Reducing Diagnostic Errors in Musculoskeletal Trauma by Reviewing Non-Admission Orthopaedic Referrals in the Next-Day Trauma Meeting

INTRODUCTION

Diagnostic errors in orthopaedics are usually caused by missing a fracture or misreading radiographs. The aim of this study was to document the pick-up rate of the wrong diagnoses by reviewing X-rays and casualty notes in the next-day trauma meeting.

PATIENTS AND METHODS

The casualty notes and radiographs of 503 patients were prospectively reviewed in the daily trauma meeting between August 2002 and December 2002 in a district general hospital. The relevant data were collected and analysed by a single assessor.

RESULTS

The false positive rate for making an orthopaedic diagnosis was 12.6% (i.e.) diagnosing a fracture, when none existed). The false negative (missing) rate was 4%, while 2.4% incidental findings were missed, or at least not documented, after reading the X-rays. There were 7.8% wrong diagnoses made. The majority of the patients were seen by the senior house officers.

CONCLUSIONS

The medicolegal significance of false negative diagnosis is obviously greater. In a busy emergency department, where a large number of patients are seen, there is a greater risk. This study shows the importance in a small-to-medium sized accident and emergency unit as well, where there is no senior cover available out-of-hours for final radiological interpretation. A morning trauma meeting which covers reviewing admitted patients as well as non-admission orthopaedic referrals has an effective risk management solution to early detection of missed and wrong diagnoses.     

Epidemiologic trends in pediatric ocular injury in the USA from 2010 to 2019

Graefe's Archive for Clinical and Experimental Ophthalmology - Epidemiologic studies related to the demographics and trends of ocular injury in the pediatric cohort in the last decade are...     

A non‐randomised,controlled clinical trial of an innovative device for negative pressure wound therapy of pressure ulcers in traumatic paraplegia patients

The conventional methods of treatment of pressure ulcers (PUs) by serial debridement and daily dressings require prolonged hospitalisation, associated with considerable morbidity. There is, however, recent evidence to suggest that negative pressure wound therapy (NPWT) accelerates healing. The commercial devices for NPWT are costly, cumbersome, and electricity dependent. We compared PU wound healing in traumatic paraplegia patients by conventional dressing and by an innovative negative pressure device (NPD). In this prospective, non‐randomised trial, 48 traumatic paraplegia patients with PUs of stages 3 and 4 were recruited. Patients were divided into two groups: group A (n = 24) received NPWT with our NPD, and group B (n = 24) received conventional methods of dressing. All patients were followed up for 9 weeks. At week 9, all patients on NPD showed a statistically significant improvement in PU healing in terms of slough clearance, granulation tissue formation, wound discharge and culture. A significant reduction in wound size and ulcer depth was observed in NPD as compared with conventional methods at all follow‐up time points (P = 0·0001). NPWT by the innovative device heals PUs at a significantly higher rate than conventional treatment. The device is safe, easy to apply and cost‐effective.     

抗程序化细胞死亡基因5抗体与类风湿关节炎相关性研究

目的 探讨抗程序化细胞死亡基因5（PDCD5）抗体在类风湿关节炎（RA）中的意义.方法 采用酶联免疫吸附法（ELISA）对55例RA 患者和44例健康对照者（NC）外周血清中抗PDCD5抗体的水平进行检测,并与RA患者相关临床资料、实验室指标及影像学资料进行统计学分析.结果 55例RA患者和44例NC外周血清中抗PDCD5抗体的水平分别为（18.06±4.70）μg/L,（13.62±4.35）μg/L,阳性率分别为18.2%（10/55）,4.5%（2/44）,二者在抗体水平和阳性率上差异有统计学意义（P＜0.05）.抗PDCD5抗体阳性组Sharp评分,类风湿因子（RF）和抗环瓜氨酸肽（CCP）抗体水平明显高于抗PDCD5抗体阴性组,抗PDCD5抗体与抗CCP抗体呈正相关（r=0.374,P=0.01,2-tailed）.结论 抗PDCD5抗体与RA密切相关,且抗体阳性患者易出现骨侵蚀,有望成为诊断早期RA的实验室指标之一.     

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目的    了解高海拔地区藏族牧民口腔健康情况,探讨口腔疾病发病情况和规律,为采取防治措施和改善口腔医疗服务提供依据。方法    2008年10月选择西藏羊易村成年人为调查对象,共439人接受调查,其中男206人,女233人。按照年龄分为：18～24岁组（120人）、>24～34岁组（108人）、>34～44岁组（96人）、>44岁组（115人）;每个年龄组内按性别再分组。以世界卫生组织1997年口腔健康调查基本方法为标准,调查成年牧民龋齿、牙周疾病、第三磨牙萌出及口腔其他疾病患病情况,并对结果进行分析。结果    羊易村成人龋患率、龋均、平均缺牙数分别为74.94%、5.74、3.57。18～24岁和>24～34岁组女性龋均显著高于男性,且差异有统计学意义（P < 0.05）。各年龄组内男女间人均缺牙数、龋患率、有28颗牙人数、牙结石检出率、牙周炎发生率差异无统计学意义（P > 0.05）;而从总体统计,女性缺牙数、龋患率、牙周炎发生率高于男性（P < 0.05）,有28颗牙人数低于男性（P < 0.05）,男性>24～34岁组牙龈炎发生率显著高于同龄女性（P < 0.05）。>24～34岁组中女性第三磨牙萌出率高于男性（P < 0.05）,而在>44岁组中男性高于女性（P < 0.05）。在>24～34岁组、>44岁组和全体样本总计中女性萌出的第三磨牙龋齿发生率均高于男性（P < 0.05）。439名被调查者中有22人有不良固定义齿修复;38人有上颌侧切牙装饰性义齿修复。龋齿充填率为0。结论    高海拔地区缺氧环境和饮食习惯对口腔发育和疾病有一定影响。西藏牧民口腔健康状况较差,需要改善牧区口腔医疗条件,建立口腔防治体系。     

