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Background: Standards for accurate and timely diagnosis are ill-defined. In 2015, the National Academies of Science, Engineering, and Medicine (NASEM) committee published a landmark report, Improving Diagnosis in Health Care , and proposed a new definition of diagnostic error, "the failure to ( a ) establish an accurate and timely explanation of the patient's health problem(s) or ( b ) communicate that explanation to the patient.", Objective: This study aimed to explore how researchers operationalize the NASEM's definition of diagnostic error with relevance to accuracy, timeliness, and/or communication in peer-reviewed published literature., Methods: Using the Arskey and O'Malley's framework framework, we identified published literature from October 2015 to February 2021 using Medline and Google Scholar. We also conducted subject matter expert interviews with researchers., Results: Of 34 studies identified, 16 were analyzed and abstracted to determine how diagnostic error was operationalized and measured. Studies were grouped by theme: epidemiology, patient focus, measurement/surveillance, and clinician focus. Nine studies indicated using the NASEM definition. Of those, 5 studies also operationalized with existing definitions proposed before the NASEM report. Four studies operationalized the components of the NASEM definition and did not cite existing definitions. Three studies operationalized error using existing definitions only. Subject matter experts indicated that the NASEM definition functions as foundation for researchers to conceptualize diagnostic error., Conclusions: The NASEM report produced a common understanding of diagnostic error that includes accuracy, timeliness, and communication. In recent peer-reviewed literature, most researchers continue to use pre-NASEM report definitions to operationalize accuracy and timeliness. The report catalyzed the use of patient-centered concepts in the definition, resulting in emerging studies focused on examining errors related to communicating diagnosis to patients., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I 2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

Background: Studies report a wide spectrum of 124 I positron emission tomography (PET)/computed tomography (CT) sensitivity and specificity in the detection of differentiated thyroid cancer (DTC) lesions. This study reviews the lesion detection rate of pretherapy 124 I PET/CT in different patient populations and further analyzes the factors necessary for a better detection on 124 I PET/CT. Methods: A literature search was performed using multiple different databases (MEDLINE, EMBASE, Northern Lights, and handsearching) covering 1996 to April 2018. Two reviewers reviewed and extracted study data for 124 I, 123 I, and 131 I scans in DTC. Results: This review includes 4 retrospective and 10 prospective studies in which 495 DTC patients underwent 124 I and 131 I imaging; no studies made comparisons with 123 I. In the reports that compared 124 I PET/CT with diagnostic 131 I scans, there were a total of 72 patients in whom 120 lesions were detected on 124 I imaging, whereas only 52 were detected on diagnostic 131 I scans. In publications that compared 124 I with post-therapy 131 I scans in 266 patients, 410 lesions were detected with 124 I PET, whereas 390 were detected on post-therapy 131 I scans. Based on 124 I PET/CT in six studies, TNM staging was revised in 15-21% of patients, and disease management was altered in 5-29% of patients. Conclusions: 124 I PET/CT is able to identify a greater number of foci compared with diagnostic 131 I scans. 124 I PET may have better detection compared with post-therapy 131 I scans in patients who are 131 I therapy naive, have less aggressive pathology, or do not have disseminated lung metastases. Additional metastatic lesion detection by 124 I PET may have a significant clinical impact in the management of patients before 131 I therapy in some patients.

Vocalizations resembling known Bryde's whale sounds were recorded on autonomous hydrophones at seven sites in the eastern tropical Pacific. Five short (<3 s) low-frequency (<80 Hz) "phrase" types were observed. "Swept alternating tonal" phrases included a 37-Hz tone and often a 25-16-Hz downswept tone, while "nonswept alternating tonal" phrases had a predominant tone at 29 Hz and often additional tones at 16 and 47 Hz. Alternating tonal phrases were found in 79% of the total hours in which phrases were detected, and occurred primarily at the eastern hydrophone sites. "Burst-tonal" phrases included tones that were often preceded by a wideband burst of noise. The "low burst-tonal" phrase contained tones at 19 and 30 Hz, and was detected at five of the hydrophone sites. The "high burst-tonal" phrase included a 42-Hz tone and was observed only on the northwestern hydrophones. A single "harmonic tone" phrase type was observed that included a fundamental tone at 26 Hz and at least two harmonics; this phrase was observed exclusively at the eastern hydrophone stations. This opportunistic survey has shown that acoustics is an effective means of studying this poorly understood, pelagic balaenopterid.