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

Understanding the influence of the head coach on soccer training drills—an 8 season analysis

Soccer players perform a variety of training drills to develop the physical, technical and tactical qualities required for match-play. The role of coaches in prescribing training suggests that players may not always meet physical targets set by conditioning staff. To quantify the physical outputs elicited by different training drill types, 183 professional soccer players were monitored over 8 seasons using Microelectromechanical Systems during normal training, yielding 65,825 drill observations [362 ± 341 observations·player−1]. Linear mixed models assessed the influence of drill type, head coach and playing position on physical output. Drills lasted ~14 min, eliciting total distances and high speed running of ~1000 m and 40 m, respectively. Conditioning drills elicited substantially greater relative high-speed running [18.8 ± 27.2 m.min−1] and Sprint [3.5 ± 9.4 m.min−1] distances than all other drill types. The proportion of training drill types used and external outputs elicited per drill were affected by the head coach. Midfielders recorded the highest total distance [77.3 ± 36.1 m.min] and PlayerLoad™ [8.29 ± 3.54] of any playing position, whilst the lowest outputs were recorded by goalkeepers. This study provides reference data for practitioners when seeking to manipulate training prescription to achieve physical output targets whilst also meeting the team’s technical and tactical objectives

Use of High-Resolution Ultrasound to Guide Alcohol Neurolysis for Chronic Pain

BACKGROUND: The diagnosis and treatment of neuropathic pain is often clinically challenging, with many patients requiring treatments beyond oral medications. To improve our percutaneous treatments, we established a clinical pathway that utilized ultrasound (US) guidance for steroid injection and alcohol ablation for patients with painful neuropathy. OBJECTIVES: To describe a collaborative neuropathy treatment pathway developed by a neurosurgeon, pain physicians, and a sonologist, describing early clinical experiences and patient-reported outcomes. STUDY DESIGN: A retrospective case series was performed. METHODS: Patients that received percutaneous alcohol ablation with US guidance for neuropathy were identified through a retrospective review of a single provider\u27s case log. Demographics and treatment information were collected from the electronic medical record. Patients were surveyed about their symptoms and treatment efficacy. Descriptive statistics were expressed as medians and the interquartile range ([IQR]; 25th and 75th data percentiles). Differences in the median follow-up pain scores were assessed using a Wilcoxon signed-rank test. RESULTS: Thirty-five patients underwent US-guided alcohol ablation, with the average patient receiving one treatment (range: 1 to 2), having a median duration of 4.8 months until reinjection (IQR: 2.9 to 13.1). The median number of steroid injections that individuals received before US-guided alcohol ablation was 2 (IQR: 1 to 3), and the median interval between steroid injections was 3.7 months (IQR: 2.0 to 9.6). Most (20/35 [57%]) patients responded to the survey, and the median pain scores decreased by 3 units (median: -3, IQR: -6 to 0; P \u3c 0.001) one week following the alcohol ablation. This pain reduction remained significant at one month (P \u3c 0.001) and one year (P = 0.002) following ablation. Most (12/20 [60%]) patients reported that alcohol ablation was more effective in improving their pain than oral pain medications. LIMITATIONS: Given the small sample size, treatment efficacy for alcohol neurolysis cannot be generalized to the broader population. CONCLUSIONS: US-guided percutaneous treatments for neuropathic pain present a growing opportunity for interprofessional collaboration between neurosurgery, clinicians who treat chronic pain, and sonologists. US can provide valuable diagnostic information and guide accurate percutaneous treatments in skilled hands. Further studies are warranted to determine whether a US-guided treatment pathway can prevent unnecessary open surgical management

Plasmatrough exohiss waves observed by Van Allen Probes: Evidence for leakage from plasmasphere and resonant scattering of radiation belt electrons

Abstract Exohiss waves are whistler mode hiss observed in the plasmatrough region. We present a case study of exohiss waves and the corresponding background plasma distributions observed by the Van Allen Probes in the dayside low-latitude region. The analysis of wave Poynting fluxes, suprathermal electron fluxes, and cold electron densities supports the scenario that exohiss leaks from the plasmasphere into the plasmatrough. Quasilinear calculations further reveal that exohiss can potentially cause the resonant scattering loss of radiation belt electrons

