Diagnostic error in Medicine
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Diagnostic errors are common, accounting for 3.7% of adverse events and 14% of deaths. Most errors stem from cognitive biases and failures of clinical reasoning rather than a lack of knowledge or skills. System-level factors like poor communication, outdated medical records, and lack of alerts also contribute. Improving diagnosis requires addressing cognitive biases through metacognition, encouraging team-based care, and fixing systemic problems like ensuring access to complete patient information.
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Lawyers look for them.
Jurors may not understand the medicine in a malpractice case, but all have been the target of rude or rushed care. This rude behavior multiplier leads to “Jackpot Justice”.
Lawyers just love a good “service lapse”- angry words, a “TUDE”, even a late return phone call, or a cranky staff person. They revel when doctors and nurses are at odds.
In fact, patients often sue not because of genuine rude behavior, but their perception of short, curt treatment, or a feeling of incomplete disclosure. How can caregivers improve their patients’ perceptions, their expectations of care, to immunize themselves against suits?
Dilemma #3 again
The hospice medical director recommends anticoagulant therapy rather than surgical intervention for Helen, who has a terminal illness. The anticoagulants may provide relief from her DVT and allow for a more peaceful dying process, while surgery could prolong her suffering without changing the inevitable outcome. The medical director believes Helen's wishes should be prioritized, and that attempting anticoagulation first without surgery respects patient autonomy and avoids unnecessary pain and suffering at the end of life.
Dilemma #3 again
The hospice medical director recommends anticoagulant therapy rather than surgical intervention for Helen, who has a terminal illness. The anticoagulants may provide relief from her DVT and allow for a more peaceful dying process, while surgery could prolong her suffering without changing the inevitable outcome. The medical director believes Helen's wishes and avoiding unnecessary pain should be prioritized over interventions aimed at prolonging her life.
Online forums dalu_nov20
This document summarizes Marina Sokolova's research on opinion mining of online medical forums. It discusses how personal health information is shared online, challenges with analyzing such data, and the development of an analytics framework. Key aspects included collecting forum data, classifying comments using machine learning models, and identifying sentiments through manual annotation. The results demonstrated the ability to extract opinions and emotions from online health discussions to better understand shared experiences and perspectives.
MedicalResearch.com: Medical Research Exclusive Interviews May 26 2015
MedicalResearch.com features exclusive interviews with medical researchers from major and specialty medical and health care journals and meetings.
Delirium en el paciente hospitalizado
“Iamsorry,Icannotdo
thattestwithyou.Let'smoveonto
thenextquestion.”
Askpatientthefollowing:
Whatmonthisit?
Whatyearisit?
Whatdayoftheweekisit?
Askpatientthefollowing:
Canyoutellmeaboutwhatyou
didyesterday?
Askpatientthefollowing:
Howareyoufeelingtoday?
* The 3-Minute Diagnostic Interview for Delirium Using the Confusion Assessment Method (3D-CAM) is a brief, structured interview that incorporates elements of the Confusion Assessment Method (CAM) to diagnose delirium. It takes approximately 3 minutes to administer.
† Feature 1 assesses for
Dilemma #3 again
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The patient's wishes should be determined and respected, through discussion with her, her family, and spiritual advisors, considering her right to refuse treatment.
Dilemma #3 second attempt side a
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The best alternative is to ask Helen her preference, or if unable, her next of kin, and administer anticoagulants as the hospice physician advocates, to avoid prolonging her suffering from her terminal illness.
Medicine Killed my Mother
This document discusses medical errors and their impact. It provides examples of medical errors that resulted in patient harm or death, such as medication errors, misdiagnoses, and surgical mistakes. The document notes that between 44,000 to 98,000 people in the US die from preventable medical errors each year. It advocates learning from errors to improve healthcare systems and prevent future harm rather than focusing solely on individual blame. Patients are encouraged to be engaged in their own care to help reduce errors.
Proposal written abstract report
This document summarizes a research study that aims to compare the effectiveness of clinical and pharmacological trials in diagnosing Alzheimer's disease. The study will involve two groups in the clinical trial - one with a history of cardiovascular conditions and one without. In the pharmacological trial, there will be four groups - two with cardiovascular conditions receiving either treatment or no treatment, and two without. The study hypothesizes that cardiovascular disease increases Alzheimer's risk and that related drugs may negatively impact dementia development in younger patients. It aims to show pharmacological trials more accurately diagnose Alzheimer's and that cardiovascular conditions increase disease risk before age 65.
