Source Of Error In Diagnosis Research Articles

Severe Acute Respiratory Syndrome -Possible Sources of Error in Diagnosis and their Validity in the Coronavirus Disease Series

Severe Acute Respiratory Syndrome -Possible Sources of Error in Diagnosis and their Validity in the Coronavirus Disease Series

The Value of Monitoring Requisition Forms in the Laboratory

Abstract Objectives Insufficient or extraneous information on requisition forms may delay turnaround time and become a source of error in diagnosis. Monitoring the completeness and accuracy of clinical information in the requisition forms provided to pathologists is a potential target in laboratory quality improvement, but its effectiveness is currently not known. Here, we describe a pilot study at our institution’s anatomic pathology laboratory to determine the effect of monitoring the completeness of information filled in the requisition forms by clinicians. Methods We randomly selected and reviewed records in each quarter from August 2017 to January 2019. All records were obtained from one hospital site and included requisition forms for specimens from inpatient and outpatient surgical operating rooms. The percentage of incomplete or improperly filled forms was tracked each quarter and feedback is provided to clinicians with insufficient information in the forms. Results A total of 70 requisition forms from 7 quarters were reviewed. Five different physicians were responsible for all the requisition forms without complete information. One physician was responsible for 33.3% of all requisition forms with incomplete information. Commonly recurring missing information in requisition forms were preoperative diagnosis (40%), postoperative diagnosis (35%), type of procedure (15%), and indications for procedure (10%). There was a remarkable improvement on completion of requisition forms from 60% at the beginning of the review period to 100% at the end of the review period (P < .0001). Conclusion Long-term review of requisition forms submitted to the laboratory and provisional feedback to clinicians are associated with sustainable improvement on information provided to pathologists to ensure specimen identification, integrity, and accurate interpretation.

Accidents d’hypersensibilité per-anesthésiques : expérience d’un hôpital universitaire belge

BackgroundAllergic peri-anaesthetic hypersensitivity reactions are rare but can have serious consequences. In Belgium, there are currently no published epidemiological papers on this subject. The aim of this paper is to describe the experience of a Belgian university hospital where patients were examined after suspected allergic peri-anaesthetic reaction. MethodsWe retrospectively analysed the medical files of 31 patients consulting the same allergist at the cliniques universitaires Saint-Luc in Brussels between 2012 and 2015 in a context of suspected peri-anaesthetic allergic reaction. Data were collected from the pre-anaesthesia and allergology consultation files as well as the anaesthesia reports and medico-surgical reports. ResultsTwenty-one patients (67.7%) developed an allergic peri-anesthetic hypersensitivity reaction to a substance used during anaesthesia. Most reactions (95%) were IgE-mediated and the majority were severe. The substances most frequently incriminated were rocuronium, cefazolin, latex and chlorhexidine. Cross-sensitivities were documented for neuromuscular blocking agents and cephalosporins. This work highlights certain dysfunctions that constitute a source of error in diagnosis. ConclusionThe results are similar to those of other studies. The diagnosis of peri-anaesthetic allergic hypersensitivity is difficult to establish for several reasons, and it is thus important to make as accurate a record as possible of the various indicators and ensure good communication with the allergy specialist, who must prepare an etymological report as early as possible.

Surgical management of extreme lateral lumbar disc herniations: review of 138 cases.

Extreme lateral disc herniations in the authors' series account for 10% of all lumbar herniations; 80% occurred at the L3, L4 and L4, L5 interspaces. The authors review the clinical findings in 138 patients and point to the characteristic features of the clinical syndrome. They compare the accuracy of various diagnostic studies and conclude that computed tomography is highly accurate and should be used before other diagnostic studies. Discography is still helpful as a confirmatory study in some cases, whereas myelography is particularly useful in disclosing other associated lesions. Analysis of the operative series revealed a high percentage of extruded fragments (60%) and a significant number of double herniations on the same side and at the same level (15%). These two findings may respectively preclude chemonucleolysis and microsurgery from the surgical management of extreme lateral herniations. Double herniations explain some discrepancies in the clinical picture and are emphasized as a potential source of error in diagnosis. The surgical technique allows exploration for herniations within the intervertebral canal as well as for extraforaminal herniations without sacrifice of the facet. Operative results are presented.

Ultrastructure of skin biopsy specimens in lysosomal storage diseases: common sources of error in diagnosis.

Common sources of error in the diagnosis of lysosomal storage diseases by ultrastructural examination of skin specimens have been identified in a series of biopsies from 72 patients. Four principal factors have emerged as leading pitfalls and sources of error in diagnosis. First, the skin biopsy technique itself may lead to alterations of normal skin ultrastructure. Second, artifacts may be produced during fixation and preparation of tissue for electron microscopy. Third, cellular organelles and structures normally present in human skin may be mistakenly interpreted as pathological. Fourth, the use of cultured skin fibroblasts for ultrastructural identification of storage material is often accompanied by artifacts induced in tissue culture and is not recommended. Recognition of these common problems may aid interpretation of the fine structure of skin abnormalities. Furthermore, when skin biopsy specimens are used as the primary source of diagnostic material, correlation of both skin ultrastructure and assay for specific lysosomal enzymes in cultured dermal fibroblasts will facilitate diagnostic accuracy.

