Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19.

BACKGROUND: The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). OBJECTIVE: To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19. DESIGN: Retrospective cohort. SETTING: Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). TARGET POPULATION: Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. MEASUREMENTS: We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs. RESULTS: Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error. LIMITATIONS: Results are limited by available documentation and do not capture communication between providers and patients. CONCLUSION: Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Effects of age and mood on emotional face processing differ depending on the intensity of the facial expression.

Research suggests that mood can moderate age differences in recognizing facial emotion. In this study, we examined how an anxious versus calm mood state affected younger and older adults' processing of emotional faces. Older adults had greater difficulty identifying negative emotions, particularly when emotions were displayed at a low intensity level. However, an anxious mood did not affect age differences in emotional face recognition. In contrast, age, emotional intensity, and current mood state all affected the perceived intensity of emotion. The effects of age and mood on perceived emotional intensity were only observed for low intensity facial expressions. When induced into an anxious mood, younger adults perceived threatening emotions (i.e., fear, anger) as more emotionally intense, whereas older adults perceived anger and happiness to be more intense. These findings emphasize the need to consider both internal and external factors when investigating the effects of age on emotional face processing.

Influences on the perception of elder financial abuse among older adults in Southern California.

BACKGROUND: Under-reporting of elder financial abuse is partly due to failure of those around the victim to perceive the financial mistreatment as abuse. This study explored the effect of victim and perceiver factors on perception of elder financial abuse in the context of Routine Activity Theory (RAT). METHODS: 488 older adults in Ventura County (CA) were surveyed about financial abuse using vignette method. In the study's Vignette 1, the amount of money taken, the type of frailty, and the relationship of perpetrator and victim were manipulated. In Vignette 2, the victim's age and relationship of perpetrator and victim were manipulated. Respondents' demographics (age, gender, education, and ethnicity) were collected. RESULTS: Logistic regression analyses revealed that children of the victim were least likely to be seen as committing abuse in both vignettes. In Vignette 1, there was an interaction of gender of respondent and the amount of money taken. In Vignette 2, non-Whites were less likely to perceive the signing over of the house as financial abuse. Respondents endorsed the concept of a special court with expertize in elder abuse as a way to increase the likelihood that they would report. CONCLUSIONS: Even though most financial abuse is perpetrated by family members, older adults are less likely to perceive a financial situation as abuse when it involves a child of the victim, thus making reporting and prevention less likely. The support for a specialty Elder Abuse Court (EAC) suggests that some reluctance to report is based on misgivings about punishing the perpetrator.

The effectiveness of a comprehensive mind body weight loss intervention for overweight and obese adults: a pilot study.

OBJECTIVES: This pilot study evaluated the effectiveness of a comprehensive mind body intervention for weight loss in overweight and obesity and the maintenance of weight loss at 6-month follow-up. DESIGN: Thirty-one overweight and obese employees (Body Mass Index (BMI) 28.6-47.9 kg/m²) from a large corporation participated in a 20-week comprehensive mind body intervention targeting weight loss. MAIN OUTCOME MEASURES: Weight, BMI, waist and hip circumference, rate pressure product (RPP), blood pressure, fasting blood glucose, cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and psychological variables were collected at baseline, post-intervention, and 6-month follow-up. RESULTS: Using linear mixed model analyses, the intervention resulted in significant mean weight loss (-4.3 kg, 95% CI -5.8 to -2.8), decreases in BMI (-1.51, 95% CI -2.1 to -1.0), hip circumference measurement (-4.3 cm, 95% CI -6.9 to -1.5), and triglyceride levels (95% CI -33.1 to -4.8). In 6-month follow-up after intervention, statistically significant improvements in weight, BMI and waist measurement were sustained. Participants also showed positive changes in self-reported psychological indices: food-related disinhibition, and hunger both decreased significantly (p<0.01); general self-efficacy increased (p<0.05); positive affect increased (p<0.001); physical function and self-esteem increased (p<0.01); and measures of health-promoting behaviors on 4 subscales (health responsibility, physical activity, nutrition, and stress management) also showed statistically significant improvements (p<0.001) at post-intervention and 6-month follow-up. CONCLUSIONS: This comprehensive mind body intervention showed modest effects on physical, laboratory, and psychological outcomes, both immediately following treatment and at 6-month follow-up, in overweight and obese individuals.

A relaxation response training for women undergoing breast biopsy: exploring integrated care.

BACKGROUND: Recent changes in clinical guideline recommendations for age of breast cancer screening initiation highlighted the potential psychological ramifications associated with screening. This study examined the feasibility, acceptability, and preliminary efficacy of a brief Relaxation Response training (RRT) to decrease distress among women undergoing breast biopsy. METHODS: Women scheduled for percutaneous core-needle biopsy were recruited into a single-arm RRT trial, including 3 individual sessions. Psychosocial assessments were completed pre- and postintervention. RESULTS: Forty women were enrolled between 6/1/10 and 8/31/11. Among enrollees, 75% completed all 3 RRT sessions, and 75% completed the post-assessment. Participants showed significant reductions in acute distress following each RRT session. Qualitative feedback indicated a positive impact of RRT on clinic care experiences. CONCLUSIONS: RRT is a portable intervention that was feasible to implement, acceptable to patients and associated with significant decreases in acute emotional distress during the period of diagnostic uncertainty related to percutaneous breast biopsy.

Test-retest reliability of memory task functional magnetic resonance imaging in Alzheimer disease clinical trials.

OBJECTIVE: To examine the feasibility and test-retest reliability of encoding-task functional magnetic resonance imaging (fMRI) in mild Alzheimer disease (AD). DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Memory clinical trials unit. PARTICIPANTS: We studied 12 patients with mild AD (mean [SEM] Mini-Mental State Examination score, 24.0 [0.7]; mean Clinical Dementia Rating score, 1.0) who had been taking donepezil hydrochloride for more than 6 months from the placebo arm of a larger 24-week study (n = 24, 4 scans on weeks 0, 6, 12, and 24, respectively). INTERVENTIONS: Placebo and 3 face-name, paired-associate encoding, block-design blood oxygenation level-dependent fMRI scans in 12 weeks. MAIN OUTCOME MEASURES: We performed whole-brain t maps (P < .001, 5 contiguous voxels) and hippocampal regions-of-interest analyses of extent (percentage of active voxels) and magnitude (percentage of signal change) for novel-greater-than-repeated face-name contrasts. We also calculated intraclass correlation coefficients and power estimates for hippocampal regions of interest. RESULTS: Task tolerability and data yield were high (95 of 96 scans yielded favorable-quality data). Whole-brain maps were stable. Right and left hippocampal regions-of-interest intraclass correlation coefficients were 0.59 to 0.87 and 0.67 to 0.74, respectively. To detect 25.0% to 50.0% changes in week-0 to week-12 hippocampal activity using left-right extent or right magnitude with 80.0% power (2-sided α = .05) requires 14 to 51 patients. Using left magnitude requires 125 patients because of relatively small signal to variance ratios. CONCLUSIONS: Encoding-task fMRI was successfully implemented in a single-site, 24-week, AD randomized controlled trial. Week 0 to 12 whole-brain t maps were stable, and test-retest reliability of hippocampal fMRI measures ranged from moderate to substantial. Right hippocampal magnitude may be the most promising of these candidate measures in a leveraged context. These initial estimates of test-retest reliability and power justify evaluation of encoding-task fMRI as a potential biomarker for signal of effect in exploratory and proof-of-concept trials in mild AD. Validation of these results with larger sample sizes and assessment in multisite studies is warranted.