Utility of The Paris System (TPS) for upper urinary tract cytopathology: correlation with histology follow-up and UroVysion fluorescence in situ hybridization (FISH) analysis

INTRODUCTION

The Paris System (TPS) provides a uniform reporting system of urine cytology based on well-defined cytologic criteria. Due to their rarity, there are limited data on the utility of TPS in upper urinary tract (UUT) lesions and follow-up histology of cases with abnormal cytology. We aimed to evaluate the utility of TPS for UUT lesions by correlating the cytologic diagnoses using TPS criteria with subsequent histology. Additionally, the diagnostic utility of UroVysion (Abbott) fluorescence in situ hybridization (FISH) was assessed.

MATERIALS AND METHODS

A total of 148 UUT cytology specimens were retrospectively identified (2018-2022). Cytologic interpretation was performed using TPS, and then correlated with the findings of concurrent or subsequent histologic specimens. The performance of UroVysion FISH was analyzed. Sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade urothelial carcinoma (HGUC) were determined.

RESULTS

Among 83 patients who had concurrent or subsequent histologic specimens, cyto-histologic discrepancy was seen in 7 cases (8.4%). The sensitivity, specificity, PPV, and NPV using TPS criteria for detecting HGUC were 87%, and 92%, 96.4%, and 73%, respectively. UroVysion FISH was performed in 21 patients with atypical cytologic findings. The sensitivity and specificity of UroVysion for detecting HGUC was 75% and 86%, respectively, while PPV and NPV were 86% and 75%, respectively.

CONCLUSIONS

In our experience, the application of TPS criteria for reporting upper urinary cytology was reliable at detecting UUT lesions, especially HGUC. UroVysion FISH was a valuable ancillary test for detecting HGUC of UUT.

Party membership and self-assessed health: Evidence from the Communist Party of China

Background

In some countries, party membership is often associated with returns. We studied the relationship between party membership and self-assessed health.

Methods

Data were obtained from the 2017 Chinese General Social Survey (N = 11,641). Self-assessed health was defined as the personal evaluation of physical and psychological well-being. Logistic regression was used to explore relevant associations.

Results

Members of the Communist Party of China (CPC) were more likely than non-CPC respondents to register self-assessments of relatively healthy physical (beta = 0.319, SE = 0.098, P < 0.01, CI: 0.127-0.512) and psychological (beta = 0.257, SE = 0.072, P < 0.01, CI: 0.115-0.399) conditions.

Conclusions

Previous studies have overlooked the health-related rewards of CPC membership. Reforms to China's public health system can be smoothly implemented probably because of the health benefits accrued to party members.

Brief Report: Convergence and Discrepancy Between Self- and Informant-Reported Depressive Symptoms in Young Autistic Adults

PURPOSE

Autistic individuals exhibit elevated rates of depression; however, assessment is complicated by clinical presentations and limited validation in this population. Recent work has demonstrated the utility of the Beck Depression Inventory (BDI-II) in screening for depression in ASD. The current study extends this work by examining the convergence and divergence of self- and informant-reported depression in autistic (n = 258) and non-autistic (n = 255) young adults.

METHODS

Participants completed the BDI-II as a self-report measure of depression; informants completed the Achenbach Adult Behavior Checklist. Analyses probed for between-group differences in rates of depression symptoms, convergence between self- and informant-reported depression, and discrepancy between self- and informant-reported depression.

RESULTS

Results indicated significantly higher rates of depressive symptoms in the autistic group. Convergence was significant in both groups, with significantly greater agreement in the autistic group. There was differential divergence, with the autistic group reporting significantly lower scores relative to informants, and the non-autistic group reporting significantly higher scores relative to informants.

CONCLUSIONS

Consistent with prior reports, results suggest that depression rates are elevated in autism. Additionally, while the BDI-II may be adequate for screening depressive symptoms in speaking autistic young adults, eliciting information from a close adult informant provides valuable diagnostic information, due to clinically critical concerns about underreporting in this population. Although controlled in analyses, between-group differences in gender, age, race, and informant identity, and a predominantly White and non-Latinx sample, limit the generalizability of these results.

Reliability of the Risser+ grade for assessment of bone maturity in pediatric scoliosis cases: Investigation using standing and supine whole-spine radiograph

BACKGROUND

Although several radiography-based systems for assessing skeletal maturity are available to clinicians, the classical Risser grading system remains a clinical gold standard. For scoliosis follow-up, a standing whole-spine radiograph is usually used. However, in our clinical practice, we have occasionally encountered cases in which ossification of the iliac crest is seen differently in the standing and supine whole-spine radiography. Here, we aimed to clarify the reliability of the Risser+ grading system for supine versus standing position radiographs.

METHODS

This study recruited patients with all types of scoliosis who had been radiographed in both the standing and supine positions. We retrospectively evaluated the Risser+ grade of standing and supine whole-spine radiographs taken consecutively. Kappa statistics were computed to investigate the agreement between standing and supine Risser+ grades for this study.

RESULTS

We evaluated 111 patients (age: 12.6 ± 2.0; male-to-female = 23:88). The Kappa value for the standing and supine Risser+ grade systems was 0.74. The degree of agreement between the two positions for each Risser+ grade revealed high agreement for grades 0 and 5 in all cases, whereas grades 2 and 3 had low agreement.

CONCLUSIONS

Overall, there was substantial agreement between the Risser+ grades assigned to standing and supine position radiographs. However, disagreement was observed between standing and supine position radiographs assigned Risser+ grades of 2 or 3. Therefore, we have found a wide range in the visibility of iliac apophysis ossification of the iliac depending on the posture, and there are limitations in assessing bone maturity using the Risser+ grade alone. Clinicians should use other evaluation systems, in addition to the Risser+ system, to achieve a more accurate bone maturity assessment, especially for cases with standing position radiographs assigned Risser grades of 2 or 3.

Comparison of effect estimates between preprints and peer-reviewed journal articles of COVID-19 trials

BACKGROUND

Preprints are increasingly used to disseminate research results, providing multiple sources of information for the same study. We assessed the consistency in effect estimates between preprint and subsequent journal article of COVID-19 randomized controlled trials.

METHODS

The study utilized data from the COVID-NMA living systematic review of pharmacological treatments for COVID-19 (covid-nma.com) up to July 20, 2022. We identified randomized controlled trials (RCTs) evaluating pharmacological treatments vs. standard of care/placebo for patients with COVID-19 that were originally posted as preprints and subsequently published as journal articles. Trials that did not report the same analysis in both documents were excluded. Data were extracted independently by pairs of researchers with consensus to resolve disagreements. Effect estimates extracted from the first preprint were compared to effect estimates from the journal article.

RESULTS

The search identified 135 RCTs originally posted as a preprint and subsequently published as a journal article. We excluded 26 RCTs that did not meet the eligibility criteria, of which 13 RCTs reported an interim analysis in the preprint and a final analysis in the journal article. Overall, 109 preprint-article RCTs were included in the analysis. The median (interquartile range) delay between preprint and journal article was 121 (73-187) days, the median sample size was 150 (71-464) participants, 76% of RCTs had been prospectively registered, 60% received industry or mixed funding, 72% were multicentric trials. The overall risk of bias was rated as 'some concern' for 80% of RCTs. We found that 81 preprint-article pairs of RCTs were consistent for all outcomes reported. There were nine RCTs with at least one outcome with a discrepancy in the number of participants with outcome events or the number of participants analyzed, which yielded a minor change in the estimate of the effect. Furthermore, six RCTs had at least one outcome missing in the journal article and 14 RCTs had at least one outcome added in the journal article compared to the preprint. There was a change in the direction of effect in one RCT. No changes in statistical significance or conclusions were found.

CONCLUSIONS

Effect estimates were generally consistent between COVID-19 preprints and subsequent journal articles. The main results and interpretation did not change in any trial. Nevertheless, some outcomes were added and deleted in some journal articles.

Sociodemographic and health-related factors associated with exclusive breastfeeding in 77 districts of Uganda

BACKGROUND

Uganda surpasses many African nations and the global average in exclusive breastfeeding (EBF) rates. Yet, malnutrition is a critical issue, with stunting impacting roughly 29% of children under 5 years. Enhancing EBF could mitigate such nutritional challenges. This study focused on determining the current EBF prevalence and identifying associated factors across 77 surveyed districts.

METHODS

Pooled data from the Lot Quality Assurance Sampling (LQAS) surveys conducted in 77 districts in Uganda during 2021 and 2022 were analyzed. The analysis involved 7,210 mothers of children under 6 months, EBF was considered as the proportion of infants who received breast milk only in the 24 hours before the survey. A mother practicing EBF was (1) currently breastfeeding (2) had not started giving foods other than breastmilk (3) had not given any other probed liquids or (4) semi-solid foods the previous day or night. Multivariable logistic regression was used to identify factors associated with EBF, presenting adjusted odds ratios (aOR) with corresponding 95% confidence intervals at a 5% significance level.

