Assessing data accuracy in a large multi-institutional quality improvement registry: an update from the Pediatric Cardiac Critical Care Consortium (PC4)

Background: The Pediatric Cardiac Critical Care Consortium (PC4) is a multi-institutional quality improvement registry focused on the care delivered in the cardiac ICU for patients with CHD and acquired heart disease. To assess data quality, a rigorous procedure of data auditing has been in place since the inception of the consortium. Materials and methods: This report describes the data auditing process and quantifies the audit results for the initial 39 audits that took place after the transition from version one to version two of the registry’s database. Results: In total, 2219 total encounters were audited for an average of 57 encounters per site. The overall data accuracy rate across all sites was 99.4%, with a major discrepancy rate of 0.52%. A passing score is based on an overall accuracy of >97% (achieved by all sites) and a major discrepancy rate of <1.5% (achieved by 38 of 39 sites, with 35 of 39 sites having a major discrepancy rate of <1%). Fields with the highest discrepancy rates included arrhythmia type, cardiac arrest count, and current surgical status. Conclusions: The extensive PC4 auditing process, including initial and routinely scheduled follow-up audits of every participating site, demonstrates an extremely high level of accuracy across a broad array of audited fields and supports the continued use of consortium data to identify best practices in paediatric cardiac critical care.

Cemented Bipolar Hemiarthroplasty for Fracture Neck of Femur and Unstable Intertrochanteric Fractures - Prospective and Retrospective Study

Hip fractures in elderly patients are becoming a major social problem from various perspectives, including the progressive aging of global societies. The elderly have a high risk of hip fracture, even with minor injuries because of osteoporosis, while early surgical treatment may be difficult due to comorbidities and medication. In this study, significant risk factors were identified. Patients over age 70 had three times the mortality of younger patients. Greater than three pre-existing medical conditions is associated with a 25 percent mortality rate, more than twice that of healthier patients. Surgery performed on the first day of admission and beyond the fifth day was associated with a 34 percent mortality rate. Those patients operated in during days 2 through 5 had a 5.8 percent mortality rate. There was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length, there was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length and only 1 patient had shortening of about 2 cms post operatively which was slightly better than that of James et al (11%).

Increasing university students' organizational skills during practical application of event management technologies in organizing events

Socio-cultural events are currently gaining increasing relevance and the problem of their organization is becoming urgent both for commercial companies and professionals in this sphere. Today, event management is becoming the leading technology for the organization of events and, notwithstanding the importance of the mastery of theoretical knowledge, only the practical implementation of event management technologies in event organization serves as a prerequisite for the development of organizational skills in professionals in the socio-cultural sphere. The conducted experimental work reveals a major discrepancy in the level of university students’ mastery of organizational skills in the process of theoretical and practical training and proves the effectiveness of the latter in the development of professional mastery of socio-cultural workers. The reasons underlying the development of socio-cultural workers’ organizational skills specifically in the course of practical mastery of event management technologies are identified and comprise contingency on multiple factors, the variability of the socio-cultural situation, and high competition in the market of socio-cultural services.

Overnight radiology resident discrepancies at a large pediatric hospital: categorization by year of training, program, imaging modality, and report type

Background Overnight radiology resident discrepancies have been described in multiple studies; however, study of resident discrepancies specific to pediatric radiology is limited. Purpose To examine radiology resident discrepancies as they pertain to a large pediatric hospital system. Material and Methods A total of 21,560 preliminary reports issued by 39 residents over a one-year period were scored as agreement, minor discrepancy, or major discrepancy by faculty members using a modification of the 2009 RADPEER scoring system. Residents were trainees of three different diagnostic radiology programs: large university-based, medium-sized community-based, or small community-based. Discrepancy rates were evaluated based on resident postgraduate year, program, and imaging modality. The effect of a general pediatric radiology report versus pediatric neuroradiology report of a CT scan was also tested. CT was the only modality in which there were comparable numbers of studies scored by both general pediatric radiologists and neuroradiologists. Results The rate of major resident to faculty assessment discrepancies was 1.01%, and the rate of minor resident to faculty assessment discrepancies was 4.47%. Major discrepancy rates by postgraduate years 3-5 were 1.08%, 0.75%, and 1.59%, respectively. Major discrepancy rates were highest for MR (11.22%), followed by CT (1.82%), radiographs (0.91%), and ultrasound (0.56%). There was no significant difference in discrepancy rate between residency programs and general pediatric radiology report of a CT versus pediatric neuroradiology report of a CT. Conclusion Radiology discrepancy rates for residents issuing preliminary reports at a large children’s hospital system are similar to those reported for adult procedures.

