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2.
Nurse Pract ; 46(2): 44-49, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33475330

RESUMO

ABSTRACT: Misdiagnosis and delayed diagnosis are common problems in healthcare and are typically related to patient, provider, and socioeconomic factors. A syndemics model of COVID-19 is used to analyze the synergistic relationship between diseases and influences that impact patients' living conditions and health. NPs can use this approach to promote patient safety and equitable healthcare.


Assuntos
/diagnóstico , Diagnóstico Tardio , Erros de Diagnóstico , /enfermagem , Diagnóstico Tardio/prevenção & controle , Erros de Diagnóstico/prevenção & controle , Disparidades em Assistência à Saúde , Humanos , Profissionais de Enfermagem , Medição de Risco , Fatores Socioeconômicos , Sindemia
5.
Foot Ankle Spec ; 13(5): 415-419, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32924585

RESUMO

Skin cancer is the most common cancer within the United States. Reports estimate that 1 in 5 Americans will develop some form of skin cancer. Eccrine porocarcinoma is a rare type of skin cancer of sweat gland origin. Eccrine porocarcinoma is most commonly found on the lower extremities. Clinically it may appear similar to benign skin lesions and it has significant metastatic potential. The authors present a case report with 22 months' follow-up. It describes a multiyear delay in diagnosis involving 3 specialties, including primary care, dermatology, and wound physical therapy. Information is given on techniques when high-risk cutaneous cancers are suspected or encountered. A multispecialty treatment plan is discussed.Levels of Evidence: Level V.


Assuntos
Diagnóstico Tardio/prevenção & controle , Porocarcinoma Écrino/diagnóstico , Porocarcinoma Écrino/cirurgia , Hallux/cirurgia , Procedimentos Ortopédicos/métodos , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/cirurgia , Idoso , Amputação/métodos , Porocarcinoma Écrino/diagnóstico por imagem , Porocarcinoma Écrino/patologia , Humanos , Comunicação Interdisciplinar , Extremidade Inferior , Masculino , Equipe de Assistência ao Paciente , Doenças Raras , Biópsia de Linfonodo Sentinela , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/patologia , Resultado do Tratamento
6.
JBJS Case Connect ; 10(3): e2000288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32910604

RESUMO

CASE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease. Patients typically present with fever, cough, and radiological lung changes. However, a significant proportion of these patients are asymptomatic. To date, we have limited information on the operations performed on these patients. We report our experience of a relatively asymptomatic elderly patient who underwent surgery for a hip fracture and was confirmed postoperatively to have COVID-19. CONCLUSION: Meticulous hand hygiene and use of surgical mask in daily practice is crucial to protect against asymptomatic and undiagnosed patients.


Assuntos
Doenças Assintomáticas , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Diagnóstico Tardio/prevenção & controle , Fraturas do Colo Femoral/diagnóstico , Hemiartroplastia/métodos , Controle de Infecções , Pandemias , Pneumonia Viral , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Período Pós-Operatório , Resultado do Tratamento , Precauções Universais/métodos
8.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32839243

RESUMO

OBJECTIVES: African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this study was to analyze data from the largest-available repository of diagnostic and phenotypic information on AA children with ASD, and to explore the wide variation in outcome within the cohort as a function of sociodemographic risk and specific obstacles to service access for the purpose of informing a national approach to resolution of these disparities. METHODS: Parents of 584 AA children with autism consecutively enrolled in the Autism Genetic Resource Exchange across 4 US data collection sites completed event history calendar interviews of the diagnostic odysseys for their children with ASD. These data were examined in relation to developmental outcomes of the children with autism and their unaffected siblings. RESULTS: The average age of ASD diagnosis was 64.9 months (±49.6), on average 42.3 months (±45.1) after parents' first concerns about their children's development. The relationship between timing of diagnosis and ASD severity was complex, and ID comorbidity was not predicted in a straightforward manner by familial factors associated with cognitive variation in the general population. CONCLUSIONS: These findings document significant opportunity to expedite diagnosis, the need to further understand causes of ID comorbidity, and the necessity to identify effective approaches to the resolution of disparities in severity-of-outcome for AA children with autism.


