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Andrew J. Solomon - One of the best experts on this subject based on the ideXlab platform.
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Functional neurological disorder and multiple sclerosis: a systematic review of Misdiagnosis and clinical overlap
Journal of Neurology, 2021Co-Authors: Dennis Walzl, Andrew J. Solomon, Jon StoneAbstract:Multiple sclerosis (MS) and functional neurological disorder (FND) are both diagnostically challenging conditions which can present with similar symptoms. We systematically reviewed the literature to identify patients with MS who were misdiagnosed with FND, patients with FND who were misdiagnosed with MS, and reports of patients with both conditions. In addition to FND, we included studies of patients with other functional and psychiatric disorders where these caused symptoms leading to investigation for or a diagnosis of MS, which in a different context would likely have been labeled as FND. Our review suggests that MS is one of the most common causes of Misdiagnosis of FND and vice versa. We discuss the clinical errors that appear to result in misdiagnoses, such as over-reliance on psychiatric comorbidity when making a diagnosis of FND or over-reliance on neuroimaging for the diagnosis of MS, and practical ways to avoid them. Comorbidity between these two conditions is also likely common, has been poorly studied, and adds complexity to diagnosis and treatment in patients with both MS and FND. Misdiagnosis and comorbidity in a landscape of emerging evidence-based treatments for both MS and FND are issues not only of clinical importance to the care of these patients, but also to treatment trials, especially of MS, where FND could be a hidden confounder.
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Misdiagnosis of multiple sclerosis: Impact of the 2017 McDonald criteria on clinical practice
Neurology, 2018Co-Authors: Andrew J. Solomon, Robert T. Naismith, Anne H. CrossAbstract:Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS Misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to Misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS Misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.
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the contemporary spectrum of multiple sclerosis Misdiagnosis a multicenter study
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective: To characterize patients misdiagnosed with multiple sclerosis (MS). Methods: Neurologists at 4 academic MS centers submitted data on patients determined to have been misdiagnosed with MS. Results: Of 110 misdiagnosed patients, 51 (46%) were classified as “definite” and 59 (54%) “probable” misdiagnoses according to study definitions. Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%). Duration of Misdiagnosis was 10 years or longer in 36 (33%) and an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%). Seventy-seven (70%) received disease-modifying therapy and 34 (31%) experienced unnecessary morbidity because of Misdiagnosis. Four (4%) participated in a research study of an MS therapy. Leading factors contributing to Misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms. Conclusions: Misdiagnosis of MS leads to unnecessary and potentially harmful risks to patients. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important contemporary contributors to Misdiagnosis.
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The spectrum of multiple sclerosis Misdiagnosis in the era of McDonald criteria: A multicenter study (PL01.003)
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective : To characterize patients misdiagnosed with multiple sclerosis (MS) and hypothesize common causes for Misdiagnosis. Background : Misdiagnosis of MS is a persistent if not growing problem despite, and perhaps because of, improved radiographic diagnostic techniques. Few studies have characterized the contemporary spectrum of MS Misdiagnosis. Methods : Over 13 months, neurologists at four academic MS Centers submitted data concerning individual patients whom they had evaluated and determined to have been misdiagnosed with MS. Results : Of 110 misdiagnosed patients, 51 (46[percnt]) had “definite” and 59 (54[percnt]) “probable” misdiagnoses according to study definitions. The most frequent primary diagnoses were migraine alone or in combination with other diagnoses 24 (21[percnt]), fibromyalgia 16 (15[percnt]), nonspecific or non-localizing neurological symptoms with abnormal MRI 13 (12[percnt]), and conversion or psychogenic disorder 12 (11[percnt]). 27 additional diagnoses were reported. 