Search

To evaluate the feasibility of adding pathology to recent radiologist error characterization schemes of modality and anatomic region and the potential of this data to more specifically inform peer review and peer learning. Quality assurance data originating from 349 radiologists in a national teleradiology practice were collected for 2019. Interpretive errors were simply categorized as major or minor. Reporting or communication errors were classified as administrative errors. Interpretive errors were then divided by modality, anatomic region and placed into one of 64 pathologic categories. Out of 1,628,464 studies, the discrepancy rate was 0.5% (8181/1,634,201). The 8181 total errors consisted of 2992 major errors (0.18%) and 5189 minor errors (0.32%). Precisely, 3.1% (257/8181) of total errors were administrative. Of major interpretive errors, 75.5% occurred on CT, with CT abdomen and pelvis accounting for 40.4%. The most common pathologic discrepancy for all exams was in the category of mass, nodule, or adenopathy (1583/8181), the majority of which were minor (1315/1583). The most common pathologic discrepancy for the 2937 major interpretive errors was fracture or dislocation (27%; 793/2937), followed by bleed (10.7%; 315/2937). The addition of error-related pathology to peer review is both feasible and practical and provides a more detailed guide to targeted individual and practice-wide peer learning quality improvement efforts. Future research is needed to determine if there are measurable improvements in detection or interpretation of specific pathologies following error feedback and educational interventions.

Accidents involving poisonous animals in southern Santa Catarina State, Brazil, from 1994 to 2005 were evaluated with the aim of verifying their frequency through the analysis of 2,625 victim’s reports involving poisonous animals from the SINAN (System of Injury Notification Information) files of the Municipal Health Secretary of the AMESC and AMREC microregions, formed by 27 municipalities. Statistical analysis was performed using the chi-square exact test to verify similarities between the AMREC and AMESC microregions, where p values ≤0.05 were considered significant. The results demonstrated that: 52.95% (n = 1,390) of occurrences involved spiders, 18.13% (n = 476) snakes, 5.00% (n = 131) bees, 2.29% (n = 60) caterpillars, 1.41% (n = 37) scorpions, 5.45% (n = 143) other animals and 14.78% (n = 388) unknown. The anatomic region that suffered the most bites was the feet 16.11% (n = 444). Accidents were more frequent in men 54.64% (n = 1.437) than in women 45.25% (n = 1,188). In only 1.18% (n = 31) of cases did recovery present sequelae. The months presenting the highest number of recorded cases were October through March, spring and summer in Brazil. The high frequency of victim recuperation suggests that the public health system is efficient, and the low frequency of recovered victims with sequelae also suggests that this system is fast and well-adjusted. However, there may have been deficiencies in the epidemiologic information system.

There are few data regarding the frequency and type of diagnostic errors made by radiology residents and fellows (“trainees”). However, increasing interest in reducing medical errors highlights the need to analyze which areas of medical knowledge are most problematic for physicians-in-training, including radiology trainees. Once these areas are identified, they can be emphasized during training. To quantify the diagnostic errors made by radiology trainees interpreting radiographs from a pediatric emergency department. A total of 23,273 dictations of emergency radiographs performed over a 1-year period at a pediatric hospital were analyzed for corrections after staff interpretation and for type and incidence of missed abnormalities by radiology trainees. Errors were categorized by type of pathology and anatomic region. Of the 80 errors detected, 90% were false negatives and 69% were recurrent. Most errors (69%) involved the diagnosis of fractures and/or dislocations. Sixty-one percent of all recurrent errors involved buckle, Salter II, avulsion, and transverse fractures—yet these cases constituted only 3% of all cases seen during the study period. The most common errors made by radiology trainees can be identified. By targeting these errors, training programs can improve the quality and relevance of the education they provide.

BACKGROUND The aim of the German Study Group on Cleft Lip and Palate-Craniofacial Deformities is to develop a precise system for documentation of cleft lip and palate patients which is suitable for use in PC-databases. DOCUMENTATION In cooperation with the medical disciplines involved in the therapy such as otolaryngology, oral and maxillofacial surgery, orthodontics and speech therapy a system of documentation was developed with regard to the international classification of diseases (ICD) and the operating procedures system (OPS). Malformations are classified with the LAHS coding system. In addition to this concept of minimal documentation photographic images in standardized projections are stored. Furthermore, each operative procedure is documented by its date and the anatomic region of malformation treated without details of operative methods or descriptions of other procedures. SOFTWARE On behalf of the German Study Group on Cleft Lip and Palate a software to meet these purposes was developed called CleftData. Based on a relational Access database it is equipped with SQL connectivity enabling its use on all hard- and software-systems.

To evaluate the histologic manifestations of collagenous colitis and correlate histologic changes with disease behavior, 14 patients who had undergone sequential evaluations during 33 +/- 6 months of follow-up were studied. Two hundred twelve tissue specimens from all anatomic regions of the colon (mean, 15 +/- 3 samples per patient) were interpretated independently under code by two pathologists. Eight patients (57%) had histologic resolution after 14 +/- 4 months of empiric therapy and in only one of these (12%) did symptoms persist. Four patients (29%) had sequential histologic examinations from the same anatomic region that varied from classical collagenous colitis to inflamed mucosa without a thickened collagen band to normal mucosa. Eight patients (57%) had varying histologic findings from different anatomic regions during the same examination that ranged from classical collagenous colitis to increased inflammation with resolution of the collagen band to normal mucosa. Normal mucosa was found mainly in specimens from the rectosigmoid, and proctosigmoidoscopic examinations alone would have missed the diagnosis of collagenous colitis in 40% of cases. Pathologic interpretations were concordant in 171 of 212 instances (81%). We conclude that histologic resolution of collagenous colitis can occur and it is associated with loss of symptoms. The histologic features of collagenous colitis are distinctive, but they may be patchy and inconsistently sampled. Rectosigmoid biopsies underestimate the diagnosis.

Introduction Soft tissue sarcomas are rare tumours that are infrequently seen in most surgical practices. They can occur in any anatomic region of the body. The size of a soft tissue sarcoma is an important prognostic variable and so affects the quality of tumour resection. Case presentation A 25-year-old Nigerian African presented with recurrent huge fibrosarcoma measuring about 55 × 40 × 10 cm at his posterior trunk. The patient's clinical condition was poor; the tumour seemed unresectable and the patient looked inoperable. He had an extensive excision of the tumour but could not afford adjuvant therapies. He was discharged home against medical advice but may succumb to metastases. Conclusion Sarcomas in black people can present as extremely large masses; the dilemma in management is not only limited to the delay in presentation but also the poor socio-economic status of the patients and the frequent non-availability of supporting services. Treatment grants or subsidies from government may go a long way to ensuring that patients receive appropriate care.