scholarly journals Interpretation of Thoracic Radiography Shows Large Discrepancies Depending on the Qualification of the Physician—Quantitative Evaluation of Interobserver Agreement in a Representative Emergency Department Scenario

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1868
Author(s):  
Jan Rudolph ◽  
Nicola Fink ◽  
Julien Dinkel ◽  
Vanessa Koliogiannis ◽  
Vincent Schwarze ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pleural Effusion ◽  
Interrater Reliability ◽  
Interobserver Agreement ◽  
Medical Training ◽  
Pulmonary Nodules ◽  
Long Time ◽  
Radiology Residents ◽  
The Right ◽  
Posterior Anterior

(1) Background: Chest radiography (CXR) is still a key diagnostic component in the emergency department (ED). Correct interpretation is essential since some pathologies require urgent treatment. This study quantifies potential discrepancies in CXR analysis between radiologists and non-radiology physicians in training with ED experience. (2) Methods: Nine differently qualified physicians (three board-certified radiologists [BCR], three radiology residents [RR], and three non-radiology residents involved in ED [NRR]) evaluated a series of 563 posterior-anterior CXR images by quantifying suspicion for four relevant pathologies: pleural effusion, pneumothorax, pneumonia, and pulmonary nodules. Reading results were noted separately for each hemithorax on a Likert scale (0–4; 0: no suspicion of pathology, 4: safe existence of pathology) adding up to a total of 40,536 reported pathology suspicions. Interrater reliability/correlation and Kruskal–Wallis tests were performed for statistical analysis. (3) Results: While interrater reliability was good among radiologists, major discrepancies between radiologists’ and non-radiologists’ reading results could be observed in all pathologies. Highest overall interrater agreement was found for pneumothorax detection and lowest agreement in raising suspicion for malignancy suspicious nodules. Pleural effusion and pneumonia were often suspected with indifferent choices (1–3). In terms of pneumothorax detection, all readers mainly decided for a clear option (0 or 4). Interrater reliability was usually higher when evaluating the right hemithorax (all pathologies except pneumothorax). (4) Conclusions: Quantified CXR interrater reliability analysis displays a general uncertainty and strongly depends on medical training. NRR can benefit from radiology reporting in terms of time efficiency and diagnostic accuracy. CXR evaluation of long-time trained ED specialists has not been tested.

scholarly journals Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

2021 ◽  
Vol 14 (7) ◽  
pp. e243760
Author(s):  
Mohsin F Butt ◽  
Maggie Symonds ◽  
Ruhaid Khurram
Keyword(s):  
Emergency Department ◽  
Mycobacterium Tuberculosis ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Left Lung ◽  
Pleural Effusions ◽  
Mediastinal Shift ◽  
History Of ◽  
The Right

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

scholarly journals RECURRENT EMERGENCY DEPARTMENT PRESENTATION - A CASE OF HEPATIC HYDROTHORAX

2020 ◽  
pp. 1-1
Author(s):  
Mohammad Ismail Nizami ◽  
Vishwa Reddy Gankidi
Keyword(s):  
Emergency Department ◽  
Pleural Effusion ◽  
Extracellular Fluid ◽  
Emergency Department Presentation ◽  
Hepatic Hydrothorax ◽  
Advanced Liver Disease ◽  
Massive Pleural Effusion ◽  
Abnormal Accumulation ◽  
Cirrhosis Of Liver ◽  
The Right

Introduction : In patients with advanced liver disease, dysregulation of extracellular fluid volume results in abnormal accumulation of fluid such as ascites, pleural effusion and edema .Hepatic hydrothorax occurs with accumulation of fluid (≥500ml) in patients with cirrhosis of liver in the absence of cardiopulmonary disease.The effusion which is transudate most commonly occurs in the right hemithorax .Treatment includes pharmacological–diuretics administration ,therapeutic thoracocentesis, operative interventions like TIPSS would be required in relapsed and refractory cases . We present a rare case of a male patient ,who presented to emergency with progressively worsening dyspnoea, having massive pleural effusion ,was later diagnosed to have hepatic hydrothorax with cirrhosis of liver with portal hypertension , was stabilized and treated in the emergency department .

Rancang Bangun Sistem Penerimaan Dan Mutasi Barang Pada PDAM Tirta Kerta Raharja

Sensi Journal ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. 236-246
Author(s):  
Ilamsyah Ilamsyah ◽  
Yulianto Yulianto ◽  
Tri Vita Febriani
Keyword(s):  
System Analysis ◽  
Object Oriented ◽  
Analysis Method ◽  
Web Based ◽  
Visual Modeling ◽  
Long Time ◽  
The Right ◽  
And Control ◽  
Web Based System ◽  
The Web

The right and appropriate system of receiving and transferring goods is needed by the company. In the process of receiving and transferring goods from the central warehouse to the branch warehouse at PDAM Tirta Kerta Raharja, Tangerang Regency, which is currently done manually is still ineffective and inaccurate because the Head of Subdivision uses receipt documents, namely PPBP and mutation of goods, namely MPPW in the form of paper as a submission media. The Head of Subdivision enters the data of receipt and mutation of goods manually and requires a relatively long time because at the time of demand for the transfer of goods the Head of Subdivision must check the inventory of goods in the central warehouse first. Therefore, it is necessary to hold a design of information systems for the receipt and transfer of goods from the central warehouse to a web-based branch warehouse that is already database so that it is more effective, efficient and accurate. With the web-based system of receiving and transferring goods that are already datatabed, it can facilitate the Head of Subdivision in inputing data on the receipt and transfer of goods and control of stock inventory so that the Sub Head of Subdivision can do it periodically to make it more effective, efficient and accurate. The method of data collection is done by observing, interviewing and studying literature from various previous studies, while the system analysis method uses the Waterfall method which aims to solve a problem and uses design methods with visual modeling that is object oriented with UML while programming using PHP and MySQL as a database.

