Diagnostic Medical Errors: Patient\u27s Perspectives on a Pervasive Problem

Introduction. The Institute of Medicine defines diagnostic error as the failure to establish an accurate or timely explanation for the patient\u27s health problem(s), or effectively communicate the explanation to the patient. To our knowledge, no studies exist characterizing diagnostic error from patient perspectives using this definition. Objective. We sought to characterize diagnostic errors experienced by patients and describe patient perspectives on causes, impacts, and prevention strategies. Methods. We screened 77 adult inpatients at University of Vermont Medical Center and conducted 27 structured interviews with patients who experienced diagnostic error in the past five years. We performed qualitative analysis using Grounded Theory. Results. In the past five years, 39% of interviewed patients experienced diagnostic error. The errors mapped to the following categories: accuracy (30%), communication (34%) and timeliness (36%). Poor communication (13 responses) and inadequate time with doctors (7) were the most identified causes of errors. Impacts of errors included emotional distress (17 responses), adverse health outcomes (7) and impaired activities of daily living (6). Patients suggested improved communication (11 responses), clinical management (7) and access to doctors (5) as prevention strategies. For communication, patients rated talk to your doctor highest (mean 8.4, on 1-10 Likert scale) and text message lowest (4.8). Conclusions/Recommendations. Diagnostic errors are common and have dramatic impact on patients\u27 well-being. We suggest routine surveillance to identify errors, support for patients who have experienced errors, and implementation of patient and provider checklists to enhance communication. Future studies should investigate strategies to allow care providers adequate time with patients.https://scholarworks.uvm.edu/comphp_gallery/1246/thumbnail.jp

Reliability Analysis of Soil Slopes

Slope stability analysis is a classical problem of geotechnical engineering characterized by many sources of uncertainty. Some of these sources are connected to the uncertainties of soil properties involved in the analysis. Current practice of slope stability analysis relies in the deterministic characterization and assessment of performance of embankments, excavations and Municipal Solid Waste (MSW) landfills. These slopes have been evaluated in terms of the factor of safety, where the shear strength mobilized along the failure envelop is compared with the shear stresses generated due to self-weight of the soil mass and surcharge loading on the slope. The significant uncertainties associated with the shear strength and shear stresses render deterministic modeling potentially misleading. For example, two slopes with the same factor of safety can have significantly different probabilities of failure

Primary Hepatic Leiomyosarcoma Report of a rare case with review of literature

Primary hepatic leiomyosarcoma is an extremely rare tumor with a dismal prognosis and difficulty in diagnosis. We present a 36-year-old female who presented with complaints of pain in right hypochondrium and epigastric region. Real-time ultrasonography revealed an enlarged liver with multiple hypoechoic lesions of varying sizes in both the lobes of the liver. USG guided core biopsy from the lesion showed an infiltrating malignant spindle cell neoplasm positive for smooth muscle actin and caldesmon-H confirming the diagnosis of leiomyosarcoma. It is vital to diagnose these lesions even on limited biopsies as early diagnosis can reduce hospital and operative morbidity and mortality rates in the patients

Preparation and Evaluation of Chewable Tablets of Syzygium cumini Seed Powder

Aim of this study is to develop chewable tablets of Syzygium cumini seed powder. It has been chosen to do so as there are no oral solid dosage forms of this seed powder developed so far. There are numerous health benefits and nutrient properties of this seed powder, thus it can be used as a nutraceutical. Phytochemical screening of the Syzygium cumini seed powder has been conducted and the various phyto constituents present were detected. Seven different formulations have been developed by direct compression method out of which five were optimized. All these formulations were developed with Syzygium cumini seed powder as the active ingredient and lactose, acacia, glucose, talc, magnesium stearate, hydroxy propyl methyl cellulose, sodium alginate, guar gum and stevia were used as excipients. Various evaluations tests were performed to check the stability of the chewable tablets. Fourier Transform Infrared Spectroscopy (FTIR) analysis was conducted to check the interactions among the seed powder and the excipients. Anti-bacterial activity of the chewable tablets was tested against three different species of bacteria (Escherichia coli and Bacillus subtilis) by agar diffusion method. It is concluded that the Syzygium cumini seed powder and the developed chewable tablets were active against Escherichia coli and Bacillus subtilis.     Keywords: Syzygium cumini, Chewable tablet, anti-bacterial activit

Delivering a “Dose of Hope”: A Faith-Based Program to Increase Older African Americans’ Participation in Clinical Trials