RESULTS

The prevalence of EBF was 62.3%. In the adjusted analysis, EBF was more common among older mothers 20-24 years, 25-29 years and 30 + years (aOR 1.4; 95% CI 1.2,1.6), (aOR 1.4; 95% CI 1.1, 1.6) and (aOR 1.3; 95% CI 1.1, 1.5) respectively compared to teenage mothers. Also, EBF was more likely among mothers who lived in rural areas compared to urban areas (aOR 1.1; 95% CI 1.0, 1.3) and those who attended antenatal care (ANC) (aOR 2.2; 95% CI 1.5, 3.1). On the contrary, EBF was less common for children aged 3-5 months compared to younger (aOR 0.5; 95% CI 0.5, 0.6) and children who had received Vitamin A supplementation (aOR 0.7; 95% 0.6, 0.8).

CONCLUSION

The study suggests that most districts in Uganda might not have made significant strides in improving EBF rates over the last twenty years, pointing to possible ongoing hurdles that need urgent attention. Particularly, there's a pressing need to focus on teenage mothers. Maintaining and strengthening programs that advocate EBF, such as ANC, is crucial to bridge the gaps and bring about more equitable rates among different groups.

Sleep-wake state discrepancy among cancer survivors with insomnia symptoms

PURPOSE

To evaluate the discrepancy and correlation between sleep-wake measures (i.e., time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%)) reported on sleep diary and measured by actigraphy among cancer survivors with insomnia symptoms; and examine the influences of sociodemographic and clinical variables on these measurement differences.

METHODS

A heterogenous sample of cancer survivors with insomnia symptoms (n = 120; M age = 63.7 ± 10.1; female = 58.3%) was included. Seven consecutive days of sleep diary and actigraphic data were obtained along with information on demographic, sleep, and mental health symptoms. Bland-Altman plot, Pearson correlation coefficient, concordance correlation coefficient, and mixed linear model approach were used to conduct the analysis.

RESULTS

Self-reported TIB, SOL, and WASO were longer than measured by actigraphy (TIB: 8.6 min. (95% CI, 3.7, 13.5; p < .001); SOL: 14.8 min. (95% CI, 9.4, 20.2; p < .0001); and WASO: 20.7 min. (95% CI, 9.4, 20.2; p < .0001), respectively); and self-reported TST and SE% were shorter than measured by actigraphy (TST: 6.8 min. (95% CI, -18.7, 5.13); and SE%: 0.7% (95%CI, -3.0, 2.0), respectively), but were not statistically significant. Sex, higher insomnia severity, and poor sleep quality were associated with discrepancy between several sleep-wake measures.

CONCLUSION

Subjective and objective sleep-wake measures may present discrepant finding among cancer survivors with symptoms of insomnia. Future research is needed to validate appropriate sleep-wake assessment, and better understand factors that influence the discrepancy that exists between measures among this population.

CLINICAL TRIAL REGISTRATION

Clinical trials identifier: NCT03810365. Date of registration: January 14, 2019.

Medication reconciliation on admission in paediatric chronic patients: A multicentre study

INTRODUCTION

Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised.

OBJECTIVES

To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated.

METHODOLOGY

Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver.

RESULTS

1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance.

CONCLUSIONS

The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.

Empirical Quantification of Predictive Uncertainty Due to Model Discrepancy by Training with an Ensemble of Experimental Designs: An Application to Ion Channel Kinetics

When using mathematical models to make quantitative predictions for clinical or industrial use, it is important that predictions come with a reliable estimate of their accuracy (uncertainty quantification). Because models of complex biological systems are always large simplifications, model discrepancy arises-models fail to perfectly recapitulate the true data generating process. This presents a particular challenge for making accurate predictions, and especially for accurately quantifying uncertainty in these predictions. Experimentalists and modellers must choose which experimental procedures (protocols) are used to produce data used to train models. We propose to characterise uncertainty owing to model discrepancy with an ensemble of parameter sets, each of which results from training to data from a different protocol. The variability in predictions from this ensemble provides an empirical estimate of predictive uncertainty owing to model discrepancy, even for unseen protocols. We use the example of electrophysiology experiments that investigate the properties of hERG potassium channels. Here, 'information-rich' protocols allow mathematical models to be trained using numerous short experiments performed on the same cell. In this case, we simulate data with one model and fit it with a different (discrepant) one. For any individual experimental protocol, parameter estimates vary little under repeated samples from the assumed additive independent Gaussian noise model. Yet parameter sets arising from the same model applied to different experiments conflict-highlighting model discrepancy. Our methods will help select more suitable ion channel models for future studies, and will be widely applicable to a range of biological modelling problems.

Patient-reported outcome measures compared to clinician reported outcomes regarding incontinence and erectile dysfunction in localized prostate carcinoma after robot assisted radical prostatectomy: Impact on management

PURPOSE/ BACKGROUND

Patient-reported outcome measures (PROMs) are widely used after robot assisted radical prostatectomy (RARP) in order to evaluate the impact/burden of the treatment. The most bothersome side effects of RARP are urine incontinence (UI) and erectile dysfunction (ED). During the follow up consultations, clinicians report these side effects in interviewing patients. Our study examined the discrepancy between the PROMs and clinician report outcomes (CROs) and hypothesized that the disagreement could have an impact on the management of UI and ED.

METHODS

Up to 1 year after RARP, UI and ED recovery of 312 men with localized and locally advanced prostate cancer were assessed using the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and the International Index of Erectile Function (IIEF-EF) and CROs by interview. Discrepancies between PROs and CROs were studied in light of treatment offered and management.

RESULTS

The ICIQ-SF Score matched with CROs in all sum score categories except in ICIQ sum score 6 to 12; here the UI was underreported by clinicians in 58% and 59% of patients at 8 and 12 months (P < 0.001). Furthermore, at 8 and 12 months postoperatively, clinicians underreported UI in 29% and 23% of patients with ICIQ score 13-18 (P < 0.001). The clinician significantly over-reported the recovery of erectile function ("normal erection") (P < 0.001), especially in men with IIEF-EF sum score 6 to 16. Independently of ICIQ-SF/IIEF-EF scores, discrepancy between PROs and CROs did not affect rate of health care offered to patients.

CONCLUSIONS

This is to our knowledge the first study that compared the PROs with clinician reported functional outcomes and the impact of discrepancies on the management of side effects of RARP in prostate cancer. Observed discrepancies between the PROs and CROs did not affect offered management and counseling of UI and ED.

Multicentre study of medication reconciliation in paediatric onco-hematology

OBJECTIVE

To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them.

METHODS

A 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur.

RESULTS

Medication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE.

CONCLUSIONS

In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors.

[Translated article] Medication reconciliation in pediatric hemato-oncologic patients: A multicenter study

OBJECTIVE

To determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them.

METHODS

A 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients.

RESULTS

Medication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error.

CONCLUSIONS

In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors.

Patterns of Major Frozen Section Interpretation Error: An In-Depth Analysis From a Complex Academic Surgical Pathology Practice

OBJECTIVES

To establish baseline error rates due to misinterpretation and to identify scenarios in which major errors were most common and potentially preventable.

METHODS

Our database was queried over a 3-year period for major discrepancies due to misinterpretation. These were stratified by histomorphologic setting, service, availability/type of prior material, and years of experience and subspecialization of the interpreting pathologist.

RESULTS

The overall discordance rate between frozen section (FS) and final diagnoses was 2.9% (199/6,910). Seventy-two errors were due to interpretation, of which 34 (47.2%) were major. Major error rates were highest on the gastrointestinal and thoracic services. Of major discrepancies, 82.4% were rendered in subdisciplines outside those of the FS pathologist. Pathologists with fewer than 10 years' experience made more errors than those with more experience (55.9% vs 23.5%, P = .006). Major error rates were greater for cases without previous material compared to those with a prior glass slide (47.1% vs 17.6%, P = .009). Common histomorphologic scenarios in which disagreements were made involved discriminating mesothelial cells from carcinoma (20.6%) and accurately recognizing squamous carcinoma/severe dysplasia (17.6%).

CONCLUSIONS

To improve performance and decrease future misdiagnoses, monitoring discordances should be a continuous component of surgical pathology quality assurance programs.

Accuracy of Leg Length and Hip Offset Measurements Using a Fluoroscopic Grid During Anterior Approach Total Hip Arthroplasty

Background

Minimizing leg length (LLD) and hip offset (OD) discrepancies is critical for tissue tension and implant longevity in total hip arthroplasty (THA). The direct anterior approach (DAA) helps surgeons recreate these values under fluoroscopy. Several methods to accomplish this have been described, with no consensus on which is superior. This study evaluated the ability to minimize LLD and OD using a surgeon-controlled, adjustable fluoroscopic grid. We hypothesized that this tool would recreate parameters to within 10 mm of the contralateral side.

