scholarly journals Selection with Variation in Diagnostic Skill: Evidence from Radiologists

2019 ◽  
Author(s):  
David Chan ◽  
Matthew Gentzkow ◽  
Chuan Yu
Keyword(s):  
Diagnostic Skill

Can Surgical Registrars Accurately Identify the Urgent from the Non-Urgent Patient Presenting with Acute Abdominal Pain?

2019 ◽  
Vol 60 (1-2) ◽  
pp. 24-30 ◽  
Author(s):  
Kirsten J. de Burlet ◽  
Anna B.M. Lam ◽  
Simon J. Harper ◽  
Peter D. Larsen ◽  
Elizabeth R. Dennett
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Initial Assessment ◽  
Wide Range ◽  
Urgent Patient ◽  
Hospital Resources ◽  
A Prospective Study ◽  
Diagnostic Skill

Background: Acute abdominal pain is a common surgical presentation with a wide range of causes. Differentiating urgent patients from non-urgent patients is important to optimise patient outcomes and the use of hospital resources. The aim of this study was to determine how accurately urgent and non-urgent patients presenting with abdominal pain can be identified. Methods: A prospective study of consecutive patients admitted with abdominal pain was undertaken. Urgent patients were classified as requiring treatment (theatre, intensive care unit, endoscopy, or radiologic drainage) within 24 h. Differentiation between urgent and non-urgent was made on the basis of the initial assessment prior to the use of advanced imaging. Outcomes were compared to a final classification based on final diagnosis as adjudicated by an expert panel. Results: Of the 301 patients included, 93 (30.9%) were deemed urgent based on initial assessment, compared to 83 (27.6%) on final diagnosis. Overall sensitivity for recognising urgent patients was 74.7% and specificity 89.9%, and overall accuracy was higher for senior registrars compared to junior registrars (p = 0.015). Urgent patients more often looked unwell or had peritonism on examination (39.8 vs. 17.4% and 56.6 vs. 14.7%, respectively, p < 0.001 for both). Conclusions: Registrars can accurately differentiate urgent from non-urgent patients with acute abdominal pain in the majority of cases. Accuracy was higher amongst senior registrars. The “end-of-the-bed-o-gram” and clinical examination are the most important features used for making this differentiation. This demonstrates that there is no substitute for exposure to acute presentations to improve a trainee’s diagnostic skill.

scholarly journals Heel Pain in the Athlete

2009 ◽  
Vol 1 (5) ◽  
pp. 427-434 ◽  
Author(s):  
Kenneth John Hunt ◽  
Robert B. Anderson
Keyword(s):  
English Literature ◽  
Nonoperative Treatment ◽  
Heel Pain ◽  
Imaging Evaluation ◽  
Surgical Interventions ◽  
Treatment Techniques ◽  
Common Causes ◽  
Pathologic Findings ◽  
Diagnostic Skill ◽  
Painful Heel

Context: Heel pain, a relatively common problem in the athlete, can present a diagnostic and therapeutic dilemma. The purpose of this article is to review treatment techniques for common causes of heel pain in the athlete. Evidence Acquisition: Articles in the English literature through August 2008 were selected and reviewed in the context of the management of heel pain in the athlete. Clinical and surgical photographs are presented as an illustration of preferred techniques and pertinent pathologic findings. Results: Although nonoperative treatment remains the mainstay for most painful heel pathologies, a number of surgical interventions have shown encouraging results in carefully selected patients. Conclusions: The management of heel pain in the athlete requires diagnostic skill, appropriate imaging evaluation, and a careful, initially conservative approach to treatment. Surgical treatment can be successful in carefully selected patients.

scholarly journals Effect of processing strategy on diagnostic skill in dermatology

1994 ◽  
Vol 69 (10) ◽  
pp. S34-6 ◽  
Author(s):  
G Regehr ◽  
J Cline ◽  
G R Norman ◽  
L Brooks
Keyword(s):  
Processing Strategy ◽  
Diagnostic Skill

THE PEDIATRICIAN AND THE INDIVIDUAL DELINQUENT

PEDIATRICS ◽  
1960 ◽  
Vol 26 (1) ◽  
pp. 126-131
Author(s):  
Julius B. Richmond
Keyword(s):  
Juvenile Delinquency ◽  
Left Behind ◽  
Child Guidance ◽  
First Child ◽  
Current Concern ◽  
Per Se ◽  
The Individual ◽  
Single Formula ◽  
Diagnostic Skill

The Current Concern over juvenile delinquency has brought this problem more forcefully to the attention of physicians. It becomes important, therefore, in a period when people are charging off in all directions in search of a panacea for the prevention of juvenile delinquency, for us to remain aware of the fact that juvenile delinquency is a symptom and not a diagnosis. Just as headache and abdominal pain are symptoms which challenge the diagnostic skill of the physician, so juvenile delinquency is a symptom which is similarly challenging. The symptom per se never tells us the cause; the cause becomes a matter for further investigation. Those who seek a single formula for the prevention of all delinquency are destined to experience nothing but frustration. We should recall that some very good minds have struggled with this problem over many years. In this field, as in all others, those who are ignorant of history are destined to repeat it. A brief historical note is in order to indicate that the role of physicians in programs concerned with the prevention and treatment of the delinquent is not a new one. A Chicago physician, Dr. William Healy, in 1909 organized the first child guidance clinic in the world in an effort to deal with children brought to the attention of the court because of their antisocial behavior. The establishment of this clinic under medical auspices served as a stimulus for the development of child psychiatry as a discipline. Dr. Healy left behind him in Chicago the Institute for Juvenile Research which has carried on work in the field of delinquency for 50 years; he then went on to found the Judge Baker Clinic in Boston.

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