estimates the number of tuberculosis cases that are potentially misdiagnosed as alternative respiratory illnesses in months prior to receiving a correct diagnosis. Inpatient and emergency department records in the state of California, from 2005 to 2011, were analyzed for patients that had an initial tuberculosis diagnosis along with a previous recorded visit. Tuberculosis patients were far more likely to receive a respiratory diagnosis in a window 5 to 90 days prior to their initial tuberculosis diagnosis than were uninfected patients. Findings suggest that more than 20% of tuberculosis cases are potentially missed in inpatient and emergency department settings.

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

Diagnosis ◽  
2015 ◽  
Vol 2 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Ernest Moy ◽  
Marguerite Barrett ◽  
Rosanna Coffey ◽  
Anika L. Hines ◽  
David E. Newman-Toker
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Missed Opportunities ◽  
Admission Rates ◽  
Populations At Risk ◽  
Occupancy Rates ◽  
Missed Diagnoses

Abstract: An estimated 1.2 million people in the US have an acute myocardial infarction (AMI) each year. An estimated 7% of AMI hospitalizations result in death. Most patients experiencing acute coronary symptoms, such as unstable angina, visit an emergency department (ED). Some patients hospitalized with AMI after a treat-and-release ED visit likely represent missed opportunities for correct diagnosis and treatment. The purpose of the present study is to estimate the frequency of missed AMI or its precursors in the ED by examining use of EDs prior to hospitalization for AMI.: We estimated the rate of probable missed diagnoses in EDs in the week before hospitalization for AMI and examined associated factors. We used Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for 2007 to evaluate missed diagnoses in 111,973 admitted patients aged 18 years and older.: We identified missed diagnoses in the ED for 993 of 112,000 patients (0.9% of all AMI admissions). These patients had visited an ED with chest pain or cardiac conditions, were released, and were subsequently admitted for AMI within 7 days. Higher odds of having missed diagnoses were associated with being younger and of Black race. Hospital teaching status, availability of cardiac catheterization, high ED admission rates, high inpatient occupancy rates, and urban location were associated with lower odds of missed diagnoses.: Administrative data provide robust information that may help EDs identify populations at risk of experiencing a missed diagnosis, address disparities, and reduce diagnostic errors.

Minimizing Missed Opportunities: Modeling Relationships between the State and Business in Russia

2009 ◽  
pp. 42-61
Author(s):  
A. Oleynik
Keyword(s):  
Decision Making ◽  
Empirical Evidence ◽  
Common Good ◽  
The State ◽  
Power Relationships ◽  
Individual Decision ◽  
Missed Opportunities ◽  
Power Domination ◽  
Individual Decision Making ◽  
Optimal Outcomes

Power involves a number of models of choice: maximizing, satisficing, coercion, and minimizing missed opportunities. The latter is explored in detail and linked to a particular type of power, domination by virtue of a constellation of interests. It is shown that domination by virtue of a constellation of interests calls for justification through references to a common good, i.e. a rent to be shared between Principal and Agent. Two sources of sub-optimal outcomes are compared: individual decision-making and interactions. Interactions organized in the form of power relationships lead to sub-optimal outcomes for at least one side, Agent. Some empirical evidence from Russia is provided for illustrative purposes.

PERSINGGUNGAN KEWENANGAN MENGADILI PENYALAHGUNAAN DISKRESI ANTARA PENGADILAN TUN DAN PENGADILAN TIPIKOR / INTERCEPTION OF JUSTICE AUTHORITY OF DISCRETION ABUSE BETWEEN ADMINISTRATION COURT AND CORRUPTION COURTS

2018 ◽  
Vol 7 (2) ◽  
pp. 213
Author(s):  
Budi Suhariyanto
Keyword(s):  
Supreme Court ◽  
Criminal Law ◽  
Administrative Law ◽  
The State ◽  
Government Officials ◽  
Criminal Process ◽  
The Supreme Court ◽  
State Finance ◽  
The Law ◽  
To Receive

