Swedish population-based national health registers are widely used data sources in epidemiological research. Register-based diagnoses of Parkinson's disease have not been validated against clinical information.
Parkinson's disease (PD) and other parkinsonian disorder diagnoses were ascertained in two registers, i.e. the National Patient Register (NPR) and the Cause of Death Register (CDR). Diagnoses were validated in terms of accuracy (positive predictive value) and sensitivity against data from a population-based study of PD in 1998-2004 that screened more than 35,000 persons and identified 194 cases of parkinsonian disorders including 132 PD cases (the gold standard for the purposes of this study).
Accuracy for any parkinsonian disorder diagnoses was 88.0% in the NPR and 94.4% in the CDR. Accuracy of PD diagnoses was 70.8% in the NPR and 66.7% in the CDR. Misclassification between differential parkinsonian diagnoses was common. The accuracy of PD diagnoses in the NPR improved to 83.0% by restricting the definition to primary diagnoses only. The sensitivity of PD diagnoses in the NPR and CDR combined was 83.1%, with a mean time to detection of 6.9 years.
Population-based national health registers are valid data sources in epidemiological studies of PD or parkinsonian disorder etiology but are less suitable in studies of incidence or prevalence.
Cites: Arch Neurol. 1999 Jan;56(1):33-99923759
Cites: Clin Auton Res. 1998 Dec;8(6):359-629869555
Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland. firstname.lastname@example.org.
Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis.
A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic's preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital's patient records. Logistic regression analysis and a binomial test were used to test the statistical significance.
The agreement between the paramedics' preliminary diagnosis vs. hospital diagnosis was 70% (n?=?261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p?=?0,000), cerebral strokes (81%, p?=?0,007) to infections (31% p?=?0,029). The educational background of a bachelor-degree-level paramedic (p?=?0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p?=?0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis.
Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
To review the literature to ascertain best practices in the diagnosis and treatment of adult attention-deficit/hyperactivity disorder (ADHD) and to determine the current beliefs and practices of nurse practitioners (NPs) regarding adult ADHD.
Licensed NPs (n= 260) responded to a questionnaire that inquired about numbers of patients seen with ADHD and about current diagnostic and treatment methods. Diagnostic confidence and referral patterns were also surveyed. Best practices were identified through a review of current and classic nursing, medical, and psychological literature on ADHD.
The results of the survey showed that most NPs believe that adult ADHD exists, although the majority diagnose and treat this condition infrequently. Psychiatric NPs were an exception.
NPs are diagnosing and treating adult ADHD at levels far below expected based on population prevalence data. While those NPs who suspected ADHD were using appropriate diagnostic and treatment methods, more education is warranted to increase confidence for a greater number of nonpsychiatric NPs to improve targeted diagnosis and treatment for this condition.
BACKGROUND: In the 1993-99 period, the NPCS reached decisions on 4,041 orthopaedic injury cases. This paper reviews the complaints lodged. MATERIAL AND METHODS: We have analysed data from 700 randomly selected cases in order to elucidate the reasons for complaint. RESULTS: Complaints were lodged against all types of hospitals and primary health care providers. The most frequent primary diagnosis were osteoarthritis of the hip, lumbar disc herniation, and various fractures. Complaints were most commonly related to faulty treatment, continued pain, nerve injuries, reduced function, mistaken diagnosis, malposition of bone or joint, and infection. 84% of complaints were related to treatment and to operative treatment in particular. In 209 cases (30%), the complaints were heard. Of these 209, 43% were heard because of the treatment given, 21% because of infection, 18% because of diagnostic fault, and 6% because of defective follow-up. 491 complaints were rejected; in 70% of them because the injury was acceptable according to general rules, in 19% because the basic disorder had caused the injury, and in 7% because there was in fact no injury. INTERPRETATION: In our opinion, better knowledge about treatment injury cases represents valuable information that contributes to a higher quality of care.