Assuntos
Afro-Americanos/genética , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/genética , Bases de Dados Genéticas/tendências , Diagnóstico Tardio/tendências , Afro-Americanos/psicologia , Fatores Etários , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Diagnóstico Tardio/prevenção & controle , Diagnóstico Tardio/psicologia , Feminino , Humanos , Masculino
9.
Epidemiol Health ; 42: e2020058, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32777881

RESUMO

OBJECTIVES: Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis. METHODS: An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas. RESULTS: The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables. CONCLUSIONS: The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.


Assuntos
Brucelose/epidemiologia , Diagnóstico Tardio/prevenção & controle , Vigilância da População , Brucelose/diagnóstico , Cidades/epidemiologia , Análise por Conglomerados , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Análise Espacial
10.
BMC Infect Dis ; 20(1): 594, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787869

RESUMO

BACKGROUND: Implementation of an effective Tuberculosis Routine Surveillance System in low-income countries like Tanzania is problematic, despite being an essential tool for the detection and effective monitoring of drug resistant tuberculosis. Long delays in specimen transportation from the facilities to reference laboratory and results dissemination back to the health facilities, result in poor patient management, particularly where multidrug-resistant tuberculosis disease is present. METHODS: Following a detailed qualitative study, a pilot intervention of a revised Tuberculosis Routine Surveillance System was implemented in Mwanza region, Tanzania. This included the use of rapid molecular methods for the detection of both tuberculosis and drug resistance using Xpert MTB/RIF in some Mwanza sites, the use of Xpert MTB/RIF and Line Probe Assay at the Central Tuberculosis Reference Laboratory, a revised communication strategy and interventions to address the issue of poor form completion. A before and after comparison of the intervention on the number of drug resistant tuberculosis cases identified and the time taken for results feedback to the requesting site was reported. RESULTS: The revised system for previously treated cases tested at the Central Reference Laboratory was able to obtain the following findings; the number of cases tested increased from 75 in 2016 to 185 in 2017. The times for specimen transportation from health facilities to the reference laboratory were reduced by 22% (from 9 to 7 days). The median time for the district to receive results was reduced by 36% (from 11 to 7 days). Overall the number of drug resistant tuberculosis cases starting treatment increased by 67% (from 12 to 20). CONCLUSION: Detection of drug resistance could significantly be enhanced, and delays reduced by introduction of new technologies and improved routine surveillance system, including better communication using mobile applications such as 'WhatsApp' and close follow-ups. A larger scale study is now merited to ascertain if these benefits are robust across different contexts.


Assuntos
Diagnóstico Tardio/prevenção & controle , Testes Diagnósticos de Rotina/métodos , Monitoramento Epidemiológico , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Antibióticos Antituberculose/uso terapêutico , Comunicação , Farmacorresistência Bacteriana Múltipla , Instalações de Saúde , Humanos , Laboratórios , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Projetos Piloto , Estudos Prospectivos , Pesquisa Qualitativa , Rifampina/uso terapêutico , Manejo de Espécimes/métodos , Tanzânia/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
12.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32613916

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Assuntos
Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Biópsia por Agulha Fina/instrumentação , Protocolos Clínicos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Tardio/prevenção & controle , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Encaminhamento e Consulta , Medição de Risco , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia de Intervenção/métodos
14.
Postgrad Med J ; 96(1137): 392-398, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32522844

RESUMO

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Tardio/prevenção & controle , Erros de Diagnóstico/prevenção & controle , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/fisiopatologia , Síndrome da Liberação de Citocina/virologia , Diagnóstico Tardio/estatística & dados numéricos , Diagnóstico Diferencial , Erros de Diagnóstico/estatística & dados numéricos , Diarreia/virologia , Disgeusia/virologia , Humanos , Doenças do Sistema Nervoso/virologia , Transtornos do Olfato/virologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Replicação Viral
15.
JAMA Netw Open ; 3(6): e206752, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32584406

RESUMO

Importance: Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. Objective: To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. Design, Setting, and Participants: This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA) National Center for Patient Safety from January 1, 2013, to July 31, 2018. Main Outcomes and Measures: Common themes associated with the role of HIT-related safety concerns were identified and categorized according to the Health IT Safety framework for measuring, monitoring, and improving HIT safety. This framework includes 3 related domains (ie, safe HIT, safe use of HIT, and using HIT to improve safety) situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety. Hence, themes identified enhanced understanding of the sociotechnical context and domain of HIT safety involved. Results: Of 214 RCAs categorized by the terms delay and outpatient submitted during the study period, 88 were identified as involving diagnostic delays and HIT, from which 172 unique HIT-related safety concerns were extracted (mean [SD], 1.97 [1.53] per RCA). Most safety concerns (82.6% [142 of 172]) involved problems with safe use of HIT, predominantly sociotechnical factors associated with people, workflow and communication, and a poorly designed human-computer interface. Fewer safety concerns involved problems with safe HIT (14.5% [25 of 172]) or using HIT to improve safety (0.3% [5 of 172]). The following 5 key high-risk areas for diagnostic delays emerged: managing electronic health record inbox notifications and communication, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results. Conclusions and Relevance: This qualitative study of a national RCA data set suggests that interventions to reduce outpatient diagnostic delays could aim to improve test result management, interoperability, data visualization, and order entry, as well as to decrease information overload.


Assuntos
Diagnóstico Tardio/prevenção & controle , Informática Médica/métodos , Pacientes Ambulatoriais/estatística & dados numéricos , Análise de Causa Fundamental/métodos , Estudos de Coortes , Comunicação , Assistência à Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Humanos , Informática Médica/estatística & dados numéricos , Segurança do Paciente , Pesquisa Qualitativa , Estudos Retrospectivos , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Interface Usuário-Computador , Veteranos , Fluxo de Trabalho
16.
Rev. senol. patol. mamar. (Ed. impr.) ; 33(2): 61-67, abr.-jun. 2020.
Artigo em Inglês | IBECS | ID: ibc-188000

RESUMO

We are facing a pandemic that is going to affect a significant part of the population. At the end of April in the world there are about 3,000,000 cases, with 205,000 deaths and 860,000 patients recovered. The response to this pandemic has in many cases led to a significant change in the daily work of caring for cancer patients, the good results of which depend largely on time-adjusted protocols and multidisciplinary treatments. We present a review of local, surgical and radiotherapy treatment together with authors' recommendations made from personal experience on ways to act in the diagnosis and surgical treatment of breast cancer during the COVID-19 pandemic. The multidisciplinary Breast Committees must continue to meet weekly in videoconference format. All surgical actions and irradiations must be carried out with maximum safety for both the patients and the participating teams. Hypofractionation in radiation therapy should be the standard treatment. Sometimes it is recommended to apply a primary systemic treatment or even a primary irradiation. Great coordination between the surgical and oncology teams, both medical and radiotherapeutic, is essential


Nos enfrentamos a una pandemia que afecta a una parte importante de la población.  A finales de abril de 2020, en el mundo hay cerca de 3.000.000 de casos, con 205.000 muertes y 860.000 pacientes recuperados. La respuesta a esta pandemia en muchos casos ha supuesto modificaciones importantes en el cuidado diario de las pacientes con cáncer, dependiendo el buen resultado en buena parte del ajuste de los protocolos a las circunstancias especiales y a los tratamientos multidisciplinarios. Presentamos una revisión del tratamiento quirúrgico y radioterapia junto con las recomendaciones de los autores basadas en su experiencia personal a la hora del diagnóstico y tratamiento locorregional del cáncer de mama durante la pandemia del COVID-19. Los comités multidisciplinarios deben seguir reuniéndose semanalmente en formato de videoconferencia. Todos las intervenciones quirúrgicas e irradiaciones deben ser llevadas a cabo con la máxima seguridad tanto para las pacientes como para el personal sanitario que participa. El hipofraccionamiento debe ser el tratamiento radioterápico estándar. En algunos casos se utilizará tratamiento sistémico primario o incluso radioterapa preoperatoria. Es esencial una coordinación importante entre los equipos quirúrgicos y los oncológicos, tanto radioterápicos como médicos


Assuntos
Humanos , Feminino , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Vírus da SARS/patogenicidade , Precauções Universais/métodos , Segurança do Paciente/normas , Consulta Remota/métodos , Telemonitoramento , Equipe de Assistência ao Paciente/organização & administração , Neoplasias da Mama/diagnóstico , Diagnóstico Tardio/prevenção & controle , Tempo para o Tratamento/tendências
17.
PLoS Med ; 17(5): e1003039, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32407407

RESUMO

BACKGROUND: Tuberculosis (TB) incidence in India continues to be high due, in large part, to long delays experienced by patients before successful diagnosis and treatment initiation, especially in the private sector. This diagnostic delay is driven by patients' inclination to switch between different types of providers and providers' inclination to delay ordering of accurate diagnostic tests relevant to TB. Our objective is to quantify the impact of changes in these behavioral characteristics of providers and patients on diagnostic delay experienced by pulmonary TB patients. METHODS AND FINDINGS: We developed a discrete event simulation model of patients' diagnostic pathways that captures key behavioral characteristics of providers (time to order a test) and patients (time to switch to another provider). We used an expectation-maximization algorithm to estimate the parameters underlying these behavioral characteristics, with quantitative data encoded from detailed interviews of 76 and 64 pulmonary TB patients in the 2 Indian cities of Mumbai and Patna, respectively, which were conducted between April and August 2014. We employed the estimated model to simulate different counterfactual scenarios of diagnostic pathways under altered behavioral characteristics of providers and patients to predict their potential impact on the diagnostic delay. Private healthcare providers including chemists were the first point of contact for the majority of TB patients in Mumbai (70%) and Patna (94%). In Mumbai, 45% of TB patients first approached less-than-fully-qualified providers (LTFQs), who take 28.71 days on average for diagnosis. About 61% of these patients switched to other providers without a diagnosis. Our model estimates that immediate testing for TB by LTFQs at the first visit (at the current level of diagnostic accuracy) could reduce the average diagnostic delay from 35.53 days (95% CI: 34.60, 36.46) to 18.72 days (95% CI: 18.01, 19.43). In Patna, 61% of TB patients first approached fully qualified providers (FQs), who take 9.74 days on average for diagnosis. Similarly, immediate testing by FQs at the first visit (at the current level of diagnostic accuracy) could reduce the average diagnostic delay from 23.39 days (95% CI: 22.77, 24.02) to 11.16 days (95% CI: 10.52, 11.81). Improving the diagnostic accuracy of providers per se, without reducing the time to testing, was not predicted to lead to any reduction in diagnostic delay. Our study was limited because of its restricted geographic scope, small sample size, and possible recall bias, which are typically associated with studies of patient pathways using patient interviews. CONCLUSIONS: In this study, we found that encouraging private providers to order definitive TB diagnostic tests earlier during patient consultation may have substantial impact on reducing diagnostic delay in these urban Indian settings. These results should be combined with disease transmission models to predict the impact of changes in provider behavior on TB incidence.


Assuntos
Diagnóstico Tardio/prevenção & controle , Modelos Teóricos , Tuberculose Pulmonar/diagnóstico , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Comportamento/fisiologia , Estudos Transversais , Pessoal de Saúde , Humanos , Índia , Setor Privado , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
18.
Acta Orthop Traumatol Turc ; 54(2): 217-220, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32254040

RESUMO

Nontyphoidal salmonella (NTS) infection can lead to gastroenteritis, enteric fever, and bacteremia. However, osteoarticular infections caused by NTS are rarely encountered. We report the case of a 53-year-old male patient with bilateral hip infection caused by NTS. We performed a two-stage reconstruction comprising debridement of both hip joints followed by prosthetic replacement with antibiotic-loaded acrylic cement because the patient's diagnosis was delayed for approximately three months and the hip joints were already damaged. At two-year follow-up, the clinical, radiologic, and laboratory findings were within the normal limits, and there was no sign of infection. This case is presented because reports of bilateral hip joint infection due to NTS are rare. Early detection and proper treatment are essential for the eradication of the infection. The use of a prosthesis made of antibiotic-loaded acrylic cement and prolonged antimicrobial therapy can be considered in the management of bilateral hip joint destruction due to delayed diagnosis of NTS infection.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa , Artroplastia de Quadril/métodos , Desbridamento/métodos , Diagnóstico Tardio , Articulação do Quadril , Infecções por Salmonella/tratamento farmacológico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Cimentos para Ossos/uso terapêutico , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella/isolamento & purificação , Resultado do Tratamento
19.
Gastroenterology ; 158(5): 1287-1299.e2, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31926170

RESUMO

BACKGROUND & AIMS: Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS: We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS: Of the PCCRCs identified, 43% were in high-risk patients (those with inflammatory bowel disease, previous CRC, previous multiple large polyps, or hereditary cancer syndromes) and 66% were located distal to the hepatic flexure. There was no correlation between postcolonoscopy colorectal tumor size and time to diagnosis after index colonoscopy. Bowel preparation was poor in 19% of index colonoscopies, and only 36% of complete colonoscopies had adequate photodocumentation of completion. Development of 73% of PCCRCs was determined to be affected by technical endoscopic factors, 17% of PCCRCs by administrative factors (follow-up procedures delayed/not booked by administrative staff), and 27% of PCCRCs by decision-making factors. Twenty-seven percent of PCCRCs were categorized as possible missed lesion, prior examination adequate; 58% as possible missed lesion, prior examination inadequate; 8% as detected lesion, not resected; and 7% as incomplete resection of previously observed lesion; 89% were deemed to be avoidable. CONCLUSIONS: In a retrospective analysis of PCCRCs, using the WEO system of categorization, we found 43% to occur in high-risk patients; this might be reduced with more vigilant surveillance. Measures are needed to reduce technical, decision-making, and administrative factors. We found that 89% of PCCRCs may be avoidable. If half of avoidable PCCRCs could be prevented, the target rate of 2% for the PCCRC-3y (cancer diagnosed between 6 and 36 months after index colonoscopy) benchmark would be achievable.


Assuntos
Assistência ao Convalescente/normas , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/prevenção & controle , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Adulto , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Benchmarking/estatística & dados numéricos , Tomada de Decisão Clínica , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Inglaterra/epidemiologia , Reações Falso-Negativas , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Reto/diagnóstico por imagem , Reto/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Carga Tumoral
20.
J Pediatr Orthop ; 40(4): e293-e299, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31990821

RESUMO

BACKGROUND: Radial head dislocation with ulnar bowing (Monteggia type I equivalent injury) is a frequently missed injury. If not recognized acutely, these missed injuries can lead to serious long-term complications. The purpose of this study was to evaluate the rate of missed diagnosis and to report on the characteristics and early management of this specific injury pattern. METHODS: A total of 112 patients with Monteggia fracture-dislocation were identified, of which 18 patients had sustained a Monteggia type I equivalent injury. The total duration between injury, diagnosis, and treatment was noted. Medical records were reviewed to identify cases with the initially missed diagnosis. The radiographic assessment included the direction of radial head dislocation and location/displacement of the apex of the ulnar bow. Clinical outcomes were evaluated using Kim elbow performance score. RESULTS: Thirteen of 18 cases with Monteggia equivalent injury were missed at the initial presentation. The diagnosis was established when the patients followed up in the orthopaedic clinic. Of these 18 patients, 11 were treated by closed reduction/cast and 7 patients required surgery. Significant differences were found between the closed reduction/cast and operative group for the mean time from injury to treatment (3.2±2.6 vs. 12.7±13.6 d). For each day of delay in treatment, the odds for surgical intervention increased by a factor of 1.126 (12.6%). There were no significant differences between the location and magnitude of the apex of the ulnar deformity between the 2 groups. Kim elbow score was excellent in all cases at the latest follow-up. CONCLUSIONS: Clinical suspicion and careful radiographic assessment are of utmost importance for every child with forearm and elbow injury without an apparent fracture, as there is a high rate of missed diagnosis for this specific Monteggia injury pattern. Prompt treatment would allow for successful closed reduction while even minor delays would increase the need for surgical intervention. LEVEL OF EVIDENCE: Therapeutic, level III.


Assuntos
Redução Fechada/métodos , Articulação do Cotovelo , Diagnóstico Ausente , Fratura de Monteggia , Ulna , Criança , Pré-Escolar , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Humanos , Masculino , Diagnóstico Ausente/efeitos adversos , Diagnóstico Ausente/prevenção & controle , Fratura de Monteggia/diagnóstico , Fratura de Monteggia/cirurgia , Fratura de Monteggia/terapia , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/lesões , Ulna/cirurgia , Estados Unidos
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