32 (29[percnt]) of patients carried a Misdiagnosis between 3-9 years and 29 (26[percnt]) for 10-20 years. 77 (70[percnt]) had taken disease modifying therapy, including natalizumab 14 (13[percnt]), mitoxantrone 2 (2[percnt]), cyclophosphamide 1 (1[percnt]). Four (4[percnt]) had participated in a research study of an MS therapy. In 79 (72[percnt]) of patients, participating neurologists indicated that there was evidence an earlier missed opportunity to make a correct diagnosis and 34 (31[percnt]) suffered unnecessary morbidity as a direct result of a Misdiagnosis. Inappropriate attribution of symptoms to demyelinating disease contributed to Misdiagnosis in 72 (65[percnt]) patients, and reliance upon historical symptoms without corroborating objective evidence of a lesion in 53 (48[percnt]). Over-reliance on MRI abnormalities to satisfy dissemination in space in a patient with nonspecific neurological symptoms contributed to Misdiagnosis in 66 (60[percnt]). Conclusions : Misdiagnosis of MS is a common problem that may lead to treatment-related as well as psychosocial morbidity. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important causes of Misdiagnosis. Disclosure: Dr. Solomon has received personal compensation from Haymarket Media as a speaker. Dr. Bourdette has received personal compensation for activities with Biogen Idec, Serono, and Teva Neurosciences as a speaker/faculty. Dr. Cross has received personal compensation for activities with Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Hoffman-La Roche, Teva Neuroscience, Novartis, and Questcor. Dr. Applebee has nothing to disclose. Dr. Skidd has nothing to disclose. Dr. Howard has nothing to disclose. Dr. Spain has nothing to disclose. Dr. Michelle Cameron has received compensation for activities with Acorda therapeutics, MD consult and ReWalk as a consultant. Dr. Kim has received personal compensation for activities with Teva pharmaceutical and Genzyme. Dr. Mass has nothing to disclose. Dr. Yadav has received personal compensation for activities with Novartis as a consultant. Dr. Yadav has received research support from Biogen Idec. Dr. Whitham has received personal compensation for activities with Chugai Pharmaceutical as a data safety monitoring board member. Dr. Longbrake has received personal compensation for activities with Genzyme. Dr. Naismith received personal compensation for activities with Alkermes, Acorda, Bayer, Biogen Idec, Genentech Inc., Genzyme Corporation, EMD Serono, Novartis, and Questcor as a consultant and from Acorda Therapeutics and Genzyme Corporation as a speaker Dr. Wu has received personal compensation for activities with Biogen Idec and Pfizer Inc. Dr. Parks has received personal compensation for activities with BiogenIdec and Novartis as an advisory board member. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Rabin has nothing to disclose. Dr. Toledano has nothing to disclose. Dr. Tobin has nothing to disclose. Dr. Kantarci has nothing to disclose. Dr. Carter has received personal compensation for activities with EMD-Serono, University of Louisville and Omnicare, Inc. for serving as a member of the board and various other activities. Dr. Carter has received research support from the Sanofi, Genzyme Dr. Keegan has received research support from Terumo BCT. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford
Michele Mass - One of the best experts on this subject based on the ideXlab platform.
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the contemporary spectrum of multiple sclerosis Misdiagnosis a multicenter study
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective: To characterize patients misdiagnosed with multiple sclerosis (MS). Methods: Neurologists at 4 academic MS centers submitted data on patients determined to have been misdiagnosed with MS. Results: Of 110 misdiagnosed patients, 51 (46%) were classified as “definite” and 59 (54%) “probable” misdiagnoses according to study definitions. Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%). Duration of Misdiagnosis was 10 years or longer in 36 (33%) and an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%). Seventy-seven (70%) received disease-modifying therapy and 34 (31%) experienced unnecessary morbidity because of Misdiagnosis. Four (4%) participated in a research study of an MS therapy. Leading factors contributing to Misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms. Conclusions: Misdiagnosis of MS leads to unnecessary and potentially harmful risks to patients. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important contemporary contributors to Misdiagnosis.
