1
|
Sharma A, Gupta G, Nishadham V, Malik A, Kumar A, Pasricha S, Kamboj M, Durga G, Mehta A. Amendments in surgical pathology reports: An 8-year institutional experience. Ann Diagn Pathol 2024; 71:152308. [PMID: 38640807 DOI: 10.1016/j.anndiagpath.2024.152308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
Surgical pathology reports may undergo revisions broadly categorized as addenda (supplementary information) or amendments (changes to finalized reports). Amendments indicate potential flaws in the diagnostic process and serve as important indicators of vulnerabilities in the histopathology workflow. This study analyzed the frequency and distribution of amendments in surgical pathology reports over 8 years to identify patterns highlighting opportunities for improvement. Surgical biopsies, excisions, and resections were included; cytology and molecular tests were excluded. Amended reports were categorized using previously used taxonomy documented in literature. Defects were classified as misinterpretations, misidentifications, defective specimens, or defective reports. Of 101,355 reports, 155 (0.15 %) were signed out with amendments. The amendment rate was approximately 1-2 cases per 1000 reports annually. Misinterpretations accounted for the majority (52 %) of amended reports, with undercalls (62 %) and overcalls (27 %) being predominant subtypes. Tumor staging was amended in 57 (37 %) cases, with 30 being upstaged and 11 downstaged clinically. The highest number of misinterpretation defects occurred in head and neck (36 %) and breast (21 %) specimens. Misinterpretation defects were present in 53 % of malignant cases versus 42 % of benign cases. In 18 cases, there were significant changes in pathological diagnosis (14 major and 4 minor). A standard taxonomy categorizing report defects is crucial for measuring and improving quality control. Accurate pathology reporting impacts patient care and guides workflow improvements. This taxonomy enables us to track variations and deficiencies in our pathology reporting processes in a reproducible way across the department.
Collapse
Affiliation(s)
- Anila Sharma
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Gurudutt Gupta
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Vikas Nishadham
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - Akanksha Malik
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Ankur Kumar
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Meenakshi Kamboj
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Garima Durga
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| | - Anurag Mehta
- Department of Pathology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India
| |
Collapse
|
2
|
Guo F, Ye W, Qin D, Fang X, Hua F, He H. Abstracts of randomized controlled trials in pediatric dentistry: reporting quality and spin. BMC Med Res Methodol 2023; 23:263. [PMID: 37950213 PMCID: PMC10636842 DOI: 10.1186/s12874-023-02085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Abstracts provide readers a concise and readily accessible information of the trials. However, poor reporting quality and spin (misrepresentation of research findings) can lead to an overestimation in trial validity. This methodological study aimed to assess the reporting quality and spin among randomized controlled trial (RCT) abstracts in pediatric dentistry. METHODS We hand-searched RCTs in five leading pediatric dental journals between 2015 and 2021. Reporting quality in each abstract was assessed using the original 16-item CONSORT for abstracts checklist. Linear regression analyses were performed to identify factors associated with reporting quality. We evaluated the presence and characteristics of spin only in abstracts of parallel-group RCTs with nonsignificant primary outcomes according to pre-determined spin strategies. RESULTS One hundred eighty-two abstracts were included in reporting quality evaluation. The mean overall quality score was 4.57 (SD, 0.103; 95% CI, 4.36-4.77; score range, 1-10). Only interventions, objective, and conclusions were adequately reported. Use of flow diagram (P < 0.001) was the only significant factor of higher reporting quality. Of the 51 RCT abstracts included for spin analysis, spin was identified in 40 abstracts (78.4%), among which 23 abstracts (45.1%) had spin in the Results section and 39 in the Conclusions Sect. (76.5%). CONCLUSIONS The reporting quality of RCT abstracts in pediatric dentistry is suboptimal and the prevalence of spin is high. Joint efforts are needed to improve reporting quality and minimize spin.