Notable Source of Error in Diagnosis of Appendicitis

Notable Source of Error in Diagnosis of Appendicitis

Pantopaque Myelography: Diagnostic Errors and Review of Cases

Numerous articles dealing with the use of Pantopaque in myelography have appeared in the medical literature in the past three years. While the more typical myelographic pictures due to rupture of the nucleus pulposus are easily recognizable, one occasionally encounters bizarre patterns whose interpretation is difficult. We wish to present some of these unusual patterns, to discuss common sources of error in diagnosis, and to review 215 Pantopaque myelograms. Of the 215 cases examined, 69 came to operation, and the myelographic findings will be compared with the preoperative diagnosis. Technic Site of Injection: In myelography for detection of a protruded disk in the lumbar region, the needle should not be introduced at the level of the suspected protrusion, since removal of the oil may be more difficult and defects due to the needle may resemble those due to a protruded disk. If we encounter a defect at the site of introduction of the needle, it is our practice to remove it, continue the fluoroscopic and ...

The Roentgen-ray Examination in Individuals Suffering from Low Back and Sciatic Pain, with Examples of Some Lesions in Which Errors in Diagnosis may Readily be Made

THE problem of low back and sciatic pain has been given much attention in medical literature during the past five years and, as a result, the medical profession in general is rapidly acquiring a better understanding of the abnormalities responsible for the symptoms and signs presented by persons suffering from these conditions. Increasing numbers of individuals are being referred to those presumably especially trained in the diagnosis of the many conditions which may be responsible for these symptoms. Roentgenologists have made important contributions to the knowledge and understanding of these conditions and have, and in my opinion will continue to have, a sphere of major importance in this field of diagnosis. Recently in some centers there has been a tendency to resort to roentgenologic examinations on y in those cases which do not present what are considered to be characteristic localizing signs and symptoms of intraspinal lesions. Neurologic localization in quite a high percentage of cases can be very accurate. Our recent experiences would seem to indicate, however, that the information obtained, and the errors avoided by a properly performed roentgen examination of the spina canal with some contrast medium, make this type of examination desirable in most cases in which operative intervention is under consideration. The operative approach now in use demands accurate localization. Formerly, wide exposures were employed, the dura opened, etc. Errors in localization of one segment, or at times more, usually did not preclude the discovery and removal of the offending lesions. In our recent cases, however, only a portion of the lamina over the suspected lesion has been removed, the dura and its contents retracted, and the cartilaginous mass, if found, removed. The dura has not been opened and no attempt has been made to remove the contrast medium. Some of the illustrations forming a part of this communication show the findings in certain of our recent cases which seem to show the value of the roentgen examination. Others illustrate potential sources of error in diagnosis. Figures 1, 1-A, and 1-B are of an individual who had a severe spinal injury with a crushing fracture of the body of the twelfth dorsal vertebra more than a year prior to the time of our examination. She suffered from pain in the region of the fracture from the time of the injury and a few weeks later developed symptoms of low back disease. She was seen by Dr. R. G. Spur ling who suspected an encroaching lesion in the spinal canal. He injected 2 c.c. of lipiodol into the lumbar subarachnoid space and referred her to the x-ray department of the Norton Memorial Infirmary for examination. Figure 1 shows serial exposures of the lower lumbar area of the spinal canal. An hourglass type of deformity is shown as the lipiodol column passed the region of the fourth lumbar interspace. As is routine in our department, even when obvious lesions are found low in the canal, the patient was turned on the table, the head lowered, and the progress of the column cephalward was observed.

Studies on Oxyuriasis

Artifacts which simulate ova of Enterobius are frequently found in the “Cellophane” of the NIH swab, described by Hall (1937), used in diagnosis of pinworm infection. Attention is called to these artifacts in order to avoid possible confusion of them with pinworm ova. These artifacts are not superficial but are imbedded in the cellulose film and cannot be dislodged by surface scratching. They consist of a definite hyaline outline, usually ovoid, sometimes rounded, enveloping a dark, amorphous mass, the whole structure markedly similar to a pinworm egg. The hyaline outline, which appears to be composed of several layers, resembles the transparent shell layers of the egg of Enterobius. The central mass is irregular, brownish or greenish, with usually a clear space between it and the hyaline outline. Size variation is great but usually falls within the range of the pinworm egg, so that size and appearance constitute a potential source of error in diagnosis of oxyuriasis.

ROUTINE METHOD OF DETECTING AND DIFFERENTIATING REDUCING AGENTS FOUND IN THE URINE.

It is my purpose in this paper briefly to call attention to a few well-established facts, point out some of the fallacies of our principal tests and outline a reliable and simple course of procedure for the differentiation of the various reducing agents which may appear in the urine. Most of the tests ordinarily employed are good negative tests, but to accept a positive reaction without confirmation is a frequent source of error in diagnosis, as I shall point out. While, as a rule, we are called on to determine the presence or absence of dextrose, occasionally it is very important to determine whether or not other carbohydrates, as well as some other compounds, are present in the urine. Without exact confirmatory tests, it is practically impossible to definitely determine the presence or absence of dextrose. It is a rule with many physicians to depend on one single test for sugar

Adipose Deposits in the Omentum and Abdominal Walls of Woman as a Source of Error in Diagnosis

Adipose Deposits in the Omentum and Abdominal Walls of Woman as a Source of Error in Diagnosis