Diagnostic Experience Research Articles

Improved Task Performance, Low Workload, and User-Centered Design in Medical Diagnostic Equipment Enhance Decision Confidence of Anesthesia Providers: A Meta-Analysis and a Multicenter Online Survey.

Decision confidence—the subjective belief to have made the right decision—is central in planning actions in a complex environment such as the medical field. It is unclear by which factors it is influenced. We analyzed a pooled data set of eight studies and performed a multicenter online survey assessing anesthesiologists’ opinions on decision confidence. By applying mixed models and using multiple imputation to determine the effect of missing values from the dataset on the results, we investigated how task performance, perceived workload, the utilization of user-centered medical diagnostic devices, job, work experience, and gender affected decision confidence. The odds of being confident increased with better task performance (OR: 1.27, 95% CI: 0.94 to 1.7; p = 0.12; after multiple imputation OR: 3.19, 95% CI: 2.29 to 4.45; p < 0.001) and when user-centered medical devices were used (OR: 5.01, 95% CI: 3.67 to 6.85; p < 0.001; after multiple imputation OR: 3.58, 95% CI: 2.65 to 4.85; p < 0.001). The odds of being confident decreased with higher perceived workload (OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001; after multiple imputation, OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001). Other factors, such as gender, job, or professional experience, did not affect decision confidence. Most anesthesiologists who participated in the online survey agreed that task performance (25 of 30; 83%), perceived workload (24 of 30; 80%), work experience (28 of 30; 93%), and job (21 of 30; 70%) influence decision confidence. Improved task performance, lower perceived workload, and user-centered design in medical equipment enhanced the decision confidence of anesthesia providers.

Программно-аппаратный комплекс диагностики состояния электрических изоляторов на основе технического зрения

Control of the equipment dielectric insulation is one of the most important types of diagnostics in operation of the electrical networks, because the defects cause ionization of voids and partial corona discharges. These discharges gradually destroy the insulation causing the energy loss, radio interference and decreasing the fire safety of the operated electrical equipment. Common failures of electrical insulators are breakdowns, overlaps and mechanical damage. The need to determine the resistance against the surface discharges increases in case of using the new polymer materials due to their characteristics. Developing the systems with computer (technical) vision is one of the ways for implementing automated control of the quantity and the area of corona discharges. The long-term experience of diagnostics accumulated by the specialists by using the ultraviolet flaw detectors and thermovision cameras has demonstrated the high efficiency in checking the damages in the high-voltage equipment and power lines. Application of vision technologies in the hardware and software complex will eliminate errors in checking and analyzing the flares, as well as minimize human participation in a number of monotonous operations, reduce the loss of working time caused by the human factor, protect the life and health of workers.

Diagnostic Delay in Paediatric Inflammatory Bowel Disease-A Systematic Investigation.

Diagnostic delays (time from the first symptoms to diagnosis) are common in inflammatory bowel disease (IBD) and may lead to worse disease progression and treatment outcomes. This study aimed to determine the duration of diagnostic delays (DD) and to explore associated factors in a cohort of children with IBD in New Zealand. In this study, patients with IBD diagnosed as children and their parents/caregivers completed questionnaires on the patients’ medical history, diagnostic experience, and demographic characteristics. The parent/caregiver questionnaire also included the Barriers to Care Questionnaire (BCQ). Patients’ healthcare data was reviewed to summarise the history of clinical visits and determine symptoms. Total DD, healthcare DD, patient DD and parent DD were derived from the primary dataset. Factors associated with the different types of DD were explored with a series of simple linear and logistical ordinal regressions. A total of 36 patients (Crohn’s disease 25, ulcerative colitis 10; male 17) were included. They were diagnosed at a median age of 12 years (interquartile range (IQR) 10–15 years). Total healthcare delay (from first healthcare visit to formal diagnosis) was median (IQR) 15.4 (6.5–34.2) months. The median (IQR) specialist-associated delay was 4.5 (0–34) days. Higher household income was associated with shorter healthcare delay (p < 0.018), while lower overall BCQ scores (indicating more barriers experienced) were associated with longer total healthcare DD. Higher scores in each subscale of BCQ (Skills; Pragmatics; Expectations; Marginalization; Knowledge and Beliefs) were also significantly associated with shorter total healthcare delay (p < 0.04). This study found substantial diagnostic delays in paediatric patients with IBD and identified significant associations between longer total healthcare diagnostic delays and overall household income and higher self-reported barriers to accessing healthcare.

