Clinical, radiologic, and morphological diagnosis of hypersensitivity pneumonitis

Aim. To study the relationship between clinical, radiologic, and morphological features in nonfibrotic and fibrotic hypersensitivity pneumonitis.Materials and methods. Clinical symptoms, data of high-resolution computed tomography, parameters of external respiration, and histological changes in the lung tissue obtained via open and transbronchial biopsies were studied retrospectively in 175 patients with hypersensitivity pneumonitis (HP). Statistical analysis was performed using the Statistica software.Results. We found that the clinical error rate in the diagnosis of HP was 84.5%, among pathologists – 92%. Among all the variants of HP, the most common was fibrotic HP. It was shown that non-necrotizing granulomas and giant cells in the cavities of the alveoli, microcells, and interalveolar septa were more typical of nonfibrotic HP. In fibrotic HP, peribronchial fibrosis, smooth muscle metaplasia in fibrotic areas, and the presence of fibroblastic foci in the walls of terminal bronchioles are signs of differential diagnosis with usual interstitial pneumonia. The classical triad of histological signs was observed in 19.2% of patients with nonfibrotic HP and in 5.6% of patients with fibrotic HP.Conclusion. Diagnosis of HP is complex and should be based on a multidisciplinary approach involving clinicians (pulmonologists), radiologists, functional diagnostics specialists, and pathologists. In this case, it is imperative to take into account and identify factors causing development of the disease, as well as the age of patients.

Traditional Interference Experiments vs. Method Comparison Interference Experiments

Two papers have appeared evaluating interferences in glucose meters. These studies are method comparisons with the added information of the medication(s) taken by the subjects. This paper contrasts a traditional interference study with the method comparison protocols. Unlike the advice in CLSI EP7, a substance that interferes should be reported even if the level of interference is clinically acceptable. The evidence of no clinically important interference in the method comparison protocol is very weak, and there is no possibility to detect statistically significant interferences. I provide an example where vitamin C at a therapeutic level was within clinical error limits, but when the concentration was at levels used to treat cancer, there was bias well above clinically acceptable limits.

Prevalance and role of Melatonin on PCOS in its treatment using Herbal Drugs

The polycystic ovarian syndrome is a convoluted endocrine disorder of the reproductive system which influences several girls with puberty and 6-8% of germinating women in endemic populations and displays a wide spectrum of clinical phenomenon. This disorder was first reported in 1935 as a synthetic clinical error for its associations with high androgen levels, hyperinsulinemia, and PCOS. The pineal hormone melatonin is known to regulate a mixture of central and peripheral actions related to circadian rhythms. It is a pleiotropic fragment, which plays a vital role in female reproduction as a capable free radical hunter and involves many gynecological and obstetrical pathology. PCOS is a compound condition for which the symptoms are irregular, and the cause is anonymous. Herbal products like Yastimadhu (Glycyrrhiza glabra), Kumari (Aloe vera), Tvaka (Cinnamomum Zeylanicum), Mostly the Ayurvedic drugs used for the PCOS, all are Vata-kapha shamaka. Neurological associated in pcos is still in the platform of research, no drugs melatonin an important modulator in pcos can be concentrated to cure pcos. Melatonin might be effective against neurological associate pcos. In ayurvedic way of treatment it can be cured with several natural drugs.

Medical malpractice related to dialysis and vascular access: An analysis of lawsuit judgements in South Korea

Background Hemodialysis is a life-saving renal replacement treatment for patients with chronic kidney disease, but various complications occur during hemodialysis and associated procedures. This study was conducted to analyze the specific characteristics of hemodialysis-related complications and malpractice that have led to legal disputes. Methods Judgments from cases litigated between 1991 and 2019 due to complications related to hemodialysis or vascular access were analyzed using the database of the Korean Supreme Court Judgment System. Results Of 32 dialysis-related litigation cases, 14 cases were dismissed and malpractice was recognized in 18 cases. Among all cases and those in which malpractice was recognized, the most common clinical complication was associated with central venous catheter (CVC) insertion (25.0% and 42.9%, respectively). In 22 of 32 (68.8%) cases, complications occurred before or after (not during) dialysis, and performance error was the most common clinical error leading to legal disputes (58.3%). Complications resulted in death in 59.4% of cases, and CVC-related complications were associated with the largest proportion (63.2%) of deaths. Conclusions Hemodialysis was implicated in various medical disputes, and CVC-related complications were the most common and serious adverse events. Clinicians’ awareness of the incidence and severity of possible complications of hemodialysis procedures should be increased.