Diskresi sebagai wewenang bebas, keberadaannya rentan akan disalahgunakan. Penyalahgunaan diskresi yang berimplikasi merugikan keuangan negara dapat dituntutkan pertanggungjawabannya secara hukum administrasi maupun hukum pidana. Mengingat selama ini peraturan perundang-undangan tentang pemberantasan tindak pidana korupsi tidak merumuskan secara rinci yang dimaksudkan unsur menyalahgunakan kewenangan maka para hakim menggunakan konsep penyalahgunaan wewenang dari hukum administrasi. Problema muncul saat diberlakukannya Undang-Undang Nomor 30 Tahun 2014 dimana telah memicu persinggungan dalam hal kewenangan mengadili penyalahgunaan wewenang (termasuk diskresi) antara Pengadilan Tata Usaha Negara dengan Pengadilan Tindak Pidana Korupsi. Pada perkembangannya, persinggungan kewenangan mengadili tersebut ditegaskan oleh Peraturan Mahkamah Agung Nomor 4 Tahun 2015 bahwa PTUN berwenang menerima, memeriksa, dan memutus permohonan penilaian ada atau tidak ada penyalahgunaan wewenang (termasuk diskresi) dalam Keputusan dan/atau Tindakan Pejabat Pemerintahan sebelum adanya proses pidana. Sehubungan tidak dijelaskan tentang definisi dan batasan proses pidana yang dimaksud, maka timbul penafsiran yang berbeda. Perlu diadakan kesepakatan bersama dan dituangkan dalam regulasi tentang tapal batas persinggungan yang jelas tanpa meniadakan kewenangan pengujian penyalahgunaan wewenang diskresi pada Pengadilan TUN.Discretion as free authority is vulnerable to being misused. The abuse of discretion implicating the state finance may be prosecuted by both administrative and criminal law. In view of the fact that the law on corruption eradication does not formulate in detail the intended element of authority abuse, the judges use the concept of authority abuse from administrative law. Problems arise when the enactment of Law No. 30 of 2014 triggered an interception in terms of justice/ adjudicate authority on authority abuse (including discretion) between the Administrative Court and Corruption Court. In its development, the interception of justice authority is affirmed by Regulation of the Supreme Court Number 4 of 2015 that the Administrative Court has the authority to receive, examine and decide upon the appeal there is or there is no misuse of authority in the Decision and / or Action of Government Officials prior to the criminal process. That is, shortly before the commencement of the criminal process then that's when the authority of PTUN decides to judge the misuse of authority over the case. In this context, Perma No. 4 of 2015 has imposed restrictions on the authority of the TUN Court in prosecuting the abuse of discretionary authority.

scholarly journals “Crazy Jack” and the “Gay CEO”: Visions, Entrepreneurship, and the Chinese State in the New Digital Economy

2021 ◽  
Vol 50 (1) ◽  
pp. 63-85
Author(s):  
Marina Svensson
Keyword(s):  
Social Relations ◽  
Personal Narratives ◽  
Digital Economy ◽  
The State ◽  
Business Leader ◽  
Online Spaces ◽  
Chinese State ◽  
To Receive

This article analyses the visions, careers, and companies of Jack Ma of Alibaba and Geng Le of Blue City. Jack Ma is a well-known business leader and visionary, whereas the less well-known Geng Le only began to receive more attention since launching a successful gay dating app in 2012. The article focuses on the personal narratives and visions of these two IT entrepreneurs. It provides new perspectives on the role of individual entrepreneurs in relation to the Chinese state’s global ambitions and vision of creating a “strong internet country.” It argues that the commercialisation and platformisation of the Chinese internet, and the growing transnational nature of Chinese IT companies, serve to make them more, not less, co-dependent of the state and its visions. The internet’s emancipatory potential is today increasingly conflated with consumption, and online spaces and social relations are subject to both commodification and datafication.

Child Life Reduces Distress and Pain and Improves Family Satisfaction in the Pediatric Emergency Department

2018 ◽  
Vol 57 (13) ◽  
pp. 1567-1575 ◽  
Author(s):  
Natasha Sanchez Cristal ◽  
Jennifer Staab ◽  
Rachel Chatham ◽  
Sarah Ryan ◽  
Brian Mcnair ◽  
...  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Pediatric Trauma ◽  
Family Satisfaction ◽  
Pediatric Emergency ◽  
Child Life ◽  
Convenience Sample ◽  
Patient Cooperation ◽  
To Receive ◽  
Pain Rating Scale

This study evaluated the effects of Certified Child Life Specialist (CCLS) intervention on pediatric distress and pain and family satisfaction during routine peripheral intravenous (PIV) line placement in the emergency department (ED). A convenience sample of 78 children (3-13 years) requiring PIV placement for their treatment at a regional level 1 pediatric trauma center ED with 70 000 annual visits were selected to receive either standard nursing care or CCLS intervention for PIV placement. CCLS involvement was associated with fewer negative emotional behaviors as indicated by a lower score on the Children’s Emotional Manifestation Scale (−3.37 ± 1.49, P = .027), a reduction in self-reported pain on the Wong-Baker Faces pain rating scale (−1.107 ± 0.445, P = .017), an increase in parent-reported patient cooperation during PIV placement, and greater satisfaction with the ED visit. This study demonstrates that Child Life can have an impact on important outcomes in the pediatric ED such as distress, pain, and visit satisfaction.

