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  1. Article ; Online: Stigmatizing Language, Patient Demographics, and Errors in the Diagnostic Process.

    Brooks, Katherine C / Raffel, Katie E / Chia, David / Karwa, Abhishek / Hubbard, Colin C / Auerbach, Andrew D / Ranji, Sumant R

    JAMA internal medicine

    2024  

    Language English
    Publishing date 2024-04-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2024.0705
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Trainees' knowledge and application of guideline recommendations for colorectal cancer screening and surveillance.

    Patell, Rushad / Karwa, Abhishek / Lopez, Rocio / Burke, Carol A

    Cancer treatment and research communications

    2019  Volume 21, Page(s) 100153

    Abstract: Background: Data shows that practicing physicians don't recommend colorectal (CRC) screening and surveillance as suggested by guidelines. We assessed knowledge of CRC guidelines in medical trainees.: Methods: A survey assessing confidence and ... ...

    Abstract Background: Data shows that practicing physicians don't recommend colorectal (CRC) screening and surveillance as suggested by guidelines. We assessed knowledge of CRC guidelines in medical trainees.
    Methods: A survey assessing confidence and knowledge of published CRC guidelines was emailed to program directors (PDs) of Accreditation Council of Graduate Medical Education approved training programs in the United States. PDs were requested to forward it to trainees. We analyzed trainees' knowledge by answers to clinical vignettes and identification of factors required by guidelines for screening and post polypectomy colonoscopy interval. We compared confidence and knowledge by specialty.
    Results: 586 trainees in internal medicine (159), family medicine and primary care (147), gastroenterology (114), general surgery (51), ob/gyn (78), urology (13), and colorectal surgery (13) responded. 97% reported following guidelines. 68% and 50% stated confidence recalling screening and surveillance guidelines, respectively. 16% and 8% correctly identified all factors and answered corresponding vignettes for screening and surveillance, respectively. Overall accuracy of screening ranged between 11-23% and was not different between specialties (p = 0.11) while significant differences were noted between specialties in surveillance knowledge (0-39%, p < 0.001).
    Conclusions: United States trainees' CRC screening and surveillance knowledge is poor. Measures are needed to enhance knowledge of CRC guidelines.
    MeSH term(s) Clinical Competence ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer ; Education, Medical, Graduate ; Female ; Humans ; Male ; Mass Screening ; Practice Guidelines as Topic ; Training Support
    Language English
    Publishing date 2019-06-11
    Publishing country England
    Document type Journal Article
    ISSN 2468-2942
    ISSN (online) 2468-2942
    DOI 10.1016/j.ctarc.2019.100153
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  3. Article ; Online: Poor Knowledge of Colorectal Cancer Screening and Surveillance Guidelines in a National Cohort of Digestive Disease Specialists.

    Patell, Rushad / Karwa, Abhishek / Lopez, Rocio / Burke, Carol A

    Digestive diseases and sciences

    2018  Volume 64, Issue 2, Page(s) 391–400

    Abstract: Background: Colorectal cancer (CRC) screening is cost-effective and prevents death from CRC if used appropriately. Physicians do not recommend CRC screening according to guidelines. Physician-related factors associated with CRC screening knowledge are ... ...