Prototype of Augmented Reality Technology for Orthodontic Bracket Positioning: An In Vivo Study

To improve the accuracy of bracket placement in vivo, a protocol and device were introduced, which consisted of operative procedures for accurate control, a computer-aided design, and an augmented reality–assisted bracket navigation system. The present study evaluated the accuracy of this protocol. Methods: Thirty-one incisor teeth were tested from four participators. The teeth were bonded by novice and expert orthodontists. Compared with the control group by Boone gauge and the experiment group by augmented reality-assisted bracket navigation system, our study used for brackets measurement. To evaluate the accuracy, deviations of positions for bracket placement were measured. Results: The augmented reality-assisted bracket navigation system and control group were used in the same 31 cases. The priority of bonding brackets between control group or experiment group was decided by tossing coins, and then the teeth were debonded and the other technique was used. The medium vertical (incisogingival) position deviation in the control and AR groups by the novice orthodontist was 0.90 ± 0.06 mm and 0.51 ± 0.24 mm, respectively (p < 0.05), and by the expert orthodontist was 0.40 ± 0.29 mm and 0.29 ± 0.08 mm, respectively (p < 0.05). No significant changes in the horizontal position deviation were noted regardless of the orthodontist experience or use of the augmented reality–assisted bracket navigation system. Conclusion: The augmented reality–assisted bracket navigation system increased the accuracy rate by the expert orthodontist in the incisogingival direction and helped the novice orthodontist guide the bracket position within an acceptable clinical error of approximately 0.5 mm.

Total Knee Arthroplasty with CAOS Augmentation

This study sought to evaluate the efficiency, usage, and accuracy of a novel technology that augments mechanical instrumentation with intraoperative CAOS guidance. Technical reports on 411 primary TKA cases performed using the technology were reviewed. The results demonstrated high surgical efficiency (time) and resection accuracy (alignment and resection depth). Furthermore, it was observed that one fifth of the time, the surgeons placed the cutting block that deviated more than &gt;2°/mm from the ideal position in the coronal plane. Substantial adjustments were found to be required (on average ~10 °/mm per case) to correct the initial placement of the cutting block. The CAOS augmentation minimized the error in cutting block placement and assisted in achieving high accuracy in bony resections. The findings revealed the prevalence of clinical error with manual conventional bony preparation that can be addressed with efficiency and accuracy by adding CAOS augmentation to the mechanical instrumentation.

4294 Patient Matching Errors and Associated Safety Events

OBJECTIVES/GOALS: Errors in patient matching could result in serious adverse safety events. Unlike publicized mix-ups by healthcare providers these errors are insidious and with increased data sharing, this is a growing concern in healthcare. The following project will examine patient matching errors and quantify their association with safety. METHODS/STUDY POPULATION: EHR systems perform matching out-of-the-box with unknown quality. Using matching processes outside the EMR, the rate at which matching errors are present was quantified and the erroneous records were flagged providing both comparative measures and data necessary to evaluate patient safety. To understand the relationship between matching and safety we will establish a percent of voluntarily reported safety events in our institution where a matching error existed during an encounter. Any safety events occurring for a flagged patient will be reviewed to determine if matching errors contributed to the safety problem. Not all safety events are reported so we will perform full chart review of a filtered list of medical records that have a higher likelihood of safety events. RESULTS/ANTICIPATED RESULTS: We were able to quantify matching errors, and the preliminary matching error rate is approximately 1%, representing over 700 patients. The work is in progress and we are beginning to determine the association between safety events and incorrect matching. Together these results will provide an incentive to identify errors, make corrections, and develop methods to achieve these objectives. The number of matching errors impacts patient care as well as business operations and is likely to have a negative financial impact on institutions with high error rates regardless of its relationship to safety. DISCUSSION/SIGNIFICANCE OF IMPACT: Patient matching is bundled with EHR software and institutions have little control over error rates, yet bear the liability for resulting clinical error. Institutions need to be able to identify undetected matching errors and any associated safety events and this project will provide that solution.