Methods

One hundred eleven primary THAs performed with an adjustable radiopaque grid to equalize leg length and hip offset were retrospectively reviewed. These values were measured on postoperative radiographs and compared to the contralateral hip. Patients were excluded if they had inadequate imaging, revision arthroplasty, preexisting deformities, or underwent approaches other than DAA.

Results

Mean age was 59.1 ± 11.1 years, 63.1% of patients were female, and average body mass index was 27.8 ± 7.0. Mean LLD was 3.7 ± 3.0 mm, while mean OD was 4.6 ± 3.6 mm. 95.5% of hips showed LLD < 10 mm, while 93.7% of hips had OD < 10 mm. Furthermore, 76.6% of hips had LLD < 5 mm, while 62.2% of hips had OD < 5 mm.

Conclusions

The described technique restored limb length and hip offset during DAA THA. This technique yields consistent results and offers an inexpensive alternative to costly digital software and more cumbersome fixed grid systems.

Discrepancy rate and clinical impact of preliminary reports from radiology residents

Background

Residents usually cover night and weekend shifts issuing the preliminary reading of radiological studies in university hospitals. This is essential to strengthening decision-making skills when facing complex cases independently. However, there should be a balance between patient safety and academic experience since some concern has been expressed about the accuracy of the interpretations generated by trainees. This work aims to evaluate and characterize the discrepancies in preliminary reports issued by radiology residents.

Material and methods

Radiologists filled out a questionnaire to evaluate preliminary reports of trainees considering diagnosis, findings description, clinical approach changes, and critical findings. Analysis was performed considering modality, imaging type, body part, and resident academic year. A Chi-square test with a significance level α of 0.05 was used to make group comparisons.

Results

A total of 9072 studies were reviewed. Major and minor overall discrepancy rates were 1.7% and 8.3%, respectively. Minor discrepancy rate, findings description, and critical findings identification improved with increasing academic year, both overall and by modality. Discrepancy rates were lower for CT than MR and neuroimaging than for body-imaging studies. The highest major and minor discrepancy rates as abdomen/pelvis CT and lumbar-spine MR, respectively. Two percent of reports presented discrepancies that could generate a medical approach change.

Conclusion

Discrepancy rates are low and comparable with those reported in the literature. These rates tend to improve as the resident's academic year increases. Our results suggest that radiology residents' coverage of night shifts and weekends is a practice that benefits the educational process without negatively impacting patient safety.

Drug approval prediction based on the discrepancy in gene perturbation effects between cells and humans

BACKGROUND

Poor translation between in vitro and clinical studies due to the cells/humans discrepancy in drug target perturbation effects leads to safety failures in clinical trials, thus increasing drug development costs and reducing patients' life quality. Therefore, developing a predictive model for drug approval considering the cells/humans discrepancy is needed to reduce drug attrition rates in clinical trials.

METHODS

Our machine learning framework predicts drug approval in clinical trials based on the cells/humans discrepancy in drug target perturbation effects. To evaluate the discrepancy to predict drug approval (1404 approved and 1070 unapproved drugs), we analysed CRISPR-Cas9 knockout and loss-of-function mutation rate-based gene perturbation effects on cells and humans, respectively. To validate the risk of drug targets with the cells/humans discrepancy, we examined the targets of failed and withdrawn drugs due to safety problems.

FINDINGS

Drug approvals in clinical trials were correlated with the cells/humans discrepancy in gene perturbation effects. Genes tolerant to perturbation effects on cells but intolerant to those on humans were associated with failed drug targets. Furthermore, genes with the cells/humans discrepancy were related to drugs withdrawn due to severe side effects. Motivated by previous studies assessing drug safety through chemical properties, we improved drug approval prediction by integrating chemical information with the cells/humans discrepancy.

INTERPRETATION

The cells/humans discrepancy in gene perturbation effects facilitates drug approval prediction and explains drug safety failures in clinical trials.

FUNDING

S.K. received grants from the Korean National Research Foundation (2021R1A2B5B01001903 and 2020R1A6A1A03047902) and IITP (2019-0-01906, Artificial Intelligence Graduate School Program, POSTECH).

Completeness and consistency of primary outcome reporting in COVID-19 publications in the early pandemic phase: a descriptive study

BACKGROUND

The COVID-19 pandemic saw a steep increase in the number of rapidly published scientific studies, especially early in the pandemic. Some have suggested COVID-19 trial reporting is of lower quality than typical reports, but there is limited evidence for this in terms of primary outcome reporting. The objective of this study was to assess the prevalence of completely defined primary outcomes reported in registry entries, preprints, and journal articles, and to assess consistent primary outcome reporting between these sources.

METHODS

This is a descriptive study of a cohort of registered interventional clinical trials for the treatment and prevention of COVID-19, drawn from the DIssemination of REgistered COVID-19 Clinical Trials (DIRECCT) study dataset. The main outcomes are: 1) Prevalence of complete primary outcome reporting; 2) Prevalence of consistent primary outcome reporting between registry entry and preprint as well as registry entry and journal article pairs.

RESULTS

We analyzed 87 trials with 116 corresponding publications (87 registry entries, 53 preprints and 63 journal articles). All primary outcomes were completely defined in 47/87 (54%) registry entries, 31/53 (58%) preprints and 44/63 (70%) journal articles. All primary outcomes were consistently reported in 13/53 (25%) registry-preprint pairs and 27/63 (43%) registry-journal article pairs. No primary outcome was specified in 13/53 (25%) preprints and 8/63 (13%) journal articles. In this sample, complete primary outcome reporting occurred more frequently in trials with vs. without involvement of pharmaceutical companies (76% vs. 45%), and in RCTs vs. other study designs (68% vs. 49%). The same pattern was observed for consistent primary outcome reporting (with vs. without pharma: 56% vs. 12%, RCT vs. other: 43% vs. 22%).

CONCLUSIONS

In COVID-19 trials in the early phase of the pandemic, all primary outcomes were completely defined in 54%, 58%, and 70% of registry entries, preprints and journal articles, respectively. Only 25% of preprints and 43% of journal articles reported primary outcomes consistent with registry entries.

Discordance of light chain isotypes between serum and glomerular deposits in proliferative glomerulonephritis with monoclonal IgG deposits: a case report and review of the literature

BACKGROUND

Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) is a disease entity with nonorganized granular glomerular deposition with monoclonal proteins of both heavy and light chains. Dysproteinemia was observed in only 30% of the patients with PGNMID. We herein report a case of PGNMID with discrepancy between serum and glomerular deposits.

CASE PRESENTATION

The patient was a 50-year-old man who had been followed at a local clinic due to hypertension, type 2 diabetes, hyperlipidemia, hyperuricemia, fatty liver, and obesity. Proteinuria had been noted five years previously, and he had been referred to a hematology department due to hyperproteinemia, high gamma globulin, and κ Bence-Jones protein (BJP) positivity one year previously. Bone marrow aspiration showed 5% plasma cells, and he was referred to the nephrology department to evaluate persistent proteinuria. He was hypertensive, and his estimated glomerular filtration rate was 54.2 ml/min/1.73 m2. His urinary protein level was 0.84 g/g⋅Cr. Urine and serum immunofixation showed BJP-κ type and IgG-κ type, respectively. Kidney biopsy showed an increase in mesangial cells and matrix without nodular lesions under a light microscope. Immunofluorescence microscopy showed granular deposits of IgG and C3 on the capillary wall and weak positivity for C1q. IgG3 was predominant among the IgG subclasses, and intraglomerular κ and λ staining was negative for κ and positive for λ. Direct fast scarlet staining was negative. Electron microscopy showed lumpy deposits without a fibrillar structure in the subepithelial area. Based on the above findings, a diagnosis of membranous nephropathy-type PGNMID was made. Since proteinuria increased gradually after three years of treatment with valsartan (40 mg, daily), oral prednisolone (30 mg, daily) was initiated, which led to decreased proteinuria. The dose of oral prednisolone was gradually tapered to 10 mg per day. At that time, proteinuria was 0.88 g/g⋅Cr. We found 204 cases in 81 articles in the PubMed database, among which 8 showed discrepancy in the heavy and/or light chains between serum and kidney.

CONCLUSIONS

We experienced a case of membranous nephropathy-type PGNMID with discrepancy in light chains between serum and kidney that was successfully treated with oral prednisolone.

Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China

BACKGROUND

Patient-centered, high-quality health care relies on accurate and timely diagnosis. Diagnosis is a complex, error-prone process. Prevention of errors involves understanding the cause of errors. This study investigated diagnostic discordance between admission and discharge in pediatric cases.

