Comparing Methods to Measure Error in Gynecologic Cytology and Surgical Pathology

2006 ◽  
Vol 130 (5) ◽  
pp. 626-629 ◽  
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Clinical Practice ◽  
Error Detection ◽  
Gold Standard ◽  
Diagnostic Error ◽  
Error Rates ◽  
Surgical Pathology ◽  
Measuring Error ◽  
Review Of The Literature ◽  
Actual Clinical Practice ◽  
Measure Error

Abstract Context.—Both gynecologic cytology and surgical pathology use similar methods to measure diagnostic error, but differences exist between how these methods have been applied in the 2 fields. Objective.—To compare the application of methods of error detection in gynecologic cytology and surgical pathology. Data Sources.—Review of the literature. Conclusions.—There are several different approaches to measuring error, all of which have limitations. Measuring error using reproducibility as the gold standard is a common method to determine error. While error rates in gynecologic cytology are well characterized and methods for objectively assessing error in the legal setting have been developed, meaningful methods to measure error rates in clinical practice are not commonly used and little is known about the error rates in this setting. In contrast, in surgical pathology the error rates are not as well characterized and methods for assessing error in the legal setting are not as well defined, but methods to measure error in actual clinical practice have been characterized and preliminary data from these methods are now available concerning the error rates in this setting.

Modern imagine methods in diagnostics of acute pancreatitis in clinical practice

2020 ◽  
pp. 14-25
Author(s):  
G. R. Ahunova ◽  
R. R. Ahunova
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Practice ◽  
Mortality Rate ◽  
High Mortality ◽  
Surgical Pathology ◽  
Diagnostic Radiology ◽  
Common Disease ◽  
Review Of The Literature ◽  
Abdominal Organs ◽  
Comprehensive Examination

Acute pancreatitis is one of the most frequent and formidable diseases, and rates as one of the most common disease in the structure of acute surgical pathology of the abdominal organs. In the last decade, there has been an increase in the proportion of necrotic forms of the disease with damage to various departments of the retroperitoneal space and a stably high mortality rate. The diagnostics problem of acute pancreatitis is still relevant due to difficulties that persist despite the possibility of a comprehensive examination of patients upon admission to the hospital and during treatment. This article presents a review of the literature, reflecting the state of the problem and aspects of diagnostic radiology of acute pancreatitis.

Detecting diagnostic error in psychiatry

Diagnosis ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 75-78 ◽  
Author(s):  
James Phillips
Keyword(s):  
Error Detection ◽  
Gold Standard ◽  
Laboratory Tests ◽  
General Medicine ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Psychiatric Diagnoses ◽  
Tissue Analysis ◽  
Laboratory Findings ◽  
Diagnostic Categories

AbstractThe question of diagnostic error in psychiatry involves two intertwined issues, diagnosis and error detection. You cannot detect diagnostic error unless you have a reliable, valid method of making diagnoses. Since the diagnostic process is less certain in psychiatry than in general medicine, that will make the detection of error less confidant. Psychiatric diagnostic categories are developed without laboratory tests and other biomarkers. These limitations dramatically weaken the validity of psychiatric diagnoses and render error detection an uncertain undertaking, with go gold standard such as laboratory findings and tissue analysis, as in most of general medicine. With these limitations in mind, I review the methods that are available for error detection in psychiatry.

Interpretation of Skin Biopsies by General Pathologists: Diagnostic Discrepancy Rate Measured by Blinded Review

2003 ◽  
Vol 127 (11) ◽  
pp. 1489-1492 ◽  
Author(s):  
Martin J. Trotter ◽  
Andrea K. Bruecks
Keyword(s):  
Primary Care ◽  
Error Detection ◽  
Primary Care Physicians ◽  
False Negative ◽  
Diagnostic Error ◽  
Surgical Pathology ◽  
Total Quality ◽  
Improvement Program ◽  
Discrepancy Rate ◽  
Skin Biopsies