The article contains information on 280 patients with nasal and paranasal cancer of epithelial (85%) and non-epithelial genesis (15%); on diagnosis, spread of the primary tumor, regional and distant metastases; principles of patients grouping according to TNM staging; analysis of causes of late diagnosis and misdiagnosis.
The main objective of our study was to determine the rates of negative appendectomies and perforated appendices at the Labrador Health Centre, and make a comparison with the rates published in the literature.
The study population consisted of all patients who underwent appendectomies during the 5-year period ending Apr. 3, 2006. The number and rates of negative appendectomies and perforated appendices were determined for each age and sex category.
Of the 64 patients who were included in the study, 11% were found to have undergone negative appendectomies and 27% had perforated appendices. There was a clear trend toward decreasing perforation rates with increasing age as well as a trend toward increasing negative appendectomy rates with increasing age.
The rates of negative appendectomies and perforated appendices at the Labrador Health Centre are comparable with those published in the literature. Trends found in the data will help to guide future improvements in patient management.
Expert evaluation of the correctness of medical care is one of the most complex problems for experts. A total of 303 expert evaluations of this kind were carried out in the Moscow regional Bureau during the recent 11 years. Expert evaluation of surgical care were the most numerous. The percentage of cases when grave defects of medical care were detected is rather high: 58-88%. The authors consider that a universal scheme of expert evaluation concerning infringement of the law by medical workers is to be developed for forensic medical service of the Russian Federation. They propose a table, which takes account of the type of error (diagnostic, strategic, medical, management), causes of errors (objective or subjective), causes of improper actions of physicians, relationship between death and the error, probability of survival if medical care had been proper, data on bringing an action against the physician, etc.
To compare the percentages and mammographic features of cancers missed at full-field digital mammography (FFDM) and screen-film mammography (SFM) in women who participated in the Norwegian Breast Cancer Screening Program in 2002-2008.
Social Science Data Services approval was obtained; the requirement for informed consent was waived. Cases were all the interval and screening-detected cancers from 35 127 FFDM and 52 444 SFM examinations in two Norwegian counties. Prior and diagnostic FFDM examinations of 49 interval and 86 screening-detected breast cancers were reviewed by four breast radiologists and compared with a review of SFM examinations of 81 interval and 123 screening-detected cancers. Cancers were classified as missed or true, mammographic features were described, percentages were compared by using the ?(2) or Fisher exact test, and 95% confidence intervals (CIs) were calculated.
The percentages of interval and screening-detected cancers missed at FFDM and SFM did not differ significantly. (interval cancers missed: 33% [16 of 49] at FFDM vs 30% [24 of 81] at SFM [P = .868]; screening-detected cancers missed: 20% [17 of 86] at FFDM vs 21% [26 of 123] at SFM [P = .946]). Asymmetry was present in 27% (95% CI: 13.3%, 45.5%) of prior mammograms of cancers missed at FFDM and 10% (95% CI: 3.3%, 21.8%) of those missed at SFM (P = .070). Calcifications were observed in 18% (95% CI: 7.0%, 35.5%) of the cancers missed at FFDM and 34% (95% CI: 21.2%, 48.8%) of those missed at SFM (P = .185). Average mammographic tumor size of missed cancers manifesting as masses was 10.4 mm at FFDM and 13.6 mm at SFM (P = .036).
The use of FFDM has not reduced the challenge of missed cancers. Cancers missed at FFDM tend to have different mammographic features than those missed at SFM.
The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.
Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities. However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA.
This was a prospective, observational cohort study including patients (= 15 years of age) admitted on suspicion of AA. The surgeons were instructed to perform their physical examination and to register whether they found the patient more or less than 50% likely to have AA. Thereafter, the surgeons had to assess the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology.
A total of 226 patients were included of whom 91 (40.3%) had appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant.
The results of CRP and leucocyte counts did not influence clinical decision-making.
Financial support was obtained from the Danish Council for Independent Research (Ref. no. 12-132020).