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Chan-Pak-Choon F, Foulkes WD. On the Hunt for the Missed Genetic Causes of Multiple Primary Tumors. Cancer Prev Res (Phila) 2024; 17:193-195. [PMID: 38693900 DOI: 10.1158/1940-6207.capr-24-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Improved cancer screening and treatment programs have led to an increased survivorship of patients with cancer, but consequently also to the rise in number of individuals with multiple primary tumors (MPT). Germline testing is the first approach investigating the cause of MPT, as a positive result provides a diagnosis and proper clinical management to the affected individual and their family. Negative or inconclusive genetic results could suggest non-genetic causes, but are negative genetic results truly negative? Herein, we discuss the potential sources of missed genetic causes and highlight the trove of knowledge MPT can provide. See related article by Borja et al., p. 209.
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Affiliation(s)
- Fiona Chan-Pak-Choon
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Lemanska A, Andrews C, Fisher L, Bacon S, Mehrkar A, Inglesby P, Davy S, Goldacre B, MacKenna B, Walker AJ. During the COVID-19 pandemic 20 000 prostate cancer diagnoses were missed in England. BJU Int 2024; 133:587-595. [PMID: 38414224 DOI: 10.1111/bju.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England. PATIENTS AND METHODS With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates. RESULTS In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019. CONCLUSIONS Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
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Affiliation(s)
- Agnieszka Lemanska
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Colm Andrews
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Davy
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Simcoe SM, Gilmour J, Garnett MS, Attwood T, Donovan C, Kelly AB. Are there gender-based variations in the presentation of Autism amongst female and male children? J Autism Dev Disord 2023; 53:3627-3635. [PMID: 35829944 PMCID: PMC10465371 DOI: 10.1007/s10803-022-05552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
The Questionnaire for Autism Spectrum Conditions (Q-ASC; Attwood, Garnett & Rynkiewicz, 2011) is one of the few screening instruments that includes items designed to assess female-specific ASD-Level 1 traits. This study examined the ability of a modified version of the Q-ASC (Q-ASC-M; Ormond et al., 2018) to differentiate children with and without ASD-Level 1. Participants included 111 parents of autistic children and 212 parents of neurotypical children (5-12 years). Results suggested that the gendered behaviour, sensory sensitivity, compliant behaviours, imagination, and imitation subscales differentiated autistic females from neurotypical females. Compared to autistic males, autistic females had higher scores on gendered behaviour, sensory sensitivity, social masking, and imitation. Results are discussed in relation to early detection of autistic female children.
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Affiliation(s)
- Sarah Mae Simcoe
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
| | - John Gilmour
- Institute of Social Science Research, University of Queensland, St Lucia, Brisbane, Australia
| | | | - Tony Attwood
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
- Attwood and Garnett Events, Brisbane, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
| | - Adrian B Kelly
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
- Centre for Child Health and Well-being, Mental Health and Resilience Theme, Queensland University of Technology, Kelvin Grove, Child Adversity, Brisbane, Australia
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Li L, Na R, Mi T, Cheng H, Ma L, Chen G. Medical Image Diagnostic Value of Computed Tomography for Bladder Tumors. Comput Math Methods Med 2021; 2021:3781028. [PMID: 34824598 PMCID: PMC8610659 DOI: 10.1155/2021/3781028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study computed tomography (CT) imaging characteristics of bladder tumors, to explore the value of CT in tumor diagnosis, and to identify the relevant factors of CT missed diagnosis so that medical staff can be more accurate in the diagnosis of bladder tumors. METHODS To retrospectively analyze the CT manifestations of 153 bladder tumor cases confirmed by paraffin pathology in our hospital and to study the difference between the benign and CT imaging features. CT indicators mainly include the number, location, morphology, calcification, bladder wall smoothness, CT value, degree of enhancement, and invasion of surrounding tissues and organs. Then, we retrospectively analyze 17 cases of CT missed diagnosis of bladder tumors, analyze related factors, and discuss the role of CT in the diagnosis of bladder tumors. RESULTS This study has shown that with the help of CT images, the diagnosis rate of bladder tumors has been greatly improved. Of the 153 patients studied, noninvasive urothelial carcinoma accounted for 18.95% of all benign and malignant bladder tumors, invasive urothelial carcinoma accounted for 67.93%, prostatic metastatic carcinoma and inflammatory myofibroblastoma accounted for 8.47%, pheochromocytoma accounted for 1.31%, inverted papilloma accounted for 1.31%, tubular choriocarcinoma accounted for 0.63%, and endocystitis accounted for 1.31%. In addition, the blood supply level, CT index bladder wall smoothness, and CT value are also statistically significant (P < 0.05). CONCLUSIONS CT is of high value in the diagnosis of bladder tumors, and benign and malignant bladder tumors have CT and CT imaging features. The size of bladder tumors is related to the missed diagnosis rate of CT. The application of CT examination technology can improve the accuracy of diagnosis of bladder tumors.