METHODS

We retrospectively reviewed the electronic medical records of 5381 pediatric inpatients during 2017-2018 in a tertiary teaching hospital. We analyzed diagnostic consistency by comparing the first 4 digits of admission and discharge ICD-10 codes of the cases and classified them as concordant for "complete and partial match" or discordant for "no match".

RESULTS

Diagnostic discordance was observed in 49.2% with the highest prevalence in infections of the nervous and respiratory systems (Ps < 0.001). Multiple (multivariable) logistic regression analysis predicted a lower risk of diagnostic discordance with older children (aOR, 95%CI: 0.94, 0.93-0.96) and a higher risk with infectious diseases (aOR, 95%CI: 1.49, 1.33-1.66) and admission by resident and attending pediatricians (aOR, 95%CI: 1.41, 1.30-1.54). Discordant cases had a higher rate of antibiotic prescription (OR, 95%CI: 2.09, 1.87-2.33), a longer duration of antibiotic use (P = 0.02), a longer length of hospital stay (P < 0.001), and higher medical expenses (P < 0.001).

CONCLUSIONS

This study denotes a considerably high rate of discordance between admission and discharge diagnoses with an associated higher and longer prescription of antibiotics, a longer length of stay, and higher medical expenses among Chinese pediatric inpatient cases. Infectious diseases were identified as high-risk clinical conditions for discordance. Considering potential diagnostic and coding errors, departmental investigation of preventable diagnostic discordance is suggested for quality health care and preventing potential medicolegal consequences.

IgG4-IgE complex interferes with measurement of IgE concentration

BACKGROUND AND AIMS

Patients with immunoglobulin G4 (IgG4)-related disease (IgG4-RD) have elevated immunoglobulin E (IgE) concentration compared to that in healthy individuals, which suggests the occurrence of IgE-mediated allergic reactions. We have previously shown that IgG4 and IgE form a complex in some patients with IgG4-RD. However, it is currently unknown whether and how the presence of the IgG4-IgE complex affects IgE concentration measurements by different assays.

MATERIALS AND METHODS

Twenty patients with confirmed presence or absence of IgG4-IgE complex were evaluated. We compared IgE concentrations measured by ST AIA-PACK IgE II (AIA-PACK), Elecsys IgE II Immunoassay (Elecsys), and Iatroace IgE (Iatroace) and evaluated to what extent the IgG4-IgE complex interfered with these measurements.

RESULTS

In patients with the IgG4-IgE complex, IgE concentrations measured using Iatroace were significantly lower than those measured using Elecsys and tended to be lower than those measured using AIA-PACK. IgE concentrations determined by Iatroace were significantly different in patients with and without the IgG4-IgE complex, whereas no significant differences between these groups were detected when IgE concentrations were measured by AIA-PACK or Elecsys.

CONCLUSION

The formation of the IgG4-IgE complex underestimates measured IgE concentrations depending on the method used. Therefore, caution should be exercised when selecting a specific IgE assay for patients with IgG4-RD.

Use and perception of ecosystem services on an urban river: a case from lower Gangatic plain, Eastern India

Rapid urbanisation and climate change have emerged as serious threats to ecosystem services (ES), and the deterioration of ES is affecting the quality of life. The research on ES was long performed from monetary perspectives and neglected evaluation of ES from social perspectives. This study proposes a social appraisal approach for evaluating urban river ES on Mahananda River in English Bazar Urban Agglomeration (EBUA), Eastern India, through the social perception and preference (SPP) approach. SPP approach was performed using the importance-performance analysis (IPA) model and satisfaction index (SI). Mann-Whitney U test, correlation analysis, and a median regression were performed to better understand the overall scenario on the perception and preference for ES. The findings of the study showed that (i) the stakeholder residing along the left bank of the river were highly dependent on provisioning ES; (ii) there was limited access to cultural ES provided by the river; (iii) the stakeholders residing along the left bank and slum stakeholders residing along the right bank of the river were more dependent on rive ES; (iv) relatively higher discrepancy was reported from recreation, aesthetic, and bio-diversity; (v) satisfaction level on ES was relatively low to the stakeholder residing along the left bank (50%); and (vi) as per improvement index (II), recreation, aesthetic value, bio-diversity, and purification of water must be prioritised to meet the societal needs. Thus, the study's findings can be very effective in implementing actions for sustainable holistic river ES management through the SPP approach.

The subjective feeling of a gap between conceptual and perceptual fluency is interpreted as a metacognitive signal of pastness

The present study aimed to address the following question: does the discrepancy between an expected word and its readability enhances or impair its memorability? We used an adaptation of the sentence stem paradigm (Whittlesea in J Exp Psycol 19:1235-1253, 1993) and manipulated the perceptual clarity of the words by introducing some Gaussian noise (Reber in Psycol Sci 9:45-48, 1998). The target words were semantically predictable or otherwise (conceptual fluency) or were easy or difficult to read (perceptual fluency). The first experiment was conducted to ensure that the two manipulated factors had an impact on the readability of the words. In particular, results showed that when the words were written against a noisy background their predictability enhanced the judgement of readability. The second experiment aimed to test the hypothesis that recognition would be influenced by the discrepancy between conceptual and perceptual fluency. The results showed that with a noisy background, the predictability of the target words had an impact on recognition judgement; with a clear background, the effect on the recognition judgement was caused by the non-predictability of the target words. Conversely, confidence in judgement increased when the two factors went in the same direction, that is, predictability with clarity and non-predictability with low clarity. The results showed that (a) depending on the task, the effects of conceptual and perceptual fluency did not go in the same direction; (b) the kinds of fluency (conceptual and perceptual) were not independent; and (c) recognition judgements were affected by the gap between conceptual and perceptual fluency.

Reporting inconsistency between published conference abstracts and article abstracts of randomised controlled trials in prosthodontics presented at IADR general sessions

Background

There is commonly a discrepancy between conference abstracts and published article abstracts in prosthodontic randomized controlled trials (RCTs), which may mislead the scholars those attend conferences.

Objective

To identify the characteristics predicting inconsistency between conference abstracts and published article abstracts in prosthodontic RCTs.

Methods

The conference abstracts of prosthodontic RCTs presented at the IADR general sessions from 2002 to 2015 were searched. Electronic searches of MEDLINE, EMBASE, the Cochrane Library, and Google Scholar databases were conducted to match full-text publications for conference abstracts. Two investigators extracted basic characteristics and assessed the consistency and reporting quality independently and in duplicate. The linear regression model was used to analyze the predictors of inconsistency.

Results

A total of 147 conference abstracts were matched with published articles. Results for the secondary outcome measure, Statistical analysis, and precision measure were less than 50% consistent, and even nearly 5% of the studies had opposite conclusions. Multiple linear regression analysis showed that three factors were correlated with lower inconsistency, including continent of origin (p = 0.011), presentation type (p = 0.017), and difference in reporting quality (p = 0.013).

Conclusion

Conference attendees should cautiously treat the findings of the conference abstracts. Researchers should improve the precision of the information delivered at conferences. We recommend the authors of RCTs to explain the primary difference between conference abstracts and article abstracts.

Assessment of Quality of Frozen Section Services at a Large Academic Hospital Before and After Relocation

OBJECTIVES

To determine outcomes following relocation of frozen section services (FSS) and the implementation of a dedicated gastrointestinal frozen service.

METHODS

We reviewed our FSS 6 months prior to and following FSS relocation. Satisfaction surveys were sent to surgeons and pathologists. Survey feedback resulted in a pilot of gastrointestinal subspecialist frozen section coverage.

RESULTS

There were 1,607 and 1,472 specimens from 667 and 602 patients pre- and post-FSS relocation, respectively. There was a decline in median specimen delivery time to pathology (12 vs 10 minutes, P < .001) and an increase in median time from receipt in pathology to intraoperative diagnosis (20 vs 22 minutes, P = .008) in cases with intrapathology consultation but no change without consultation (median, 19 minutes). Intrapathology consultation decreased from 19.7% (317/1,607) to 11.5% (169/1,472) (P < .001). Discordance rates between frozen section and permanent section remained low and similar (2.0% [33/1,607] vs 2.7% [40/1,472], P = .24). There was no significant change in discordance with dedicated gastrointestinal subspecialty frozen section interpretation.

CONCLUSIONS

Relocation of FSS and dedicated subspecialty interpretation may improve surgeon satisfaction but can also create workflow challenges. Pathology departments need to achieve a balance between satisfaction and adequacy to establish best frozen section coverage models.

A Quantitative and Qualitative Assessment of Frozen Section Diagnosis Accuracy and Deferral Rate Across Organ Systems

OBJECTIVES

Monitoring of frozen section diagnostic performance provides an important quality improvement measure.

