Search Results for "error"

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Diagnostic Errors & Excellence

Inaccurate or delayed diagnoses are harmful to patients on a global scale. Among hospitalized patients in the United States, an estimated 250,000 detrimental diagnostic errors occur annually. Efforts to reduce the incidence of misdiagnosis vary, ranging from changes to medical pedagogy, support strategies, and technological tools.

Mental Health and Burnout, Part 1

While there has been increased awareness of the concept of burnout in general, many Internal Medicine physicians may have gaps in their knowledge as to what burnout is and how they may be affected by it. Given that over 50% of physicians have experienced symptoms of burnout at some point during their careers (with rates significantly increasing during the COVID-19 pandemic), it is imperative that they understand the signs and the physical and mental consequences burnout can have. This includes increased rates of medical errors, depression, suicide, and leaving the medical field.

High Value Care Cases 3: Diagnostic Process

In these 3 cases, you will practice using tools and resources designed to help you choose interventions and care settings that maximize benefits, minimize harms, and reduce costs. Complete this activity to improve your clinical reasoning skills and reflect on current diagnostic processes as a means to practice high value care and minimize errors and delays.

Disparities in Diagnostic Reasoning

Diagnostic error is a significant cause of preventable harm for adult patients. Diagnostic errors are the leading type of paid medical malpractice claim and are nearly twice as likely to result in death as any other category of error. Implicit racial bias is pervasive and associated with diagnostic uncertainty. No intervention has been shown to meaningfully reduce implicit bias; however, there are evidence-backed strategies that clinicians can employ to reduce discriminatory behavior based on their biases.

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Medication Reconciliation Post-Discharge

The percentage of discharges from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years and older of age seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record. This measure is reported as three rates stratified by age group: Reporting Criteria 1: 18-64 years of age Reporting Criteria 2: 65 years of age Total Rate: All patients 18 years of age and older

Hepatitis C Ribonucleic Acid (RNA) Testing Before Initiating Treatment

INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment for whom quantitative HCV RNA testing was performed within 6 months prior to initiation of antiviral treatment (paired with NQF 0396)

HCV Genotype Testing Prior to Treatment

Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment for whom HCV genotype testing was performed prior to initiation of antiviral treatment (paired with NQF 0395)

Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy

All female patients of childbearing potential (12 - 44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.

Displaying 1 - 10 of 25 in Annals of Internal Medicine: Clinical Cases

Sensing Error in Respironics Continuous Positive Airway Pressure Machine Risks Compromising Patient Compliance | Annals of Internal Medicine: Clinical Cases

We report a continuous positive airway pressure (CPAP) machine malfunction that may compromise patient compliance. A patient's Respironics DreamStation machine (Philips Respironics) was observed to sense “vibratory snore” events incorrectly, resulting in pressure increases that led to poor mask fit, large air leaks, and patient discomfort. A replacement machine developed the same problem. Once aware of the defect, we observed it in 2 other patients. The manufacturer acknowledges receiving a few similar reports, but our experience suggests that this may be an underreported defect. The resulting increased pressures reduce patient tolerance for CPAP. This may be an unrecognized cause for patients abandoning CPAP therapy.

From a Papule to Friable Papillary Projections: A Case of Old World Cutaneous Leishmaniasis | Annals of Internal Medicine: Clinical Cases

This case aims to characterize an unusual cutaneous manifestation in a patient with confirmed cutaneous leishmaniasis, highlighting clinical features that are often underrecognized and may contribute to diagnostic uncertainty. By exploring this atypical presentation, it underscores the potential for misdiagnosis and its implications for patient management. Additionally, it emphasizes the broad spectrum of cutaneous lesions that can mimic Old World cutaneous leishmaniasis, further increasing the risk of diagnostic error.

A Case of Maple Syrup Urine Disease Diagnosed in Adulthood | Annals of Internal Medicine: Clinical Cases

Classic maple syrup urine disease (MSUD) is typically diagnosed in newborns, whereas nonclassic forms may manifest at any age. We describe a 58-year-old man presenting with recurrent encephalopathy, found with a nonclassic form of MSUD. This patient case highlights the importance of considering inborn errors of metabolism in the differential diagnosis of adult patients presenting with neurologic symptoms of unclear cause.

When Sarcoidosis Looks Like Myeloma: A Diagnostic Pitfall | Annals of Internal Medicine: Clinical Cases

Multiple myeloma (MM) is a plasma cell malignant disorder with variable clinical presentations. Because MM is the most prevalent hematologic malignancy among Black patients, a high index of suspicion is often applied in this population. However, premature diagnostic closure may occur when initial findings appear consistent with MM, while conflicting information is overlooked. This case describes a 46-year-old Black man initially diagnosed with active MM but ultimately found to have active sarcoidosis and smoldering myeloma. This case illustrates the importance of recognizing cognitive bias and considering granulomatous disease in the differential diagnosis of hypercalcemia, lytic lesions, and systemic abnormalities.

