Reliability of the knee examination in osteoarthritis: effect of standardization.

Objective: To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization.

Methods: Forty-two physical signs and techniques were evaluated using a 6 x 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques.

Does full disclosure of medical errors affect malpractice liability? The jury is still out.

Background: Mandatory disclosure of medical errors has been advocated to improve patient safety. Many resist mandatory disclosure policies because of concerns about increasing malpractice exposure. It has been countered that malpractice liability actually decreases when there is full disclosure of medical errors.

Infliximab treatment of rheumatoid arthritis and Crohn's disease.

Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, and pharmacoeconomic impact of infliximab in the treatment of Crohn's disease (CD) and rheumatoid arthritis (RA).

Data Sources: MEDLINE and Pre-MEDLINE (1966-June 2002) and manufacturer prescribing literature were employed to find English-language articles on infliximab. Additional studies and abstracts were identified from the bibliographies of reviewed literature and conference proceedings.

Classifying laboratory incident reports to identify problems that jeopardize patient safety.

We developed a laboratory incident report classification system that can guide reduction of actual and potential adverse events. The system was applied retrospectively to 129 incident reports occurring during a 16-month period. Incidents were classified by type of adverse event (actual or potential), specific and potential patient impact, nature of laboratory involvement, testing phase, and preventability.

Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.

Background: Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates.

Methods: We identified trials that evaluated the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles.

Changes in rates of autopsy-detected diagnostic errors over time: a systematic review.

Context: Substantial discrepanies exist between clinical diagnoses and findings at autopsy. Autopsy may be used as a tool for quality management to analyze diagnostic discrepanies.

Objective: To determine the rate at which autopsies detect important, clinically missed diagnoses, and the extent to which this rate has changed over time.

Cardiovascular risk factor screening in systemic lupus erythematosus.

Objective: To evaluate the frequency of cardiovascular (CV) disease risk factor screening in systemic lupus erythematosus (SLE).

Methods: Medical records of patients from a lupus clinic and 5 private practices were assessed for CV disease risk factors, including hyperlipidemia, hypertension, diabetes mellitus, smoking, family history of CV disease, antiphospholipid antibodies, hyperhomocysteinemia, postmenopausal status, obesity, and nephrotic syndrome.

Results: A total of 183 records were included: 60 (33%) from the lupus clinic and 123 (67%) from private practices.

Does this patient have acute cholecystitis?

Context: Although few patients with acute abdominal pain will prove to have cholecystitis, ruling in or ruling out acute cholecystitis consumes substantial diagnostic resources.

Objective: To determine if aspects of the history and physical examination or basic laboratory testing clearly identify patients who require diagnostic imaging tests to rule in or rule out the diagnosis of acute cholecystitis.

Data Sources: Electronic search of the Science Citation Index, Cochrane Library, and English-language articles from January 1966 through November 2000 indexed in MEDLINE.

Understanding medical error and improving patient safety in the inpatient setting.

Improving patient safety incorporates two complementary approaches. The first, inspired by research in cognitive psychology and the lessons of accident investigation in other industries, provides qualitative methods for anticipating errors, documenting critical incidents, and responding to them in a blame-free and structured manner. Using such qualitative methods, physicians can generate meaningful strategies for preventing similar occurrences in the future.

Searching the health care literature efficiently: from clinical decision-making to continuing education.

Searching the health care literature is an activity in which infection control professionals must routinely engage to seek evidence-based answers to specific practice questions and to stay abreast of developments in the field. Without the appropriate tools, the tremendous volume of clinical literature makes both of these daunting tasks. In this article, we illustrate techniques for searching MEDLINE efficiently, both as a means of answering particular clinical questions and for generating periodic updates on topics of general interest.

Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy.

Context: Systematic reviews of the literature are an important resource for clinicians. Unfortunately, the few published strategies for identifying these articles involve MEDLINE interfaces not widely available outside of academic medicine. In addition, the performance of these strategies is unknown.

Making health care safer: a critical analysis of patient safety practices.

Objectives: Patient safety has received increased attention in recent years, but mostly with a focus on the epidemiology of errors and adverse events, rather than on practices that reduce such events. This project aimed to collect and critically review the existing evidence on practices relevant to improving patient safety.

Search Strategy And Selection Criteria: Patient safety practices were defined as those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions.