To evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians.

The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists.

Pediatric ambulatory diagnostic errors (DEs) occur frequently. We used root cause analyses (RCAs) to identify their failure points and contributing factors.

No abstract available

Diagnostic errors are prevalent and associated with increased economic burden; however, little is known about their characteristics at the national level in Japan. This study aimed to investigate clinical outcomes and indemnity payment in cases of diagnostic errors using Japan's largest database of national claims.

Preventive strategies against diagnostic errors require the knowledge of underlying mechanisms. We examined the effects of a wrong a priori diagnosis on diagnostic accuracy of a focussed assessment in an acute myocardial infarction scenario. One-hundred-and-fifty-six medical students (cohort 1) were randomized to three study arms differing in the a priori diagnosis revealed: no diagnosis (control group), myocardial infarction (correct diagnosis group), and pulmonary embolism (wrong diagnosis group). Forty-four physicians (cohort 2) were randomized to the control group and the wrong diagnosis group. Primary endpoint was the participants' final presumptive diagnosis. Among students, the correct diagnosis of an acute myocardial infarction was made by 48/52 (92%) in the control group, 49/52 (94%) in the correct diagnosis group, and 14/52 (27%) in the wrong diagnosis group (p < 0.001 vs. both other groups). Among physicians, the correct diagnosis was made by 20/21 (95%) in the control group and 15/23 (65%) in the wrong diagnosis group (p = 0.023). In the wrong diagnosis group, 31/52 (60%) students and 6/23 (19%) physicians indicated their initially given wrong a priori diagnosis pulmonary embolism as final diagnosis. A wrong a priori diagnosis significantly increases the likelihood of a diagnostic error during a subsequent patient encounter.

There is lack of evidence for the association between multimorbidity and diagnostic errors. Information on diagnostic errors from patients' perspectives is crucial to improve the diagnostic process. In this study, we aimed to investigate patient-reported diagnostic errors and to examine the relationship between multimorbidity and patient-reported diagnostic errors in the primary care setting.

There is an increasing concern about diagnostic errors and their impact on patient safety. Physicians' diagnostic ability is significantly undermined by certain distractions that can carry potential negative consequences such as diagnostic and management errors. This study aimed to examine the effects of distracting factors for physicians during consultation and their consequent effects on diagnostic accuracy and disease or condition management.

Inborn error of immunity (IEI) comprises a broad group of inherited immunological disorders that usually display an overlap in many clinical manifestations challenging their diagnosis. The identification of disease-causing variants from whole-exome sequencing (WES) data comprises the gold-standard approach to ascertain IEI diagnosis. The efforts to increase the availability of clinically relevant genomic data for these disorders constitute an important improvement in the study of rare genetic disorders. This work aims to make available WES data of Brazilian patients' suspicion of IEI without a genetic diagnosis. We foresee a broad use of this dataset by the scientific community in order to provide a more accurate diagnosis of IEI disorders.

Lyme disease accounted for more than two-thirds (56 of 81, 69.1%) of all tick-borne disease referrals to a large, academic infectious diseases clinic in a low-incidence state. Deviations from diagnostic testing guidelines and errors in test interpretation were common (23 of 35, 65.7%), suggesting that frontline providers need additional clinical support.

Peripheral arterial disease (PAD) is an indicator of widespread atherosclerosis. However, most individuals with PAD, in spite of being at high cardiovascular risk, are asymptomatic. This fact, together with the limitations of the Doppler ankle-brachial index (ABI), contributes to PAD underdiagnose. The aim of this study was to compare oscillometric ABI and Doppler ABI to diagnose peripheral arterial disease, and also to examine the influence of oscillometric errors and calcified legs on the PAD diagnoses.