Collapse
Affiliation(s)
- Feiyang Guo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Wengwanyue Ye
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Danchen Qin
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaolin Fang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| |
Collapse
|
3
|
Dehan LM, Lewis JS, Mehrad M, Ely KA. Patterns of Major Frozen Section Interpretation Error: An In-Depth Analysis From a Complex Academic Surgical Pathology Practice. Am J Clin Pathol 2023; 160:247-254. [PMID: 37141256 DOI: 10.1093/ajcp/aqad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To establish baseline error rates due to misinterpretation and to identify scenarios in which major errors were most common and potentially preventable. METHODS Our database was queried over a 3-year period for major discrepancies due to misinterpretation. These were stratified by histomorphologic setting, service, availability/type of prior material, and years of experience and subspecialization of the interpreting pathologist. RESULTS The overall discordance rate between frozen section (FS) and final diagnoses was 2.9% (199/6,910). Seventy-two errors were due to interpretation, of which 34 (47.2%) were major. Major error rates were highest on the gastrointestinal and thoracic services. Of major discrepancies, 82.4% were rendered in subdisciplines outside those of the FS pathologist. Pathologists with fewer than 10 years' experience made more errors than those with more experience (55.9% vs 23.5%, P = .006). Major error rates were greater for cases without previous material compared to those with a prior glass slide (47.1% vs 17.6%, P = .009). Common histomorphologic scenarios in which disagreements were made involved discriminating mesothelial cells from carcinoma (20.6%) and accurately recognizing squamous carcinoma/severe dysplasia (17.6%). CONCLUSIONS To improve performance and decrease future misdiagnoses, monitoring discordances should be a continuous component of surgical pathology quality assurance programs.
Collapse
Affiliation(s)
- Lauren M Dehan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Kim A Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| |
Collapse
|
4
|
Andaur Navarro CL, Damen JAA, Takada T, Nijman SWJ, Dhiman P, Ma J, Collins GS, Bajpai R, Riley RD, Moons KGM, Hooft L. Systematic review finds "spin" practices and poor reporting standards in studies on machine learning-based prediction models. J Clin Epidemiol 2023; 158:99-110. [PMID: 37024020 DOI: 10.1016/j.jclinepi.2023.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES We evaluated the presence and frequency of spin practices and poor reporting standards in studies that developed and/or validated clinical prediction models using supervised machine learning techniques. STUDY DESIGN AND SETTING We systematically searched PubMed from 01/2018 to 12/2019 to identify diagnostic and prognostic prediction model studies using supervised machine learning. No restrictions were placed on data source, outcome, or clinical specialty. RESULTS We included 152 studies: 38% reported diagnostic models and 62% prognostic models. When reported, discrimination was described without precision estimates in 53/71 abstracts (74.6% [95% CI 63.4-83.3]) and 53/81 main texts (65.4% [95% CI 54.6-74.9]). Of the 21 abstracts that recommended the model to be used in daily practice, 20 (95.2% [95% CI 77.3-99.8]) lacked any external validation of the developed models. Likewise, 74/133 (55.6% [95% CI 47.2-63.8]) studies made recommendations for clinical use in their main text without any external validation. Reporting guidelines were cited in 13/152 (8.6% [95% CI 5.1-14.1]) studies. CONCLUSION Spin practices and poor reporting standards are also present in studies on prediction models using machine learning techniques. A tailored framework for the identification of spin will enhance the sound reporting of prediction model studies.
Collapse
Affiliation(s)
- Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Steven W J Nijman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paula Dhiman
- Center for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jie Ma
- Center for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Gary S Collins
- Center for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ram Bajpai
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
5
|
Grautoff S. QRS double counting by ECG software in ST elevation myocardial infarction. Herzschrittmacherther Elektrophysiol 2023; 34:75-77. [PMID: 36745235 DOI: 10.1007/s00399-023-00925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
A 62-year-old female patient suffering from ST elevation myocardial infarction (STEMI) was transported to a cardiology facility. During transport, the monitor triggered an alarm for tachycardia despite a normal pulse. The reason was a misinterpretation of the ECG software, which double counted the QRS complex. QRS double counting has been reported in the setting of hyperkalemia only. In this case report, QRS double counting in association with STEMI is documented for the first time. Healthcare workers who are monitoring patients with myocardial infarction should be aware of this misdiagnosis and able to recognize the pattern.