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The spectrum of multiple sclerosis Misdiagnosis in the era of McDonald criteria: A multicenter study (PL01.003)
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective : To characterize patients misdiagnosed with multiple sclerosis (MS) and hypothesize common causes for Misdiagnosis. Background : Misdiagnosis of MS is a persistent if not growing problem despite, and perhaps because of, improved radiographic diagnostic techniques. Few studies have characterized the contemporary spectrum of MS Misdiagnosis. Methods : Over 13 months, neurologists at four academic MS Centers submitted data concerning individual patients whom they had evaluated and determined to have been misdiagnosed with MS. Results : Of 110 misdiagnosed patients, 51 (46[percnt]) had “definite” and 59 (54[percnt]) “probable” misdiagnoses according to study definitions. The most frequent primary diagnoses were migraine alone or in combination with other diagnoses 24 (21[percnt]), fibromyalgia 16 (15[percnt]), nonspecific or non-localizing neurological symptoms with abnormal MRI 13 (12[percnt]), and conversion or psychogenic disorder 12 (11[percnt]). 27 additional diagnoses were reported. 32 (29[percnt]) of patients carried a Misdiagnosis between 3-9 years and 29 (26[percnt]) for 10-20 years. 77 (70[percnt]) had taken disease modifying therapy, including natalizumab 14 (13[percnt]), mitoxantrone 2 (2[percnt]), cyclophosphamide 1 (1[percnt]). Four (4[percnt]) had participated in a research study of an MS therapy. In 79 (72[percnt]) of patients, participating neurologists indicated that there was evidence an earlier missed opportunity to make a correct diagnosis and 34 (31[percnt]) suffered unnecessary morbidity as a direct result of a Misdiagnosis. Inappropriate attribution of symptoms to demyelinating disease contributed to Misdiagnosis in 72 (65[percnt]) patients, and reliance upon historical symptoms without corroborating objective evidence of a lesion in 53 (48[percnt]). Over-reliance on MRI abnormalities to satisfy dissemination in space in a patient with nonspecific neurological symptoms contributed to Misdiagnosis in 66 (60[percnt]). Conclusions : Misdiagnosis of MS is a common problem that may lead to treatment-related as well as psychosocial morbidity. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important causes of Misdiagnosis. Disclosure: Dr. Solomon has received personal compensation from Haymarket Media as a speaker. Dr. Bourdette has received personal compensation for activities with Biogen Idec, Serono, and Teva Neurosciences as a speaker/faculty. Dr. Cross has received personal compensation for activities with Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Hoffman-La Roche, Teva Neuroscience, Novartis, and Questcor. Dr. Applebee has nothing to disclose. Dr. Skidd has nothing to disclose. Dr. Howard has nothing to disclose. Dr. Spain has nothing to disclose. Dr. Michelle Cameron has received compensation for activities with Acorda therapeutics, MD consult and ReWalk as a consultant. Dr. Kim has received personal compensation for activities with Teva pharmaceutical and Genzyme. Dr. Mass has nothing to disclose. Dr. Yadav has received personal compensation for activities with Novartis as a consultant. Dr. Yadav has received research support from Biogen Idec. Dr. Whitham has received personal compensation for activities with Chugai Pharmaceutical as a data safety monitoring board member. Dr. Longbrake has received personal compensation for activities with Genzyme. Dr. Naismith received personal compensation for activities with Alkermes, Acorda, Bayer, Biogen Idec, Genentech Inc., Genzyme Corporation, EMD Serono, Novartis, and Questcor as a consultant and from Acorda Therapeutics and Genzyme Corporation as a speaker Dr. Wu has received personal compensation for activities with Biogen Idec and Pfizer Inc. Dr. Parks has received personal compensation for activities with BiogenIdec and Novartis as an advisory board member. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Rabin has nothing to disclose. Dr. Toledano has nothing to disclose. Dr. Tobin has nothing to disclose. Dr. Kantarci has nothing to disclose. Dr. Carter has received personal compensation for activities with EMD-Serono, University of Louisville and Omnicare, Inc. for serving as a member of the board and various other activities. Dr. Carter has received research support from the Sanofi, Genzyme Dr. Keegan has received research support from Terumo BCT. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford
Anne H. Cross - One of the best experts on this subject based on the ideXlab platform.
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Misdiagnosis of multiple sclerosis: Impact of the 2017 McDonald criteria on clinical practice
Neurology, 2018Co-Authors: Andrew J. Solomon, Robert T. Naismith, Anne H. CrossAbstract:Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS Misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to Misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS Misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.