METHODS

Surgical specimens involving a frozen section diagnosis over a 3-year period were retrospectively reviewed. Glass slides were reviewed on cases with discordance. Discordance and deferral rates were calculated.

RESULTS

Of 3,675 frozen section diagnoses included, 96 (2.7%) were discordant with the final diagnosis. Additionally, 114 frozen section diagnoses (3.1%) were deferred. The organ-specific discordance rates were lowest in breast and genitourinary specimens and highest for pancreas, lymph node, and gynecologic specimens. Deferral rates were highest in musculoskeletal, breast, and hepatobiliary cases and lowest in thyroid, parathyroid, and neuropathology cases. Discordance was explained by block-sampling error (45%), specimen-sampling error (27%), or interpretation error (27%). Discordant frozen section diagnoses from gynecologic specimens were responsible for 81% of specimen-sampling errors; frozen section diagnoses of lymph nodes, head and neck, and pancreas were responsible for 54% of interpretation errors; 51% of block-sampling errors involved lymph node evaluation for metastatic carcinoma.

CONCLUSIONS

Careful gross evaluation and microscopic examination of multiple levels should minimize specimen-sampling error and block-sampling error, respectively. Periodic review of accuracy and deferral rates may help reduce errors and improve the overall performance of this essential procedure.

A psycho-educational intervention for the prevention of foot lesions in people with diabetes: Report of a clinical audit

BACKGROUND AND AIMS

Motivational approaches may help target the psychological aspects of self-care, improving adherence to good practices in individuals with diabetes. The present study was designed to test the feasibility and effectiveness of a psychoeducational program for diabetic foot prevention or disease progression.

METHODS AND RESULTS

Eighty-one subjects with or at high risk of foot ulcer development entered a program consisting of six 120-min group sessions, conducted by a podiatrist and an expert in psycho-education. Occurrence/recurrence of lesions in a 3-year follow-up was compared with 172 cases with similar risk score (IWGDF score 2019), receiving education at any 6-month podiatric visit (standard-of-care). Motivation to self-care and competence were assessed by specific questionnaires. The experimental program increased adherence to follow-up. The prevalence of foot lesions was higher at baseline and was remarkably reduced at any time-point in patients attending the psychoeducational program, whereas it remained relatively stable in standard care (around 10% of cases). The cumulative incidence was lower in the psychoeducational program (13.2, 95% CI 9.2-18.0 per 100 patient-year vs. 26.1; 95% CI 22.1-30.2); time to new lesions was increased (P = 0.022). Cox proportional hazard analysis confirmed an overall reduction of lesions in the psychoeducational program (HR 0.34; 95% CI 0.18-0.66; P < 0.001), after adjustment for confounders. The program was associated with significant changes in competence and motivation to self-care.

CONCLUSION

A psychoeducational approach is both feasible and effective to support patients with diabetes at high risk of first or recurrent foot lesions, increasing their adherence to self-care practices.

Characteristics and publication discrepancies of foot & ankle surgery-related clinical trials

BACKGROUND

Trial registration can provide more reliable study designs, however, the final publications are not exempt from bias. This study aimed to show the characteristics of foot & ankle surgery-related clinical trials registered in ClinicalTrials.gov (CTG) and analyze possible risk factors that can lead to discrepancies between the original trial registry and published results.

METHODS

Foot & ankle surgery-related randomized controlled studies registered in CTG with an anticipated completion date until 2018 were extracted. 157 trials were found eligible for final analysis and corresponding publications were investigated through literature databases. Discrepancies between trial registries and published results were analyzed.

RESULTS

67.5% of trials were registered whether during the trial period or after completion. 46.5% were funded by industry. 54.8% of trials were reported to be completed. The results of 66 (42%) trials were published in a journal. There was a sample size discrepancy in 57.6%, follow-up time discrepancy in 28.8%, primary outcome discrepancy in 45.5%, and inclusion/exclusion criteria discrepancy in 89.4% of registries. Sample size, inclusion/exclusion criteria discrepancies were significantly more in trials funded by industry (p = 0.024, 0.001, 0.037, respectively). Industry-funded studies reported positive results more frequently (p = 0.011).

CONCLUSION

Only 42% of all registered foot & ankle surgery-related studies had the chance to be published. The majority of studies presented discrepancies in sample size, outcome assessment method, follow-up time, or inclusion/exclusion criteria. Industry-funded studies showed a higher rate of discrepancies and were more inclined towards reporting positive results indicating a risk of bias in assessments.

LEVEL OF CLINICAL EVIDENCE

Level 3.

Parent-Child Discrepancy in Educational Aspirations and Depressive Symptoms in Early Adolescence: A Longitudinal Study

Adolescents may have educational aspirations that are different from their parents' educational aspirations for them, and such discrepancy may affect adolescents' psychological adjustment. This longitudinal study examined how parent-child discrepancy in educational aspirations relate to depressive symptoms in early adolescents, both concurrently and prospectively, when controlling for parents' depressive symptoms. Moreover, parent and child gender differences in the effects were explored. Data were collected from 3799 students (52.0% boys; M_age = 10.78) and their fathers and mothers when the students were in fifth and seventh grade over 2 years. Polynomial regression with response surface analysis was used to analyze the effects of parent-child aspiration discrepancy on depressive symptoms separately in four parent-child gender dyads. Cross-sectional results demonstrated that for all parent-child gender dyads, congruently higher aspirations were related to lower depressive symptoms, and greater incongruence in aspirations was related to higher depressive symptoms. Moreover, for parent-son dyads, adolescents whose aspirations were lower than those of their parents reported higher depressive symptoms than adolescents whose aspirations were higher than those of their parents. However, longitudinal results further showed that, for father-son dyads only, congruently higher aspirations were related to increased depressive symptoms over time, while for parent-daughter dyads only, greater incongruence in aspirations was related to increased depressive symptoms over time. The findings support the importance of considering parent-child discrepancy when exploring the role of educational aspirations in adolescents' psychological adjustment and call for a more detailed and rigorous analysis and interpretation of this relationship.

Implementation of a peer-learning program in an academic abdominal radiology practice and comparison with a traditional peer-review system

OBJECTIVE

The purpose of this study was to transition from a traditional score-based peer-review system to an education-oriented peer-learning program in our academic abdominal radiology practice.

MATERIAL AND METHODS

This retrospective study compared our experience with a score-based peer-review model used prior to September 2020 and a peer-learning model implemented and used exclusively beginning in October of 2020. In peer review, a web-based peer-review tool randomly generated a list of cases, which were blindly reviewed in consensus. Comparison of the consensus interpretation with the original report was used to categorize each reviewed case and to calculate the rates of significant and minor discrepancies. Only cases with a discrepancy were considered to represent a learning opportunity. In peer learning, faculty prospectively identified and submitted cases for review in several categories, including case interpretations with a discrepancy from subsequent opinion or result, interpretations considered to represent a great call, and interesting or challenging cases meriting further discussion. The peer-learning coordinator showed each case to the group in a manner which blinded the group to both submitting and interpreting radiologist and invited discussion during various stages of the case.

RESULTS

During peer review, a total of 172 cases were reviewed over 16 sessions occurring between April 2016 and September 2020. Only 3 cases (1.8%) yielded significant discrepancies whereas 13 (7.6%) yielded minor discrepancies, representing a total of 16 learning opportunities (3.6 per year). In peer learning, 64 cases were submitted and 52 reviewed over 7 sessions occurring between October 2020 and October 2021. 29 (56%) were submitted as an interesting or challenging case meriting further discussion, 18 (35%) were submitted for a discrepancy, and 5 (10%) were submitted for a great call. All 52 presented cases represented learning opportunities (48 per year).

CONCLUSION

An education-focused peer-learning program provided a platform for continuous quality improvement and yielded substantially more learning opportunities compared to score-based peer review.

Distance Bounds for High Dimensional Consistent Digital Rays and 2-D Partially-Consistent Digital Rays

We consider the problem of digitalizing Euclidean segments. Specifically, we look for a constructive method to connect any two points in Z d . The construction must be consistent (that is, satisfy the natural extension of the Euclidean axioms) while resembling them as much as possible. Previous work has shown asymptotically tight results in two dimensions with Θ ( log N ) error, where resemblance between segments is measured with the Hausdorff distance, and N is the L 1 distance between the two points. This construction was considered tight because of a Ω ( log N ) lower bound that applies to any consistent construction in Z 2 . In this paper we observe that the lower bound does not directly extend to higher dimensions. We give an alternative argument showing that any consistent construction in d dimensions must have Ω ( log 1 / ( d - 1 ) N ) error. We tie the error of a consistent construction in high dimensions to the error of similar weak constructions in two dimensions (constructions for which some points need not satisfy all the axioms). This not only opens the possibility for having constructions with o ( log N ) error in high dimensions, but also opens up an interesting line of research in the tradeoff between the number of axiom violations and the error of the construction. A side result, that we find of independent interest, is the introduction of the bichromatic discrepancy: a natural extension of the concept of discrepancy of a set of points. In this paper, we define this concept and extend known results to the chromatic setting.

