Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.

Background: The 21st Century Cures Act mandates patients' access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review.

Objective: To test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes.

A Program to Provide Clinicians with Feedback on Their Diagnostic Performance in a Learning Health System.

Problem: Reducing diagnostic errors requires improving both systems and individual clinical reasoning. One strategy to achieve diagnostic excellence is learning from feedback. However, clinicians remain uncomfortable receiving feedback on their diagnostic performance.

Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan.

Reducing errors in diagnosis is the next big challenge for patient safety. Diagnostic safety improvement efforts should become a priority for health care organizations, payers, and accrediting bodies; however, external incentives, policies, and practical guidance to develop these efforts are largely absent. In this Perspective, the authors highlight ways in which health care organizations can pursue learning and exploration of diagnostic excellence (LEDE).

Corneal melt in rheumatic disorders: effect of disease-modifying antirheumatic drugs on morbidity.

Objective: The objective of this study was to review the characteristics of patients with corneal melt and to assess if treatment with disease-modifying antirheumatic drugs (DMARDs) improved the visual outcome.

Method: We did a retrospective analysis of patients diagnosed with corneal melt between 1976 and 2002. Twenty-one patients with rheumatoid arthritis and 5 patients with primary Sjögren syndrome (26 patients, 42 eyes) were included in the analysis of visual outcome.

Suppurative extensor tenosynovitis caused by Staphylococcus aureus.

Suppurative tenosynovitis is a rare infection, occurring almost exclusively in the flexor tendon sheath as a posttraumatic event. We report the case of a systemically ill woman with suppurative tenosynovitis of the extensor tendons caused by Staphylococcus aureus. Early recognition of this unusual infection may prevent unnecessary morbidity.

Polymyalgia rheumatica. Duration of therapy and long-term outcome.

The duration of therapy and outcome were examined in 76 patients with polymyalgia rheumatica without evidence of temporal arteritis at presentation. Seventy-five patients received corticosteroids, with a mean prednisone dosage of 22.8 mg per day initially.

Pulmonary hypertension, hypoxemia, and death in a patient with scleroderma.

Pulmonary hypertension in systemic sclerosis is usually secondary to pulmonary fibrosis or vascular changes. We have described a patient with systemic sclerosis who had pulmonary hypertension as a result of unsuspected thromboembolic disease.

Reye's syndrome associated with long-term aspirin therapy.

Reye's syndrome has been infrequently described in children receiving long-term salicylate therapy. We report the clinical and laboratory findings of two children in whom Reye's syndrome developed while taking salicylates for systemic inflammatory disorders. Monitoring of hepatocellular function should be considered in children who are receiving long-term salicylate therapy.

Hereditary angioedema and coronary arteritis.

A 30-year-old white male with hereditary angioedema developed substernal chest pain with multiple arterial stenoses at coronary angiography. Histopathologic studies of the fibromembranous thickening removed from the left coronary artery at the time of the revascularization procedure revealed an inflammatory lesion compatible with an arteritis. The significance of this association in the spectrum of immunologically-mediated disorders in hereditary angioedema is discussed.

The efficacy and safety of auranofin compared to placebo in rheumatoid arthritis.

This double-blind multicenter study compares the effect of adding auranofin (AF) 3 mg bid or placebo to patients already taking nonsteroidal antiinflammatory drugs for rheumatoid arthritis. The 242 patients who completed 3 months of therapy demonstrated that the group receiving AF responded better than those receiving placebo. Of the 144 patients who completed 6 months coded medication, the efficacy in the AF group was superior to the placebo group in several parameters including a reduction in the number of painful or swollen joints, grip strength, dropout rate, and global efficacy as judged by the evaluating physician.

Clostridium perfringens: an unusual case of septic arthritis.

Anaerobic joint infections may be a more common occurrence than previously reported. A nine-year-old with a septic knee due to Clostridium perfringens following a puncture wound was seen in the emergency department. Diagnosis was established by isolating the organism from an anaerobic synovial fluid culture.

Error in anti-DNA antibody radioimmunoassay after gallium scanning.

Significant interference with the accurate measurement of anti-DNA antibodies occurs after gallium-67 scanning. The observed effect is dependent on the radioimmunoassay used. False-negative results are observed with a modified Farr assay whereas false-positive results are noted in the millipore filter assay.

Ureteral obstruction and pyelonephritis caused by an inguinal hernia: report of a case.

An elderly man had pyelonephritis and sepsis owing to ureteral obstruction. Retrograde pyelography showed entrapment of the right ureter in an inguinal hernia. This condition, which may be congenital or acquired, should be considered before herniorrhapy is performed and as a possible cause of ureteral obstruction.