Background: Diagnostic errors are a major patient safety concern in primary healthcare and emergency care. These settings involve a high degree of uncertainty regarding patients' diagnoses and appear to be those most prone to diagnostic errors. Diagnostic errors comprise missed, delayed, or incorrect diagnoses preventing the patient from receiving correct and timely treatment. Data regarding which diagnoses are affected in these settings are scarce. Objectives: To understand the distribution of diagnoses among reported diagnostic errors in primary health and emergency care as a step towards creating countermeasures for safer care. Methods: A retrospective and descriptive cohort study investigating reported diagnostic errors. A nationwide cohort was collected from two databases. The study was performed in Sweden from 1 January 2011 until 31 December 2016. The setting was primary healthcare and emergency departments. Results: In total, 4830 cases of preventable harm were identified. Of these, 2208 (46%) were due to diagnostic errors. Diagnoses affected in primary care were cancer (37% and 23%, respectively, in the two databases; mostly colon and skin), fractures (mostly hand), heart disease (mostly myocardial infarction), and rupture of tendons (mostly Achilles). Of the diagnostic errors in the emergency department, fractures constituted 24% (mostly hand and wrist, 29%). Rupture/injury of muscle/tendon constituted 19% (mostly finger tendons, rotator cuff tendons, and Achilles tendon). Conclusion: Our findings show that the most frequently missed diagnoses among reported harm were cancers in primary care and fractures in the emergency departments.

The prevalence of chronic cardiovascular diseases (CVDs) has risen globally, nearly doubling from 1990 to 2019. ECG is a simple, non-invasive measurement that can help identify CVDs at an early and treatable stage. A multi-lead ECG, up to 15 leads in a wearable form factor, is desirable. We seek to derive multiple ECG leads from a select subset of leads so that the number of electrodes can be reduced in line with a patient-friendly wearable device. We further compare personalized derivations to generalized derivations.

Increasing demand on emergency healthcare systems has prompted introduction of new healthcare service models including the provision of GP services in or alongside emergency departments. In England this led to a policy proposal and £100million (US$130million) of funding for all emergency departments to have co-located GP services. However, there is a lack of evidence for whether such service models are effective and safe. We examined diagnostic errors reported in patient safety incident reports to develop theories to explain how and why they occurred to inform potential priority areas for improvement and inform qualitative data collection at case study sites to further refine the theories.

During mitosis, cells round up and utilize the interphase adhesion sites within the fibrous extracellular matrix (ECM) as guidance cues to orient the mitotic spindles. Here, using suspended ECM-mimicking nanofiber networks, we explore mitotic outcomes and error distribution for various interphase cell shapes. Elongated cells attached to single fibers through two focal adhesion clusters (FACs) at their extremities result in perfect spherical mitotic cell bodies that undergo significant 3-dimensional (3D) displacement while being held by retraction fibers (RFs). Increasing the number of parallel fibers increases FACs and retraction fiber-driven stability, leading to reduced 3D cell body movement, metaphase plate rotations, increased interkinetochore distances, and significantly faster division times. Interestingly, interphase kite shapes on a crosshatch pattern of four fibers undergo mitosis resembling single-fiber outcomes due to rounded bodies being primarily held in position by RFs from two perpendicular suspended fibers. We develop a cortex-astral microtubule analytical model to capture the retraction fiber dependence of the metaphase plate rotations. We observe that reduced orientational stability, on single fibers, results in increased monopolar mitotic defects, while multipolar defects become dominant as the number of adhered fibers increases. We use a stochastic Monte Carlo simulation of centrosome, chromosome, and membrane interactions to explain the relationship between the observed propensity of monopolar and multipolar defects and the geometry of RFs. Overall, we establish that while bipolar mitosis is robust in fibrous environments, the nature of division errors in fibrous microenvironments is governed by interphase cell shapes and adhesion geometries.

Inborn errors of immunity (IEI) are disorders mostly caused by mutations in genes involved in host defense and immune regulation. Different degrees of gastrointestinal (GI) involvement have been described in IEI, and for some IEI the GI manifestations represent the main and characteristic clinical feature. IEI also carry an increased risk for atopic manifestations. Eosinophilic gastrointestinal diseases (EGIDs) are emerging disorders characterized by a chronic/remittent and prevalent eosinophilic inflammation affecting the GI tract from the esophagus to the anus in the absence of secondary causes of intestinal eosinophilia. Data from the U.S. Immunodeficiency Network (USIDNET) reported that EGIDs are more commonly found in patients with IEI. Considering this element, it is reasonable to highlight the importance of an accurate differential diagnosis in patients with IEI associated with mucosal eosinophilia to avoid potential misdiagnosis. For this reason, we provide a potential algorithm to suspect an EGID in patients with IEI or an IEI in individuals with a diagnosis of primary EGID. The early diagnosis and detection of suspicious symptoms of both conditions are fundamental to prevent clinically relevant complications.