An Overview of Diabetic Foot Ulcers and Associated Problems with Special Emphasis on Treatments with Antimicrobials.

One of the most significant challenges of diabetes health care is diabetic foot ulcers (DFU). DFUs are more challenging to cure, and this is particularly true for people who already have a compromised immune system. Pathogenic bacteria and fungi are becoming more resistant to antibiotics, so they may be unable to fight microbial infections at the wound site with the antibiotics we have now. This article discusses the dressings, topical antibacterial treatment, medications and debridement techniques used for DFU and provides a deep discussion of DFU and its associated problems. English-language publications on DFU were gathered from many different databases, such as Scopus, Web of Science, Science Direct, Springer Nature, and Google Scholar. For the treatment of DFU, a multidisciplinary approach involving the use of diagnostic equipment, skills, and experience is required. Preventing amputations starts with patient education and the implementation of new categorization systems. The microbiota involved in DFU can be better understood using novel diagnostic techniques, such as the 16S-ribosomal DNA sequence in bacteria. This could be achieved by using new biological and molecular treatments that have been shown to help prevent infections, to control local inflammation, and to improve the healing process.

Universal newborn hearing screening with automated auditory brainstem response (AABR) in Hungary: 5-year experience in diagnostics and influence on the early intervention

PurposeIn 2015 a new regulation and guidelines for the universal newborn hearing screening by AABR measurement have been implemented in Hungary. The aim of our study was to analyse (1) the past 5 years of data from our diagnostic centre about the incidence and types of congenital hearing losses, and (2) the first experiences with the National Newborn Hearing Screening Registry, started in 2019, and (3) the influence of the screening on the pediatric cochlear implant program.Methods1269 children referred to our diagnostic centre between 2017 and 2021 were investigated. A third AABR measurement and full audiological evaluation were performed. Furthermore, one-year period data of the screening registry, and the number of implanted children at or under the age of 3 were analysed using the national databases.ResultsAltogether 276 newborns (22% of the referred cases after the two-stage screening) had hearing loss, 134 (49%) out of them was conductive origin, almost twice frequent in male as in female. Permanent sensorineural hearing impairment was found in 142 (51%), 58 (40%) of them had bilateral, severe to profound hearing loss, occurring more frequently in male as in female. The national digital registration of the screening data within 12 months concerned 68%. The number of early cochlear implantation in one year increased from 1 to 23 children in the past 15 years.ConclusionA third AABR after the two-stage screening increased the efficiency and filtered the 78% false-positive cases. The audiological diagnostics verified and typed the hearing losses ensuring the early intervention.

Misdiagnosis of Thoracic Aortic Emergencies Occurs Frequently Among Transfers to Aortic Referral Centers: An Analysis of Over 3700 Patients.