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Affiliation(s)
- Lin Li
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Risu Na
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Tao Mi
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Hao Cheng
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Lili Ma
- Qinghai University, Xining, Qinghai 810000, China
| | - Guojun Chen
- Department of Urology, Affiliated Hospital of Qinghai University, Xining, Qinghai 810000, China
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Sharain K, Vasile VC, Sandoval Y, Donato LJ, Clements CM, Newman JS, Karon BS, Jaffe AS. The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes. Mayo Clin Proc 2021; 96:2366-2375. [PMID: 33992452 DOI: 10.1016/j.mayocp.2021.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values. PATIENTS AND METHODS Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed. RESULTS Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction. CONCLUSION There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.
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Affiliation(s)
- Korosh Sharain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vlad C Vasile
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Casey M Clements
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James S Newman
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Abstract
BACKGROUND Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups. OBJECTIVE The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia. RESEARCH DESIGN This was a prospective cohort study. SUBJECTS A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims. MEASURES We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity. RESULTS A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites. CONCLUSIONS Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | | | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Holmstrom AL, Ott KC, Weiss HK, Ellis RJ, Hungness ES, Shapiro MB, Yang AD. Improving trauma tertiary survey performance and missed injury identification using an education-based quality improvement initiative. J Trauma Acute Care Surg 2021; 90:1048-1053. [PMID: 34016928 DOI: 10.1097/ta.0000000000003152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance of a trauma tertiary survey (TTS) reduces rates of missed injuries, but performance has been inconsistent at trauma centers. The objectives of this study were to assess whether quality improvement (QI) efforts would increase the frequency of TTS documentation and determine if TTS documentation would increase identification of traumatic injuries. Our hypothesis was that QI efforts would improve documentation of the TTS. METHODS Before-and-after analysis of QI interventions at a level 1 trauma center was performed. The interventions included an electronic template for TTS documentation, customized educational sessions, and emphasis from trauma leadership on TTS performance. The primary outcome was documentation of the TTS. Detection of additional injuries based on tertiary evaluation was a secondary outcome. Associations between outcomes and categorical patient and encounter characteristics were assessed using χ2 tests. RESULTS Overall, 592 trauma encounters were reviewed (296 preimplementation and 296 postimplementation). Trauma tertiary survey documentation was significantly higher after implementation of the interventions (30.1% preimplementation vs. 85.1% postimplementation, p < 0.001). Preimplementation documentation of the TTS was less likely earlier in the academic year (14.3% first academic quarter vs. 46.5% last academic quarter, p < 0.001), but this temporal pattern was no longer evident postimplementation (88.5% first academic quarter vs. 77.9% last academic quarter, p = 0.126). Patients were more likely to have a missed traumatic injury diagnosed on TTS postimplementation (1.7% in preimplementation vs. 5.7% postimplementation, p = 0.009). CONCLUSION Documentation of the TTS and missed injury detection rates were significantly increased following implementation of a bundle of QI interventions. The association between time of year and documentation of the TTS was also attenuated, likely through reduction of the resident learning curve. Targeted efforts to improve TTS performance may improve outcomes for trauma patients at teaching hospitals. LEVEL OF EVIDENCE Care management, Level IV.
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Affiliation(s)
- Amy L Holmstrom
- From the Department of Surgery (A.L.H., K.C.O., H.K.W., R.J.E., E.S.H., M.B.S., A.D.Y.), Feinberg School of Medicine, and Surgical Outcomes and Quality Improvement Center (R.J.E., A.D.Y.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Kharbanda AB, Vazquez-Benitez G, Ballard DW, Vinson DR, Chettipally UK, Dehmer SP, Ekstrom H, Rauchwerger AS, McMichael B, Cotton DM, Kene MV, Simon LE, Zhu J, Warton EM, O’Connor PJ, Kharbanda EO. Effect of Clinical Decision Support on Diagnostic Imaging for Pediatric Appendicitis: A Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2036344. [PMID: 33560426 PMCID: PMC7873779 DOI: 10.1001/jamanetworkopen.2020.36344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Appendicitis is the most common pediatric surgical emergency. Efforts to improve efficiency and quality of care have increased reliance on computed tomography (CT) and ultrasonography (US) in children with suspected appendicitis. OBJECTIVE To evaluate the effectiveness of an electronic health record-linked clinical decision support intervention, AppyCDS, on diagnostic imaging, health care costs, and safety outcomes for patients with suspected appendicitis. DESIGN, SETTING, AND PARTICIPANTS In this parallel, cluster randomized trial, 17 community-based general emergency departments (EDs) in California, Minnesota, and Wisconsin were randomized to the AppyCDS intervention group or usual care (UC) group. Patients were aged 5 to 20 years, presenting for an ED visit with right-sided or diffuse abdominal pain lasting 5 days or less. We excluded pregnant patients, those with a prior appendectomy, those with selected comorbidities, and those with traumatic injuries. The trial was conducted from October 2016 to July 2019. INTERVENTIONS AppyCDS prompted data entry at the point of care to estimate appendicitis risk using the pediatric appendicitis risk calculator (pARC). Based on pARC estimates, AppyCDS recommended next steps in care. MAIN OUTCOMES AND MEASURES Primary outcomes were CT, US, or any imaging (CT or US) during the index ED visit. Safety outcomes were perforations, negative appendectomies, and missed appendicitis. Costs were a secondary outcome. Ratio of ratios (RORs) for primary and safety outcomes and differences by group in cost were used to evaluate effectiveness of the clinical decision support tool. RESULTS We enrolled 3161 patients at intervention EDs and 2779 patients at UC EDs. The mean age of patients was 11.9 (4.6) years and 2614 (44.0%) were boys or young men. RORs for CT (0.94; 95% CI, 0.75-1.19), US (0.98; 95% CI, 0.84-1.14), and any imaging (0.96; 95% CI, 0.86-1.07) did not differ by study group. In an exploratory analysis conducted in 1 health system, AppyCDS was associated with a reduction in any imaging (ROR, 0.82; 95% CI, 0.73- 0.93) for patients with pARC score of 15% or less and a reduction in CT (ROR, 0.58; 95% CI, 0.45-0.74) for patients with a pARC score of 16% to 50%. Perforations, negative appendectomies, and cases of missed appendicitis by study phase did not differ significantly by study group. Costs did not differ overall by study group. CONCLUSIONS AND RELEVANCE In this study, AppyCDS was not associated with overall reductions in diagnostic imaging; exploratory analysis revealed more appropriate use of imaging in patients with a low pARC score. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02633735.