Effect of educational intervention addressing inaccurate self-assessment of driving performance in older Japanese adults

To maintain road safety for older drivers as well as other road users, it is important to provide interventions that improve self-awareness and behaviors in older drivers. We developed an intervention that provides feedback on accuracy of self-awareness of driving performance using a workbook, and examined its effectiveness using a prospective design with a follow-up after two months. Japanese drivers aged between 69 and 87 (Mean = 73.96) years were assigned to either the intervention group (n = 26) or the wait-list control group (n = 27). All participants were asked to assess their own driving performance by completing a questionnaire. They also completed an on-road driving assessment that involved driving on a public road while wearing an electronic device that measured their actual driving behaviors, accompanied by a driving instructor who sat in the passenger seat and assessed the participant's driving performance (expert assessment). Thereafter, only the intervention group received the immediate intervention (first wave). One month later, the intervention group completed the booster intervention by post. Two months after the first wave, both groups completed the questionnaire and on-road driving assessment again (second wave). Result revealed that discrepancy between self-assessment and expert assessment reduced in only the intervention group between the two waves. This finding suggests that the intervention was able to improve the accuracy of self-assessment. Furthermore, the expert assessment improved in the intervention group between the two waves, but this change was not observed in the control group. Similar trend was evident for vehicle speed at intersections with a stop sign but the result was not statistically significant. Changes in head rotation at intersections requiring turn in the intervention group did not differ from those in the control group. Improved accuracy of self-assessment as a result of the intervention could have led to improved general driving performance, but did not influence head rotation.

Sleep-wake misperception. A comprehensive analysis of a large sleep lab cohort

OBJECTIVES

Sleep-wake misperception has mainly been reported in insomnia patients. Conversely, the present study aimed to assess the prevalence and correlates of sleep-wake misperception in a large cohort of patients with various sleep-wake disorders, all diagnosed along the third version of the International Classification of Sleep Disorders.

METHODS

We retrospectively included 2738 patients examined by polysomnography, who in addition estimated upon awakening their total sleep time, sleep onset latency and Wake after sleep onset (WASO). We computed subjective-objective mismatch by the formula (subjective - objective value)/objective value ×100; negative and positive values indicated under- and overestimation, respectively.

RESULTS

In the entire sample, the magnitude of under- and overestimation of total sleep time was similar, but varied significantly between diagnostic groups, with insomnia and insufficient sleep syndrome showing the most pronounced underestimation and REM parasomnia and circadian rhythm disorders showing the most pronounced overestimation of total sleep time. In all diagnostic categories, a majority tended to overestimate their sleep onset latency and to underestimate the amount of WASO. Younger age was independently correlated with underestimation of total sleep time and WASO, and with overestimation of sleep onset latency. Overestimation of sleep onset latency independently correlated to an increased latency to N3 sleep stage on polysomnography.

CONCLUSIONS

While sleep-wake misperception is highly prevalent in all sleep-wake disorders, significant differences exist in magnitude of under- and overestimation between distinct diagnostic groups.

On the course of goal pursuit: The influence of goal progress on explicit judgments of self-agency

The experience of causing our own actions and resulting outcomes (i.e., self-agency) is essential for the regulation of our actions during goal pursuit. In two experiments, participants indicated experienced self-agency over presented outcomes, which varied in distance to their goal in an agency-ambiguous task. In Study 1, progress was manipulated at trial level (i.e., stimuli moved randomly or sequentially towards the goal). In Study 2, progress was constant at trial level (sequential), but varied at task level (i.e., goal discrepancy of the outcomes was random or decreased over trials). Study 1 showed that self-agency gradually increased in the progress condition as unsuccessful outcomes were objectively closer to the goal, while self-agency increased exponentially upon full goal attainment in the absence of progress. The gradual pattern for the progress condition was replicated in Study 2. These studies indicate that explicit judgments of self-agency are more flexible when there is goal progress.

Frozen-Permanent Section Discrepancy Rate in Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Frozen section evaluation of head and neck squamous cell carcinoma (SCC) is critical for margin status and subsequent patient therapy. In this study, we retrospectively reviewed the rate of frozen-permanent section discrepancies in blocks with two frozen section levels compared to ≥ three levels in oral cavity and oropharyngeal SCCs. A search of the cases with both intraoperative frozen sections and corresponding permanent sections for SCCs in the oral cavity and oropharynx was performed. Frozen sections and permanent slides were compared. The nature of discrepancies was assigned to one of the following: change in diagnosis, margin status, or distance of the tumor from the margin. The cause of the discrepancy was designated as one of the following: block sampling, gross sampling, interpretation, or technical error. The pathologist experience, frozen section technical experience, and intraoperative impact of each discrepancy were also evaluated. A total of 654 frozen and corresponding permanent blocks were assessed. For 532 of the frozen section blocks, two levels were cut, while 122 frozen section blocks had ≥ three levels. Thirty-five frozen-permanent section discrepancies were observed (5.4% of all blocks). Among these, 2.5% had a possible or definitive intraoperative impact. The percentage of discrepancies in the ≥ three levels group (5.7%) was slightly higher than the two-level group (5.3%), and this difference was not statistically significant. For the two-level group, the overall block sampling error rate was 4.5%. This was not significantly different from the 4.1% block sampling error rate seen in the ≥ three levels group. The rate of block sampling discrepancy did not show significant differences based on attending or frozen section technical experience. A change in margin distance (closer margin detected on permanent) occurred in 4% of the blocks and involved 16% of the patients. This review of oral cavity and oropharynx SCCs frozen/permanent section discrepancies shows that the error rate is not significantly different depending on the number of levels cut. The results suggest that always performing more than two frozen section levels may not yield a decreased discrepancy rate. A change in margin distance occurred quite frequently, but only in rare cases it had a definitive impact on the intraoperative management. Given the importance of correct intraoperative diagnosis in patient management, additional levels may be warranted depending on the clinical scenario.

Sociodemographic and psychological characteristics associated with discrepancy between body satisfaction and weight change among adolescents

This study aimed to describe the discrepancy between body satisfaction change and weight change among adolescents following a 2-year school-based intervention, to identify associated sociodemographic factors, and to explore possible associations with perceived health indicators. We used data from a northeastern France representative adolescents sample (14-18 years old) who participated in the PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) study (2006-2009). Weight change was measured by the change in body mass index z-score from the start to the end of the study. Body satisfaction and self-perceived health (anxiety, depression, eating disorder and quality of life) changes were assessed using self-administered questionnaires. Discrepancy between body satisfaction change and weight change was described with cross-tabulations, and subdivided into optimism/pessimism (i.e. positive/negative body satisfaction change compared to weight change). Sociodemographic factors associated with discrepancy were determined by multivariate logistic regression models. Adjusted linear regression models described 2-year change in weight and self-perceived health according to discrepancy. Among the 3279 adolescents included (aged 15.1 ± 0.6 years), the proportion of discrepancy was 74.8% (pessimism = 41.6%; optimism = 33.2%). Discrepancy, especially pessimism, was higher in boys than in girls (OR = 1.44 [1.19; 1.74], p = .0002), and in socially advantaged adolescents (OR = 1.82 [1.20; 2.74], p = .004) than in disadvantage ones. Body satisfaction change was rather in line with anxiety, depression and quality of life changes than weight change. Body satisfaction change should be considered in overweight and obesity prevention interventions alongside body weight change, and could be used as indicator of long-term behavior maintenance. Clinical trials registry and number:ClinicalTrials.gov (NCT01688453).

Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery

PURPOSE

Patients who undergo surgery for lung cancer experience a variety of symptoms, such as pain and coughing, which interfere with their postoperative daily functions. However, there may be differences between the perception of symptoms among healthcare providers and patients. This study aimed to investigate patients' experiences after lung cancer surgery and analyze whether the perception of postoperative symptoms among the healthcare providers differed from that reported by patients.

METHODS

Semi-structured qualitative interviews involving 39 patients who underwent lung cancer surgery at the Sichuan Cancer Hospital were conducted between November 2018 and October 2019. In addition, 22 healthcare providers from the Department of Thoracic Surgery at the hospital answered open-ended questions about their perception of symptoms related to lung cancer surgery. The types and frequencies of symptoms reported by the patients and healthcare providers were compared.

RESULTS

The most frequent patient-reported symptoms were pain (967 times, 39 patients, 100%), coughing (904 times, 37 patients, 94.87%), shortness of breath (491 times, 35 patients, 89.74%), Disturbed sleep (412 times, 34 patients, 87.18%), and interference while walking (347 times, 36 patients, 92.31%). Of the patient-reported symptoms, the first four were perceived by the healthcare providers, while they interpreted interference while walking as fatigue.