Processing into Dominance: Nero, the Crowning of Tiridates I, and a New Narrative of Rome’s Supremacy in the East

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Timothy Clark
Keyword(s):  
The State ◽  
Royal Family ◽  
Military Conflict ◽  
Roman People ◽  
Roman Military ◽  
To Come ◽  
To Receive

Abstract In 66 CE, the emperor Nero crowned the Parthian prince Tiridates I king of Armenia before the Roman people in the Forum Romanum. Much scholarship on Roman interactions with Parthia or Armenia focuses on histories of military conflict or diplomatic negotiation. Ritual and ceremonial evidence, however, is often taken for granted. This article uses the coronation to highlight a different way in which Rome articulated its relations with Parthia and Armenia to domestic and foreign audiences. It will show how Nero and his regime used the art of public spectacle to project an image of Roman superiority over Parthia and Armenia in spite of Roman military losses in the recent Armenian war. Tiridates, a Parthian prince and a brother of the Parthian king of kings, traveled to Rome to be crowned the first king of Armenia from the Parthian royal family. To receive this title, Tiridates passed by several monuments to Augustan triumphs over Parthia and Armenia in the Forum. He was also surrounded by a group of Roman citizens, who watched him as they would have watched a defeated foreign leader in a triumph. At the culmination of the ceremony, Tiridates performed proskynesis before Nero at the rostra Augusti and was granted his crown. Through Augustus’ monuments, the collective viewing of Tiridates, and his acts of public submission and deference to Nero, the crowning intimated a new narrative about the state of Roman-Parthian/Armenian relations. While Augustus had represented Parthian and Armenian defeat in art, Nero had compelled a representative of both Parthia and Armenia to come to Rome and kneel before the emperor. Both states were now subservient to Rome, which remained the dominant power in the East.

Abstract 3097: Acute In-hospital Stroke: How Do We Do Compared To Strokes In The Emergency Department?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dolora Wisco ◽  
Christopher Newey ◽  
Pravin George ◽  
James Gebel
Keyword(s):  
Emergency Department ◽  
Time Window ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tertiary Center ◽  
Neuro Imaging ◽  
One Year ◽  
To Receive ◽  
Iv Tpa ◽  
Arterial Thrombolysis

Introduction: Intravenous tissue plasminogen activator (IV tPA) has been approved for treating strokes up to 3 hours after onset of symptoms and may be beneficial up to 4.5 hours in patients who qualify. Additionally, neuro-intervention, i.e., intra-arterial thrombolysis or thrombectomy, is also an approved treatment option. Population studies show that 6% receive IV tPA within 3 hours of stroke onset. However, in-hospital strokes present challenges to treating within an adequate time. We present here our experience with in-hospital strokes, treatments, and identifiable delays in treatments. Methods: Single, tertiary center retrospective study of 55 in-hospital strokes over a one-year period from January 2009 to January 2010, and strokes in the Emergency Department over 6 month period from January 2010 to June 2010. Results: Twenty-nine in-hospital strokes were evaluated within 3 hours of symptoms onset. Two (6.9%) received IV tPA, and four (13.8%) received neuro-intervention (either intra-arterial thrombolysis or thrombectomy). None of the patients who presented greater than 3 hours after symptom onset was treated with any treatment (n=28). When compared to patients who present to the ED within 3 hours, in-hospital strokes were less likely to get IV tPA (6.9% vs. 20.8%), and they were more likely to receive neuro-intervention (13.8% vs. 10.3%). Neuro-intervention was performed on 9.09% of all in-hospital strokes (1 of 5 presented beyond the 3 hour time window). For in-hospital strokes that receive any treatment within 3 hours, the average time to neurology evaluation, to CT, and to treatment are 35 min, 68 min, and 237 min, respectively. For strokes in the Ed, the average time to evaluation, to CT, and to treatment are 90 min, 28 min, and 66 min respectively. The delay for in-hospital strokes is in obtaining the CT and initiating the treatment. Discussion: In-hospital stroke patients wait longer than their ED counterparts to be taken to CT and to receive stroke treatment. They are also less likely to receive IV tPA, and more likely to receive neuro-intervention. The longer time to neuro-imaging and thrombolytic treatment may reflect the fact that patients suffering in-hospital strokes have more complex medical co-morbidities that must be taken account during the evaluation and administration of thrombolytic therapy.

Factors Causing Delay of Access to Tuberculosis Diagnosis Among New, Active Tuberculosis Patients

2013 ◽  
Vol 26 (1) ◽  
pp. 33-41 ◽  
Author(s):  
Wen Shu ◽  
Wei Chen ◽  
Shiyu Zhu ◽  
Yongchun Hou ◽  
Jian Mei ◽  
...  
Keyword(s):  
Active Tuberculosis ◽  
Tuberculosis Patients ◽  
Tuberculosis Diagnosis
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