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Affiliation(s)
- Anupam B. Kharbanda
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | | | - Dustin W. Ballard
- The Permanente Medical Group, Oakland, California
- The Kaiser Permanente Northern California Division of Research, Oakland, California
| | - David R. Vinson
- The Permanente Medical Group, Oakland, California
- The Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Steven P. Dehmer
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Heidi Ekstrom
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Adina S. Rauchwerger
- The Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Brianna McMichael
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | | | | | - Laura E. Simon
- The Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Jingyi Zhu
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - E. Margaret Warton
- The Kaiser Permanente Northern California Division of Research, Oakland, California
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Pellikaan K, Rosenberg AGW, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, Veen-Roelofs JMC, van Wieringen N, Hoekstra FME, van den Berg SAA, van der Lely AJ, de Graaff LCG. Missed Diagnoses and Health Problems in Adults With Prader-Willi Syndrome: Recommendations for Screening and Treatment. J Clin Endocrinol Metab 2020; 105:5900721. [PMID: 32877518 PMCID: PMC7553248 DOI: 10.1210/clinem/dgaa621] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a complex hypothalamic disorder, combining hyperphagia, hypotonia, intellectual disability, and pituitary hormone deficiencies. Annual mortality of patients with PWS is high (3%). In half of the patients, the cause of death is obesity related and/or of cardiopulmonary origin. Health problems leading to this increased mortality often remain undetected due to the complexity and rareness of the syndrome. OBJECTIVE To assess the prevalence of health problems in adults with PWS retrospectively. PATIENTS, DESIGN, AND SETTING We systematically screened 115 PWS adults for undiagnosed health problems. All patients visited the multidisciplinary outpatient clinic for rare endocrine syndromes at the Erasmus University Medical Center, Rotterdam, Netherlands. We collected the results of medical questionnaires, interviews, physical examinations, biochemical measurements, polygraphy, polysomnography, and radiology. MAIN OUTCOME MEASURES Presence or absence of endocrine and nonendocrine comorbidities in relation to living situation, body mass index, genotype, and demographic factors. RESULTS Seventy patients (61%) had undiagnosed health problems, while 1 in every 4 patients had multiple undiagnosed health problems simultaneously. All males and 93% of females had hypogonadism, 74% had scoliosis, 18% had hypertension, 19% had hypercholesterolemia, 17% had type 2 diabetes mellitus, and 17% had hypothyroidism. Unfavorable lifestyles were common: 22% exercised too little (according to PWS criteria) and 37% did not see a dietitian. CONCLUSIONS Systematic screening revealed many undiagnosed health problems in PWS adults. Based on patient characteristics, we provide an algorithm for diagnostics and treatment, with the aim to prevent early complications and reduce mortality in this vulnerable patient group.
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Affiliation(s)
- Karlijn Pellikaan
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Anna G W Rosenberg
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | | | | | - Anja G Bos-Roubos
- Vincent van Gogh, Center of Excellence for Neuropsychiatry, DN Venray, Netherlands
| | | | - Nina van Wieringen
- Department of Physical Therapy, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Franciska M E Hoekstra
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Department of Internal Medicine, Reinier de Graaf Hospital, AD Delft, Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Aart Jan van der Lely
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Laura C G de Graaff
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, GD Rotterdam, Netherlands
- Correspondence and Reprint Requests: Laura de Graaff, MD, PhD, Dept. of Internal Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail:
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Abstract
To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ = 32.151, χ = 31.211, χ = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.
