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Articles Posted in Delay to Treat or Failure to Diagnose a Medical Condition

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Failure%20to%20diagnose%20sepsis.jpgDelay to treat or Failure to diagnose Sepsis may lead to the loss of multiple organs and ultimately to death. Every year 500,000 Americans will be hospitalized because they suffer from severe Sepsis and 250,000 will die from it. Sepsis is a condition that is usually triggered by a bacterial infection of the bloodstream. Early diagnosis is key to preventing mortality. Thanks to a new automated diagnostic test developed by a team of researchers led by Nathan Ledeboer from the Medical College of Wisconsin (MCW), USA, sepsis could be diagnosed much faster and many lives could be saved.

The study is published this week in PLOS Medicine.

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Aneurysm.jpgIn order to prevent Medical Malpractice, observation should be the treatment of choice for all stable brain aneurysms including the smallest ones as all brain aneurysms, even those smaller than the current 7-mm treatment threshold, have 12 times more of a chance to break and lead to a catastrophic brain injury or death if they are growing in size according a recent study published in the Journal of Radiology and lead by J. Pablo Villablanca, M.D., chief of diagnostic neuroradiology at the David Geffen School of Medicine at the University of California, Los Angeles. The study also demonstrates that Aneurysm growth, size, and smoking were associated with increased rupture risk.

30,000 Americans each year suffer ruptured brain aneurysms and 40% of them die. Among the survivors, two-thirds suffer permanent neurological damage. A cerebral aneurysm is a growth in a blood vessel in the brain. If it breaks, blood is leaked into or around the brain, which can cause brain damage or death.

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Dosing errors, delay to treat or failure to diagnose a medical condition because of poor interaction between humans and computers or loss of data can result in serious personal injury and wrongful death.

Poor choice or inadequate implementation of Emergency Department Information Systems (EDISs) can threaten health care quality and patient safety. Findings and recommendations from two work groups from the American College of Emergency Physicians were released in a report last Friday in Annals of Emergency Medicine.

The report indicates that The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs as well as additional requirements for detailed reporting of quality metrics have been major catalysts for the development and implementations of EDISs. However systems functionality varies greatly and it is crucial for emergency providers to actively participate in decisions about EDISs selection, implementation and monitoring.

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During colonoscopy, endoscopists can find potentially precancerous growths (polyps) and remove them, however some polyps especially on the right side of the colon are more difficult to detect. Failure to detect these polyps reduces the efficacy of colonoscopy for colon cancer screening.

By using a quarterly report card, endoscopists at the Roudebush Veterans Affairs Medical Center in Indianapolis were able to increase the overall adjusted adenoma (precancerous polyp) detection rate from 44.7 percent to 53.9 percent, and to improve the cecal intubation rate from 95.6 percent to 98.1 percent. The complete study can be found in the June issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE)

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Diagnostic errors are not a new problem, in 1991 the Harvard medical Practice Study, investigated Medical Malpractice in New York Hospitals and found out that diagnostic errors were accounting for 14% of physicians errors and that 75% of them were due to doctors negligence.

In 1999 a study from the Institute of Medicine “To Err is Human”, looks at diagnostic errors and classifies them in four different categories: error or delay in diagnosis, failure to employ indicated tests, use of outmoded tests or therapy and failure to act on results of monitoring or testing.

Despite these studies, diagnostic errors have been largely ignored until recent research calculated the impact of such errors. Results from a 2009 report funded by the federal Agency for Healthcare Research and Quality showed that 28% of diagnostic mistakes were life-threatening or had resulted in death or permanent disability.

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230px-Cerebral_angiography%2C_arteria_vertebralis_sinister_injection.JPG Angiography alone doesn’t detect Ischemia and may lead to misdiagnosis when a patient is being checked for chest pain. A routine Functional Flow Reserve Measurement (FFR) after the angiography would lead to a change of diagnosis for 1 out of 4 patients according to a new study presented at EuroPCR 2013 by Nick Curzen, Professor of Interventional Cardiology, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton, Southampton, UK.

Most cadiologists base their decision on the angiography only. The angiography is an X-ray of the blood vessel (see picture) that the cardiologist uses to assess if some blood vessels are blocked or damaged. The study argues that angiography only doesn’t detect ischemia, a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed to keep tissue alive. This may lead cardiologists to fail to diagnose a medical condition and to develop an inappropriate treatment plan for the patient.

Researchers, studied 200 patients suffering from Chest Pain. Each patient underwent an angiography. Based on the angiography only a cardiologist made a diagnosis and developed a treatment plan for each patient as well as recommendations for medical treatment such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or request for more information. The cardiologist left the room and then each patient had a Fractional Flow Reserve (FFR) measurement. Results with FFR were shown again to the cardiologist. Based on this additional information the cardiolgist changed the treatment for 25% of the patients.

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According to a new study by New York Presbyterian Hospital and Weill-Cornell Medical College presented at Digestive Disease Week® (DDW), usual methods to diagnose and treat gastrointestinal problems are controversial and lead to a high rate of misdiagnosis.

Gastroesophageal reflux disease (GERD) happens when stomach acid or bile flows back into the esophagus from the stomach, causing acid reflux and heartburn. The usual method used to treat this condition is to submit the patient to an eight eight-week trial of proton-pump inhibitors (PPI) and then to observe the patient to see if symptoms subside.

According to David Kleiman, MD, a research fellow in the department of surgery at New York Presbyterian Hospital, “Many patients remain on proton-pump inhibitors for years after the trial period without any confirmation that they are being treated for the right diagnosis,”. This leads to unnecessary expenses and increased medical risks linked to extended PPI use.

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