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Accuracy and sensitivity of Parkinsonian disorder diagnoses in two Swedish national health registers.

https://arctichealth.org/en/permalink/ahliterature125521
Source
Neuroepidemiology. 2012;38(3):186-93
Publication Type
Article
Date
2012
Author
Adina L Feldman
Anna L V Johansson
Margaret Gatz
Måns Flensburg
Giselle M Petzinger
Håkan Widner
Mark F Lew
Nancy L Pedersen
Karin Wirdefeldt
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Source
Neuroepidemiology. 2012;38(3):186-93
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cause of Death
Diagnostic Errors - statistics & numerical data
Diseases in Twins - diagnosis - epidemiology
Female
Humans
Male
Parkinsonian Disorders - diagnosis - epidemiology
Predictive value of tests
Registries
Sensitivity and specificity
Sweden - epidemiology
Abstract
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.
Notes
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Cites: Arch Neurol. 1999 Jan;56(1):98-1029923767
PubMed ID
22472568 View in PubMed
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The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study.

https://arctichealth.org/en/permalink/ahliterature305210
Source
Scand J Trauma Resusc Emerg Med. 2020 Jul 23; 28(1):70
Publication Type
Comparative Study
Journal Article
Date
Jul-23-2020
Author
Outi Koivulahti
Miretta Tommila
Elina Haavisto
Author Affiliation
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. outi@koivulahti.net.
Source
Scand J Trauma Resusc Emerg Med. 2020 Jul 23; 28(1):70
Date
Jul-23-2020
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Allied Health Personnel
Cross-Sectional Studies
Diagnosis
Diagnostic Errors - statistics & numerical data
Educational Status
Emergency medical services
Finland
Humans
Surveys and Questionnaires
Abstract
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.
PubMed ID
32703267 View in PubMed
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Adult attention-deficit/hyperactivity disorder: a survey of diagnosis and treatment practices.

https://arctichealth.org/en/permalink/ahliterature139518
Source
J Am Acad Nurse Pract. 2010 Nov;22(11):593-601
Publication Type
Article
Date
Nov-2010
Author
Kathleen C Knutson
Maureen O'Malley
Author Affiliation
Anchorage Medical and Surgical Clinic, Anchorage, Alaska. k2c2knutson@ak.net
Source
J Am Acad Nurse Pract. 2010 Nov;22(11):593-601
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Alaska - epidemiology
Attention Deficit Disorder with Hyperactivity - complications - diagnosis - epidemiology - therapy
Attitude of Health Personnel
Benchmarking
Comorbidity
Diagnostic Errors - statistics & numerical data
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Nurse Practitioners - education - organization & administration - psychology
Nurse's Practice Patterns - organization & administration
Nurse's Role
Nursing Evaluation Research
Questionnaires
Referral and Consultation
Abstract
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.
PubMed ID
21054633 View in PubMed
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[Analysis of 700 orthopedic complaints reported to the Norwegian Patient Compensation System]

https://arctichealth.org/en/permalink/ahliterature31829
Source
Tidsskr Nor Laegeforen. 2001 Oct 30;121(26):3050-2
Publication Type
Article
Date
Oct-30-2001
Author
I. Bjerkreim
H. Steen
Author Affiliation
Oslo ortopediske universitetsklinikk Trondheimsveien 132 0570 Oslo. ingjald.bjerkreim@rikshospitalet.no
Source
Tidsskr Nor Laegeforen. 2001 Oct 30;121(26):3050-2
Date
Oct-30-2001
Language
Norwegian
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child, Preschool
Diagnostic Errors - statistics & numerical data
English Abstract
Female
Humans
Insurance Claim Review
Male
Malpractice - statistics & numerical data
Medical Errors - statistics & numerical data
Middle Aged
Norway - epidemiology
Orthopedics - standards - statistics & numerical data
Surgical Wound Infection - diagnosis - epidemiology
Trauma, Nervous System
Abstract
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.
PubMed ID
11757438 View in PubMed
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[Analysis of nasal and paranasal cancer in the Rostov region for 35 years: problems of early diagnosis].

https://arctichealth.org/en/permalink/ahliterature191074
Source
Vestn Otorinolaringol. 2002;(1):31-3
Publication Type
Article
Date
2002
Author
G I Chiz
M A Solov'eva
Source
Vestn Otorinolaringol. 2002;(1):31-3
Date
2002
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Catchment Area (Health)
Diagnosis, Differential
Diagnostic Errors - statistics & numerical data
Female
Humans
Male
Middle Aged
Neoplasm Staging
Paranasal Sinus Neoplasms - diagnosis - epidemiology
Russia - epidemiology
Time Factors
Abstract
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.
PubMed ID
11892390 View in PubMed
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An analysis of appendectomies performed in a Labrador general surgery practice.