BackgroundAcute aortic syndromes may be prone to misdiagnosis by nonreferral aortic centers with less diagnostic experience. We evaluated regional variability in these misdiagnosis trends among patients transferred to different regional quaternary care centers with presumed acute aortic syndromes.Methods and ResultsTwo institutional aortic center databases were retrospectively reviewed for emergency transfers in patients diagnosed with acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm between 2008 and 2020. Transferring diagnoses versus actual diagnoses were reviewed using physician notes and radiology reports. Misdiagnoses were confirmed by a board‐certified cardiothoracic surgeon. A total of 3772 inpatient transfers were identified, of which 1762 patients were classified as emergency transfers. The mean age was 64 years (58% male). Patients were transferred from 203 medical centers by ground (51%) or air (49%). Differences in transfer diagnosis and actual diagnosis were identified in 188 (10.7%) patients. Of those, incorrect classification of Type A versus B dissections was identified among 23%, and 30% of patients with a referring diagnosis of an acute aortic dissection did not have one. In addition, 14% transferred for contained/impending rupture did not have signs of rupture. All misdiagnoses were secondary to misinterpretation of imaging, with motion artifacts (n=32, 17%) and postsurgical changes (n=44, 23%) being common sources of diagnostic error.ConclusionsMisdiagnosis of acute aortic syndromes commonly occurred in patients transferred to 2 separate large aortic referral centers. Although diagnostic accuracy may be improving, there are opportunities for improved physician awareness through standardized web‐based imaging education.

Spectral features and optimal Hierarchical attention networks for pulmonary abnormality detection from the respiratory sound signals

The most important concern in the medical field is to consider the analysis of data and perform accurate diagnosis. However, the analysis of pulmonary abnormalities may depend on the diagnostic experience and the medical skills of the physicians, and is a time-consuming practice. In order to solve such issues, an efficient Water Cycle Swarm Optimizer-based Hierarchical Attention Network (WCSO-based HAN) is developed for detecting the pulmonary abnormalities from the respiratory sound signals. However, the developed optimization technique named WCSO is devised by incorporating the Water Cycle Algorithm (WCA) with Competitive Swarm Optimizer (CSO). Here, the pre-processing is performed using the Hanning window and Spectral gating-based noise reduction method in order to remove the falsifications or noises from the signal. Thereafter, the process of feature extraction is carried out to extract the significant features, such as Bark frequency Cepstral coefficient (BFCC) and the short-term features, such as spectral flux and spectral centroid. Once the significant features are extracted, classification is performed using HAN where the training procedure of HAN is carried out using WCSO. Furthermore, the developed WCSO-based HAN obtained efficient performance using True Positive Rate (TPR), True Negative Rate (TNR) and accuracy with the values of 0.943, 0.913, and 0.923 using dataset 1, respectively. All test results are validated with the k-fold cross validation method in order to make an assessment of the generalizability of these results.

P1701: A COMPARATIVE STUDY OF THE IMPACT OF COUNTRIES’ HEALTH EXPENDITURE ON THE DIAGNOSIS EXPERIENCES OF PATIENTS WITH LYMPHOMA AND CLL IN EUROPE