Abstract Context.—Slide review has been advocated as a means to reduce diagnostic error in surgical pathology and is considered an important component of a total quality assurance program. Blinded review is an unbiased method of error detection, and this approach may be used to determine the diagnostic discrepancy rates in surgical pathology. Objective.—To determine the diagnostic discrepancy rate for skin biopsies reported by general pathologists. Design.—Five hundred eighty-nine biopsies from 500 consecutive cases submitted by primary care physicians and reported by general pathologists were examined by rapid-screen, blinded review by 2 dermatopathologists, and the original diagnosis was compared with the review interpretation. Results.—Agreement was observed in 551 (93.5%) of 589 biopsies. Blinded review of these skin biopsies by experienced dermatopathologists had a sensitivity of 100% (all lesions originally reported were detected during review). False-negative errors were the most common discrepancy, but false positives, threshold discrepancies, and differences in type or grade were also observed. Only 1.4% of biopsies had discrepancies that were of potential clinical importance. Conclusions.—Blinded review demonstrates that general pathologists reporting skin biopsies submitted by primary care physicians have a low diagnostic error rate. The method detects both false-negative and false-positive cases and identifies problematic areas that may be targeted in continuing education activities. Blinded review is a useful component of a dermatopathology quality improvement program.

Pathologists can get it right the first time

2020 ◽  
pp. jclinpath-2020-206991
Author(s):  
Murali Varma ◽  
W Glenn McCluggage ◽  
Varsha Shah ◽  
Daniel M Berney
Keyword(s):  
Error Detection ◽  
Good Practice ◽  
Diagnostic Error ◽  
Error Rates ◽  
Diagnostic Confidence ◽  
Team Meetings ◽  
Process And Outcome ◽  
First Time ◽  
Multidisciplinary Team Meetings ◽  
Difficult Cases

It is established good practice for histopathologists to obtain a second opinion in difficult cases. However, it is becoming more common for histology material to be reviewed either at the time of reporting (double-reporting) or as part of the preparation for multidisciplinary team meetings. Routine histological review does not provide ‘value for money’ and could even increase the risk of diagnostic error. The focus should be on error prevention as opposed to error detection. If pathologists get it right the first time, then there would be less need for ‘double checking’. Increased subspecialisation could increase diagnostic confidence and reduce error rates. Double-reporting and retrospective review should be limited to selected cases. We describe a protocol for clearly recording the process and outcome of such reviews.

Pediatric Surgical Pathology: Pitfalls and Strategies for Error Prevention

2006 ◽  
Vol 130 (5) ◽  
pp. 610-612
Author(s):  
Cheryl M. Coffin
Keyword(s):  
Quality Assurance ◽  
Error Detection ◽  
Hirschsprung Disease ◽  
Diagnostic Error ◽  
Surgical Pathology ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Quality Aspects ◽  
Few Data ◽  
Diagnostic Pitfalls

Abstract Context.—Few data exist regarding quality measures for pediatric surgical pathology, types of errors, or how error-prone situations and diagnostic pitfalls can be minimized. Objective.—This review reports on survey findings regarding methodology for quality assurance and error detection measurement and classification in pediatric surgical pathology. It presents information regarding, and quality aspects of, intraoperative consultations in pediatric surgical pathology. General strategies for identifying diagnostic pitfalls in pediatric surgical pathology are briefly discussed. Data Sources.—A survey of children's hospitals based on a survey created by the Association of Directors of Anatomic and Surgical Pathology, literature review, and institutional quality assurance records provided information for this review. Conclusions.—Approaches to quality assurance and error reduction in pediatric surgical pathology are similar to those used in general surgical pathology. The children's hospitals that were surveyed used a variety of standard quality assurance measures. Because of differences in data collection, classification, and reporting, it is not possible to provide a detailed analysis of the types of diagnostic error across institutions at this time. Intraoperative consultations are a potential source of error. Pediatric neoplasms and Hirschsprung disease account for the majority of intraoperative consultations in the pediatric setting. Further considerations include the unique aspects of pediatric medical and neoplastic disorders and special diagnostic criteria, classification, grading, and staging requirements.