scholarly journals Reported and unreported potentially important incidental findings in urgent nonenhanced abdominal CT for renal colic

2021 ◽  
Author(s):  
Elena Belloni ◽  
Stefania Tentoni ◽  
Ilaria Fiorina ◽  
Chandra Bortolotto ◽  
Olivia Bottinelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Status ◽  
Pleural Effusion ◽  
Incidental Findings ◽  
Renal Colic ◽  
Legal Issues ◽  
Abdominal Ct ◽  
Significant Difference ◽  
Original Report ◽  
The Difference

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

scholarly journals Variations in regulations to control standards for training and licensing of physicians: a multi-country comparison

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wafa Aftab ◽  
Mishal Khan ◽  
Sonia Rego ◽  
Nishant Chavan ◽  
Afifah Rahman-Shepherd ◽  
...  
Keyword(s):  
Medical Education ◽  
Health Systems ◽  
Clinical Training ◽  
Medical Training ◽  
Grey Literature ◽  
Analytical Framework ◽  
Online News ◽  
Country Comparison ◽  
Education Delivery ◽  
The Right

Abstract Background To strengthen health systems, the shortage of physicians globally needs to be addressed. However, efforts to increase the numbers of physicians must be balanced with controls on medical education imparted and the professionalism of doctors licensed to practise medicine. Methods We conducted a multi-country comparison of mandatory regulations and voluntary guidelines to control standards for medical education, clinical training, licensing and re-licensing of doctors. We purposively selected seven case-study countries with differing health systems and income levels: Canada, China, India, Iran, Pakistan, UK and USA. Using an analytical framework to assess regulations at four sequential stages of the medical education to relicensing pathway, we extracted information from: systematically collected scientific and grey literature and online news articles, websites of regulatory bodies in study countries, and standardised input from researchers and medical professionals familiar with rules in the study countries. Results The strictest controls we identified to reduce variations in medical training, licensing and re-licensing of doctors between different medical colleges, and across different regions within a country, include: medical education delivery restricted to public sector institutions; uniform, national examinations for medical college admission and licensing; and standardised national requirements for relicensing linked to demonstration of competence. However, countries analysed used different combinations of controls, balancing the strictness of controls across the four stages. Conclusions While there is no gold standard model for medical education and practise regulation, examining the combinations of controls used in different countries enables identification of innovations and regulatory approaches to address specific contextual challenges, such as decentralisation of regulations to sub-national bodies or privatisation of medical education. Looking at the full continuum from medical education to licensing is valuable to understand how countries balance the strictness of controls at different stages. Further research is needed to understand how regulating authorities, policy-makers and medical associations can find the right balance of standardisation and context-based flexibility to produce well-rounded physicians.

scholarly journals P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Natalia Cernovschi - Feasey ◽  
Julekha Wajed
Keyword(s):  
Pleural Effusion ◽  
Soft Tissue ◽  
Middle Finger ◽  
Joint Involvement ◽  
Long Bones ◽  
History Of ◽  
Systemic Symptoms ◽  
The Right ◽  
Hands And Feet ◽  
Radiographic Changes

Abstract Background/Aims  Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods  A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results  Blood tests showed elevated c-reactive protein 55 (normal &lt;4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion  Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure  N. Cernovschi - Feasey: None. J. Wajed: None.

A rare encounter of obstructed direct inguinal hernia

2019 ◽  
Vol 22 (2) ◽  
pp. 41-43
Author(s):  
Amit Kumar Singh ◽  
Nripesh Rajbhandari ◽  
Balaram Malla ◽  
Gakul Bhatta
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Intestinal Obstruction ◽  
Intestinal Resection ◽  
Posterior Wall ◽  
Acute Intestinal Obstruction ◽  
University Hospital ◽  
Direct Inguinal Hernia ◽  
Direct Hernia ◽  
The Right

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids. The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall. Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA

2014 ◽  
Vol 38 (4) ◽  
pp. 445-447 ◽  
Author(s):  
Bruno Hochhegger ◽  
Giordano R.T. Alves ◽  
Marcus Chaves ◽  
Ana Luiza Moreira ◽  
Renato Kist ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Emergency Physicians ◽  
Radiology Residents

scholarly journals An Unusual Cause of Pulmonary Nodules in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Ryan Yu ◽  
Melanie Ferri
Keyword(s):  
Emergency Department ◽  
Smooth Muscle ◽  
Clinical Presentation ◽  
Pulmonary Nodules ◽  
Pleuritic Chest Pain ◽  
Benign Metastasizing Leiomyoma ◽  
Spindle Cells ◽  
Smooth Muscle Tumors ◽  
Metastasizing Leiomyoma ◽  
Tomography Scan

We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

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