Notice bibliographique
Résumé
The article by Chung and colleagues on the discordance between community- and hospital-based ultrasound is striking because of the error rate data. Community based ultrasounds, typically performed by a technician, were discordant for significant genito-urinary abnormalities compared with subsequent hospital based ultrasounds or CT scans in about half of cases. False-positive results were the most prevalent error. The authors conclude that the performance of ultrasound without direct involvement of a radiologist was responsible for the relatively poorer quality of community-based studies. The article is timely in the context of 2 recent widely publicized episodes of medical error in Newfoundland. Faulty estrogen receptor tests disqualified scores of women with breast cancer in Newfoundland and Labrador from receiving an anti-estrogen. Of 763 patients who tested negative, 317 turned out to be receptor positive, a false negative rate of 42%. Last month, 2 radiologists in that province were suspended within weeks of one another. The first, Dr. Fred Kasirye, was responsible for misreading hundreds of x-rays. His resignation was followed by a massive undertaking to re-read all of the 2000 studies he had interpreted. A second radiologist was suspended recently, and subsequently reinstated when it was determined that fewer than 10% of the reports were questionable. More recently, the CEO of Newfoundland's Health Authority, George Tilley, resigned over the handling of these issues. These events increase costs dramatically, and most important, they undermine trust in physicians and contribute to patient anxiety. These errors have led to inappropriate management in some cases. The Chung paper demonstrates that questionable interpretation of imaging studies is not confined to Newfoundland. All physicians are vulnerable to medical error. In most cases, serious mistakes occur when several safeguards have gone awry. Management theory holds that minor process flaws may point to underlying hazards that are catastrophic under different circumstances. The airline industry recognizes this. When near misses occur, the cause is sought even though both planes landed safely. As an analogy, the fact that the CT scan is not available in the operating room today didn't result in a problem, because the dictated note and ultrasound both identify the correct side of the tumour. Tomorrow, those notes also might not be available, or might contain an error, and the wrong kidney might be removed. Or the wrong drug administered. In an imperfect health care system operated and managed by human beings, errors occur. The implications are pretty clear. Know your pathologist. Review radiologic and pathologic findings yourself. Be skeptical. Analyze minor glitches to identify systemic problems, and correct them. Primum non nocere.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,099 | 0,428 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,010 | 0,007 |
| Études des sciences et des technologies | 0,011 | 0,056 |
| Communication savante | 0,022 | 0,037 |
| Science ouverte | 0,007 | 0,019 |
| Intégrité de la recherche | 0,018 | 0,025 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,015 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».