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the contemporary spectrum of multiple sclerosis Misdiagnosis a multicenter study
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective: To characterize patients misdiagnosed with multiple sclerosis (MS). Methods: Neurologists at 4 academic MS centers submitted data on patients determined to have been misdiagnosed with MS. Results: Of 110 misdiagnosed patients, 51 (46%) were classified as “definite” and 59 (54%) “probable” misdiagnoses according to study definitions. Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%). Duration of Misdiagnosis was 10 years or longer in 36 (33%) and an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%). Seventy-seven (70%) received disease-modifying therapy and 34 (31%) experienced unnecessary morbidity because of Misdiagnosis. Four (4%) participated in a research study of an MS therapy. Leading factors contributing to Misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms. Conclusions: Misdiagnosis of MS leads to unnecessary and potentially harmful risks to patients. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important contemporary contributors to Misdiagnosis.
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The spectrum of multiple sclerosis Misdiagnosis in the era of McDonald criteria: A multicenter study (PL01.003)
Neurology, 2016Co-Authors: Andrew J. Solomon, Anne H. Cross, Dennis Bourdette, Angela Applebee, Philip Skidd, Diantha B Howard, Rebecca Spain, Michelle H Cameron, Edward Kim, Michele MassAbstract:Objective : To characterize patients misdiagnosed with multiple sclerosis (MS) and hypothesize common causes for Misdiagnosis. Background : Misdiagnosis of MS is a persistent if not growing problem despite, and perhaps because of, improved radiographic diagnostic techniques. Few studies have characterized the contemporary spectrum of MS Misdiagnosis. Methods : Over 13 months, neurologists at four academic MS Centers submitted data concerning individual patients whom they had evaluated and determined to have been misdiagnosed with MS. Results : Of 110 misdiagnosed patients, 51 (46[percnt]) had “definite” and 59 (54[percnt]) “probable” misdiagnoses according to study definitions. The most frequent primary diagnoses were migraine alone or in combination with other diagnoses 24 (21[percnt]), fibromyalgia 16 (15[percnt]), nonspecific or non-localizing neurological symptoms with abnormal MRI 13 (12[percnt]), and conversion or psychogenic disorder 12 (11[percnt]). 27 additional diagnoses were reported. 32 (29[percnt]) of patients carried a Misdiagnosis between 3-9 years and 29 (26[percnt]) for 10-20 years. 77 (70[percnt]) had taken disease modifying therapy, including natalizumab 14 (13[percnt]), mitoxantrone 2 (2[percnt]), cyclophosphamide 1 (1[percnt]). Four (4[percnt]) had participated in a research study of an MS therapy. In 79 (72[percnt]) of patients, participating neurologists indicated that there was evidence an earlier missed opportunity to make a correct diagnosis and 34 (31[percnt]) suffered unnecessary morbidity as a direct result of a Misdiagnosis. Inappropriate attribution of symptoms to demyelinating disease contributed to Misdiagnosis in 72 (65[percnt]) patients, and reliance upon historical symptoms without corroborating objective evidence of a lesion in 53 (48[percnt]). Over-reliance on MRI abnormalities to satisfy dissemination in space in a patient with nonspecific neurological symptoms contributed to Misdiagnosis in 66 (60[percnt]). Conclusions : Misdiagnosis of MS is a common problem that may lead to treatment-related as well as psychosocial morbidity. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important causes of Misdiagnosis. Disclosure: Dr. Solomon has received personal compensation from Haymarket Media as a speaker. Dr. Bourdette has received personal compensation for activities with Biogen Idec, Serono, and Teva Neurosciences as a speaker/faculty. Dr. Cross has received personal compensation for activities with Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Hoffman-La Roche, Teva Neuroscience, Novartis, and Questcor. Dr. Applebee has nothing to disclose. Dr. Skidd has nothing to disclose. Dr. Howard has nothing to disclose. Dr. Spain has nothing to disclose. Dr. Michelle Cameron has received compensation for activities with Acorda therapeutics, MD consult and ReWalk as a consultant. Dr. Kim has received personal compensation for activities with Teva pharmaceutical and Genzyme. Dr. Mass has nothing to disclose. Dr. Yadav has received personal compensation for activities with Novartis as a consultant. Dr. Yadav has received research support from Biogen Idec. Dr. Whitham has received personal compensation for activities with Chugai Pharmaceutical as a data safety monitoring board member. Dr. Longbrake has received personal compensation for activities with Genzyme. Dr. Naismith received personal compensation for activities with Alkermes, Acorda, Bayer, Biogen Idec, Genentech Inc., Genzyme Corporation, EMD Serono, Novartis, and Questcor as a consultant and from Acorda Therapeutics and Genzyme Corporation as a speaker Dr. Wu has received personal compensation for activities with Biogen Idec and Pfizer Inc. Dr. Parks has received personal compensation for activities with BiogenIdec and Novartis as an advisory board member. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Rabin has nothing to disclose. Dr. Toledano has nothing to disclose. Dr. Tobin has nothing to disclose. Dr. Kantarci has nothing to disclose. Dr. Carter has received personal compensation for activities with EMD-Serono, University of Louisville and Omnicare, Inc. for serving as a member of the board and various other activities. Dr. Carter has received research support from the Sanofi, Genzyme Dr. Keegan has received research support from Terumo BCT. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford
David J Lederer - One of the best experts on this subject based on the ideXlab platform.