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Affiliation(s)
- Guangliang Chen
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Jin Wei
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Qing Duan
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
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Chu Y, Zhang J, Wang P, Li T, Jiang S, Zhao Q, Liu F, Gao X, Qiao X, Wang X, Song Z, Liang H, Yue J, Linghu E. Will purposely seeking detect more colorectal polyps than routine performing during colonoscopy? Medicine (Baltimore) 2020; 99:e22738. [PMID: 33080734 PMCID: PMC7572006 DOI: 10.1097/md.0000000000022738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND & GOALS We observed that the number of colorectal polyps found intraoperatively was often higher than that encountered preoperatively during elective colonoscopic polypectomy. To evaluate whether more polyps can be detected when they are purposely sought than when they are routinely examined during colonoscopy. MATERIALS AND METHODS Patients undergoing colonoscopy were randomized into groups A and B. Before colonoscopy was performed, endoscopists were instructed to seek polyps for group A purposely but not for group B. Polypectomy was electively completed. In groups A and B, the cases of elective polypectomy were named groups AR and BR, including groups AR-1 and BR-1, during the first colonoscopy and groups AR-2 and BR-2 during the second colonoscopy for polypectomy, respectively. The following data were calculated: the number of polyps detected (NPD) and the polyp detection rate (PDR) in all cases and the number of polyps missed (NPM) and partial polyp miss rate (PPMR) in the cases of colorectal polyps. RESULTS A total of 419 cases were included in group A, 421 in group B, 43 in group AR, and 35 in group BR. No significant differences in PDR were found between groups A and B and in PPMR between groups AR-1 and BR-1 (P > .05), although PPMR in group AR-1 was higher than in group AR-2 (P < .05), similar results were found in PPMR between groups BR-1 and BR-2 (P < .05). CONCLUSION Purposely seeking for colorectal polyps did not result in more polyps detected compared with routine colonoscopy.
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Affiliation(s)
- Yanliu Chu
- Department of Hepatology and Gastroenterology, Chinese PLA General Hospital, Beijing
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Juan Zhang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Ping Wang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Tian Li
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Shuyi Jiang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Qinfu Zhao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Feng Liu
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiaozhong Gao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiuli Qiao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiaofeng Wang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Zhenhe Song
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Heye Liang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Jing Yue
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Enqiang Linghu
- Department of Hepatology and Gastroenterology, Chinese PLA General Hospital, Beijing
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12
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Ikomi A, Mannan S, Simon G, Khan R, Smith S, Robbins J, Kavanagh U, Crone D. Diagnosis of gestational diabetes during the pandemic: what is the risk of falling through the net? Diabet Med 2020; 37:1782-1784. [PMID: 32585723 PMCID: PMC7362157 DOI: 10.1111/dme.14346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Ikomi
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Mannan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - G. Simon
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - R. Khan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Smith
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - J. Robbins
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - U. Kavanagh
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - D. Crone
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
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Portuondo JI, Probstfeld L, Massarweh NN, Le L, Wei Q, Chai CY, Taylor J, Awad SS, Tran Cao HS. Malnutrition in elective surgery: How traditional markers might be failing surgeons and patients. Surgery 2020; 168:1144-1151. [PMID: 32919780 DOI: 10.1016/j.surg.2020.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Serologic and anthropometric measures are commonly used as surrogate markers of nutritional status in clinical practice. In 2012, leading dietetic organizations published a standard definition of malnutrition based on clinical characteristics. We hypothesize that surrogate markers underrecognize clinical malnutrition and do not accurately identify patients at risk for adverse outcomes. METHODS A single-institution cohort study of elective surgical inpatients from August 2015 to November 2017. Nutritional assessment was completed by trained registered dietitians using leading dietetic guidelines. Multivariable logistic regression was used to determine the association between malnutrition and perioperative outcomes. RESULTS Among 953 elective surgical admissions, 456 underwent full clinical nutritional assessment. Of these, 202 (44.3%) met malnutrition criteria. In addition, 20.3% of patients with clinical malnutrition were underweight (<18.5 kg/m2) and 38.1% had a serum albumin <3.0 g/dL. Compared with nonmalnourished patients, those with clinical malnutrition had higher rates of any complication (46.5% vs 37.8%, P = .06), overall infectious complications (26.2% vs 14.6%, P = .002), surgical site infections (9.4% vs 3.9%, P = .02), and mortality (8.9% vs 1.9%, P = .001). Clinical malnutrition was associated with death (odds ratio 3.99; 95% confidence interval, 1.27-12.54), overall infectious complication (odds ratio 1.77; 95% confidence interval, 1.07-2.94), and surgical site infections (odds ratio 2.65; 95% confidence interval, 1.12-6.22). CONCLUSION In this cohort of elective surgical patients, traditional markers failed to identify malnutrition in a substantial portion of patients who met clinical malnutrition criteria. Clinical malnutrition assessment is effective in identifying patients who may be at risk for suboptimal outcomes. Surgeons should implement clinical nutritional assessment and factor that information into their preoperative evaluation and management of elective surgical patients.