Collapse
Affiliation(s)
- Steffen Grautoff
- Sicherheit und Ordnung, Gefahrenabwehr, Rettungsdienst Kreis Herford, Wittekindstr. 7, 32051, Herford, Germany. .,Zentrale Notaufnahme, Klinikum Herford, Schwarzenmoorstr. 70, 32049, Herford, Germany.
| |
Collapse
|
6
|
Jia J, Ao L, Luo Y, Liao T, Huang L, Zhuo D, Jiang C, Wang J, Hu J. Quantum dots assembly enhanced and dual-antigen sandwich structured lateral flow immunoassay of SARS-CoV-2 antibody with simultaneously high sensitivity and specificity. Biosens Bioelectron 2022; 198:113810. [PMID: 34840014 PMCID: PMC8595965 DOI: 10.1016/j.bios.2021.113810] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/27/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Exploring reliable and highly-sensitive SARS-CoV-2 antibody diagnosis by point-of-care (POC) manner, holds great public health significance for extensive COVID-19 screening and controlling. Unfortunately, the currently applied gold based lateral flow immunoassay (GLFIA) may expose both false-negative and false-positive interpretations owing to the sensitivity and specificity limitations, which may cause significant risk and waste of public resources for large population screening. To simultaneously overcome the drawbacks of GLFIA, a novel fluorescent LFIA based on signal amplification and dual-antigen sandwich structure was established with largely improved sensitivity and specificity. The compact three-dimensional incorporation of hydrophobic quantum dots within dendritic affinity templates and multilayer surface derivation guaranteed a high and robust fluorescence of single label, which lowered the false negative rate of GLFIA prominently. A dual-antigen sandwich structure using labeled/immobilized SARS-CoV-2 spike receptor binding domain antigen for capturing total human SARS-CoV-2 antibody was developed, instead of general indirect antibody capturing approach, to reduce the false positive rate of GLFIA. Over 300 cases of COVID-19 negative and 97 cases of COVID-19 positive samples, the current assay revealed a 100% sensitivity and 100% specificity confirmed by both polymerase chain reaction (PCR) and chemiluminescence immunoassay (CLIA), compared with the considerable misinterpretation cases by currently applied GLFIA. The quantitative results verified by receiver operating characteristic curve and other statistical analysis indicated a well-distinguished positive/negative sample groups. The proposed strategy is highly sensitive towards low concentrated SARS-CoV-2 antibody serums and highly specific towards serums from COVID-19 negative persons and patients infected by other viruses.
Collapse
Affiliation(s)
- Jianghua Jia
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China; Medicalsystem Biotechnology Co., Ltd, Ningbo, 315104, China
| | - Lijiao Ao
- Institute of Biomedical Engineering, The Second Clinical Medical College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Yongxin Luo
- Xinyu People's Hospital, Xinyu, 338000, China
| | - Tao Liao
- Shenzhen WWHS Biotech. Inc, Shenzhen, 518100, China
| | - Liang Huang
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Dinglv Zhuo
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Chenxing Jiang
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Jing Wang
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Jun Hu
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China.
| |
Collapse
|
7
|
Thorsteinsson K, Jensen JB. Misinterpretation resulting in a diagnosis of bladder cancer - A case emphasising the value of diagnostic reconsideration. Urol Case Rep 2021; 40:101928. [PMID: 34815943 PMCID: PMC8593442 DOI: 10.1016/j.eucr.2021.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
A patient was suspected for MIBC and underwent multiple TURBTs but due to large discrepancy between pathological findings, symptom progression and clinical findings, diagnostic reconsideration was necessary. Re-evaluation revealed a benign inflammatory condition of the bladder with no malignancy. Final treatment involved robotic assisted reconstruction of the bladder with bowel augmentation. This patient case emphasises the need for reconsideration when pathological findings are not consistent with the suspected diagnosis. Reconsideration is needed when pathological findings are not consistent with the suspected diagnosis. Accurately diagnosing required reconsideration of the initial interpretation of the original pathological specimen. Wrongful interpretation in the diagnostic process can result in an incorrect diagnosis and treatment.
Collapse
Affiliation(s)
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
8
|
Assadsangabi R, Maralani P, Chen AF, Loevner LA, Mohan S. Common blind spots and interpretive errors of neck imaging. Clin Imaging 2021; 82:29-37. [PMID: 34773810 DOI: 10.1016/j.clinimag.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Complex anatomy and a wide spectrum of diseases in the head and neck predispose interpretation of neck imaging to cognitive pitfalls and perceptual errors. Extra attention to common blind spots in the neck and familiarity with common interpretive challenges could aid radiologists in preventing these diagnostic errors.