The X-ray luminous cluster underlying the bright radio-quiet quasar H1821+643

We present a Chandra observation of the only low redshift, z=0.299, galaxy cluster to contain a highly luminous radio-quiet quasar, H1821+643. By simulating the quasar PSF, we subtract the quasar contribution from the cluster core and determine the physical properties of the cluster gas down to 3 arcsec (15 kpc) from the point source. The temperature of the cluster gas decreases from 9.0\pm0.5 keV down to 1.3\pm0.2 keV in the centre, with a short central radiative cooling time of 1.0\pm0.1 Gyr, typical of a strong cool-core cluster. The X-ray morphology in the central 100 kpc shows extended spurs of emission from the core, a small radio cavity and a weak shock or cold front forming a semi-circular edge at 15 arcsec radius. The quasar bolometric luminosity was estimated to be 2 x 10^{47} erg per sec, requiring a mass accretion rate of 40 Msolar per yr, which corresponds to half the Eddington accretion rate. We explore possible accretion mechanisms for this object and determine that Bondi accretion, when boosted by Compton cooling of the accretion material, could provide a significant source of the fuel for this outburst. We consider H1821+643 in the context of a unified AGN accretion model and, by comparing H1821+643 with a sample of galaxy clusters, we show that the quasar has not significantly affected the large-scale cluster gas properties.Comment: 20 pages, 19 figures, accepted by MNRA

Disappearance of plasmaspheric hiss following interplanetary shock

Abstract Plasmaspheric hiss is one of the important plasma waves controlling radiation belt dynamics. Its spatiotemporal distribution and generation mechanism are presently the object of active research. We here give the first report on the shock-induced disappearance of plasmaspheric hiss observed by the Van Allen Probes on 8 October 2013. This special event exhibits the dramatic variability of plasmaspheric hiss and provides a good opportunity to test its generation mechanisms. The origination of plasmaspheric hiss from plasmatrough chorus is suggested to be an appropriate prerequisite to explain this event. The shock increased the suprathermal electron fluxes, and then the enhanced Landau damping promptly prevented chorus waves from entering the plasmasphere. Subsequently, the shrinking magnetopause removed the source electrons for chorus, contributing significantly to the several-hours-long disappearance of plasmaspheric hiss

On the Origin of Cosmic Magnetic Fields

We review the literature concerning how the cosmic magnetic fields pervading nearly all galaxies actually got started. some observational evidence involves the chemical abundance of the light elements Be and B, while another one is based on strong magnetic fields seen in high red shift galaxies. Seed fields, whose strength is of order 10^{-20} gauss, easily sprung up in the era preceding galaxy formation. Several mechanisms are proposed to amplify these seed fields to microgauss strengths. The standard mechanism is the Alpha-Omega dynamo theory. It has a major difficulty that makes unlikely to provide the sole origin. The difficulty is rooted in the fact that the total flux is constant. This implies that flux must be removed from the galactic discs. This requires that the field and flux be separated, for otherwise interstellar mass must be removed from the deep galactic gravitational and then their strength increased by the alpha omega theory.Comment: 90 pages and 6 figures; accepted for publication in Reports of Progress in Physics as an invited revie

A statistical study of BRIs (SMCs), isolated substorms, and individual sawtooth injections

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95420/1/jgra19762.pd

Multiscale Currents Observed by MMS in the Flow Braking Region

We present characteristics of current layers in the off-equatorial near-Earth plasma sheet boundary observed with high time-resolution measurements from the Magnetospheric Multiscale mission during an intense substorm associated with multiple dipolarizations. The four Magnetospheric Multiscale spacecraft, separated by distances of about 50 km, were located in the southern hemisphere in the dusk portion of a substorm current wedge. They observed fast flow disturbances (up to about 500 km/s), most intense in the dawn-dusk direction. Field-aligned currents were observed initially within the expanding plasma sheet, where the flow and field disturbances showed the distinct pattern expected in the braking region of localized flows. Subsequently, intense thin field-aligned current layers were detected at the inner boundary of equatorward moving flux tubes together with Earthward streaming hot ions. Intense Hall current layers were found adjacent to the field-aligned currents. In particular, we found a Hall current structure in the vicinity of the Earthward streaming ion jet that consisted of mixed ion components, that is, hot unmagnetized ions, cold E × B drifting ions, and magnetized electrons. Our observations show that both the near-Earth plasma jet diversion and the thin Hall current layers formed around the reconnection jet boundary are the sites where diversion of the perpendicular currents take place that contribute to the observed field-aligned current pattern as predicted by simulations of reconnection jets. Hence, multiscale structure of flow braking is preserved in the field-aligned currents in the off-equatorial plasma sheet and is also translated to ionosphere to become a part of the substorm field-aligned current system