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Affiliation(s)
- Jorge I Portuondo
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Lauren Probstfeld
- Department of Nutrition, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Nader N Massarweh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Lilyann Le
- Department of Nutrition, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Qi Wei
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Christy Y Chai
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Jennifer Taylor
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Samir S Awad
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Hop S Tran Cao
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
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14
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McIntyre HD, Gibbons KS, Ma RCW, Tam WH, Sacks DA, Lowe J, Madsen LR, Catalano PM. Testing for gestational diabetes during the COVID-19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia. Diabetes Res Clin Pract 2020; 167:108353. [PMID: 32739381 PMCID: PMC7391984 DOI: 10.1016/j.diabres.2020.108353] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 01/21/2023]
Abstract
AIMS We assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes. METHODS Secondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75 g OGTTs and HbA1c assays between 24 and 32 weeks' gestation and who received no treatment for GDM. RESULTS All post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk. CONCLUSIONS The modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.
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Affiliation(s)
- H David McIntyre
- Mater Research Institute, The University of Queensland, South Brisbane, Australia.
| | - Kristen S Gibbons
- Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Hung Tam
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, China
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Julia Lowe
- University of Newcastle, Newcastle, Australia
| | - Lene R Madsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Patrick M Catalano
- Department of Obstetrics and Gynecology, Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
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15
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Lain MG, Chicumbe S, de Araujo AR, Karajeanes E, Couto A, Giaquinto C, Vaz P. Correlates of loss to follow-up and missed diagnosis among HIV-exposed infants throughout the breastfeeding period in southern Mozambique. PLoS One 2020; 15:e0237993. [PMID: 32822388 PMCID: PMC7444585 DOI: 10.1371/journal.pone.0237993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Complete follow-up of human immunodeficiency virus (HIV)-exposed infants (HEI) is crucial for a successful prevention of mother-to-child HIV transmission. This study analyzed the HEI follow-up and factors associated with loss to follow-up (LTFU) in southern Mozambique. Methods This retrospective cohort study used the data of HEI enrolled between June 2017 and June 2018, followed-up for 18 months. The outcomes were the proportion of infants with completed follow-up and a definitive diagnosis, and the presence of clinical events. Kaplan–Meier survival analysis was used to calculate the cumulative probability of LTFU and of clinical events. Factors associated with LTFU and clinical events were analyzed using Cox regression to calculate the hazard ratio (HR) and adjusted HR (AHR), with a 95% confidence interval (CI) and a significance cutoff of p<0.05. Results 1413 infants were enrolled (49% males) at a median age of 32 days (IQR 31–41); the median follow-up time was 12 months (IQR 8.2–14.2); 1129 (80%) completed follow-up and had a definitive diagnosis, 58 (4%) were HIV-positive, 225 (16%) were LTFU; 266 (19%) presented a clinical event. Factors associated with LTFU were: age >2 months at entry (AHR, 1.58; 95% CI, 1.12–2.23), non-exclusive breastfeeding (AHR, 1.44; 95% CI, 1.01–2.06), poor cotrimoxazole adherence (AHR, 3.42; 95% CI, 1.59–7.35), and clinical events (AHR, 0.51; 95% CI, 0.34–0.77). Factors associated with clinical events were: malnutrition (AHR, 10.06; 95% CI, 5.92–17.09), non-exclusive breastfeeding (AHR, 1.98; 95% CI, 1.34–2.93), no nevirapine prophylaxis (AHR, 1.67; 95% CI, 1.18–2.36), and poor cotrimoxazole adherence (AHR, 2.62; 95% CI, 1.10–6.22). Conclusion The high rate of HEI LTFU, associated with delayed linkage to postnatal care, poor prophylaxis adherence, non-exclusive breastfeeding, indicates the need to design a differentiated service delivery model that is tailored to the mothers’ and infants’ specific needs.
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Affiliation(s)
- Maria Grazia Lain
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
- * E-mail:
| | - Sergio Chicumbe
- Health System Program, Instituto Nacional de Saúde, Maputo, Mozambique
| | | | | | - Aleny Couto
- HIV Program, Ministry of Health, Maputo, Mozambique
| | - Carlo Giaquinto
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Paula Vaz
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
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16
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Park JH, Moon HS, Kwon IS, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Quality of Preoperative Colonoscopy Affects Missed Postoperative Adenoma Detection in Colorectal Cancer Patients. Dig Dis Sci 2020; 65:2063-2070. [PMID: 31667695 DOI: 10.1007/s10620-019-05912-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite thorough preoperative screening, 19-30% of synchronous polyps or adenomas are detected after colon cancer surgery. Remnant synchronous lesions require additional colonoscopy procedures or surgery. AIM To investigate factors of preoperative colonoscopy potentially affecting the detection of missed lesions in patients subjected to colorectal cancer surgery. METHODS Of 1147 colorectal cancer patients subjected to curative open or laparoscopic colectomy and colonoscopy at the Chungnam National University Hospital from January 2012 to December 2016, 518 patients underwent pre- and postoperative colonoscopy. The index colonoscopy was defined as the last preoperative endoscopy performed. We analyzed pre- and postoperative medical charts for colonoscopy and pathological data. The effects of patient, procedure, and tumor factors on the postoperative adenoma detection rate, advanced adenoma detection rate, and adenoma miss rate (AMR) were analyzed. RESULTS The overall AMR was 25.7% (95% confidence interval, 22.2-29.8%). Comparing optimal and non-optimal bowel preparation groups, the latter had greater postoperative polyp missed rate (PMR), AMR (p < 0.01), and AAMR (p = 0.272). The optimal preparation group allowed identification of more synchronous adenomas than in the fair (OR 5.72) and poor (OR 11.39) preparation groups. On univariate analysis, patient age and left-sided colectomy (p < 0.01) influenced AMR. Multivariate analysis showed that age, preoperative bowel preparation, and left colon resection influenced postoperative AMR. CONCLUSION A better quality of index colonoscopy had a positive effect on lowering the detection rate of postoperative adenoma. Older age and suboptimal bowel preparation at the index colonoscopy and left-sided colectomy had negative effects on lowering the postoperative AMR.
