WorldWideScience

Sample records for clinical diagnostic study

  1. Clinical diagnostic ultrasound

    International Nuclear Information System (INIS)

    Barnett, E.; Morley, P.

    1986-01-01

    This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

  2. Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia.

    Science.gov (United States)

    Boccardi, Marina; Festari, Cristina; Altomare, Daniele; Gandolfo, Federica; Orini, Stefania; Nobili, Flavio; Frisoni, Giovanni B

    2018-04-30

    FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold-/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

  3. [Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies].

    Science.gov (United States)

    Müller-Staub, Maria; Stuker-Studer, Ursula

    2006-10-01

    Case studies, based on actual patients' situations, provide a method of clinical decision making to foster critical thinking in nurses. This paper describes the method and process of group case studies applied in continuous education settings. This method bases on Balints' case supervision and was further developed and combined with the nursing diagnostic process. A case study contains different phases: Pre-phase, selection phase, case delineation and case work. The case provider narratively tells the situation of a patient. This allows the group to analyze and cluster signs and symptoms, to state nursing diagnoses and to derive nursing interventions. Results of the case study are validated by applying the theoretical background and critical appraisal of the case provider. Learning effects of the case studies were evaluated by means of qualitative questionnaires and analyzed according to Mayring. Findings revealed the following categories: a) Patients' problems are perceived in a patient centred way, accurate nursing diagnoses are stated and effective nursing interventions implemented. b) Professional nursing tasks are more purposefully perceived and named more precise. c) Professional nursing relationship, communication and respectful behaviour with patients were perceived in differentiated ways. The theoretical framework is described in the paper "Clinical decision making and critical thinking in the nursing diagnostic process". (Müller-Staub, 2006).

  4. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    Science.gov (United States)

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

  5. Retrieval of diagnostic and treatment studies for clinical use through PubMed and PubMed's Clinical Queries filters.

    Science.gov (United States)

    Lokker, Cynthia; Haynes, R Brian; Wilczynski, Nancy L; McKibbon, K Ann; Walter, Stephen D

    2011-01-01

    Clinical Queries filters were developed to improve the retrieval of high-quality studies in searches on clinical matters. The study objective was to determine the yield of relevant citations and physician satisfaction while searching for diagnostic and treatment studies using the Clinical Queries page of PubMed compared with searching PubMed without these filters. Forty practicing physicians, presented with standardized treatment and diagnosis questions and one question of their choosing, entered search terms which were processed in a random, blinded fashion through PubMed alone and PubMed Clinical Queries. Participants rated search retrievals for applicability to the question at hand and satisfaction. For treatment, the primary outcome of retrieval of relevant articles was not significantly different between the groups, but a higher proportion of articles from the Clinical Queries searches met methodologic criteria (p=0.049), and more articles were published in core internal medicine journals (p=0.056). For diagnosis, the filtered results returned more relevant articles (p=0.031) and fewer irrelevant articles (overall retrieval less, p=0.023); participants needed to screen fewer articles before arriving at the first relevant citation (p<0.05). Relevance was also influenced by content terms used by participants in searching. Participants varied greatly in their search performance. Clinical Queries filtered searches returned more high-quality studies, though the retrieval of relevant articles was only statistically different between the groups for diagnosis questions. Retrieving clinically important research studies from Medline is a challenging task for physicians. Methodological search filters can improve search retrieval.

  6. Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn's Disease Patients: Results from the CONNECT Study.

    Directory of Open Access Journals (Sweden)

    Chang Mo Moon

    Full Text Available Diagnostic delay frequently occurs in Crohn's disease (CD patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn's Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years (p = 0.014, concomitant upper gastrointestinal (UGI disease (p = 0.012 and penetrating disease behavior at diagnosis (p = 0.001 were positively associated with long diagnostic delay (≥18 months. During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07-1.93; p = 0.017, internal fistulas (HR, 1.62; 95% CI, 1.12-2.33; p = 0.011, and perianal fistulas (HR, 1.38; 95% CI, 1.06-1.80; p = 0.016. However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.

