Release on 2017-09-19 | by Pat Croskerry,Karen Cosby,Mark L. Graber,Hardeep Singh
Interpreting the Shadows
Author: Pat Croskerry,Karen Cosby,Mark L. Graber,Hardeep Singh
Pubpsher: CRC Press
Category: Technology & Engineering
Despite diagnosis being the key feature of a physician's clinical performance, this is the first book that deals specifically with the topic. In recent years, however, considerable interest has been shown in this area and significant developments have occurred in two main areas: a) an awareness and increasing understanding of the critical role of clinical decision making in the process of diagnosis, and of the multiple factors that impact it, and b) a similar appreciation of the role of the healthcare system in supporting clinicians in their efforts to make accurate diagnoses. Although medicine has seen major gains in knowledge and technology over the last few decades, there is a consensus that the diagnostic failure rate remains in the order of 10-15%. This book provides an overview of the major issues in this area, in particular focusing on where the diagnostic process fails, and where improvements might be made.
Behind heart disease and cancer, medical error is now listed as one of the leading causes of death. Of the many medical errors that may lead to injury and death, diagnostic failure is regarded as the most significant. Generally, the majority of diagnostic failures are attributed to the clinicians directly involved with the patient, and to a lesser extent, the system in which they work. In turn, the majority of errors made by clinicians are due to decision making failures manifested by various departures from rationality. Of all the medical environments in which patients are seen and diagnosed, the emergency department is the most challenging. It has been described as a "wicked" environment where illness and disease may range from minor ailments and complaints to severe, life-threatening disorders. The Cognitive Autopsy is a novel strategy towards understanding medical error and diagnostic failure in 42 clinical cases with which the author was directly involved or became aware of at the time. Essentially, it describes a cognitive approach towards root cause analysis of medical adverse events or near misses. Whereas root cause analysis typically focuses on the observable and measurable aspects of adverse events, the cognitive autopsy attempts to identify covert cognitive processes that may have contributed to outcomes. In this clinical setting, no cognitive process is directly observable but must be inferred from the behavior of the individual clinician. The book illustrates unequivocally that chief among these cognitive processes are cognitive biases and other flaws in decision making, rather than knowledge deficits.
Accurate diagnosis is the foundation of medical practice, but at the start of the diagnostic process, uncertainty is inevitable. The clinician's skills and cognitive attributes determine the quality of the initial differential diagnosis and thus the crucial first phases of investigation and treatment; mistakes are often self-propagating. Diagnostic error is a major cause of avoidable morbidity and mortality, and is the commonest reason for successful litigation. Risk and Reasoning in Clinical Diagnosis is an accessible and readable look at the diagnostic process. Dr. Cym Ryle presents the insights and concepts developed in cognitive psychology which have led to the consensus that in all domains human reasoning is primarily driven by unconscious, intuitive mechanisms; the contribution of structured, analytical thinking is variable and inconsistent. He notes that the risk of error is inseparable from these mechanisms. Dr. Ryle then develops a description of the diagnostic process which encompasses its form, strengths and fallibility, and illustrates this description with examples from his work as a general practitioner. He argues that improving diagnostic accuracy should be a priority, and that there is sufficient evidence to guide changes in medical training, in clinical practice, and in the culture and organisation of our institutions. He identifies specific, practical steps that can be taken by individual clinicians and by clinical teams, suggests priorities for action in our institutions, and considers the obstacles to progress.
Release on 2010-09-15 | by J. Kevin Kealy,Hester McAllister,John P. Graham
Author: J. Kevin Kealy,Hester McAllister,John P. Graham
Pubpsher: Elsevier Health Sciences
Interpret diagnostic images accurately with Diagnostic Radiology and Ultrasonography of the Dog and Cat, 5th Edition. Written by veterinary experts J. Kevin Kealy, Hester McAllister, and John P. Graham, this concise guide covers the principles of diagnostic radiology and ultransonography and includes clear, complete instruction in image interpretation. It illustrates the normal anatomy of body systems, and then uses numbered points to describe radiologic signs of abnormalities. It also includes descriptions of the ultrasonographic appearance of many conditions in dogs and cats. Updated with the latest on digital imaging, CT, MR, and nuclear medicine, and showing how to avoid common errors in interpretation, this book is exactly what you need to refine your diagnostic and treatment planning skills! Hundreds of detailed radiographs and ultrasonograms clearly illustrate principles, aid comprehension, and help you accurately interpret your own films. The normal anatomy and appearance for each body system is included so you can identify deviations from normal, such as traumatic and pathologic changes. Coverage of the most common disorders associated with each body system help you interpret common and uncommon problems. Coverage of radiographic principles and procedures includes density, contrast, detail, and technique, so you can produce the high-quality films necessary for accurate diagnosis. Clinical signs help you arrive at a clinical diagnosis. An emphasis on developing a standardized approach to viewing radiographs and ultrasonograms ensures that you do not overlook elements of the image that may affect proper diagnosis. Complete coverage of diagnostic imaging of small animals includes all modalities and echocardiography, all in a comprehensive, single-source reference. Discussions of ultrasound-guided biopsy technique help you perform one of the most useful, minimally invasive diagnostic procedures. Single chapters cover all aspects of specific body compartments and systems for a logical organization and easy cross-referencing. Coverage of different imaging modalities for individual diseases/disorders is closely integrated in the text and allows easier comprehension. A consistent style, terminology, and content results from the fact that all chapters are written by the same authors.