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Affiliation(s)
- Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
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17
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van Nisselrooij AEL, Teunissen AKK, Clur SA, Rozendaal L, Pajkrt E, Linskens IH, Rammeloo L, van Lith JMM, Blom NA, Haak MC. Why are congenital heart defects being missed? Ultrasound Obstet Gynecol 2020; 55:747-757. [PMID: 31131945 PMCID: PMC7317409 DOI: 10.1002/uog.20358] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Congenital heart defects (CHD) are still missed frequently in prenatal screening programs, which can result in severe morbidity or even death. The aim of this study was to evaluate the quality of fetal heart images, obtained during the second-trimester standard anomaly scan (SAS) in cases of CHD, to explore factors associated with a missed prenatal diagnosis. METHODS In this case-control study, all cases of a fetus born with isolated severe CHD in the Northwestern region of The Netherlands, between 2015 and 2016, were extracted from the PRECOR registry. Severe CHD was defined as need for surgical repair in the first year postpartum. Each cardiac view (four-chamber view (4CV), three-vessel (3V) view and left and right ventricular outflow tract (LVOT, RVOT) views) obtained during the SAS was scored for technical correctness on a scale of 0 to 5 by two fetal echocardiography experts, blinded to the diagnosis of CHD and whether it was detected prenatally. Quality parameters of the cardiac examination were compared between cases in which CHD was detected and those in which it was missed on the SAS. Regression analysis was used to assess the association of sonographer experience and of screening-center experience with the cardiac examination quality score. RESULTS A total of 114 cases of isolated severe CHD at birth were analyzed, of which 58 (50.9%) were missed and 56 (49.1%) were detected on the SAS. The defects comprised transposition of the great arteries (17%), aortic coarctation (16%), tetralogy of Fallot (10%), atrioventricular septal defect (6%), aortic valve stenosis (5%), ventricular septal defect (18%) and other defects (28%). No differences were found in fetal position, obstetric history, maternal age or body mass index (BMI) or gestational age at examination between missed and detected cases. Ninety-two cases had available cardiac images from the SAS. Compared with the detected group, the missed group had significantly lower cardiac examination quality scores (adequate score (≥ 12) in 32% vs 64%; P = 0.002), rate of proper use of magnification (58% vs 84%; P = 0.01) and quality scores for each individual cardiac plane (4CV (2.7 vs 3.9; P < 0.001), 3V view (3.0 vs 3.8; P = 0.02), LVOT view (1.9 vs 3.3; P < 0.001) and RVOT view (1.9 vs 3.3; P < 0.001)). In 49% of missed cases, the lack of detection was due to poor adaptational skills resulting in inadequate images in which the CHD was not clearly visible; in 31%, the images showed an abnormality (mainly septal defects and aortic arch anomalies) which had not been recognized at the time of the scan; and, in 20%, the cardiac planes had been obtained properly but showed normal anatomy. Multivariate regression analysis showed that the volume of SAS performed per year by each sonographer was associated significantly with quality score of the cardiac examination. CONCLUSIONS A lack of adaptational skills when performing the SAS, as opposed to circumstantial factors such as BMI or fetal position, appears to play an important role in failure to detect CHD prenatally. The quality of the cardiac views was inadequate significantly more often in undetected compared with detected cases. Despite adequate quality of the images, CHD was not recognized in 31% of cases. A high volume of SAS performed by each sonographer in a large ultrasound center contributes significantly to prenatal detection. In 20% of undetected cases, CHD was not visible even though the quality of the images was good. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. E. L. van Nisselrooij
- Department of Obstetrics and Fetal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - A. K. K. Teunissen
- Department of Obstetrics and Fetal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - S. A. Clur
- Department of Paediatric CardiologyEmma Children's Hospital, Amsterdam University Medical CentersAmsterdamThe Netherlands
| | - L. Rozendaal
- Department of Paediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - I. H. Linskens
- Department of ObstetricsAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - L. Rammeloo
- Department of Paediatric CardiologyEmma Children's Hospital, Amsterdam University Medical CentersAmsterdamThe Netherlands
| | - J. M. M. van Lith
- Department of Obstetrics and Fetal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - N. A. Blom
- Department of Paediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - M. C. Haak
- Department of Obstetrics and Fetal MedicineLeiden University Medical CenterLeidenThe Netherlands
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18
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Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, Shaman J. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020. [PMID: 32179701 DOI: 10.1126/science.abb32214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Estimation of the prevalence and contagiousness of undocumented novel coronavirus [severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)] infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here, we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model, and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV-2, including the fraction of undocumented infections and their contagiousness. We estimate that 86% of all infections were undocumented [95% credible interval (CI): 82-90%] before the 23 January 2020 travel restrictions. The transmission rate of undocumented infections per person was 55% the transmission rate of documented infections (95% CI: 46-62%), yet, because of their greater numbers, undocumented infections were the source of 79% of the documented cases. These findings explain the rapid geographic spread of SARS-CoV-2 and indicate that containment of this virus will be particularly challenging.