Professionals performing radiographic examinations are responsible for maintaining optimal image quality for accurate diagnoses. These professionals must competently execute techniques such as film manipulation and processing to minimize patient exposure to radiation. Improper performance by the professional and/or patient may result in a radiographic image of unsatisfactory quality that can also lead to a misdiagnosis and the development of an inadequate treatment plan. Currently, the most commonly performed extraoral examination is panoramic radiography. The invention of panoramic radiography has resulted in improvements in image quality with decreased exposure to radiation and at a low cost. However, this technique requires careful, accurate positioning of the patient's teeth and surrounding maxillofacial bone structure within the focal trough. Therefore, we reviewed the literature for the most common types of positioning errors in panoramic radiography to suggest the correct techniques. We would also discuss how to determine if the most common positioning errors occurred in panoramic radiography, such as in the positioning of the patient's head, tongue, chin, or body.

Prospective memory refers to remembering to perform an intended future action, such as remembering to take medication with breakfast. Historically, the field has focused on failures to initially remember a prospective memory task (omission errors), but interestingly, individuals will occasionally repeat a prospective memory action after it has been completed (e.g., double dosing). These failures in prospective memory deactivation/forgetting are termed commission errors. The current registered study investigated structural neuroimaging correlates of a laboratory measure of commission errors in 47 healthy older adults. Extant theories differed in their predicted outcomes: commission error risk was predicted to be highest in individuals with smaller medial temporal lobe volume (output monitoring theory), larger lateral prefrontal cortex volume (residual activation theory), or a combination of larger medial temporal lobe volume and smaller lateral prefrontal cortex volume (dual mechanisms theory). In registered analyses, we found that a higher number of commission errors was associated with larger medial temporal lobe/hippocampal grey matter volume (supporting dual mechanisms theory), but not with grey or white matter volume in the lateral parietal lobe, frontal pole, or a composite of ventrolateral/dorsolateral prefrontal cortex (not supporting dual mechanisms theory). In post hoc analyses, smaller volume in the lateral orbitofrontal cortex was associated with a higher number of commission errors, possibly indicating that the dual mechanisms theory of PFC control was conceptually correct, but that a different PFC subregion than anticipated exerts control over commission errors. Collectively, the registered and post hoc analysis findings showed a functional dissociation across MTL/PFC regions that was more consistent with the dual mechanisms theory than the alternative theories.

Although a clinician may have the intention of carrying out strategies to reduce cognitive errors, this intention may not be realized especially under heavy workload situations or following a period of interruptions. Implementing strategies to reduce cognitive errors in clinical setting may be facilitated by a portable mnemonic in the form of a checklist.

Adaptive actions build on internal probabilistic models of possible outcomes that are tuned according to the errors of their predictions when experiencing an actual outcome. Prediction errors (PEs) inform choice behavior across a diversity of outcome domains and dimensions, yet neuroimaging studies have so far only investigated such signals in singular experimental contexts. It is thus unclear whether the neuroanatomical distribution of PE encoding reported previously pertains to computational features that are invariant with respect to outcome valence, sensory domain, or some combination of the two. We acquired functional MRI data while volunteers performed four probabilistic reversal learning tasks which differed in terms of outcome valence (reward-seeking versus punishment-avoidance) and domain (abstract symbols versus facial expressions) of outcomes. We found that ventral striatum and frontopolar cortex coded increasingly positive PEs, whereas dorsal anterior cingulate cortex (dACC) traced increasingly negative PEs, irrespectively of the outcome dimension. Individual reversal behavior was unaffected by context manipulations and was predicted by activity in dACC and right inferior frontal gyrus (IFG). The stronger the response to negative PEs in these areas, the lower was the tendency to reverse choice behavior in response to negative events, suggesting that these regions enforce a rule-based strategy across outcome dimensions. Outcome valence influenced PE-related activity in left amygdala, IFG, and dorsomedial prefrontal cortex, where activity selectively scaled with increasingly positive PEs in the reward-seeking but not punishment-avoidance context, irrespective of sensory domain. Left amygdala displayed an additional influence of sensory domain. In the context of avoiding punishment, amygdala activity increased with increasingly negative PEs, but only for facial stimuli, indicating an integration of outcome valence and sensory domain during probabilistic choices.