  7. Diagnostic stability among chronic patients with functional psychoses: an epidemiological and clinical study

    Directory of Open Access Journals (Sweden)

    Jakobsen Klaus D

    2007-08-01

    Full Text Available Abstract Background Diagnostic stability and illness course of chronic non-organic psychoses are complex phenomena and only few risk factors or predictors are known that can be used reliably. This study investigates the diagnostic stability during the entire course of illness in patients with non-organic psychoses and attempts to identify non-psychopathological risk factors or predictors. Method 100 patients with functional psychosis were initially characterised using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT, medical records and health registers. To study the stability of diagnoses (i.e. shifts per time, we used registry data to define four measures of diagnostic variation that were subsequently examined in relation to four possible measures of time (i.e. observation periods or hospitalisation events. Afterwards, we identified putative co-variables and predictors of the best measures of diagnostic stability. Results All four measures of diagnostic variation are very strongly associated with numbers-of-hospitalisations and less so with duration-of-illness, duration-of-hospitalisation and with year-of-first-admission. The four measures of diagnostic variation corrected for numbers-of-hospitalisations were therefore used to study the diagnostic stability. Conventional predictors of illness course – e.g. age-of-onset and premorbid-functioning – are not significantly associated with stability. Only somatic-comorbidity is significantly associated with two measures of stability, while family-history-of-psychiatric-illness and global-assessment-of-functioning (GAF scale score show a trend. However, the traditional variables age-of-first-admission, civil-status, first-diagnosis-being-schizophrenia and somatic-comorbidity are able to explain two-fifth of the variation in numbers-of-hospitalisations. Conclusion Diagnostic stability is closely linked with the contact between patient and the healthcare system

  8. Modern clinical laboratory diagnostics

    International Nuclear Information System (INIS)

    Balakhovskij, I.S.

    1986-01-01

    Laboratory diagnosis is auxillary medical discipline studying specific laboratory symptoms of diseases, revealed by investigations of materials taken from patients. The structure of laboratory servie in our country and abroad, items of laboratory investigations, organizational principles are described. Attention is being given to the cost of analyses, the amount of conducted investigations, methods of result presentation, problems of accuracy, quality control and information content

  9. Diagnostic dilemmas in Fabry disease: a case series study on GLA mutations of unknown clinical significance

    NARCIS (Netherlands)

    Smid, B.E.; Hollak, C.E.M.; Poorthuis, B.J.H.M.; Bergh-Weerman, M.A. van den; Florquin, S.; Kok, W.E.; Deprez, R.H.L.; Timmermans, J.; Linthorst, G.E.

    2015-01-01

    Fabry disease' (FD) phenotype is heterogeneous: alpha-galactosidase A gene mutations (GLA) can lead to classical or non-classical FD, or no FD. The aim of this study is to describe pitfalls in diagnosing non-classical FD and assess the diagnostic value of plasma globotriaosylsphingosine. This is a

  10. Thymic hyperplasia - clinical course and imaging diagnostic

    International Nuclear Information System (INIS)

    Drebov, R.; Panov, M.; Totev, M.; Deliverski, T.; Tcandev, I.; Velkovski, I.

    2006-01-01

    The real thymic hyperplasia is benign disease sometimes simulating malignant tumours. The aim of this study is to analyse the clinical symptoms of real thymic hyperplasia and the results from imaging diagnostic based on our clinical material. Clinical material include 27 children, aged from two months to 15 years, admitted in department of thoracic surgery, for a period of 20 years (1985 - 2004). We retrospectively analyze the clinical signs and results from X-ray investigation, CT (Siemens Somatom DRG and Philips Secura) and echocardiography (Acuson TX, 5 and 7 MHz). We discuss the diagnostic value of different methods as well as typical and atypical findings. (authors)

  11. The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

    OpenAIRE

    Buyukkoyuncu Pekel, Nilufer; Nar Senol, Pelin; Yildiz, Demet; Kilic, Ahmet Kasim; Kamaci Sener, Deniz; Seferoglu, Meral; Gunes, Aygul

    2017-01-01

    Objective. The aim of the study was to examine the relation between clinical findings, neurological examination and electrophysiological studies in diagnosing carpal tunnel syndrome (CTS) and share our institutional experience in patients with CTS. Methods. Patients presenting with complaints of pain, paresthesia, and weakness in hands who diagnosed CTS between 2014 and 2015 were examined retrospectively. Demographic characteristics, clinical and neurological examination findings and electrod...

