University of Illinois at Chicago

About: University of Illinois at Chicago is a education organization based out in Chicago, Illinois, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 57071 authors who have published 110536 publications receiving 4264936 citations.

Diagnostic error in medicine: analysis of 583 physician-reported errors.

Abstract: Background Missed or delayed diagnoses are a common but understudied area in patient safety research. To better understand the types, causes, and prevention of such errors, we surveyed clinicians to solicit perceived cases of missed and delayed diagnoses. Methods A 6-item written survey was administered at 20 grand rounds presentations across the United States and by mail at 2 collaborating institutions. Respondents were asked to report 3 cases of diagnostic errors and to describe their perceived causes, seriousness, and frequency. Results A total of 669 cases were reported by 310 clinicians from 22 institutions. After cases without diagnostic errors or lacking sufficient details were excluded, 583 remained. Of these, 162 errors (28%) were rated as major, 241 (41%) as moderate, and 180 (31%) as minor or insignificant. The most common missed or delayed diagnoses were pulmonary embolism (26 cases [4.5% of total]), drug reactions or overdose (26 cases [4.5%]), lung cancer (23 cases [3.9%]), colorectal cancer (19 cases [3.3%]), acute coronary syndrome (18 cases [3.1%]), breast cancer (18 cases [3.1%]), and stroke (15 cases [2.6%]). Errors occurred most frequently in the testing phase (failure to order, report, and follow-up laboratory results) (44%), followed by clinician assessment errors (failure to consider and overweighing competing diagnosis) (32%), history taking (10%), physical examination (10%), and referral or consultation errors and delays (3%). Conclusions Physicians readily recalled multiple cases of diagnostic errors and were willing to share their experiences. Using a new taxonomy tool and aggregating cases by diagnosis and error type revealed patterns of diagnostic failures that suggested areas for improvement. Systematic solicitation and analysis of such errors can identify potential preventive strategies.

The Stampede Toward Hofstede's Framework: Avoiding the Sample Design Pit in Cross-Cultural Research

Abstract: We propose a method to design better multi-country samples for international business studies using Hofstede's framework and aimed at determining the effects of national culture on various business phenomena We describe typical research scenarios, then develop sets of algorithms that calculate indexes reflecting the power of different samples for hypotheses testing The indexes were computed from Hofstede's data, then rank ordered The top multi-country samples are presented in tables for selection when designing studies

Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis

Abstract: BackgroundThe comparative effectiveness of performing instrumented (rigid pedicle screws affixed to titanium alloy rods) lumbar spinal fusion in addition to decompressive laminectomy in patients with symptomatic lumbar grade I degenerative spondylolisthesis with spinal stenosis is unknown. MethodsIn this randomized, controlled trial, we assigned patients, 50 to 80 years of age, who had stable degenerative spondylolisthesis (degree of spondylolisthesis, 3 to 14 mm) and symptomatic lumbar spinal stenosis to undergo either decompressive laminectomy alone (decompression-alone group) or laminectomy with posterolateral instrumented fusion (fusion group). The primary outcome measure was the change in the physical-component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; range, 0 to 100, with higher scores indicating better quality of life) 2 years after surgery. The secondary outcome measure was the score on the Oswestry Disability Index (range, 0 to 100, with higher scores i...

Anatomy of an avulsion

Abstract: The Cumberland Marshes in east-central Saskatchewan, Canada, occupy over 5000 km2 and contain a variety of active and abandoned fluvial features, including straight to sinuous isolated channels, anastomosed channel systems, levees, and crevasse splays in addition to marshes, lakes and bogs In 1873, an avulsion of the Saskatchewan River diverted most of its flow into a portion of the Cumberland Marshes (locally termed the breakout area), and altered the alluvial terrain as the invaded wetlands adjusted to the influx of sediment and water These adjustments continue today, and so far over 500 km2 of wetlands have been affected by the avulsion Avulsion-controlled modification of the wetlands involves the initiation and evolution of crevasse splays and splay complexes Three intergradational forms are recognized, each associated with characteristic sand-body geometries Stage I splays are small, lobate in plan, crossed by unstable distributary channels, and form wedge-shaped sheets which depositionally overlie fine-grained, organic-rich wetland sediments Stage II splays and splay complexes evolve both spatially and temporally from Stage I splays They are larger, contain dense networks of anastomosed channels, and form disconnected tabular sand bodies or continuous sand sheets, some of which incise underlying wetland sediments Stage III splays develop from either Stage I or II splays and contain few but stable anastomosed channels that deposit isolated stringer sands encased in fine-grained floodplain sediments Although sand bodies deposited by splays comprise important components of the evolving floodplain, various fine-grained facies occurring in levees, shallow lakes, abandoned splay channels, and interchannel floodplains dominate the avulsion deposits The post-1873 record of deposition and terrain modification in the breakout area suggests four stages of floodplain evolution following avulsion In the initial avulsion stage, new channels and splay complexes increase in numbers rapidly as diverted discharge of water and sediment overwhelm the adjacent floodbasin The anastomosed stage is characterized by an approximate balance between rates of new channel and splay development, and abandonment of old ones This stage continues for as long as new floodplain areas are invaded The rate of new splay development eventually decreases as accessible floodplain becomes aggraded, forcing a higher rate of channel abandonment and concentration of remaining flow into fewer but larger channels (reversion stage) The result of reversion is eventual return to a single channel stage, completing the avulsive sequence and initiating a new alluvial ridge For the Saskatchewan River, this final-stage single channel will likely produce a meander belt which occupies only a portion of the more extensive avulsion belt which preceded it

In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis.

Abstract: Vancomycin resistance exhibited by Enterococcus faecalis isolates V583, V586, and V587 is described The vancomycin MICs ranged from 32 to 64 micrograms/ml Although resistant to vancomycin, the isolates were susceptible to teicoplanin (MIC, less than or equal to 05 micrograms/ml) Such a glycopeptide susceptibility profile has not been previously described for E faecalis Time kill studies showed that vancomycin resistance adversely affected the synergistic activity that vancomycin and aminoglycoside combinations usually demonstrate against enterococci However, the ability to detect vancomycin resistance varied with the susceptibility testing method used Whereas broth microdilution, broth macrodilution, and agar dilution methods detected resistance, disk-agar diffusion and the AutoMicrobic system Gram-Positive GPS-A susceptibility card (Vitek Systems Inc, Hazelwood, Mo) did not To detect vancomycin resistance reliably and establish the incidence of such E faecalis isolates, adjustments in some susceptibility testing methods may be necessary