Background: Lymphomas are a mixed group of cancers that have a variety of clinical presentations ranging from an indolent course to an aggressive disease. As such, they are often a challenge to diagnose. A long time to diagnosis of lymphoma or CLL can result in increased patient anxiety and may impact patients’ survival and quality of life. In addition, communication with healthcare professionals is a key part of the patient experience at diagnosis as patients will use the information to make sense of their diagnosis and care. Aims: Using data from the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL, this study examines the impact of countries’ health expenditure (as a percentage of the Gross Domestic Product (GDP)) on the diagnostic experiences of patients with lymphoma in Europe. Methods: Globally, there were 11,878 respondents to the LC 2020 GPS, comprised of 9,179 patients and 2,699 caregivers. 4,346 patients responded from 36 European countries. Using the 2019 World Health Organisation (WHO) Global Health Expenditure Database, LC calculated the average percentage of health spending by these European countries’ governments - 8.2%. A comparison was then done between GPS respondents from countries with below-average health expenditure (BA-HE) (n=452) and countries with above-average health expenditure (AA-HE) (n=3894). Demographics of the two groups were examined, and univariate, bivariate and multivariate analyses of questions relating to patients’ diagnosis experience were performed in IBM SPSS v27. Results: Both groups differed significantly in the time taken from patients’ first appointment with a GP about their symptoms to getting a lymphoma or CLL diagnosis (Table 1). 40% of patients in the BA-HE countries received their diagnosis in less than 3 months compared to 51% of patients in the AA-HE countries. Over 10% of patients in both country groups (BA-HE- 14%; AA-HE-13%) reported getting a diagnosis more than 12 months after their first GP visit for their symptoms (Table 1). Regarding information experience at diagnosis, patients in AA-HE countries were 2.5 times more likely to have been told their lymphoma subtype at diagnosis than not remember if they were told their subtype at diagnosis when compared to patients in BA-HE countries (Table 1). Patients in AA-HE countries were also 67% more likely to report that they were given the right amount of information than not given enough information when compared to patients in BA-HE countries (Table 1). Patients in AA-HE countries were 48% less likely to need more information about treatment options and 58% less likely to need more information about support for self-care compared to patients in BA-HE countries. These differences were statistically significant (Table 1). There were no significant differences in both groups in the need for more information in the following areas: psychological support, support for their families, side effects of treatment, diagnosis and what it means, and fertility (Table 1). Image:Summary/Conclusion: Both groups differed in the time taken to get a diagnosis of lymphoma or CLL and in their information experiences at diagnosis. On the other hand, both groups showed an equal need for more information in areas such as psychosocial support and the side effects of treatment. LC advocates for increasing awareness of lymphoma among the general populace and the medical community to accelerate diagnosis. Healthcare providers should also provide patients with credible, understandable information to support the best possible patient experience.

Optimization of TCM Diagnosis Information Management System Based on Artificial Neural Networks

As a treasure of Chinese medicine, TCM has gradually formed and developed into a complete medicine with a unique medical theory system and rich treatment experience after thousands of years of medical practice. It requires high diagnostic experience, which is not conducive to application promotion and management. Therefore, the concept of digital medicine has been recognized by more and more people, in which medical diagnosis is one of the core issues of digital medicine. The accuracy and efficiency of medical diagnosis are closely related to people’s life and health, which is an important problem that cannot be ignored. Use the growing case base as knowledge base to reason and realize the diagnosis function of traditional Chinese medicine. Based on the characteristics of traditional Chinese medicine and taking case reasoning as a model, an expert system of traditional Chinese medicine diagnosis is established. This paper combines the strong learning ability, strong adaptability, and large-scale parallel processing ability of artificial neural networks (ANN) to solve the nonlinear and unstructured complex problems in management information system. By improving BP algorithm to optimize the error of weight and repair or energy parameters, the overall error of the optimized system is reduced by about 75.3% after experimental analysis, and the average accuracy of prediction is 75%.

Diagnostic experiences of Duchenne families and their preferences for newborn screening: A mixed-methods study.

Duchenne muscular dystrophy is the most common form of muscular dystrophy diagnosed in childhood but is not routinely screened for prenatally or at birth in the United States. We sought to characterize the diagnostic experiences of families and describe their preferences for newborn screening (NBS). We conducted a registry-based survey of families with Duchenne and Becker muscular dystrophy that included open- and closed-ended questions regarding the journey to a diagnosis, preferences for when to learn of a diagnosis, and how knowledge of a diagnosis would impact life decisions. Open-ended responses were analyzed thematically, and closed-ended responses were analyzed descriptively. Sixty-five families completed the survey. The average ages of first concern and diagnosis were 2 and 4 years, respectively. One-third of families (30%) indicated that they would prefer to receive a diagnosis in the newborn period irrespective of treatment options available, and nearly all of the remaining families (93%) indicated that they would want to learn about a diagnosis if there were treatments that worked well during the newborn period. All families (100%) indicated that a diagnosis in the newborn period would impact life decisions. We identified three overarching themes, which described the stages of the diagnostic journey, including having concerns about the child, seeking answers, and receiving the diagnosis. NBS can facilitate improved health outcomes through early access to care, and inform families on major health and nonhealth decisions. The preferences and experiences of families and other stakeholders should be considered when determining the potential value and benefit of expanding NBS programs.