METHODS FOR SIMULATION OF ACUTE BRAIN ISCHEMIA: PATHOPHYSIOLOGICAL SUBSTANTIATION OF SELECTION AND IMPORTANCE FOR CLINICAL PRACTICE

2019 ◽  
pp. 142-152
Author(s):  
Б.И. Гельцер ◽  
Э.В. Слабенко ◽  
Ю.В. Заяц ◽  
В.Н. Котельников
Keyword(s):  
Clinical Practice ◽  
Experimental Studies ◽  
Cerebrovascular Diseases ◽  
Experimental Models ◽  
Pathological Process ◽  
Ischemic Brain ◽  
Actual Clinical Practice ◽  
Acute Cerebral Ischemia ◽  
Different Types ◽  
Acute Brain Ischemia

Одним из основных требований к разработке экспериментальных моделей цереброваскулярных заболеваний является их максимальная приближенность к реальной клинической практике. В работе систематизированы данные по основным методам моделирования острой ишемии головного мозга (ОИГМ), представлена их классификация, анализируются данные о преимуществах и недостатках той или иной модели. Обсуждаются результаты экспериментальных исследований по изучению патогенеза ОИГМ с использованием различных моделей (полной и неполной глобальной, локальной и мультифокальной ишемии) и способов их реализации (перевязка артерий, клипирование, коагуляция, эмболизация и др.). Особое внимание уделяется «стабильности» последствий острого нарушения мозгового кровообращения: необратимых ишемических повреждений головного мозга или обратимых с реперфузией заданной продолжительности. Отмечается, что важное значение в этих исследованиях должно принадлежать современным методам прижизненной визуализации очагов острого ишемического повреждения, что позволяет оценивать динамику патологического процесса. Предлагаемый метод отвечает требованиям гуманного обращения с животными. Подчеркивается, что выбор релевантной модели ОИГМ определяется задачами предстоящего исследования и технологическими ресурсами научной лаборатории. Development of experimental models for acute forms of cerebrovascular diseases is essential for implementation of methods for their prevention and treatment. One of the principal requirements to such models is their maximum approximation to actual clinical practice. This review systematized major models of acute cerebral ischemia (ACI), their classification, and presented information about their advantages and shortcomings. Also, the review presented results of experimental studies on pathophysiological mechanisms of different types of modeled ACI (complete and incomplete global, local, and multifocal ischemia) and methods for creating these models (arterial ligation, clipping, coagulation, embolization, etc.). Particular attention was paid to “stability” of the consequences of acutely impaired cerebral circulation - an irreversible ischemic brain injury or a reversible injury with reperfusion of a given duration. The authors emphasized that in such studies, a special significance should be given to intravital imaging of acute ischemic damage foci using modern methods, which allow assessing the dynamics of the pathological process and meet the requirements to humane treatment of animals. The choice of a relevant ACI model is determined by objectives of the planned study and the technological resources available at the research laboratory.

scholarly journals Filter lifetimes of different hemodiafiltration membrane materials in dogs: reevaluation of the optimal anticoagulant dosage

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroko Yuzawa ◽  
Yousuke Hirose ◽  
Tomonori Kimura ◽  
Keisuke Shinozaki ◽  
Moe Oguchi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Activated Partial Thromboplastin Time ◽  
Target Range ◽  
Membrane Material ◽  
Actual Clinical Practice ◽  
Membrane Materials ◽  
Filter Membrane ◽  
Hemorrhagic Complications ◽  
Materials Used ◽  
Nafamostat Mesylate

Abstract Background In continuous renal replacement therapy (CRRT), administration of anticoagulants is necessary for achieving a certain level of filter lifetime. Generally, anticoagulant doses are controlled to keep activated partial thromboplastin time and other indicators within a certain target range, regardless of the membrane materials used for the filter. However, in actual clinical practice, the filter lifetime varies significantly depending on the membrane material used. The objective of this study was to demonstrate that the minimum anticoagulant dose necessary for prolonging the filter lifetime while reducing the risk of hemorrhagic complications varies depending on the type of membrane. Methods In three beagles, hemodiafiltration was performed with hemofilters using polysulfone (PS), polymethylmethacrylate (PMMA), and AN69ST membranes separately. The minimum dose of nafamostat mesylate (NM) that would allow for 6 h of hemodiafiltration (required dose) was investigated for each membrane material. Results The NM doses required for 6 h of hemodiafiltration were 2 mg/kg/h for the PS membrane, 6 mg/kg/h for the PMMA membrane, and 6 mg/kg/h for the AN69ST membrane. Conclusion For hemodiafiltration performed in beagles, the required NM dose varied for each filter membrane material. Using the optimal anticoagulant dose for each membrane material would allow for safer CRRT performance.