CONCLUSION

Although the healthcare providers and patients had a certain consensus on the main symptoms, there were differences in perception. Healthcare providers need to pay more attention to postoperative interference while walking.

Diagnostic discrepancy between colposcopy and vaginoscopy: A case report

BACKGROUND

Colposcopy currently plays a vital role in the diagnosis and treatment of lower genital diseases. Exposure and biopsy are two key steps in colposcopy. When the whole transformation zone or all lesions cannot be observed, we judge colposcopy as unsatisfactory. Unsatisfactory colposcopic examination may lead to the misdiagnosis of more severe diseases. The combination of colposcopy and vaginoscopy may contribute to accurate diagnosis and clinical decisions.

CASE SUMMARY

Here, we introduce a case of posthysterectomy deep vaginal apex not fully exposed by colposcopy, and the biopsy result was a vaginal precancerous lesion. We adopted vaginoscopy to extend the observed area and expose the lesion thoroughly, and the biopsy result was vaginal squamous cancer.

CONCLUSION

The patient received a precise diagnosis and early surgery due to the combination of colposcopy and vaginoscopy.

Genetic analysis of non-severe hemophilia A phenotype with A discrepancy between one-stage and chromogenic factor VIII activity assays

INTRODUCTION

The diagnosis of hemophilia A (HA) is based on the measurement of factor VIII activity (VIII:C). About one-third of non-severe HA patients show a discrepancy of VIII:C measured by one-stage (VIII:C 1st) and chromogenic (VIII:C chr) assays. Different mutations in the F8 gene may cause the discrepancy in results of the FVIII activity assay. The aim of this study was to investigate F8 gene mutations in patients with assay discrepancies and to evaluate their impact on the results of VIII:C assays.

METHODS

Mutation analysis was performed on 41 individuals with a discrepancy in VIII:C 1st and FVIII: C chr assays by direct sequencing. In addition, the effect of the variants on FVIII macromolecule structure was investigated by in silico and bioinformatics tools.

RESULTS

Genetic analysis disclosed 22 different variants, of which 19 were identified for the first time to be involved in the phenotype of VIII:C discrepancy. Most of the variants related to the higher VIII:C 1st were found in A1, A2, A3 domains. The variant related to VIII:C chr > VIII:C 1st was located in the thrombin cleavage site. In silico analysis showed the effect of variants on FVIII macromolecule stability, which may be the possible mechanism causing the discrepancy.

CONCLUSION

Our data shed light on the impact of genetic defects on VIII:C assay and provided evidence that the consideration of these mutations may open a new window to the proper diagnosis and treatment monitoring of non-severe HA patients.

Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

BACKGROUND

Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors.

METHODS

Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected.

RESULTS

In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19-88) years and mean BMI was 22.5 (16.9-34.1) kg/m². The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475-3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367-0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385-2.469).

CONCLUSION

Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.

A colossal, enigmatic, and long-lasting high-sensitivity cardiac troponin T elevation

This case describes the incidental finding of a massive and persistent elevation of troponin T in a patient with end-stage renal disease. This high troponin T value was not consistent with the patient's clinical condition and the laboratory was called in to investigate this discrepancy. After exclusion of analytical interference and discovery of a discordance between troponin T and troponin I, a clinical investigation including cardiac and whole-body magnetic resonance imaging was performed. Magnetic resonance imaging results allowed us to exclude a cardiac origin of troponin elevation but revealed a skeletal muscle pathology. This case constitutes the first description of high-sensitivity cardiac troponin T elevation due to musculoskeletal pathology without cardiac involvement in a patient with end-stage renal disease.

Clinical factors associated with reduced global longitudinal strain in subjects with normal left ventricular ejection fraction

Characteristics of subjects with reduced GLS but no overt left ventricular dysfunction have been poorly characterized. We sought to find clinical factors associated with reduced GLS despite having normal LVEF. Subjects without documented cardiovascular disease who underwent measurement of GLS using 2D speckle-tracking echocardiography were retrospectively reviewed. All subjects had normal LVEF (≥ 55%). Because GLS is a negative value, we took the absolute value |x| for a simpler interpretation. Reduced GLS was defined as < 18%, and normal GLS was defined as ≥ 18%. Of 690 study subjects (mean age, 58 years and females, 51.2%), 208 (30.1%) had reduced GLS. Subjects with reduced GLS were more frequently male, and had more cardiovascular risk factors than those with normal GLS. In multivariable binary logistic regression analysis, male sex (odds ratio [OR] 3.02; 95% confidence interval [CI] 2.02‒4.50; P < 0.001), hypertension (OR 1.52; 95% CI 1.02‒2.28; P = 0.043) and cigarette smoking (OR 1.80; 95% CI 1.14‒2.85; P = 0.012) were independently associated with reduced GLS. The greater the number of these 3 risk factors (male sex, hypertension and cigarette smoking), the higher the probability of having reduced GLS (P < 0.001). In subjects without overt cardiovascular disease who had normal LVEF, a relevant proportion (30.1%) of subjects had reduced GLS. Male sex, hypertension and cigarette smoking were independently associated with reduced GLS. GLS measurement should be emphasized for subjects with these clinical characteristics.

Discrepancies between self-rated depression and observed depression severity: The effects of personality and dysfunctional attitudes

BACKGROUND

Patient self-reports and clinician ratings of depression severity can differ substantially. The aim of the current study was to explore factors associated with discrepancies between depressed patients' Patient Health Questionnaire (PHQ-9) self-reports and clinicians' Hamilton Rating Scale for Depression (HAMD-17) ratings.

METHODS

We first computed discrepancy scores defined as the standardized weighted HAMD-17 total score minus the standardized PHQ-9 total score. To assess correlates of inconsistent scores, results of patients with similar standardized scores were removed (i.e., within ½ standard deviation, n = 270). Positive values indicate underreporting (HAMD-17 > PHQ-9), i.e., the underreporting group (n = 200); and negative discrepancy scores indicate overreporting (PHQ-9 > HAMD-17), i.e., the overreporting group (n = 221). We examined the relationship of demographic, dysfunctional attitudes and personality variables to the discrepancies between self and observer rated depression.

RESULTS

There were significant differences in extraversion, psychoticism, neuroticism, dysfunctional attitudes and occupation between the underreporting group and the overreporting group (all p < .05). When controlling for potential confounding variables, being a working professional and having high neuroticism and dysfunctional attitudes were significantly associated with overestimating symptoms of depression (e.g., professional: OR, 2.89; 95% CI, 1.67-5.00; p < .001; high neuroticism: OR, 7.08; 95% CI, 1.47-34.08; p < .001;dysfunctional attitudes: OR, 1.01; 95% CI, 1.00-1.02; p = .030). People with average, or high extraversion tended to underestimate scores (average extraversion: OR, 0.59; 95% CI, 0.37-0.95; high extraversion: OR, 0.48; 95% CI, 0.24-0.98).

CONCLUSIONS

This study is the first to use PHQ-9 and HAMD-17 to explore the discrepancies between self and observer rated depression. Discrepancies occurred between the PHQ-9 score and HAMD-17 score, which were related to neuroticism, extraversion, dysfunctional attitudes and being a working professional. Future research should clarify the relationship between these factors and therapeutic effects of treatments, including adverse outcomes.

Discrepancy between endoscopic and pathological ulcerative findings in clinical intramucosal early gastric cancer

BACKGROUND

Ulcerative finding (UL) is one of the factors that define the indication and curability of endoscopic resection (ER) in early gastric cancer (EGC). Discrepancies between endoscopic UL (cUL) and pathological UL (pUL) sometimes occur in clinical practice. The aim of this study was to investigate the discrepancy rate in UL diagnosis and the risk factors associated with such discrepancies.

METHODS

Patients with clinical intramucosal (cT1a) EGC who underwent ER or surgery between September 2002 and December 2017 were analyzed. The proportion of cUL-negative (cUL0) lesions that were identified as pUL-positive (pUL1) and that of cUL-positive (cUL1) lesions that were identified as pUL-negative (pUL0) were calculated. Logistic regression analysis was performed to estimate the associations between discrepancy in UL diagnosis and clinical variables of the lesion, such as the size, histology, location, and macroscopic type.

RESULTS

In total, 5382 lesions were evaluated; 5.5% of cUL0 lesions (256/4619) were identified as pUL1, while 38.7% of cUL1 lesions (295/763) were pUL0. Multivariate analysis indicated that in cUL1 lesions, tumor location in the lower third of the stomach (odds ratio 3.11, 95% confidence interval 1.90-5.08) was identified as an independent risk factor for overestimation.