  12. Early complication detection after colorectal surgery (CONDOR): study protocol for a prospective clinical diagnostic study

    NARCIS (Netherlands)

    Kornmann, Verena; van Ramshorst, Bert; van Dieren, Susan; van Geloven, Nanette; Boermeester, Marja; Boerma, Djamila

    2016-01-01

    Anastomotic leakage is one of the most feared complications following colorectal surgery with a high morbidity and mortality rate. Multiple risk factors have been identified, but leakage still occurs. Early detection is crucial in order to reduce morbidity and mortality. The aim of this study is to

  13. Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies.

    Science.gov (United States)

    Ammar, Hussam; Govindu, Rukma; Fouda, Ragai; Zohdy, Wael; Supsupin, Emilio

    2017-03-01

    Objectives : Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods : We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher's exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results : Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607 914. Conclusion : Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations : OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew.

  14. Clinico-pathological study to evaluate oral lichen planus for the establishment of clinical and histopathological diagnostic criteria.

    Science.gov (United States)

    Hiremath, Santhosh; Kale, Alka D; Hallikerimath, Seema

    2015-01-01

    Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Out of the 100 cases, 50 were prospective and 50 were retrospective cases. Prospective cases were collected based on the clinical diagnosis of oral lichen planus and oral lichenoid lesion. Retrospective cases were collected based on the histopathological diagnosis of oral lichen planus. Both the clinical and histopathological analyses were performed based on a proposal for a set of modified diagnostic criteria of oral lichen planus and oral lichenoid lesion. A final diagnosis of oral lichen planus was made only after the correlation of the clinical diagnosis with the histopathological diagnosis. The interobserver agreement among three observers for both prospective and retrospective cases in the final diagnosis of oral lichen planus was found to be "good" to "very good" indicating high reproducibility. However, the final diagnoses of true oral lichen planus after clinico-pathological correlation in prospective and retrospective study groups appeared to be 38.0% and 54.0% respectively. The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively.

  15. Serumferritin - diagnostic relevance and clinical usefulness

    Energy Technology Data Exchange (ETDEWEB)

    Linkesch, W [Vienna Univ. (Austria). 2. Medizinische Klinik

    1984-01-01

    The introduction of a WHO Standard for serumferritin effected a standardisation of different methods, improving quality and security for clinical routine diagnostic purposes. Therefore the clinical evaluation of serumferritin gained even more importance. For evaluation of iron stores of children, pregnant women, population studies, patients on hemodialysis or patients with rheumatoid arthritis low serumferritin values give safe results. In addition serumferritin is of clinical usefulness in monitoring therapy of both iron deficiency and iron overload. Evaluating a single serumferritin value one should consider the total clinical situation of the patient. As some tumors can produce and secrete serumferritin, e.g. acute myeloblastic leukemia, germ cell tumors, malignant melanoma, serumferritin might be helpful in monitoring the malignant disease. The ongoing characterization of tissue isoferritin, especially acidic isoferritin, may eventually lead to a clinically significant diagnostic marker of neoplasia.

  16. Serumferritin - diagnostic relevance and clinical usefulness

    International Nuclear Information System (INIS)

    Linkesch, W.

    1984-01-01

    The introduction of a WHO Standard for serumferritin effected a standardisation of different methods, improving quality and security for clinical routine diagnostic purposes. Therefore the clinical evaluation of serumferritin gained even more importance. For evaluation of iron stores of children, pregnant women, population studies, patients on hemodialysis or patients with rheumatoid arthritis low serumferritin values give safe results. In addition serumferritin is of clinical usefulness in monitoring therapy of both iron deficiency and iron overload. Evaluating a single serumferritin value on should consider the total clinical situation of the patient. As some tumors can produce and secrete serumferritin, e. g. acute myeloblastic leukemia, germ cell tumors, malignant melanoma, serumferritin might be helpful in monitoring the malignant disease. The ongoing characterization of tissue isoferritin, especially acidic isoferritin, may eventually lead to a clinically significant diagnostic marker of neoplasia. (Author)

  17. Optoacoustic diagnostic modality: from idea to clinical studies with highly compact laser diode-based systems

    Science.gov (United States)

    Esenaliev, Rinat O.