An exceptionally giant left atrial myxoma: a case report and literature review

Background Cardiac myxomas are considered the most common benign heart tumours. The clinical manifestations mainly depend on the size of the tumour. They usually vary from asymptomatic, mild non-specific symptoms, to severe obstructive cardiac and systemic findings. We describe herein a significantly large left atrial myxoma in a patient misdiagnosed with respiratory asthma. Case summary A 54-year-old lady, was diagnosed previously with asthma, presented with a history of dyspnoea on exertion, palpitations, and mild peripheral oedema. Chest X-ray suggested pulmonary congestion. Due to high suspicion of cardiac issues, transthoracic echocardiography was done revealing giant left atrial mass. Consequently, the mass was approached and excised surgically through the inverted T biatrial incision. Grossly, the mass measured 10 × 8 × 6 cm, and it had a smooth surface and was filled with gelatinous material. The histopathology confirmed benign myxoma without malignant features. Discussion Our article mainly focuses on the diagnostic challenges of a patient with atrial myxoma. The major discrepancy between the tumour size and the severity of the patient’s symptoms should draw physicians’ attention to consider atrial myxoma over a long list of differentials, in order to take immediate action to reduce the mortality and improve the overall prognosis.

Susceptibility of Elizabethkingia spp. to commonly tested and novel antibiotics and concordance between broth microdilution and automated testing methods

Objectives We aimed to determine susceptibilities of Elizabethkingia spp. to 25 commonly tested and 8 novel antibiotics, and to compare the performance of different susceptibility testing methods. Methods Clinical isolates of Elizabethkingia spp., Chryseobacterium spp. and Flavobacterium spp. collected during 2002–18 (n = 210) in a nationwide surveillance programme in Taiwan were speciated by 16S rRNA sequencing. MICs were determined by broth microdilution. The broth microdilution results of 18 common antibiotics were compared with those obtained by the VITEK 2 automated system. Results Among the Elizabethkingia spp. identified (n = 108), Elizabethkingia anophelis was the most prevalent (n = 90), followed by Elizabethkingia meningoseptica (n = 7) and Elizabethkingia miricola cluster [E. miricola (n = 6), Elizabethkingia bruuniana (n = 3) and Elizabethkingia ursingii (n = 2)]. Most isolates were recovered from respiratory or blood specimens from hospitalized, elderly patients. PFGE showed two major and several minor E. anophelis clones. All isolates were resistant to nearly all the tested β-lactams. Doxycycline, minocycline and trimethoprim/sulfamethoxazole inhibited &gt;90% of Elizabethkingia spp. Rifampin inhibited E. meningoseptica (100%) and E. anophelis (81.1%). Fluoroquinolones and tigecycline were active against E. meningoseptica and E. miricola cluster isolates. Novel antibiotics, including imipenem/relebactam, meropenem/vaborbactam, ceftazidime/avibactam, cefepime/zidebactam, delafloxacin, eravacycline and omadacycline were ineffective but lascufloxacin inhibited half of Elizabethkingia spp. The very major discrepancy rates of VITEK 2 were &gt;1.5% for ciprofloxacin, moxifloxacin and vancomycin. Major discrepancy rates were &gt;3% for amikacin, tigecycline, piperacillin/tazobactam and trimethoprim/sulfamethoxazole. Conclusions MDR, absence of standard interpretation criteria and poor intermethod concordance necessitate working guidelines to facilitate future research of emerging Elizabethkingia spp.

Postpartum intra-uterine contraceptive device utilization among mothers who delivered at debre tabor general hospital: cross sectional study design

Introduction: Rapid population growth is a major concern of many states globally including our country Ethiopia. The intrauterine device (IUD) is a long term reversible contraceptive method that is suitable for women of all reproductive ages, and represents the most cost effective reversible method for preventing unwanted pregnancies. However, its utilization in Ethiopia is very low as compared to other contraceptive methods. Objective: To assess postpartum intra-uterine contraceptive device utilization among mothers who delivered and seek immunization service at DTGH, North Central Ethiopia. Methods: Facility based cross sectional study design was conducted from November 17, 2017, to January 01, 2018. A total of 182 respondents were interviewed. Systematic random sampling procedure was used to select each eligible study unit as a participant. Data were collected by Midwifery professionals through face to face interview through structured questionnaires under supervision. The data collectors and supervisors were trained prior to data collection. Pretest was conducted on 5% of the study population to check for the accuracy of tools. Confidentiality was also protected by making the data collection procedure anonymous. The association between dependent and independent variables were determined by descriptive statistics of chi square test using SPSS version 20.0 software and p-values of <0.05 were considered as statistically significant. Result: One hundred eighty two mothers were interviewed to assess IUCD utilization after giving birth at DTGH with a response rate of 97%. Only 6 respondents (3.3%) are currently using IUCD after giving birth to 9 months of their post partum period. Acceptances of IUCD with P of 0.004 and Reasons for refusal of IUCD with P value of 0.035 were some of statistically associated variables for utilization of PP IUCD. Conclusion: PP IUCD utilization in the study area is low as compared to other similar studies (3.3%). There are major discrepancy between acceptance level (37.91%) and PP IUCD utilization. Responsible bodies should address the reason for this major discrepancy to minimize the gap.