CONCLUSIONS

Endoscopic diagnosis of UL in cT1a EGC was overestimated in 38.7% of lesions, especially for lesions located in the lower third of the stomach. This discrepancy should be considered in the management of cT1a EGC with UL.

Autopsy and pre-mortem diagnostic discrepancy review in an Irish tertiary PICU

Our study had two objectives: (1) to review ante- and post-mortem diagnoses and assign a Goldman error classification and (2) establish autopsy rates within our centre. We performed a retrospective analysis of autopsies performed on patients who died in our paediatric intensive care unit (PICU) between November 13, 2012, and October 31, 2018. Medical and autopsy data of all patients was reviewed, and Goldman classification of discrepancy between ante- and post-mortem diagnoses was assigned. Our centre is a tertiary PICU, and we included all patients that died in PICU within the designated timeframe. Our results were as follows: 396 deaths occurred in PICU from 8329 (4.75%) admissions. Ninety-nine (25%) had an autopsy, 75 required by the coroner. All were included in the study. Fifty-three were male and 46 females. Fifty-three patients were transferred from external hospitals, 46 from our centre. Forty-one were neonates, 32 were < 1 year of age, and 26 were > 1 year of age. The median length of stay was 3 days. Eighteen were post-cardiac surgery, and three post-cardiac catheter procedure. Major diagnostic errors (class I/II) were identified in 14 (14.1%), 2 (2%) class I, and 12 (12.1%) were class II errors. Class III and IV errors occurred in 28 (28.2%) patients. Complete concordance (class V) occurred in 57 (57.5%) cases.Conclusion: We conclude that the autopsy rate and the diagnostic discrepancy rate within our PICU are comparable to those previously reported. Our findings show the continuing value of autopsy in determining the cause of death and providing greater diagnostic clarity. Given their value, post-mortem examinations, where indicated, should be considered part of a physician's duty of care to families and future patients. What is Known: • Major diagnostic discrepancies (class I/II) in PICU have been reported at 20.2%. ⁽¹⁰⁾ • PICU autopsy rates have varied from 36 to 67% since 1994 with most recently reported rates in 2018 being 36%. ^(6-9) What is New: • We report an Irish PICU major diagnostic discrepancy (class I/II) rates of 14.1% contributing further to reported discrepancy rates in PICU literature to date. • This study contributes the Irish PICU post-mortem rate in a tertiary centre which was 25% over an almost 6-year period.

[Discrepancies in medical textbooks and their impact on medical school students]

BACKGROUND

Textbooks endorsed by national medical specialty societies and colleges are used as official references for faculty and national examinations. Oncology is transdisciplinary, practiced and taught by oncologists but also by other specialists. We aimed at identifying discrepancies between chapters on cancers in different official specialty textbooks and evaluating their impact on students.

MATERIAL AND METHODS

Volunteer 6th-year medical students of the Sorbonne University faculty were paired and asked to list the discrepancies between all official specialty textbooks addressing a given cancer and then individually asked to evaluate the impact of discrepancies on their learning experience.

RESULTS

In March 2018, the 17 cancers listed in the French medical school education program were addressed in 14 official specialty textbooks (2 to 4 textbooks/cancer). Out of a class of 390 students, 78 volunteered and were paired; each cancer was analyzed by 3 pairs of students (1 or 2 cancers/pair); 154 discrepancies were reported (range: 4-18 per cancer). Discrepancies induced doubt and anxiety in students; 85% considered that harmonization should be achieved for all topics of the national medical school program.

CONCLUSIONS

Discrepancies between official textbook are frequent, generate anxiety in students and impact learning experience.

Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies

Background

Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies.

Methods

Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases.

Results

138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%).

Conclusion

Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach.

Discrepant negative self-associations as a risk factor for depressive deterioration after outpatient psychotherapy

BACKGROUND AND OBJECTIVES

This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome.

METHODS

One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects.

RESULTS

We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up.

LIMITATIONS

The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment.

CONCLUSIONS

Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression.

Comparison of self-reports and biomedical measurements on hypertension and diabetes among older adults in China

Background

Researchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status. However, the validity of reporting is questionable as it relies on the awareness, recall bias and social desirability. Accordingly, biomedical test is generally regarded as a more precise indication of the disease.

Methods

Using data from the third wave of China Health and Retirement Longitudinal Study (CHARLS), we selected individuals aged 40–85 years old who participated in both health interview survey and biomedical test. Sensitivity, specificity, false negative reporting and false positive reporting were used as measurements of (dis) agreement or (in) validity, and binary and multinomial logistic regression were used to estimate under-report or over-report of hypertension and diabetes.

Results

Self-reported hypertension and diabetes showed low sensitivity (73.24 and 49.21%, respectively) but high specificity (93.61 and 98.05%, respectively). False positive reporting of hypertension and diabetes were 3.97 and 1.67%, while false negative reports were extremely high at 10.14 and 7.38%. Educational attainment, hukou, age and gender affected both group-specific error and overall error with some differences in their magnitude and directions.

Conclusion

Self-reported conditions underestimate the disease burden of hypertension and diabetes in China. Adding objective measurements into social survey could improve data accuracy and allow better understanding of socioeconomic inequalities in health. Furthermore, there is an urgent need to provide basic health education and physical examination to citizens, and promote the use of healthcare to lower the incidence and unawareness of disease in China.

Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management

PURPOSE

To identify the frequency, source, and management impact of discrepancies between the initial radiology report and expert reinterpretation occurring in the context of a hepatobiliary multidisciplinary tumor board (MTB).

METHODS

This retrospective study included 974 consecutive patients discussed at a weekly MTB at a large tertiary care academic medical center over a 2-year period. A single radiologist with dedicated hepatobiliary imaging expertise attended all conferences to review and discuss the relevant liver imaging and rated the concordance between original and re-reads based on RADPEER scoring criteria. Impact on management was based on the conference discussion and reflected changes in follow-up imaging, recommendations for biopsy/surgery, or liver transplant eligibility.

RESULTS

Image reinterpretation was discordant with the initial report in 19.9% (194/974) of cases (59.8%, 34.5%, 5.7% RADPEER 2/3/4 discrepancies, respectively). A change in LI-RADS category occurred in 59.8% of discrepancies. Most common causes of discordance included re-classification of a lesion as benign rather than malignant (16.0%) and missed tumor recurrence (13.9%). Impact on management occurred in 99.0% of discordant cases and included loco-regional therapy instead of follow-up imaging (19.1%), follow-up imaging instead of treatment (17.5%), and avoidance of biopsy (12.4%). 11.3% received OPTN exception scores due to the revised interpretation, and 8.8% were excluded from listing for orthotopic liver transplant.

CONCLUSION

Even in a sub-specialized abdominal imaging academic practice, expert radiologist review in the MTB setting identified discordant interpretations and impacted management in a substantial fraction of patients, potentially impacting transplant allocation. The findings may impact how abdominal imaging sections best staff advanced MTBs.

An algorithmic approach to serological work-up of ABO sub-groups which present as ABO discrepancies in resource constraint settings

BACKGROUND

ABO subgroups or weaker variants of A or B are group A or B subjects whose erythrocytes give a weak or negative reaction serologically with anti-A or Anti - B antisera respectively. Occurrence of these subgroups may lead to an ABO discrepancy which often puts transfusion services in a quandary. ABO subgroups which present as ABO discrepancies can be missed if reverse grouping is not performed.

AIM

This study was planned to estimate the prevalence of different subgroups which can present as an ABO discrepancy in Indian population, and provide an insight to transfusion services for identification of subgroups serologically.

MATERIALS AND METHODS

A cross-sectional, analytical study was performed at a tertiary healthcare based blood bank on whole blood donors and patients from January 2017 to July 2018. All suspected type II and Type IV (with Anti-A1) ABO discrepant samples were projected to an algorithmic testing process, to confirm discrepancy and then narrow down to the probable subgroup.

RESULTS

A total of 33 subgroup discrepancies; 26 of A group and 7 of B group were identified out of 73,380 patient and 35,279 donor samples tested for blood grouping. Following the algorithm, the overall prevalence of weak subgroups which can present as an ABO discrepancy was found to be 1 in 3293 or 0.03% in our population by serological testing. Out of the discrepancies caused by subgroups, the prevalence of subgroups of A were 0.0101%, 0.0018%, 0.0009%, 0.0027%, 0.0027% and 0.0018% for A2 with anti-A1, A3, Aend, Ax, Am and Ael respectively while those of B were 0.009%, 0.0009%, 0.0009% and 0.009% for B3, Bx, Bm and Bel respectively.

CONCLUSION

Algorithmic approach for resolution of ABO discrepancies caused by subgroups helps in identifying the subgroup which is important because these individuals may be mistyped as group O individuals.