Collapse
Affiliation(s)
- Reza Assadsangabi
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA.
| | - Pejman Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony F Chen
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA
| | - Laurie A Loevner
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
9
|
Pereira GC, Prates G, Medina M, Ferreira C, Latorraca CDOC, Pacheco RL, Martimbianco ALC, Riera R. High frequency of spin bias in controlled trials of cannabis derivatives and their synthetic analogues: A meta-epidemiologic study. J Clin Epidemiol 2021; 140:3-12. [PMID: 34450305 DOI: 10.1016/j.jclinepi.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the frequency and perform a qualitative analysis of spin bias in publications of controlled trials assessing the therapeutic use of cannabis derivatives and their synthetic analogues. STUDY DESIGN AND SETTING Meta-epidemiologic study carried out at the Universidade Federal de São Paulo, Brazil. RESULTS A total of 65 publications with at least one efficacy primary outcome were considered. The results analysis for the primary outcome indicated statistically significant effects in 44.6% (29/65) of the publications, and 70.7% (45/65) of the conclusions were considered favorable to the intervention. Among the 36 publications that found statistically nonsignificant results for the primary outcome, 44.4% (16/36) presented conclusions favorable to or recommending the intervention, which represents spin bias according to the definition adopted in this study. Qualitative analysis of the 16 studies with spin bias showed selective outcomes reporting (elevating secondary outcomes that had positive results or reporting only subgroup results), deviations from the planned statistical analysis, and failure to consider or report uncertainty in the estimates of treatment effects. CONCLUSION The frequency of spin bias among publications of controlled trials with statistically nonsignificant results assessing the therapeutic use of cannabis derivatives and their synthetic analogues reached 44.4%. When not observed by readers, such deviation can lead to misconduct in clinical practice through the adoption of interventions that are not effective or whose effectiveness is uncertain.
Collapse
Affiliation(s)
| | - Gabriela Prates
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | - Matheus Medina
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | | | | | - Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo - SP, Brazil. Hospital Sírio-Libanês. Universidade Federal de São Paulo (Unifesp). Oxford-Brazil EBM Alliance.
| | | | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil. Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil. Oxford-Brazil EBM Alliance
| |
Collapse
|
10
|
Margo CE. Why Are B-Scans in Some Blind Eyes with Large Intraocular Masses Misinterpreted? Ocul Oncol Pathol 2021; 7:182-184. [PMID: 34307329 DOI: 10.1159/000513490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
B-scan ultrasounds on 3 patients whose eyes were filled with cellular masses (two uveal melanomas and one reactive fibrous granulomatous proliferation) performed by 4 experienced retinal specialists were misinterpretated as containing no tumor mass. A possible explanation for this potentially avoidable oversight is offered.
Collapse
Affiliation(s)
- Curtis E Margo
- Departments of Pathology and Cell Biology, and Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
11
|
Peschard V, Philippot P. Overestimation of threat from neutral faces and voices in social anxiety. J Behav Ther Exp Psychiatry 2017; 57:206-11. [PMID: 28708974 DOI: 10.1016/j.jbtep.2017.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/08/2017] [Accepted: 06/21/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Social anxiety (SA) is associated with a tendency to interpret social information in a more threatening manner. Most of the research in SA has focused on unimodal exploration (mostly based on facial expressions), thus neglecting the ubiquity of cross-modality. To fill this gap, the present study sought to explore whether SA influences the interpretation of facial and vocal expressions presented separately or jointly. METHODS Twenty-five high socially anxious (HSA) and 29 low socially anxious (LSA) participants completed a forced two-choice emotion identification task consisting of angry and neutral expressions conveyed by faces, voices or combined faces and voices. Participants had to identify the emotion (angry or neutral) of the presented cues as quickly and precisely as possible. RESULTS Our results showed that, compared to LSA, HSA individuals show a higher propensity to misattribute anger to neutral expressions independent of cue modality and despite preserved decoding accuracy. We also found a cross-modal facilitation effect at the level of accuracy (i.e., higher accuracy in the bimodal condition compared to unimodal ones). However, such effect was not moderated by SA. LIMITATIONS Although the HSA group showed clinical cut-off scores at the Liebowitz Social Anxiety Scale, one limitation is that we did not administer diagnostic interviews. Upcoming studies may want to test whether these results can be generalized to a clinical population. CONCLUSIONS These findings highlight the usefulness of a cross-modal perspective to probe the specificity of biases in SA.