Survey on the Influence of Living Environment Factors on Diagnosis of Idiopathic Pulmonary Fibrosis in Foshan

Purpose of the study: (a) investigate the relationship between the time and diagnosis of IPF and its influencing factors, (b) provide information from patients' real-life diagnostic experiences for the development of more rational diagnostic pathways and the introduction of more treatment options and technologies, and (c) improve the publics’ awareness of IPF and promote the prevention of IPF.&#x0D; Methods of investigation: A questionnaire was designed to survey 37 patients with IPF in January 2022, including general information questionnaires and age, sex, time for diagnosis, etc. Ridge regression analysis was used to explore the factors influencing the length and difficulty of IPF diagnosis. In addition, 11 respiratory physicians were interviewed by online interview about the difficulty of IPF diagnosis, treatment options, and patient prognosis.&#x0D; Results: The stress caused by the lack of formal diagnosis (B=0.617, p&lt;0.001), the high cost of the diagnosis process (B=0.509, p&lt;0.001), and the number of misdiagnoses or missed diagnoses (B=0.177, p&lt;0.005) were significantly related to the length and difficulty of the IPF diagnosis (p&lt;0.05).&#x0D; Conclusions: The findings highlight the need for new appropriate, convenient, and economical diagnostic procedures to be developed and designed. Simultaneously, professionals should strengthen the dissemination of disease understanding among the susceptible population, improve understanding and attention to the patients' condition, and conduct more lectures on the basics of avoiding IPF to strengthen the knowledge, which can effectively improve the mental quality of the susceptible population, in conjunction with the advice given by the doctors in the interviews.

Genetic counseling and diagnostic genetic testing for familial amyotrophic lateral sclerosis and/or frontotemporal dementia: A qualitative study of client experiences.

Genetic counseling and diagnostic genetic testing is part of the multidisciplinary care of people with amyotrophic lateral sclerosis (ALS, commonly called motor neurone disease, MND) and frontotemporal dementia (FTD). We explored client experiences of genetic counseling and diagnostic testing to inform the care of future families. Semi-structured interviews with individuals with ALS/MND/FTD or their relatives were conducted. The study was designed to include a wide variety of participants with varying disease status and abilities. Genetic counseling and diagnostic testing experiences were explored using interpretive description methodology. Bioecological theory was used as the framework for the reflexive thematic analysis. Eighteen individuals with ALS/MND/FTD or their relatives from 13 Australian families participated. Three themes were identified: sharing knowledge, (un)supportive care, and 'circumstance is everything'. Consistent with bioecological theory, one's genetic counseling experience was informed by individual circumstances, time, and proximal factors. These informed the level of information and support required in the genetic counseling process. Although some client circumstances cannot be changed, efforts could be made to enhance genetic counseling experiences by improving interactions between the client and their care team. Some clients may benefit from further discussions regarding the familial implications of genetic testing, and greater support with family communication. Clients' needs were derived from the data and will contribute to genetic counseling consensus guidelines.

Gastrointestinal perforations by ingested foreign bodies: A preoperative diagnostic flowchart-based experience. A case series report.