    2017-09-01

    Optoacoustic (photoacoustic) diagnostic modality is a technique that combines high optical contrast and ultrasound spatial resolution. We proposed using the optoacoustic technique for a number of applications, including cancer detection, monitoring of thermotherapy (hyperthermia, coagulation, and freezing), monitoring of cerebral blood oxygenation in patients with traumatic brain injury, neonatal patients, fetuses during late-stage labor, central venous oxygenation monitoring, and total hemoglobin concentration monitoring as well as hematoma detection and characterization. We developed and built optical parametric oscillator-based systems and multiwavelength, fiber-coupled highly compact, laser diode-based systems for optoacoustic imaging, monitoring, and sensing. To provide sufficient output pulse energy, a specially designed fiber-optic system was built and incorporated in ultrasensitive, wideband optoacoustic probes. We performed preclinical and clinical tests of the systems and the optoacoustic probes in backward mode for most of the applications and in forward mode for the breast cancer and cerebral applications. The high pulse energy and repetition rate allowed for rapid data acquisition with high signal-to-noise ratio from cerebral blood vessels, such as the superior sagittal sinus, central veins, and peripheral veins and arteries, as well as from intracranial hematomas. The optoacoustic systems were capable of automatic, real-time, continuous measurements of blood oxygenation in these blood vessels.

  18. Standardized Ki67 Diagnostics Using Automated Scoring--Clinical Validation in the GeparTrio Breast Cancer Study.

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    Klauschen, Frederick; Wienert, Stephan; Schmitt, Wolfgang D; Loibl, Sibylle; Gerber, Bernd; Blohmer, Jens-Uwe; Huober, Jens; Rüdiger, Thomas; Erbstößer, Erhard; Mehta, Keyur; Lederer, Bianca; Dietel, Manfred; Denkert, Carsten; von Minckwitz, Gunter

    2015-08-15

    Scoring proliferation through Ki67 immunohistochemistry is an important component in predicting therapy response to chemotherapy in patients with breast cancer. However, recent studies have cast doubt on the reliability of "visual" Ki67 scoring in the multicenter setting, particularly in the lower, yet clinically important, proliferation range. Therefore, an accurate and standardized Ki67 scoring is pivotal both in routine diagnostics and larger multicenter studies. We validated a novel fully automated Ki67 scoring approach that relies on only minimal a priori knowledge on cell properties and requires no training data for calibration. We applied our approach to 1,082 breast cancer samples from the neoadjuvant GeparTrio trial and compared the performance of automated and manual Ki67 scoring. The three groups of autoKi67 as defined by low (≤ 15%), medium (15.1%-35%), and high (>35%) automated scores showed pCR rates of 5.8%, 16.9%, and 29.5%, respectively. AutoKi67 was significantly linked to prognosis with overall and progression-free survival P values P(OS) cancer that correlated with clinical endpoints and is deployable in routine diagnostics. It may thus help to solve recently reported reliability concerns in Ki67 diagnostics. ©2014 American Association for Cancer Research.

  19. Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.

    Science.gov (United States)

    Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi; Terry, Colin; Azar, Marwan M; Riddell, James; Ender, Peter; Chen, Sharon; Shehab, Kareem; Cleveland, Kerry; Esguerra, Eden; Johnson, James; Wright, Patty; Douglas, Vanja; Vergidis, Pascalis; Ooi, Winnie; Baddley, John; Bamberger, David; Khairy, Raed; Vikram, Holenarasipur R; Jenny-Avital, Elizabeth; Sivasubramanian, Geetha; Bowlware, Karen; Pahud, Barbara; Sarria, Juan; Tsai, Townson; Assi, Maha; Mocherla, Satish; Prakash, Vidhya; Allen, David; Passaretti, Catherine; Huprikar, Shirish; Anderson, Albert

    2018-03-01

    Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

  20. Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies.

    Science.gov (United States)