Lipoprotein X in the Setting of COVID-19–Induced Cholangiopathy: An Unforeseen Event | Annals of Internal Medicine: Clinical Cases

Elevated low-density lipoprotein cholesterol (LDL-C) is a well-known culprit for atherosclerosis; however, elevated lipoprotein X (LpX), an abnormal lipoprotein as dense as LDL-C, may confound differentiation between true hyperlipidemia and cholestasis-induced hyperlipidemia. We present the case of a 34-year-old man diagnosed with COVID-19–induced cholangiopathy with LpX. Despite treatment with evolocumab and plasmapheresis, the patient had persistent cholestasis and ultimately received a liver transplant, resulting in the resolution of hyperlipidemia. This case highlights the potential association between LpX and COVID-19–induced cholangiopathy, emphasizing the need for further research to better understand the underlying mechanisms and treatment options for this complex disease.

Chronic Pulmonary Silicone Embolism Syndrome Following Saline Breast Implants | Annals of Internal Medicine: Clinical Cases

Chronic pulmonary silicone embolism syndrome (CPSE) presents as progressive dyspnea occurring after silicone prosthesis implantation. Diagnostic criteria for CPSE include imaging findings of intraparenchymal ground-glass opacities and histologic evidence of silicone microdroplets. CPSE is a very rare entity but has been reported previously secondary to ruptured silicone filled breast implants. Due to safety concerns, many plastic surgeons and patients consider saline-filled breast implants to be a sound alternative. Here, we report a middle-aged woman with biopsy-proven CPSE secondary to saline breast implants, nearly a decade after prosthesis removal.

Systemic Lupus Erythematosus: Initial Manifestation as Cardiac Tamponade? | Annals of Internal Medicine: Clinical Cases

A 49-year-old man presented with 1 hour of retrosternal chest pain and ST-segment elevation. In the ambulance, he was diagnosed with an ST-segment elevation myocardial infarction and received prompt fibrinolysis. On arrival to the percutaneous coronary intervention–capable hospital, he became hemodynamically unstable, and bedside echocardiogram demonstrated a posterior pericardial effusion with tamponade physiology. He was found be profoundly thrombocytopenic secondary to a history of immune thrombocytopenic purpura (not known at the time of prehospital fibrinolysis). Given the position of his pericardial effusion, emergent surgical drainage was performed without complication. Subsequent work-up confirmed effusive pericarditis as his presenting diagnosis secondary to systemic lupus erythematosus.

A Case of Bilateral Subclavian Artery Stenosis Presenting as Refractory Hypotension | Annals of Internal Medicine: Clinical Cases

A 72-year-old woman presented with epigastric pain, hypotension, and tachycardia. Laboratory studies revealed anemia and lactic acidosis. Endoscopy showed gastric cancer without active bleeding. Although the tachycardia and lactic acidosis resolved shortly after a blood transfusion, her blood pressure (BP) remained low. BP measured in both her upper and lower extremities confirmed a discrepancy. Computed tomography revealed findings suggestive of bilateral subclavian artery stenosis. Bilateral subclavian artery stenosis should be suspected in a patient who presents with prolonged unexplained asymptomatic low BP measured in both upper extremities, noting the importance of also measuring the BP in all extremities.

A Rare Case of Surfer's Myelopathy in an Athletic Intermediate Surfer | Annals of Internal Medicine: Clinical Cases

Surfer's myelopathy is a nontraumatic spinal cord injury sustained in the setting of prolonged periods of hyperextension with intermittent Valsalva when transitioning from a prone to standing position on a surfboard. This condition almost exclusively occurs in first-time, unathletic surfers. This case report is unique in that an 18-year-old experienced female volleyball player developed surfer's myelopathy after, not her first, but eighth time surfing. In this way, we are contributing to medical education through a case report on the presentation, diagnostics, and treatment of surfer's myelopathy in a non–first-time surfer.

Sandwich-Associated Lactic Acidosis: A Case Report of a Young Adult With Pyruvate Dehydrogenase Complex Deficiency | Annals of Internal Medicine: Clinical Cases

Pyruvate dehydrogenase complex deficiency is a rare genetic disorder that can lead to severe metabolic consequences. We present the case of a young adult with pyruvate dehydrogenase complex deficiency who presented with progressive shortness of breath and subsequently required intubation in the setting of severe lactic acidemia. After resuscitation and extubation, a targeted history identified that the patient had eaten 3 grilled cheese sandwiches just before admission. In these rarely encountered cases, both detailed clinical history-gathering as well as multidisciplinary provider coordination is essential in ultimately implementing specialized dietary recommendations and thus preventing accelerated morbidity and mortality.

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