Diagnostic Imaging for the Emergency Physician, written and edited by a practicing emergency physician for emergency physicians, takes a step-by-step approach to the selection and interpretation of commonly ordered diagnostic imaging tests. Dr. Joshua Broder presents validated clinical decision rules, describes time-efficient approaches for the emergency physician to identify critical radiographic findings that impact clinical management and discusses hot topics such as radiation risks, oral and IV contrast in abdominal CT, MRI versus CT for occult hip injury, and more. Diagnostic Imaging for the Emergency Physician has been awarded a 2011 PROSE Award for Excellence for the best new publication in Clinical Medicine. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Choose the best test for each indication through clear explanations of the "how" and "why" behind emergency imaging. Interpret head, spine, chest, and abdominal CT images using a detailed and efficient approach to time-sensitive emergency findings. Stay on top of current developments in the field, including evidence-based analysis of tough controversies - such as indications for oral and IV contrast in abdominal CT and MRI versus CT for occult hip injury; high-risk pathology that can be missed by routine diagnostic imaging - including subarachnoid hemorrhage, bowel injury, mesenteric ischemia, and scaphoid fractures; radiation risks of diagnostic imaging - with practical summaries balancing the need for emergency diagnosis against long-terms risks; and more. Optimize diagnosis through evidence-based guidelines that assist you in discussions with radiologists, coverage of the limits of "negative" or "normal" imaging studies for safe discharge, indications for contrast, and validated clinical decision rules that allow reduced use of diagnostic imaging. Clearly recognize findings and anatomy on radiographs for all major diagnostic modalities used in emergency medicine from more than 1000 images. Find information quickly and easily with streamlined content specific to emergency medicine written and edited by an emergency physician and organized by body system.
Release on 2012-12-06 | by A. R. Chrispin,I. Gordon,C. Hall,C. Metreweli
Author: A. R. Chrispin,I. Gordon,C. Hall,C. Metreweli
Pubpsher: Springer Science & Business Media
All unsuccessful revolutions are the same, but each successful one is different in its own distinctive way. The reason why revolutions occur is that new forces attain increasing significance and classic institutions are incapable of accomodating these forces. Such has been the pattern of events in the English, American and French revolutions. These successful revolutions produced a new dynamic and new perspectives. One English revolutionary put this succinctly: "Let us be doing, but let us be united in doing". This book sets out what is a revolution in. the perspectives of diagnostic imaging of the kidney and urinary tract. Forces which have brought about this revolution are the advent of reliable techniques in radioisotope studies, ultrasonics and computerized tomographic (CT) scanning. This last modality carries with it specific problems for routine paediatric work and its role in the study of kidney and urinary tract problems is discrete and circumscribed. However, in conjunction with classic radiology, each of these techniques yields information of a different type and so a synthesis of data accrues.
Principles of X-Ray Diagnosis of the Skull, Second Edition focuses on the process of examining skull radiographs. This book discusses the traditional method of neuroradiology that describes in turn the vault, the sella, and the base, followed by any intracranial calcification that may be present. The radiology of ears, nose, throat and eyes that have much more common ground with neuroradiology are also considered. The radiology of the ear is found in the chapters devoted to the skull base, but the nose, nasopharynx, sinuses, and orbits are treated in a different chapter. The mandible and teeth have little connection with neuroradiology and are not covered. This publication is intended for students of radiology, before and after their diploma examination, and for clinicians to whom the head is of special concern.
Release on 2011-01-18 | by Emmanuel E. Coche,Benoit Ghaye,Johan de Mey,Philippe Duyck
Author: Emmanuel E. Coche,Benoit Ghaye,Johan de Mey,Philippe Duyck
Pubpsher: Springer Science & Business Media
Standard radiography of the chest remains one of the most widely used imaging modalities but it can be difficult to interpret. The possibility of producing cross-sectional, reformatted 2D and 3D images with CT makes this technique an ideal tool for reinterpreting standard radiography of the chest. The aim of this book is to provide a comprehensive overview of chest radiography interpretation by means of a side-by-side comparison between chest radiographs and CT images. Introductory chapters address the indications for and difficulties of chest radiography as well as the technical and practical aspects of CT reconstruction and image comparison. Thereafter, the radiographic and CT presentations of both anatomical variants and a wide range of diseases and disorders are illustrated and discussed by renowned experts in thoracic imaging. The book is complemented by online extra material which provides many further educational examples.