Collapse
|
12
|
Muotri RW, Bernik MA, Neto FL. Misinterpretation of the Borg's Rating of Perceived Exertion Scale by patients with panic disorder during ergospirometry challenge. BMJ Open Sport Exerc Med 2017; 3:e000164. [PMID: 28761695 PMCID: PMC5530104 DOI: 10.1136/bmjsem-2016-000164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The most widely used instrument to measure perceived exertion or exercise intensity is the Borg's Rating of Perceived Exertion (RPE) Scale. Panic attacks are aversive experiences that may be triggered by bodily sensations such as palpitations, breathlessness or dizziness due to increasing autonomic distress, prior sensitisation to panic and fear conditioning. The consequence is catastrophic interpretation of bodily sensations of arousal in general, which can lead to misinterpretation of exertion or exercise intensity. PURPOSE To verify the effectiveness of the Borg's RPE Scale as a measure of perceived effort in panic disorder subjects. METHODS The study enrolled 72 subjects: the control group (C, healthy sedentary subjects, n=30) and patients with panic disorder (PD, n=42). All subjects were submitted to an ergospirometry challenge. Perceived exertion RPE scores and heart rate at 90% VO2max were compared between groups. RESULTS Patients with PD showed lower levels of maximal oxygen consumption, when compared with C group [VO2max (mL/kg/min): PD=29.42±6.50xC=34.51±5.35; Student's t-test=-3.51; p <0.05]. Furthermore, among PD subjects, the maximum heart rate during ergospirometry challenge was lower than expected [predict max HR (bpm)=200.85±6.33xheart rate test (bpm)=178.86±7.28; Z=-5.64; p<0.05]. Perceived exertion, as measured by RPE, was also overestimated in relation to heart rate at 90% of maximum oxygen consumption compared with controls (RPE90%VO2max: PD=18.93±0.55xC=16.67±0.60; U=8.00; Z=7.42; p<0.05). CONCLUSIONS The present study findings suggest that the Borg's RPE Scale may not be an appropriate measure of subjective exertion among subjects with panic disorder performing a cardiopulmonary exercise test.
Collapse
Affiliation(s)
- Ricardo William Muotri
- Department of Psychiatry, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Marcio Antonini Bernik
- Department of Psychiatry, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Francisco Lotufo Neto
- Department of Psychiatry, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| |
Collapse
|
13
|
Sorleto M, Wuttig H, Aydilek E, Wiemer M. [Mismanagement in the arrhythmia recognition algorithm of the LifeVest® with consecutive fatal outcome]. Herzschrittmacherther Elektrophysiol 2016; 27:57-62. [PMID: 26830775 DOI: 10.1007/s00399-016-0420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
We describe for the first time the misinterpretation of a wearable cardioverter defibrillator in the arrhythmia recognition algorithm with subsequent fatal outcome of a multi-morbid patient with an ischemic cardiomyopathy and a highly reduced left ventricular pump function (30 %). The patient's death was preceded by a life-threatening shockable rhythm which was repeatedly documented, but ultimately not correctly recognized by the system and therefore not treated.
Collapse
Affiliation(s)
- M Sorleto
- Internistische Intensivstation, Johannes Wesling Klinikum Minden, Akademisches Lehrkrankenhaus der medizinischen Hochschule Hannover, Minden, Deutschland.
- , Hans-Nolte-Straße 1, 32429, Minden, Deutschland.
| | - H Wuttig
- Internistische Intensivstation, Johannes Wesling Klinikum Minden, Akademisches Lehrkrankenhaus der medizinischen Hochschule Hannover, Minden, Deutschland.
| | - E Aydilek
- Internistische Intensivstation, Johannes Wesling Klinikum Minden, Akademisches Lehrkrankenhaus der medizinischen Hochschule Hannover, Minden, Deutschland.
| | - M Wiemer
- Internistische Intensivstation, Johannes Wesling Klinikum Minden, Akademisches Lehrkrankenhaus der medizinischen Hochschule Hannover, Minden, Deutschland.