    Abstract Background: Colorectal cancer (CRC) screening is cost-effective and prevents death from CRC if used appropriately. Physicians do not recommend CRC screening according to guidelines. Physician-related factors associated with CRC screening knowledge are unknown.
    Aims: We tested the accuracy of CRC screening knowledge in a nationwide cohort of practicing and trainee physicians and assessed respondent's interest in a mobile app to improve appropriate CRC screening use.
    Methods: An electronic survey was emailed to practicing gastroenterology professionals and medical and surgical trainees. We assessed accuracy of responses compared to CRC screening and surveillance guidelines. We assessed factors associated with higher accuracy of knowledge, frequency of workplace smartphone use, and interest in a smartphone app to aid CRC screening and surveillance recommendations.
    Results: In total, 1432 responses were received. Hundred percent accuracy was noted in 22% of respondents for screening and 37% for surveillance. Factors associated with higher accuracy of screening guidelines included more recent training completion; academic practice; performing 21-100 colonoscopies per month (vs. < 21 or > 100). Higher accuracy of surveillance guidelines was associated with more recent training completion; academic practice; being a third-year fellow. In total, 53% use smartphones at least "often" in patient care. In total, 87% would use a CRC screening and surveillance smartphone app.
    Conclusions: Accuracy in applying CRC screening guidelines by gastroenterologists is poor. Smartphone use for patient care is prevalent. Our data show a high interest in a CRC screening/surveillance mobile app. Mobile tools appear an opportunity for rapid access and an increased adherence to CRC screening guidelines.
    MeSH term(s) Aftercare ; Clinical Competence ; Cohort Studies ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer/standards ; Fellowships and Scholarships ; Female ; Gastroenterologists/standards ; Gastroenterology ; Humans ; Internship and Residency ; Logistic Models ; Male ; Mobile Applications ; Multivariate Analysis ; Physicians/standards ; Practice Guidelines as Topic ; Smartphone ; Surgeons/standards ; Surveys and Questionnaires
    Language English
    Publishing date 2018-10-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-018-5339-2
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    Ui V Zs.35: Show issues Location:
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  4. Article ; Online: Development of an Automated Algorithm to Generate Guideline-based Recommendations for Follow-up Colonoscopy.

    Karwa, Abhishek / Patell, Rushad / Parthasarathy, Gopanandan / Lopez, Rocio / McMichael, John / Burke, Carol A

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

    2019  Volume 18, Issue 9, Page(s) 2038–2045.e1

    Abstract: Background and aims: Physician adherence to published colonoscopy surveillance guidelines varies. We aimed to develop and validate an automated clinical decision support algorithm that can extract procedure and pathology data from the electronic medical ...

    Abstract Background and aims: Physician adherence to published colonoscopy surveillance guidelines varies. We aimed to develop and validate an automated clinical decision support algorithm that can extract procedure and pathology data from the electronic medical record (EMR) and generate surveillance intervals congruent with guidelines, which might increase physician adherence.
    Methods: We constructed a clinical decision support (CDS) algorithm based on guidelines from the United States Multi-Society Task Force on Colorectal Cancer. We used a randomly generated validation dataset of 300 outpatient colonoscopies performed at the Cleveland Clinic from 2012 through 2016 to evaluate the accuracy of extracting data from reports stored in the EMR using natural language processing (NLP). We compared colonoscopy follow-up recommendations from the CDS algorithm, endoscopists, and task force guidelines. Using a testing dataset of 2439 colonoscopies, we compared endoscopist recommendations with those of the algorithm.
    Results: Manual review of the validation dataset confirmed the NLP program accurately extracted procedure and pathology data for all cases. Recommendations made by endoscopists and the CDS algorithm were guideline-concordant in 62% and 99% of cases, respectively. Discrepant recommendations by endoscopists were earlier than recommended in 94% of the cases. In the testing dataset, 69% of endoscopist and NLP-CDS algorithm recommendations were concordant. Discrepant recommendations by endoscopists were earlier than guidelines in 91% of cases.
    Conclusions: We constructed and tested an automated CDS algorithm that can use NLP-extracted data from the EMR to generate follow-up colonoscopy surveillance recommendations based on published guidelines.
    MeSH term(s) Algorithms ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Electronic Health Records ; Follow-Up Studies ; Humans ; Natural Language Processing
    Language English
    Publishing date 2019-10-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2119789-1
    ISSN 1542-7714 ; 1542-3565
    ISSN (online) 1542-7714
    ISSN 1542-3565
    DOI 10.1016/j.cgh.2019.10.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5836: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  5. Article ; Online: Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19.