scholarly journals Prevention and management of major complications in percutaneous endoscopic gastrostomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000628
Author(s):  
Kurt Boeykens ◽  
Ivo Duysburgh
Keyword(s):  
Clinical Practice ◽  
Abdominal Wall ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Early Recognition ◽  
Endoscopic Technique ◽  
Abdominal Wound ◽  
Review Of The Literature ◽  
Endoscopic Gastrostomy ◽  
Major Complications ◽  
Life Threatening

BackgroundPercutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only few major complications. Nevertheless these complicationscan be sometimes life-threatening or generate serious morbidity.MethodAnarrative review of the literature of major complications in percutaneousendoscopic gastrostomy.ResultsThis review was written from a clinical viewpoint focussing on prevention andmanagement of major complications and documentedscientific evidence with real cases from more than 20 years of clinical practice.ConclusionsMajorcomplications are rare but prevention, early recognition and popper management areimportant.

scholarly journals Exponential suppression of bit or phase errors with cyclic error correction

Nature ◽  
2021 ◽  
Vol 595 (7867) ◽  
pp. 383-387
Author(s):  
◽  
Zijun Chen ◽  
Kevin J. Satzinger ◽  
Juan Atalaya ◽  
Alexander N. Korotkov ◽  
...  
Keyword(s):  
Error Correction ◽  
Error Detection ◽  
Fault Tolerant ◽  
Error Rates ◽  
Quantum Error Correction ◽  
Superconducting Qubits ◽  
Two Dimensional ◽  
Logical Error ◽  
Quantum Error ◽  
Logical Qubit

AbstractRealizing the potential of quantum computing requires sufficiently low logical error rates1. Many applications call for error rates as low as 10−15 (refs. 2–9), but state-of-the-art quantum platforms typically have physical error rates near 10−3 (refs. 10–14). Quantum error correction15–17 promises to bridge this divide by distributing quantum logical information across many physical qubits in such a way that errors can be detected and corrected. Errors on the encoded logical qubit state can be exponentially suppressed as the number of physical qubits grows, provided that the physical error rates are below a certain threshold and stable over the course of a computation. Here we implement one-dimensional repetition codes embedded in a two-dimensional grid of superconducting qubits that demonstrate exponential suppression of bit-flip or phase-flip errors, reducing logical error per round more than 100-fold when increasing the number of qubits from 5 to 21. Crucially, this error suppression is stable over 50 rounds of error correction. We also introduce a method for analysing error correlations with high precision, allowing us to characterize error locality while performing quantum error correction. Finally, we perform error detection with a small logical qubit using the 2D surface code on the same device18,19 and show that the results from both one- and two-dimensional codes agree with numerical simulations that use a simple depolarizing error model. These experimental demonstrations provide a foundation for building a scalable fault-tolerant quantum computer with superconducting qubits.

scholarly journals New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature

2020 ◽  
Vol 22 (1) ◽  
pp. 43
Author(s):  
Irina Lousa ◽  
Flávio Reis ◽  
Idalina Beirão ◽  
Rui Alves ◽  
Luís Belo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Renal Damage ◽  
Recent Literature ◽  
Therapeutic Interventions ◽  
Review Of The Literature ◽  
Medical Need ◽  
Early Use ◽  
Reasonable Approach

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and the mortality rate continues to be unacceptably high. The biomarkers currently used in clinical practice are considered relevant when there is already significant renal impairment compromising the early use of potentially successful therapeutic interventions. More sensitive and specific biomarkers to detect CKD earlier on and improve patients’ prognoses are an important unmet medical need. The aim of this review is to summarize the recent literature on new promising early CKD biomarkers of renal function, tubular lesions, endothelial dysfunction and inflammation, and on the auspicious findings from metabolomic studies in this field. Most of the studied biomarkers require further validation in large studies and in a broad range of populations in order to be implemented into routine CKD management. A panel of biomarkers, including earlier biomarkers of renal damage, seems to be a reasonable approach to be applied in clinical practice to allow earlier diagnosis and better disease characterization based on the underlying etiologic process.

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