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Affiliation(s)
- Ruiyun Li
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Bin Chen
- Department of Land, Air and Water Resources, University of California, Davis, Davis, CA 95616, USA
| | - Yimeng Song
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | - Tao Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 10084, P. R. China
| | - Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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19
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Abstract
Estimation of the prevalence and contagiousness of undocumented novel coronavirus [severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)] infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here, we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model, and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV-2, including the fraction of undocumented infections and their contagiousness. We estimate that 86% of all infections were undocumented [95% credible interval (CI): 82-90%] before the 23 January 2020 travel restrictions. The transmission rate of undocumented infections per person was 55% the transmission rate of documented infections (95% CI: 46-62%), yet, because of their greater numbers, undocumented infections were the source of 79% of the documented cases. These findings explain the rapid geographic spread of SARS-CoV-2 and indicate that containment of this virus will be particularly challenging.
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Affiliation(s)
- Ruiyun Li
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Bin Chen
- Department of Land, Air and Water Resources, University of California, Davis, Davis, CA 95616, USA
| | - Yimeng Song
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | - Tao Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 10084, P. R. China
| | - Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Shnaekel AW, Kee JR, Travis KE, Sachleben BC, Siegel ER, Blasier RD, Rabenhorst BM. The Atypical Patient With Slipped Capital Femoral Epiphyses May Be at Increased Risk for a Missed Contralateral Slip. Orthopedics 2020; 43:e114-e118. [PMID: 31930409 DOI: 10.3928/01477447-20200107-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/16/2019] [Indexed: 02/03/2023]
Abstract
Slipped capital femoral epiphysis (SCFE) is a commonly encountered hip disorder. The goal of this study was to describe the incidence of missed contra-lateral SCFE as well as to identify risk factors. The authors hypothesized that contralateral slips are more often missed in patients with severe involvement of the treated side. After institutional review board approval was obtained, a retrospective chart review was performed of all pediatric patients who were treated for sequential and bilateral SCFE at a single institution during an 18-year period. Medical records were reviewed for demographic features and attending surgeon. Radiographs were reviewed for skeletal maturity, Klein's line, and severity of the treated slip. All radiographs were reviewed by 3 pediatric orthopedists. Contralateral SCFE was deemed present when consensus was achieved. Comparisons were made with Fisher's exact test, and P<.05 was considered significant. Of the records that were reviewed, 56 patients met the study criteria. Of these, 19 patients had bilateral involvement and 5 missed slips were identified (8.9%). The patients with missed disease tended to be younger (mean age, 10.8 vs 11.4 years), with a lower body mass index. Fellowship-trained pediatric surgeons were more likely to identify bilateral disease compared with orthopedists without pediatric training (P=.0065). A contralateral slip was more likely to be present in patients who had a positive finding for Klein's line (P<.0001). Severity of the treated slip did not increase the likelihood of missing a contralateral slip. Although Klein's line is a useful tool in the diagnosis of SCFE, a false-negative rate of 40% was observed. The authors recommend increased vigilance when an "atypical" patient with SCFE presents with unilateral disease. [Orthopedics. 2020;43(2):e114-e118.].