BackgroundGastrointestinal tract perforation is the most harmful complication of Foreign Body (FB) ingestion, besides diagnostic delay adversely affects the outcome. This paper aims to present our preoperative diagnostic flowchart and describe the surgical management in a Tunisian center.MethodsA retrospective review of 48 patients with gastrointestinal perforation by ingested FB treated in the surgery department of Jendouba Hospital. January 2010–December 2020.Results48 patients were treated for gastrointestinal tract perforation induced by FB ingestion. The mean age was 56.6 years. The sex ratio was 2/1. Acute abdominal pain was reported in all the patients. 35 patients had abdominal X-ray that showed a FB in 12 cases. CT scan was performed in 38 patients and identified the FB in 28 cases. Postoperative proofreading has identified a preoperative missed diagnosis of FB perforation in 5 cases, all before applying the diagnostic flowchart. All patients underwent open surgery after a median time of 7.12 h. This duration decreased after applying the flowchart (8.21 h versus 5.6 h). 33 patients had a terminal ileum perforation. Enterectomy was performed in 33 patients. Postoperatively, there was one abdominal abscess, one pulmonary embolism, one refractory septic choc, and one wound abscess. The median hospital stay was 6.35 days. The mortality rate was 6.25%. All patients managed with enterostomy had their stoma closed after 3–5 months.ConclusionsThe challenge of gastrointestinal perforation due to FB ingestion is accurate diagnosis and early management. A standardized initial assessment based on a diagnostic flowchart is helpful to achieve this goal and improve outcomes.

Healthcare access, satisfaction, and health-related quality of life among children and adults with rare diseases

BackgroundResearch in a variety of countries indicates that healthcare access and health-related quality of life are challenged among people with a variety of rare diseases (RDs). However, there has been little systematic research on the experiences of children and adults with RDs in the American healthcare system that identifies commonalities across RDs. This research aimed to: (1) Describe demographics, disease characteristics, diagnostic experiences, access to healthcare, knowledge about RDs, support from healthcare professionals, and patient satisfaction among people with RDs and their caregivers; (2) examine predictors of patient satisfaction among adults with RDs; (3) compare health-related quality of life and stigma to US population norms; 4) examine predictors of anxiety and depression among adults and children with RDs.ResultsThis large-scale survey included (n = 1128) adults with RD or parents or caregivers of children with RDs representing 344 different RDs. About one third of participants waited four or more years for a diagnosis and misdiagnosis was common. A subset of participants reported experiencing insurance-related delays or denials for tests, treatments, specialists, or services. Approximately half of participants felt their medical and social support was sufficient, yet less than a third had sufficient dental and psychological support. Patients were generally neither satisfied or dissatisfied with their healthcare providers. Major predictors of satisfaction were lower stigma, lower anxiety, shorter diagnostic odyssey, greater physical function, and less pain interference. Adults and children with RDs had significantly poorer health-related quality of life and stigma in all domains compared to US norms. Predictors of both anxiety and depression were greater stigma/poor peer relationships, fatigue, sleep disturbance, limited ability to participate in social roles, and unstable disease course.ConclusionsPeople in the U.S. with RDs have poor health-related quality of life and high stigma. These factors are related to patient satisfaction and healthcare access, including diagnostic delays and misdiagnosis. Advocacy work is needed in order to improve healthcare access and ultimately health-related quality of life for children and adults with RDs.

Diagnosis and management of arrhythmias in dogs: A cross-sectional online survey among Flemish veterinary practitioners.

BackgroundDiagnosis as well as management of arrhythmias in dogs can be challenging for veterinary practitioners. The aim was to describe ECG availability and use, as well as the diagnostic and therapeutic experiences and preferences of Flemish veterinarians regarding cardiac arrhythmias in dogs.MethodsCross‐sectional online survey among veterinarians in Flanders (Belgium).ResultsAn ECG device was available for 55 out of 102 respondents (54%) and 41 (43%) claimed to use it in case of arrhythmia suspicion. Insufficient knowledge about ECG interpretation and immediate patient referral upon detection of an abnormal heart rhythm were the most important reasons for not having, or not using, an ECG. About half of the respondents (56%) had never used anti‐arrhythmic drugs in dogs, although only a few reported having had a negative experience. Frequently provided reasons for not using anti‐arrhythmic drugs included insufficient knowledge and a low number of dogs with arrhythmias.ConclusionMost veterinarians reported having little or no expertise with arrhythmias in dogs. Electrocardiogram availability and use among respondents was moderate and too often restricted by insufficient ECG interpretation skills. Continued efforts are needed to increase the confidence and knowledge of veterinarians about arrhythmias in dogs.