https://arctichealth.org/en/permalink/ahliterature157780
Source
Can J Rural Med. 2008;13(2):68-72
Publication Type
Article
Date
2008
Author
Colin Clarkson
G Narsing Pradhan
Author Affiliation
Memorial University of Newfoundland, St. John's, Newfoundland.
Source
Can J Rural Med. 2008;13(2):68-72
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Appendectomy - statistics & numerical data
Appendicitis - diagnosis - surgery
Child
Child, Preschool
Diagnostic Errors - statistics & numerical data
Female
Humans
Intestinal Perforation - surgery
Male
Middle Aged
Newfoundland and Labrador
Retrospective Studies
Treatment Outcome
Abstract
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.
PubMed ID
18405463 View in PubMed
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[An analysis of forensic medical expertise on matters of the professional law infringements of medical workers].

https://arctichealth.org/en/permalink/ahliterature204835
Source
Sud Med Ekspert. 1998 May-Jun;41(3):3-6
Publication Type
Article
Author
N A Zykova
M S Ribenson
Source
Sud Med Ekspert. 1998 May-Jun;41(3):3-6
Language
Russian
Publication Type
Article
Keywords
Diagnostic Errors - statistics & numerical data
Expert Testimony - legislation & jurisprudence
Forensic Medicine - legislation & jurisprudence - statistics & numerical data
Humans
Malpractice - legislation & jurisprudence - statistics & numerical data
Medical Errors - statistics & numerical data
Physicians - legislation & jurisprudence - statistics & numerical data
Russia
Abstract
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.
PubMed ID
9703733 View in PubMed
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Breast cancer: missed interval and screening-detected cancer at full-field digital mammography and screen-film mammography-- results from a retrospective review.

https://arctichealth.org/en/permalink/ahliterature123430
Source
Radiology. 2012 Aug;264(2):378-86
Publication Type
Article
Date
Aug-2012
Author
Solveig R Hoff
Anne-Line Abrahamsen
Jon Helge Samset
Einar Vigeland
Olbjørn Klepp
Solveig Hofvind
Author Affiliation
Departments of Radiology and Oncology, Aalesund Hospital, Helse Møre og Romsdal HF, Aalesund, Norway. sorohoff@gmail.com
Source
Radiology. 2012 Aug;264(2):378-86
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - epidemiology - pathology - radiography
Chi-Square Distribution
Confidence Intervals
Diagnostic Errors - statistics & numerical data
Female
Humans
Mammography - methods
Mass Screening
Middle Aged
Neoplasm Invasiveness
Norway - epidemiology
Radiographic Image Enhancement - methods
Registries
Retrospective Studies
Abstract
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.
Notes
Erratum In: Radiology. 2013 Jan;266(1):367
PubMed ID
22700555 View in PubMed
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Cause of death and significant disease found at autopsy.

https://arctichealth.org/en/permalink/ahliterature308310
Source
Virchows Arch. 2019 Dec; 475(6):781-788
Publication Type
Journal Article
Date
Dec-2019
Author
Niklas Friberg
Oscar Ljungberg
Erik Berglund
David Berglund
Richard Ljungberg
Irina Alafuzoff
Elisabet Englund
Author Affiliation
Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden. niklas.friberg@gmail.com.
Source
Virchows Arch. 2019 Dec; 475(6):781-788
Date
Dec-2019
Language
English
Publication Type
Journal Article
Keywords
Autopsy - methods
Cause of Death
Diagnostic Errors - statistics & numerical data
Female
Hospitals, University - statistics & numerical data
Humans
Male
Myocardial Infarction - diagnosis - mortality
Prevalence
Retrospective Studies
Sweden
Abstract
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.
PubMed ID
31691009 View in PubMed
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C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis.

https://arctichealth.org/en/permalink/ahliterature276137
Source
Dan Med J. 2015 Dec;62(12):A5167
Publication Type
Article
Date
Dec-2015
Author
Tind S
Lassen AT
Zimmerman-Nielsen E
Qvist N
Source
Dan Med J. 2015 Dec;62(12):A5167
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Adult
Appendicitis - blood - diagnosis - surgery
Biomarkers - blood
C-Reactive Protein - analysis
Clinical Decision-Making - methods
Denmark
Diagnostic Errors - statistics & numerical data
Female
Humans
Leukocyte Count
Male
Predictive value of tests
Prospective Studies
Sensitivity and specificity
Young Adult
Abstract
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).
Clinicaltrials.gov: NCT02304653.
PubMed ID
26621395 View in PubMed
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