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21
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Cao X, Yang M, Huang XB, Tan XL, Liu Y, Huo N, Chen MS, Tang WW, Ma X, Xu RH. Prevalence and Rates of New Diagnosis and Missed Diagnosis of Diabetes Mellitus among 35-74-year-old Residents in Urban Communities in Southwest China. Biomed Environ Sci 2019; 32:704-709. [PMID: 31635686 DOI: 10.3967/bes2019.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Xin Cao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Min Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China; West China Research Centre for Rural Health Development, Sichuan University, Chengdu 610041, Sichuan, China; Swinburne University of Technology, Melbourne Victoria 3004, Australia
| | - Xiao Bo Huang
- Department of Cardiology, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan, China; Cardiovascular and Metabolic Disease Center, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan, China
| | - Xue Ling Tan
- Medical School of Chengdu University, Chengdu 610106, Sichuan, China
| | - Ya Liu
- Department of Cardiology, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan, China
| | - Nan Huo
- Auburn University Harrison School of Pharmacy, Auburn 36830, AL, United States
| | - Ming Sheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Wei Wei Tang
- School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Xiao Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Rong Hua Xu
- Cardiovascular and Metabolic Disease Center, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan, China; Stroke Center, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan, China
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22
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Aaronson EL, Quinn GR, Wong CI, Murray AM, Petty CR, Einbinder J, Schiff GD. Missed diagnosis of cancer in primary care: Insights from malpractice claims data. J Healthc Risk Manag 2019; 39:19-29. [PMID: 31338938 DOI: 10.1002/jhrm.21385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the ambulatory setting, missed cancer diagnoses are leading contributors to patient harm and malpractice risk; however, there are limited data on the malpractice case characteristics for these cases. OBJECTIVE The aim of this study was to examine key features and factors identified in missed cancer diagnosis malpractice claims filed related to primary care and evaluate predictors of clinical and claim outcomes. METHODS We analyzed 2155 diagnostic error closed malpractice claims in outpatient general medicine. We created multivariate models to determine factors that predicted case outcomes. RESULTS Missed cancer diagnoses represented 980 (46%) cases of primary care diagnostic errors, most commonly from lung, colorectal, prostate, or breast cancer. The majority (76%) involved errors in clinical judgment, such as a failure or delay in ordering a diagnostic test (51%) or failure or delay in obtaining a consult or referral (37%). These factors were independently associated with higher-severity patient harm. The majority of these errors were of high severity (85%). CONCLUSIONS Malpractice claims involving missed diagnoses of cancer in primary care most often involve routine screening examinations or delays in testing or referral. Our findings suggest that more reliable closed-loop systems for diagnostic testing and referrals are crucial for preventing diagnostic errors in the ambulatory setting.
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Hernanz N, Rodríguez de Santiago E, Marcos Prieto HM, Jorge Turrión MÁ, Barreiro Alonso E, Rodríguez Escaja C, Jiménez Jurado A, Sierra M, Pérez Valle I, Volpato N, García Prada M, Nuñez-Gómez L, Ríos-León R, Castaño García A, García de Paredes AG, Aicart M, Caminoa A, Peñas Parcía B, Vázquez-Sequeiros E, Albillos A. Characteristics and consequences of missed gastric cancer: A multicentric cohort study. Dig Liver Dis 2019; 51:894-900. [PMID: 30898522 DOI: 10.1016/j.dld.2019.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Missed gastric cancer (MGC) is poorly documented in Mediterranean populations. AIMS (1) To assess the rate, predictors and survival of MGC. (2) To compare MGC and non-MGC tumors. METHODS This is a retrospective-cohort study conducted at four centers. MGC was defined as cancer detected within three years after negative esophagogastroduodenoscopy. Gastric adenocarcinomas diagnosed between 2008-2015 were included. Patients with no follow-up were excluded. RESULTS During the study period 123,395 esophagogastroduodenoscopies were performed, with 1374 gastric cancers being diagnosed (1.1%). A total of 1289 gastric cancers were finally included. The overall rate of MGC was 4.7% (61/1289, 3.7-6%). A negative esophagogastroduodenoscopy in MGC patients was independently associated with PPI therapy (p < 0.001), previous Billroth II anastomosis (p = 0.002), and lack of alarm symptoms (p < 0.001). The most frequent location for MGC was the gastric body(52.4%). MGCs were smaller than non-MGCs (31 vs 41 mm, p = 0.047), more often flat or depressed (p = 0.003) and less likely to be encountered as advanced disease. Overall 2-year survival was similar between MGC (34.1%) and Non-MGC (35.3 %) (p = 0.59). CONCLUSION MGC accounted for nearly five percent of newly-diagnosed gastric adenocarcinomas. Overall survival was poor and not different between MGC and non-MGC.
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Affiliation(s)
- Nerea Hernanz
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS),Spain.
| | | | | | | | - Carlos Rodríguez Escaja
- Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Spain
| | - Andrea Jiménez Jurado
- Gastroenterology department, Hospital Universitario de Salamanca, University of Salamanca, IBSAL, Spain
| | - María Sierra
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | | | - Nadja Volpato
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - María García Prada
- Gastroenterology department, Hospital Universitario de Salamanca, University of Salamanca, IBSAL, Spain
| | - Laura Nuñez-Gómez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Raquel Ríos-León
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Andrés Castaño García
- Gastroenterology department, Hospital Universitario de Salamanca, University of Salamanca, IBSAL, Spain
| | - Ana García García de Paredes
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Marta Aicart
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Alejandra Caminoa
- Department of Pathology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain
| | - Beatriz Peñas Parcía
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS),Spain
| | - Enrique Vázquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS),Spain
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcala, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS),Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Spain
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24
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Nanditha NGA, St-Jean M, Tafessu H, Guillemi SA, Hull MW, Lu M, Henry B, Barrios R, Montaner JSG, Lima VD. Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study. PLoS One 2019; 14:e0214012. [PMID: 30897143 PMCID: PMC6428302 DOI: 10.1371/journal.pone.0214012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Late HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada. DESIGN Retrospective cohort. METHODS A missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001-2014. Multivariable logistic regression identified factors associated with missed opportunities. RESULTS Of 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause. CONCLUSIONS Based on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Silvia A. Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark W. Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Lu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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