Diabetic foot ulcer, antimicrobial remedies and emerging strategies for the treatment

According to the International Diabetes Federation's 2015 study, diabetes affects over 415 million people globally (5 million of whom die each year), and the incidence of diabetes is expected to climb to over 640 million (1 in 10) by 2040. (IDF 2015). Diabetes foot ulcers (DFU) are one of the most significant diabetic health consequences. Antimicrobial treatments, such as dressings, topical therapies, medicines, drugs, debridement procedures, molecular, cellular, and gene therapies, plant extracts, antimicrobial peptides, growth factors, devices, ozone, and energy-based therapies, would be the focus of this study. Scopus, Web of Science, Bentham Science, Science Direct, and Google Scholar were among the sources used to compile the English-language publications on DFU. DFU treatment requires a multidisciplinary approach that includes the use of proper diagnostic tools, competence, and experience. To prevent amputations, this starts with patient education and the use of new categories to steer treatment. New diagnostic methods, such as the 16S ribosomal DNA sequence in bacteria, should become available to acquire a better knowledge of the microbiota in DFUs.

Computed tomography features and clinicopathological characteristics of gastric glomus tumor

BackgroundGastric glomus tumor (GGT) is a rare neoplasm that is difficult to distinguish from other gastric submucosal tumors due to a lack of diagnostic experience. The goal of this study was to better understand GGT by looking at its clinicopathological features, computed tomography (CT) features, and differential diagnosis.MethodsThe clinical data and CT findings of 21 pathologically confirmed GGT patients were examined. The clinical characteristics and CT findings of benign GGT were compared to gastric stromal tumors (GST) (n = 30) and heterotopic pancreas (n = 30).ResultsThe 21 cases included six males and fifteen females ranging in age from 42 to 64 years. The lesions were found in the gastric body in four cases and the antrum in seventeen. GGT was diagnosed as benign in 20 cases and malignant in one. In benign cases, the glomus cells were small, uniform, showed perivascular hemangiopericytoma‑like or solid nest‑like structures. Obvious mitotic figures were observed in the malignant case. SMA staining was positive in the tumor cells. A quasi-round or round solid mass protruded into the gastric cavity in 20 benign cases, with a clear and smooth edge. The long to short diameter ratio was 1.01 ± 0.15. All of the benign cases had obvious enhancement, with homogeneous enhancement in ten cases and heterogeneous enhancement in ten cases, as well as central filling enhancement in 12 cases. The ratio of CT value of lesion to abdominal aorta in arterial phase and venous phase were (0.41 ± 0.11) and (0.81 ± 0.20), which were significantly higher than GST and heterotopic pancreas. The irregular mass broke through the gastric wall and invaded liver with poorly defined boundary and internal necrosis, heterogeneous persistent moderate enhancement with thickening blood supply arteries was seen in one malignant case with a long diameter of 150 mm and a thick diameter of 30 mm.ConclusionsCT enhancement usually shows persistent obvious enhancement, especially in arterial phase, which provides important value for the diagnosis. CT findings can help in the differential diagnosis of GGT and other submucosal tumors.

Simulation-based training in asthma exacerbation for medical students: effect of prior exposure to simulation training on performance