Background: Underrepresentation of older-age racial and ethnic minorities in clinical research is a significant barrier to health in the United States, as it impedes medical research advancement of effective preventive and therapeutic strategies. Objective: The objective of the study was to develop and test the feasibility of a community-developed faith-based intervention and evaluate its potential to increase the number of older African Americans in clinical research. Methods: Using a cluster-randomized design, we worked with six matched churches to enroll at least 210 persons. We provided those in the intervention group churches with three educational sessions on the role of clinical trials in addressing health disparity topics, and those in the comparison group completed surveys at the same timepoints. All persons enrolled in the study received ongoing information via newsletters and direct outreach on an array of clinical studies seeking participants. We evaluated the short-, mid-, and longer-term effects of the interventional program on clinical trial-related outcomes (ie, screening and enrollment)

Computation of the Probabilistic Critical Centers and Reliability Indices of MSW Landfill Slopes Using the Spencer Method of Slices

The shear strength properties of Municipal Solid Waste (MSW) are of special importance when evaluating the stability of landfill slopes. Geoenvironmental engineers are well aware of the existence of many sources of uncertainties associated with shear strength parameters of MSW due to various reasons. The significant uncertainties associated with the shear strength and shear stresses render deterministic modeling potentially misleading. The traditional engineering approaches like method of slices used for evaluating MSW slopes are frequently questionable as they do not adequately account for uncertainties included in analytical modeling and natural variability. In order to quantify the slope stability precisely by taking into account the variability, the Reliability Based Design Optimization (RBDO) framework is presented. The mean and standard deviations associated with unit weight, cohesion and angle of internal friction of the MSW are taken into account in the probabilistic optimization. Reliability analysis is performed using first order reliability method (FORM). A limit state function is formulated against sliding slope failure using Spencer method of slices. The influence of coefficients of variation (COV) of stability number and friction angle on critical center coordinates and reliability index is presented in the form of charts

Appropriation of GPIb from platelet-derived extracellular vesicles supports monocyte recruitment in systemic inflammation

Interactions between platelets, leukocytes and the vessel wall provide alternative pathological routes of thrombo-inflammatory leukocyte recruitment. We found that when platelets were activated by a range of agonists in whole blood, they shed platelet-derived extracellular vesicles which rapidly and preferentially bound to blood monocytes compared to other leukocytes. Platelet-derived extracellular vesicle binding to monocytes was initiated by P-selectin-dependent adhesion and was stabilised by binding of phosphatidylserine. These interactions resulted in the progressive transfer of the platelet adhesion receptor GPIbα to monocytes. GPIbα+-monocytes tethered and rolled on immobilised von Willebrand Factor or were recruited and activated on endothelial cells treated with TGF-β1 to induce the expression of von Willebrand Factor. In both models monocyte adhesion was ablated by a function-blocking antibody against GPIbα. Monocytes could also bind platelet-derived extracellular vesicle in mouse blood in vitro and in vivo. Intratracheal instillations of diesel nanoparticles, to model chronic pulmonary inflammation, induced accumulation of GPIbα on circulating monocytes. In intravital experiments, GPIbα+-monocytes adhered to the microcirculation of the TGF-β1-stimulated cremaster muscle, while in the ApoE−/− model of atherosclerosis, GPIbα+-monocytes adhered to the carotid arteries. In trauma patients, monocytes bore platelet markers within 1 hour of injury, the levels of which correlated with severity of trauma and resulted in monocyte clearance from the circulation. Thus, we have defined a novel thrombo-inflammatory pathway in which platelet-derived extracellular vesicles transfer a platelet adhesion receptor to monocytes, allowing their recruitment in large and small blood vessels, and which is likely to be pathogenic

Observation of tW production in the single-lepton channel in pp collisions at root s=13 TeV

A measurement of the cross section of the associated production of a single top quark and a W boson in final states with a muon or electron and jets in proton-proton collisions at root s = 13 TeV is presented. The data correspond to an integrated luminosity of 36 fb(-1) collected with the CMS detector at the CERN LHC in 2016. A boosted decision tree is used to separate the tW signal from the dominant t (t) over bar background, whilst the subleading W+jets and multijet backgrounds are constrained using data-based estimates. This result is the first observation of the tW process in final states containing a muon or electron and jets, with a significance exceeding 5 standard deviations. The cross section is determined to be 89 +/- 4 (stat) +/- 12 (syst) pb, consistent with the standard model.Peer reviewe