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1.
JMIR Public Health Surveill ; 7(1): e24220, 2021 01 14.
Article in English | MEDLINE | ID: covidwho-2141289

ABSTRACT

BACKGROUND: Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. OBJECTIVE: The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. METHODS: We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. RESULTS: In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat-related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). CONCLUSIONS: Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.


Subject(s)
COVID-19 Testing/methods , Nasopharynx/virology , SARS-CoV-2/isolation & purification , Social Media , Specimen Handling/methods , Video Recording , Diagnostic Errors/prevention & control , Humans , Real-Time Polymerase Chain Reaction
2.
Ophthalmic Surg Lasers Imaging Retina ; 53(9): 518-521, 2022 09.
Article in English | MEDLINE | ID: covidwho-2040029

ABSTRACT

We report a case of bilateral optic nerve head drusen complicated by choroidal neovascularization (CNV) in the left eye at presentation. The presence of optic disc and macular edema in addition to exudation led to the misdiagnosis of neuroretinitis at an outside medical center. Swept-source optical coherence tomography (SS-OCT) and SSOCT angiography were critical in establishing the diagnosis and follow-up in a noninvasive manner. Secondary CNV associated with optic nerve head drusen responded well to intravitreal injections of anti-vascular endothelial growth factor in the left eye. Asymptomatic nonexudative CNV that developed in the right eye during follow-up regressed spontaneously without treatment. [Ophthalmic Surg Lasers Imaging Retina 2022;53:518-521.].


Subject(s)
Chorioretinitis , Choroidal Neovascularization , Optic Disk Drusen , Optic Disk , Papilledema , Retinitis , Chorioretinitis/complications , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Diagnostic Errors/adverse effects , Endothelial Growth Factors , Humans , Optic Disk Drusen/complications , Optic Disk Drusen/diagnosis , Papilledema/complications , Papilledema/etiology , Retinitis/complications
4.
Eur J Med Res ; 27(1): 84, 2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-1951357

ABSTRACT

BACKGROUND: During the last 2 years, in the Kurdistan Region, Northern Iraq, there were thousands of COVID-19 cases that have not been reported officially, but diagnosed and confirmed by private laboratories and private hospitals, or clinicians based on typical clinical signs, as well as few people using home self-test after appearing of some flu-like clinical symptoms. Thus, this study aims to assess the misdiagnosis and mismanagement of cases before COVID-19 confirmation. METHODS: This study enrolled 100 consecutive patients who visited an outpatient clinic of Shar Hospital that had symptoms highly suspicious of COVID-19 infection while misdiagnosed previously to have other types of disease. Detailed questionnaires were filled for all studied patients, including age, gender, main presenting symptoms, and duration of these symptoms with the following questions: who made the false diagnosis, depending on which diagnostic test the false diagnosis was made, which medication was used for the false diagnosis, who prescribed those medications, and how long those medications were used. They were investigated by RT-PCR on their nasopharyngeal swab for confirmation. RESULTS: Most of the false diagnoses were typhoid (63%), influenza (14%), pneumonia (9%), gastroenteritis (5%), common cold (4%), brucellosis (4%), and meningitis (1%). Regarding the false diagnosis of cases, 92% were made by non-physician healthcare workers, and only 8% were made by physicians. All false diagnoses with typhoid, gastroenteritis, and common cold were made by non-physician healthcare workers, together with about half of the diagnosis of pneumonia and brucellosis, with statistically significant results (P < 0.001). CONCLUSIONS: We realized that some patients had been misdiagnosed before the COVID-19 infection confirmation. Their health conditions improved drastically after correct diagnosis and treatment, and this research is considered the first research to be conducted in Iraq in this regard.


Subject(s)
Brucellosis , COVID-19 , Common Cold , Gastroenteritis , Typhoid Fever , COVID-19/diagnosis , Diagnostic Errors , Humans , Iraq/epidemiology , SARS-CoV-2/genetics
6.
Diagnosis (Berl) ; 9(2): 199-206, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1917038

ABSTRACT

OBJECTIVES: To use a case review approach for investigating the types of cognitive error identifiable following a complicated patient admission with a multisystem disorder in an acute care setting where diagnosis was difficult and delayed. METHODS: A case notes review was undertaken to explore the cognitive factors associated with diagnostic error in the case of an 18-year-old male presenting acutely unwell with myalgia, anorexia and vomiting. Each clinical interaction was analysed and identified cognitive factors were categorised using a framework developed by Graber et al. RESULTS: Cognitive factors resulting in diagnostic errors most frequently occurred within the first five days of hospital admission. The most common were premature closure; failure to order or follow up an appropriate test; over-reliance on someone else's findings or opinion; over-estimating or underestimating usefulness or salience of a finding, and; ineffective, incomplete or faulty history and physical examination. Cognitive factors were particularly frequent around transitions of care and patient transfers from one clinical area to another. The presence of senior staff did not necessarily mitigate against diagnostic error from cognitive factors demonstrated by junior staff or diagnostic errors made out-of-hours. CONCLUSIONS: Cognitive factors are a significant cause of diagnostic error within the first five days after admission, especially around transitions of care between different clinical settings and providers. Medical education interventions need to ensure clinical reasoning training supports individuals and teams to develop effective strategies for mitigating cognitive factors when faced with uncertainty over complex patients presenting with non-specific symptoms in order to reduce diagnostic error.


Subject(s)
Clinical Reasoning , Cognition , Adolescent , Diagnostic Errors , Humans , Male
7.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917056
8.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917055
9.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917054
10.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917053
11.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917052
12.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917051
13.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917050
14.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917049
15.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917048
16.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917047
17.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917046
18.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917045
19.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917044
20.
Diagnosis (Berl) ; 9(2): 294-386, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1917043
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