ObjectivesTo evaluate the effect of prior exposure to simulation-based training on medical students’ performance in simulation-based training in asthma exacerbation.MethodsThird-year novice medical students, who had no prior experience in simulation education and completed diagnostics and internal medicine courses, were recruited in this prospective observational study and divided into the pre-exposure and unexposed groups. Each group received a four-hour asthma exacerbation simulation-based training. The pre-exposure group was exposed to a myocardial infarction simulation training two weeks prior to the asthma simulation training. The main outcome was the performance scores in clinical skills and abilities. Performance and task checklist completion were recorded during the training. In addition, the knowledge level was tested before and after the simulation training. Students’ satisfaction was evaluated using a feedback questionnaire.ResultsIn a class of 203 third-year novice medical students, 101 (49.8%) and 102 (50.2%) were assigned to the unexposed and pre-exposure groups, respectively. Scores were higher in the post-simulation test compared with the pre-simulation test. Checklist completion was greater in the pre-exposure group compared with the unexposed group (p < 0.001). Performances in communication and medical humanistic care were better in the pre-exposure group than in the unexposed group (p < 0.001). There were no differences in medical history taking, physical examination, auxiliary examination interpretation and treatment formulation between the two groups (p > 0.001). Totally 73.21% and 26.13% of students strongly agreed and agreed, respectively, that asthma exacerbation simulation-based training was necessary and valuable.ConclusionsPrior exposure to simulation training can improve performance in medical students, including communication skills, medical humanistic care and checklist completion in subsequent asthma exacerbation simulation-based training.

Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.

BackgroundThe 21st Century Cures Act mandates patients’ access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review.ObjectiveTo test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes.MethodsIn a large integrated health system, patients aged 18–85 years actively using the patient portal and seen between October 2019 and February 2020 were invited to respond to an online questionnaire if an EHR algorithm detected any recent unexpected return visit following an initial primary care consultation (“at-risk” visit). We developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to several dimensions of the diagnostic process based on notes review and recall of recent “at-risk” visits. Additional questions assessed patients’ trust in their providers and their general feelings about the visit. The primary outcome was a self-reported diagnostic concern. Multivariate logistic regression tested whether the primary outcome was predicted by instrument variables.ResultsOf 293 566 visits, the algorithm identified 1282 eligible patients, of whom 486 responded. After applying exclusion criteria, 418 patients were included in the analysis. Fifty-one patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements “the care plan the provider developed for me addressed all my medical concerns” [odds ratio (OR), 2.65; 95% confidence interval [CI], 1.45–4.87) and “I trust the provider that I saw during my visit” (OR, 2.10; 95% CI, 1.19–3.71) and agreed with the statement “I did not have a good feeling about my visit” (OR, 1.48; 95% CI, 1.09–2.01).ConclusionPatients can identify diagnostic concerns based on a proactive online structured evaluation of visit notes. This surveillance strategy could potentially improve transparency in the diagnostic process.

Does Gender Impact a Diagnosis of Ankylosing Spondylitis?

ObjectiveThe study objective was to explore differences in ankylosing spondylitis (AS) diagnosis experiences between men and women by examining the coding of health events over the 2 years preceding AS diagnosis.MethodsClaims data (January 2006–April 2019) from the MarketScan databases were examined. Patients who had received two or more AS diagnoses at least 30 days apart and had at least 2 years of insurance enrollment before their first AS diagnosis were analyzed. Men were matched 1:1 to women by age, diagnosis date, insurance type, and enrollment duration. Health events (diagnosis and provider codes) were examined over 2 years before AS diagnosis and stratified by gender. Data were analyzed using univariate χ2 tests.ResultsAmong 7744 patients, 274 of 1906 AS‐related codes showed statistically significant differences between men and women. Women received more diagnosis codes than men across diagnoses and providers; the largest difference in diagnosis codes among women versus men was in peripheral symptom coding (57.7% vs. 43.9%, respectively). More women than men received diagnosis codes for depression (21.2% vs. 9.8%) and other musculoskeletal symptoms (52.8% vs. 40.0%); only gout was more common in men (6.5%) than in women (2.2%). Among men, backache codes gradually increased 12 months before AS diagnosis, whereas axial and sacroiliitis coding increased sharply immediately before diagnosis. The greatest difference in physician types visited was for rheumatologists: 64.2% of women had visits compared with 45.1% of men.ConclusionFurther investigation into the dissimilarities in diagnostic experiences between men and women is needed to determine whether differences are due to disease phenotype or potential cognitive bias influencing diagnostic decision‐making.