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barriers to timely diagnosis of interstitial lung disease in the real world the intensity survey
BMC Pulmonary Medicine, 2018Co-Authors: Gregory P Cosgrove, Pauline Bianchi, Sherry Danese, David J LedererAbstract:The diagnosis of idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILD) presents significant clinical challenges. To gain insights regarding the diagnostic experience of patients with ILD and to identify potential barriers to a timely and accurate diagnosis, we developed an online questionnaire and conducted a national survey of adults with a self-reported diagnosis of ILD. A pre-specified total of 600 subjects were recruited to participate in a 40-question online survey. E-mail invitations containing a link to the survey were sent to 16 427 registered members of the Pulmonary Fibrosis Foundation. Additionally, an open invitation was posted on an online forum for patients and caregivers ( www.inspire.com ). The recruitment and screening period was closed once the pre-defined target number of respondents was reached. Eligible participants were adult U.S. residents with a diagnosis of IPF or a non-IPF ILD. A total of 600 eligible respondents met the eligibility criteria and completed the survey. Of these, 55% reported ≥ 1 Misdiagnosis and 38% reported ≥ 2 misdiagnoses prior to the current diagnosis. The most common misdiagnoses were asthma (13.5%), pneumonia (13.0%), and bronchitis (12.3%). The median time from symptom onset to current diagnosis was 7 months (range, 0–252 months), with 43% of respondents reporting a delay of ≥ 1 year and 19% reporting a delay of ≥ 3 years. Sixty-one percent of respondents underwent at least one invasive diagnostic procedure. While a minority of patients with ILD will experience an appropriate and expedient diagnosis, the more typical diagnostic experience for individuals with ILD is characterized by considerable delays, frequent Misdiagnosis, exposure to costly and invasive diagnostic procedures, and substantial use of healthcare resources. These findings suggest a need for physician education, development of clinical practice recommendations, and improved diagnostic tools aimed at improving diagnostic accuracy in patients with ILD.
Robert D. C. Elwes - One of the best experts on this subject based on the ideXlab platform.
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Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty
European journal of neurology, 2008Co-Authors: Fahmida A. Chowdhury, Lina Nashef, Robert D. C. ElwesAbstract:The diagnosis of first seizure or epilepsy may be challenging and Misdiagnosis can occur. Studies carried out in various settings have reported Misdiagnosis rates of between 4.6% and 30%. Misdiagnosis can lead to serious consequences including driving and employment restrictions and inappropriate treatments. Most studies focus on ways of reducing Misdiagnosis. However, in some cases, it may be difficult to make a definite diagnosis at initial presentation. This is because of a number of reasons including overlapping clinical features with other conditions, inadequate available history and limitations of investigations. Consequently, diagnostic uncertainty is inevitable in epilepsy, although few studies acknowledge this. In this paper we review the literature on Misdiagnosis rates, analyse reasons for Misdiagnosis and consider limitations of available investigations. We propose that diagnostic uncertainty in epilepsy should be more widely acknowledged and addressed, and that this may reduce Misdiagnosis rates.