    Auerbach, Andrew D / Astik, Gopi J / O'Leary, Kevin J / Barish, Peter N / Kantor, Molly A / Raffel, Katie R / Ranji, Sumant R / Mueller, Stephanie K / Burney, Sharran N / Galinsky, Janice / Gershanik, Esteban F / Goyal, Abhishek / Chitneni, Pooja R / Rastegar, Sarah / Esmaili, Armond M / Fenton, Cynthia / Virapongse, Anunta / Ngov, Li-Kheng / Burden, Marisha /
    Keniston, Angela / Patel, Hemali / Gupta, Ashwin B / Rohde, Jeff / Marr, Ruby / Greysen, S Ryan / Fang, Michele / Shah, Pranav / Mao, Frances / Kaiksow, Farah / Sterken, David / Choi, Justin J / Contractor, Jigar / Karwa, Abhishek / Chia, David / Lee, Tiffany / Hubbard, Colin C / Maselli, Judith / Dalal, Anuj K / Schnipper, Jeffrey L

    Journal of general internal medicine

    2023  Volume 38, Issue 8, Page(s) 1902–1910

    Abstract: 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 ... ...

    Abstract 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.
    MeSH term(s) Adult ; Humans ; COVID-19/epidemiology ; Retrospective Studies ; Pandemics ; Prevalence ; Diagnostic Errors ; COVID-19 Testing
    Language English
    Publishing date 2023-03-23
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08176-6
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    Zs.A 2205: Show issues Location:
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  6. Article ; Online: Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy.

    Cremer, Paul C / Tariq, Muhammad U / Karwa, Abhishek / Alraies, M Chadi / Benatti, Rodolfo / Schuster, Andres / Agarwal, Shikhar / Flamm, Scott D / Kwon, Deborah H / Klein, Allan L

    Circulation. Cardiovascular imaging

    2015  Volume 8, Issue 5

    Abstract: Background: Delayed hyperenhancement (DHE) of the pericardium usually represents ongoing inflammation and may identify patients with constrictive pericarditis that will improve with anti-inflammatory therapy. However, a quantitative assessment of ... ...

    Abstract Background: Delayed hyperenhancement (DHE) of the pericardium usually represents ongoing inflammation and may identify patients with constrictive pericarditis that will improve with anti-inflammatory therapy. However, a quantitative assessment of pericardial DHE has not been performed, and the hierarchical relationship among clinical factors, inflammatory markers, and pericardial DHE is unknown.
    Methods and results: We identified 41 consecutive patients with constrictive pericarditis who had a cardiovascular magnetic resonance study with DHE prior to the initiation of anti-inflammatory medications. Pericardial inflammation was quantified on short-axis DHE sequences by contouring the pericardium, selecting normal septal myocardium as a reference region, and then quantifying the pericardial signal that was >6 SD above the reference. Our primary outcome was clinical improvement with anti-inflammatory therapy. The mean age of our patients was 58 years, most patients were male (83%) with New York Heart Association Class II or III (59%) heart failure, and the median follow-up was 1 year. Chest pain, lower New York Heart Association class, higher Westergren sedimentation rates, and increased pericardial DHE were all significantly associated with clinical improvement (P<0.01 for all). When quantitative pericardial DHE was added to a model that included age, chest pain, New York Heart Association class, and Westergren sedimentation rates, the global χ(2) improved significantly (P=0.04 for DHE), and the area under the receiver operating characteristic curve was 0.96.
    Conclusions: In patients with constrictive pericarditis treated with anti-inflammatory therapy, a quantitative assessment of pericardial DHE can provide incremental information to predict clinical improvement when added to clinical factors and Westergren sedimentation rates.
    MeSH term(s) Anti-Inflammatory Agents/therapeutic use ; Echocardiography ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Pericardiectomy ; Pericarditis, Constrictive/diagnosis ; Pericarditis, Constrictive/drug therapy ; Pericarditis, Constrictive/surgery ; Predictive Value of Tests ; Prognosis ; Sensitivity and Specificity ; Treatment Outcome
    Chemical Substances Anti-Inflammatory Agents
    Language English
    Publishing date 2015-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2435045-X
    ISSN 1942-0080 ; 1941-9651
    ISSN (online) 1942-0080
    ISSN 1941-9651
    DOI 10.1161/CIRCIMAGING.114.003125
    Database MEDical Literature Analysis and Retrieval System OnLINE

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