Review of Junior Resident Plain Film Reporting and Audit in Singapore

ABSTRACT Background Graduate medical education in Singapore recently underwent significant restructuring, leading to the accreditation of residency programs by the Accreditation Council for Graduate Medical Education–International (ACGME-I). In radiology, this involved a change in teaching and quality assurance of plain film (PF) reporting. PF reported by junior residents (postgraduate year 1–3) are subject to a 50% random audit. To date, national data on junior resident performance in PF reporting have not been published. Objective We reviewed performance in PF reporting under the current teaching and audit framework. Methods Retrospective review of junior resident reported PF audit data from all 3 radiology residency programs in Singapore. The number of residents audited, number of PF reported and audited, and major discrepancy rates were analyzed. Results On average, 86 440 PF were audited annually nationwide from an estimated 184 288 junior resident-reported PF. Each program trained between 4 to 24 junior residents annually (mean 15), averaging about 44 each year nationwide. A mean of 28 813 PF were audited annually in each program (range 4355–50 880). An estimated mean of 4148 PF (range 1452–9752) were reported per junior resident per year, about 346 PF per month. The major discrepancy rate ranged from 0.04% to 1.13% (mean 0.34%). One resident required remediation in the study period. Conclusions Structured residency training in Singapore has produced a high level of junior resident competency in PF interpretation.

P040: Retrospective assessment of discrepancies in preliminary radiological reports in the emergency department

Background: Preliminary reports and subsequent immediate management decisions of radiological scans are often performed by emergency physicians and on-call radiology residents. Many academic hospitals have resident-only coverage for after-hour shifts. Generally, these preliminary reports are eventually reviewed by a staff radiologist, during which discrepancies may be identified. Depending on the severity of the discrepancy and the time taken to notify the treating physician, there is potential for significant impact on the patient's care. Aim Statement: In an attempt to identify and minimize errors in radiological readings, and to improve the communication of discrepancies, our project aims to retrospectively audit all radiological discrepancies that have occurred at The Ottawa Hospital's emergency departments from April 2018 to May 2019. Measures & Designs: A systematic review of all cases with noted radiological discrepancies was obtained from the Picture Archive and Communication System software and EPIC platform. Analysis of these cases will allow us to define when errors occur, what is the type and severity of the error, how long it took to relay the discrepancy to a treating physician, and what was the subsequent management impact. Evaluation/Results: We discovered 712 cases with radiological reading discrepancies, 168 major, 527 minor, and 17 incidentals. Interestingly, a significant portion of major (severely affecting care/life-threatning) discrepancies were reported from radiology residents, especially on CT images, although emergency physicians had the most discrepancies (mostly minor). Radiology residents were seen to have more discrepant reports during after-hour services while emergency physicians did not show any specific pattern of discrepant reporting. The average time to report a major discrepancy to a treating physician is 8.8 hours, where the maximum time taken was 104 hours and the minimum was 0.2 hours. 56% of reports with major discrepancies made no mention of who was notified. Discussion/Impact: By identifying weak points in radiological reporting, our results will allow us to provide suggestions at an administration and teaching level to minimize discrepancies. It is critical to create a workflow where mistakes are mitigated, and communication is efficient and standardized to prevent patient harm from delayed or incorrect diagnosis.

Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology

Context.— The adoption of digital capture of pathology slides as whole slide images (WSI) for educational and research applications has proven utility. Objective.— To compare pathologists' primary diagnoses derived from WSI versus the standard microscope. Because WSIs differ in format and method of observation compared with the current standard glass slide microscopy, this study is critical to potential clinical adoption of digital pathology. Design.— The study enrolled a total of 2045 cases enriched for more difficult diagnostic categories and represented as 5849 slides were curated and provided for diagnosis by a team of 19 reading pathologists separately as WSI or as glass slides viewed by light microscope. Cases were reviewed by each pathologist in both modalities in randomized order with a minimum 31-day washout between modality reads for each case. Each diagnosis was compared with the original clinical reference diagnosis by an independent central adjudication review. Results.— The overall major discrepancy rates were 3.64% for WSI review and 3.20% for manual slide review diagnosis methods, a difference of 0.44% (95% CI, −0.15 to 1.03). The time to review a case averaged 5.20 minutes for WSI and 4.95 minutes for glass slides. There was no specific subset of diagnostic category that showed higher rates of modality-specific discrepancy, though some categories showed greater discrepancy than others in both modalities. Conclusions.— WSIs are noninferior to traditional glass slides for primary diagnosis in anatomic pathology.