Prolonged confusion in Hepatic patient
1) A 73-year old male with a history of hypertension, HCV, and prostate cancer presented with recurrent hypoglycemic episodes and confusion.
2) Laboratory investigations revealed elevated liver enzymes and AFP levels suggestive of liver cirrhosis and a possible hepatocellular carcinoma (HCC).
3) Imaging found a lesion in the brain that was concerning for a metastatic deposit from a primary HCC, which is generally a rare occurrence but being seen more frequently with improved cancer treatments prolonging survival.
Dilemma #3 side A
The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness. The hospice physician recommends anticoagulants to allow a more peaceful dying process rather than prolonging suffering, as surgery could do. Alternatives include trying anticoagulants first and reassessing, or determining Helen's wishes, as prolonging her life may conflict with her goals. Patient autonomy and minimizing suffering should guide the decision.
Mca admission in india
This document provides information on effective handoffs between medical professionals. It discusses how poor communication during handoffs can lead to medical errors and adverse patient outcomes. The document outlines components of ideal handoffs, including using a structured format to systematically communicate important patient information, contingency planning, and having the receiver repeat back key details to confirm understanding. Examples of effective handoff practices from high-risk industries are also presented. The document concludes by emphasizing the importance of good communication to ensure quality and safety of patient care.
Mca admission in india
This document provides information on effective handoffs between medical professionals. It discusses how poor communication during handoffs can lead to medical errors and adverse patient outcomes. It presents examples of effective handoff practices from high-risk industries that emphasize face-to-face communication, contingency planning, and verification of understanding. The document also outlines the components of an ideal handoff, including identifying patient information, discussing current and anticipated issues, and having the receiver repeat back key details. Effective handoffs require a structured format and open communication between the sender and receiver to develop a shared understanding of the patient's situation.
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MedicalResearch.com: Medical Research Exclusive Interviews May 26 2015
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BRAF inhibitors provide improved progression-free survival for patients with BRAF V600 mutation-positive unresectable or metastatic melanoma compared to chemotherapy or immunotherapy alone. In a Phase III clinical trial, dabrafenib plus trametinib demonstrated superior progression-free survival compared to vemurafenib monotherapy, with a median progression-free survival of 11.4 months versus 8.8 months. Combined BRAF and MEK inhibition with dabrafenib and trametinib represents an effective first-line treatment option for advanced BRAF V600 mutation-positive melanoma.
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One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
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The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
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Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
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Diagnostic error in Medicine
- 2. Adverse events: 3,7% : 14% deaths 27% malpractice: 75% diagnostic problem.
- 3. Most common medical errors
- 5. System and Diagnosis An 35 y/o man went to ED Referring back pain and paraparesia He went twice to the ED. No one asked.. And couldn,t retrieve medical record At that moment was impossible to track a diagnosis of melanoma two years before Doctor´s mind: a young Person can,t have An important disease SYSTEM Cognitive
- 6. JAMA Volume 301(10) March 11, 2009 Copyright 2009 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610. ISSN: 0098-7484
- 9. More automatic: More experience More analysis Slower Less experience Wrong mental reasoning Lack of Information. Rethinking Two Systems of reasoning (Croskerry)
- 10. Examples of Cognitive errors (heuristics) Next cartoons extracted from: Sox. Clinical Decision Making. Butterworth-Heineman 1988.
- 11. Representation heuristics Endocrinologist think About Cushing in a patient with high BP and hirsutism (non prevalent)
- 12. Availability The intern saw two Splenic abscess in the previous rotation. Now he thinks that there is another one in front Of him.
- 13. Premature closing I don,t have the biopsy but anyway, he just came with fever.
- 14. Overconfidence
- 15. Framing: to put labels on people
- 18. Retroperitoneal Hematoma Hb 13/5/08 19 18/05 17,5 19/05 16,5 21/05 15 22/05/10 14,5 System Failure:”: Communicatión Organizatión informatión
- 20. Pancoast tumor : 5% lung cancer Horner Syndrom: 14-50% of cases. Framing : old people felt down .. Because they felt down Premature closing : no one examine the information about the previous diagnosis.
- 22. Fish bone diagram to study the systems aspects related to diagnosis FAILURE TEAM Communicatión Coordinatión Training PROCESS Not specified Lack of material No supervisión Bad asignament Wrong test ROLES Wrong evaluation of urgency Complications No alerts Inefficient summary of data COGNITIVE COMPOUND
- 23. (Checklist) Dr. M. Graber
- 24. IMPROVEMENT AND CHANGE IS POSSIBLE