| |
Collapse
|
14
|
Sabour S. Methods and reliability of radiographic vertebral fracture detection in older men; methodological issues to avoid misinterpretation. Bone 2015; 75:244-5. [PMID: 25479343 DOI: 10.1016/j.bone.2014.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/20/2014] [Indexed: 11/21/2022]
Affiliation(s)
- Siamak Sabour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of Clinical Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
| |
Collapse
|
15
|
Ikegami Y, Suzuki T, Nemoto C, Tsukada Y, Hasegawa A, Shimada J, Tase C. Establishment and implementation of an effective rule for the interpretation of computed tomography scans by emergency physicians in blunt trauma. World J Emerg Surg 2014; 9:40. [PMID: 25006345 PMCID: PMC4085233 DOI: 10.1186/1749-7922-9-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Computed tomography (CT) can detect subtle organ injury and is applicable to many body regions. However, its interpretation requires significant skill. In our hospital, emergency physicians (EPs) must interpret emergency CT scans and formulate a plan for managing most trauma cases. CT misinterpretation should be avoided, but we were initially unable to completely accomplish this. In this study, we proposed and implemented a precautionary rule for our EPs to prevent misinterpretation of CT scans in blunt trauma cases. Methods We established a simple precautionary rule, which advises EPs to interpret CT scans with particular care when a complicated injury is suspected per the following criteria: 1) unstable physiological condition; 2) suspicion of injuries in multiple regions of the body (e.g., brain injury plus abdominal injury); 3) high energy injury mechanism; and 4) requirement for rapid movement to other rooms for invasive treatment. If a patient meets at least one of these criteria, the EP should exercise the precautions laid out in our newly established rule when interpreting the CT scan. Additionally, our rule specifies that the EP should request real-time interpretation by a radiologist in difficult cases. We compared the accuracy of EPs’ interpretations and resulting patient outcomes in blunt trauma cases before (January 2011, June 2012) and after (July 2012, January 2013) introduction of the rule to evaluate its efficacy. Results Before the rule’s introduction, emergency CT was performed 1606 times for 365 patients. We identified 44 cases (2.7%) of minor misinterpretation and 40 (2.5%) of major misinterpretation. After introduction, CT was performed 820 times for 177 patients. We identified 10 cases (1.2%) of minor misinterpretation and two (0.2%) of major misinterpretation. Real-time support by a radiologist was requested 104 times (12.7% of all cases) and was effective in preventing misinterpretation in every case. Our rule decreased both minor and major misinterpretations in a statistically significant manner. In particular, it conspicuously decreased major misinterpretations. Conclusion Our rule was easy to practice and effective in preventing EPs from missing major organ injuries. We would like to propose further large-scale multi-center trials to corroborate these results.
Collapse
Affiliation(s)
- Yukihiro Ikegami
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Tsuyoshi Suzuki
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Chiaki Nemoto
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Yasuhiko Tsukada
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Arifumi Hasegawa
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Jiro Shimada
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Choichiro Tase
- Department of Emergency and Critical Care Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| |
Collapse
|
16
|
Sabour S. Reliability of post-chemo radiotherapy F-18-FDG PET/CT for prediction of loco regional failure in human papillomavirus-associated oropharyngeal cancer: misconception and misinterpretation. Oral Oncol 2014; 50:e29. [PMID: 24775610 DOI: 10.1016/j.oraloncology.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/23/2014] [Accepted: 03/14/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Siamak Sabour
- Safety Promotion and Injury Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Epidemiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Kim JH, Kim MY, Kim SY, Hwang IH, Kang EJ. Misinterpreting odds ratio in the articles published in korean journal of family medicine. Korean J Fam Med 2012; 33:89-93. [PMID: 22745892 PMCID: PMC3383504 DOI: 10.4082/kjfm.2012.33.2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 03/13/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In reporting results of case-control studies, odds ratios are useful methods of reporting findings. However, odds ratios are often misinterpreted in the literature and by general readers. METHODS We searched all original articles which were published in the Korean Journal of Family Medicine from 1980 to May 2011 and identified those that report "odds ratios." Misinterpretation of odds ratios as relative risks has been identified. Estimated risk ratios were calculated when possible and compared with odds ratios. RESULTS One hundred and twenty-eight articles using odds ratios were identified. Among those, 122 articles were analyzed for the frequency of misinterpretation of odds ratios as relative risks. Twenty-two reports out of these 122 articles misinterpreted odds ratios as relative risks. The percentage of misinterpreting reports decreased over years. Seventy-seven reports were analyzed to compare the estimated risk ratios with odds ratios. In most of these articles, odds ratios were greater than estimated risk ratios, 60% of which had larger than 20% standardized differences. CONCLUSION In reports published in the Korean Journal of Family Medicine, odds ratios are frequently used. They were misinterpreted in part of the reports, although decreasing trends over years were observed.
Collapse
Affiliation(s)
- Ju Heon Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|