Evaluation of Cassia occidentalis for in vitro cytotoxicity against human cancer cell lines and antibacterial activity

Objective:

To evaluate the in vitro cytotoxicity and antibacterial properties of Cassia occidentalis (whole plant) via alcoholic, hydro-alcoholic, and aqueous extracts against eight human cancer cell lines from six different tissues and four bacterial strains.

Material and Methods:

in vitro cytotoxicity against the human cancer cells, cultured for 48h in presence of different concentrations C. occidentalis extracts and percentage of cell viability, was evaluated using the sulforhodamine-B (SRB) assay. The antibacterial activity was performed using the standard protocol against bacterial strains.

Results:

It was observed that aqueous extract of C. occidentalis (whole plant) had more potential than hydro-alcoholic and alcoholic extracts against HCT-15, SW-620, PC-3, MCF-7, SiHa, and OVCAR-5 human cancer cell lines at 100, 30, and 10 μg/ml in a dose-dependent manner. The hydro-alcoholic extract showed potential against Bacillus subtillis.

Conclusion:

The plant can be explored for the possible development of lead molecules for drug discovery.     

Myocardial tissue characterization using pattern recognition procedures on backscattered ultrasonic signals

Pattern recognition techniques were applied to backscattered signals obtained in vitro from normal and abnormal canine and human heart samples. Orthogonal transforms, in conjunction with the variance criterion, comprised the feature extractors. The minimum-distance (MD) and nearest-neighbor (NN) rules were used as classification. When the MD rule was used, the magnitude of the DFT gave the best performance for both canine and human samples. When the NN rule was used, all the transforms performed comparably. The classification performances were improved for both species when the NN rule was used with feature extractors containing phase information.     

放射性同位素示踪技术在药物研发过程中的应用

药物的吸收、分布、代谢和排泄过程决定了药物分子在体内的过程和命运。作为常规生物样本检测技术的有效补充,放射性同位素标记示踪技术如今也被广泛应用于药物发现和开发过程中的各个阶段。特别是其高灵敏性、适用范围广的特点使其具有不可比拟的优势。通过对近年来放射性标记技术在药物评价领域中的应用进行了归纳和梳理,为药物研发相关领域研究人员提供可借鉴的参考。     

Fatal CNS vasculopathy in a patient with refractory celiac disease and lymph node cavitation

Celiac disease is an enteropathy occurring in genetically predisposed individuals due to a dietary intolerance to gluten. Patients with celiac disease may develop a neurological disorder of unknown cause, although autoimmune mechanisms are suspected. We report on a 56-year-old man with celiac disease, who became refractory to a gluten-free diet and died of a rapidly progressive encephalopathy. Magnetic resonance imaging indicated focal lesions of the cerebellum and brainstem, and electrodiagnostic studies suggested an axonal neuropathy. Autopsy revealed a flattened small-bowel mucosa with intraepithelial lymphocytosis, a spectrum of degenerative changes of the intra-abdominal and mediastinal lymph nodes, including cavitary degeneration, and splenomegaly. Histologically, the lymph nodes showed pseudocyst formation and lymphocytic vasculitis with fibrinoid necrosis, and sections of the brain exhibited fibrinoid degeneration of small blood vessels, sparse perivascular lymphocytic infiltrates, and perivascular ischemic lesions. Identical T-cell clones were identified in the duodenum, stomach, lymph nodes, and spleen. This patient had an unusual neurological disorder related to a vasculopathy, probably mediated by a circulating neoplastic clone of activated T cells.     

Effects of chronic administration of nicotine on drug-induced hypnosis in mice

Chronic administration of nicotine in mice for six weeks did not affect the duration of hypnosis induced by pentobarbital, hexobarbital, barbital or zoxazolamine. The onset of barbital hypnosis remained unaffected. These results suggest that chronic administration of nicotine did not affect the drug metabolizing activity of hepatic microsomes. While psychotropic drugs significantly potentiated the hypnosis due to pentobarbital and hexobarbital, the degree of potentiation was the same in both chronically nicotine pretreated mice and controls. Nicotine pre-treatment significantly increased the duration of sleeping time caused by ethanol alone. However, when treatment of nicotine continued for a longer period of time, the duration of hypnosis induced by ethanol returned to control level.