    Aw, Hau Choong; Ranasinghe, Weranja; Tan, Philip Huang Min; O'Connell, Helen E

    2017-07-01

    To identify the functional correlation of overactive pelvic floor muscles (OPFM) with cystoscopic and fluoroscopic urodynamic studies (FUDS), including urethral pressure measurements. Patients refractory to conservative therapy including bladder retraining, medications and pelvic muscle exercises for a variety of gamut of storage and voiding disorders were evaluated. Prospective data for 201 patients across both genders who underwent flexible cystoscopy and urodynamics for lower urinary tract symptoms (LUTS) refractory to conservative management between 01 Jan 2014 and 01 Jan 2016 was collected. Factors studied included history of LUTS, voiding patterns, physical examination, cystoscopic findings and functional studies, with maximum urethral closing pressure (MUCP). A total of 201 were patients recruited. The 85 were diagnosed with OPFM based on clinical presentation and presence of pelvic floor tenderness on examination. Significant differences were noted on functional studies with FUDS and urethral pressure measurement. Subjects with pelvic floor tenderness were found to have a higher (MUCP) at 93.1 cm H2O compared to 80.6 cm H2O (P=0.015). There are distinct characteristics of OPFM on clinical examination and functional studies, in particular MUCP. In patients refractory to conservative treatments, specific urodynamics tests are useful in sub-categorising patients. When OPFM is diagnosed, the impact on patient management is significant, and targeted intervention with pelvic floor physiotherapy is central in the multimodal approach of this complex condition.

  1. LC-HRMS Metabolomics for Untargeted Diagnostic Screening in Clinical Laboratories: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Bertrand Rochat

    2018-06-01

    Full Text Available Today’s high-resolution mass spectrometers (HRMS allow bioanalysts to perform untargeted/global determinations that can reveal unexpected compounds or concentrations in a patient’s sample. This could be performed for preliminary diagnosis attempts when usual diagnostic processes and targeted determinations fail. We have evaluated an untargeted diagnostic screening (UDS procedure. UDS is a metabolome analysis that compares one sample (e.g., a patient with control samples (a healthy population. Using liquid chromatography (LC-HRMS full-scan analysis of human serum extracts and unsupervised data treatment, we have compared individual samples that were spiked with one xenobiotic or a higher level of one endogenous compound with control samples. After the use of different filters that drastically reduced the number of metabolites detected, the spiked compound was eventually revealed in each test sample and ranked. The proposed UDS procedure appears feasible and reliable to reveal unexpected xenobiotics (toxicology or higher concentrations of endogenous metabolites. HRMS-based untargeted approaches could be useful as preliminary diagnostic screening when canonical processes do not reveal disease etiology nor establish a clear diagnosis and could reduce misdiagnosis. On the other hand, the risk of overdiagnosis of this approach should be reduced with mandatory biomedical interpretation of the patient’s UDS results and with confirmatory targeted and quantitative determinations.

  2. Dose and diagnostic performance comparison between phase-contrast mammography with synchrotron radiation and digital mammography: a clinical study report.

    Science.gov (United States)

    Fedon, Christian; Rigon, Luigi; Arfelli, Fulvia; Dreossi, Diego; Quai, Elisa; Tonutti, Maura; Tromba, Giuliana; Cova, Maria Assunta; Longo, Renata

    2018-01-01

    Two dosimetric quantities [mean glandular dose (MGD) and entrance surface air kerma (ESAK)] and the diagnostic performance of phase-contrast mammography with synchrotron radiation (MSR) are compared to conventional digital mammography (DM). Seventy-one patients (age range, 41 to 82 years) underwent MSR after a DM examination if questionable or suspicious breast abnormalities were not clarified by ultrasonography. The MGD and the ESAK delivered in both examinations were evaluated and compared. Two on-site radiologists rated the images in consensus according to the Breast Imaging Reporting and Data System assessment categories, which were then correlated with the final diagnoses by means of statistical generalized linear models (GLMs). Receiver operating characteristic curves were also used to assess the diagnostic performance by comparing the area under the curve (AUC). An important MGD and ESAK reduction was observed in MSR due to the monoenergetic beam. In particular, an average 43% reduction was observed for the MGD and a reduction of more than 50% for the ESAK. GLM showed higher diagnostic accuracy, especially in terms of specificity, for MSR, confirmed by AUC analysis ([Formula: see text]). The study design implied that the population was characterized by a high prevalence of disease and that the radiologists, who read the DM images before referring the patient to MSR, could have been influenced in their assessments. Within these limitations, the use of synchrotron radiation with the phase-contrast technique applied to mammography showed an important dose reduction and a higher diagnostic accuracy compared with DM. These results could further encourage research on the translation of x-ray phase-contrast imaging into the clinics.

  3. Radiation dose to children in diagnostic radiology. Measurements and methods for clinical optimisation studies

    International Nuclear Information System (INIS)

    Almen, A.J.

    1995-09-01

    A method for estimating mean absorbed dose to different organs and tissues was developed for paediatric patients undergoing X-ray investigations. The absorbed dose distribution in water was measured for the specific X-ray beam used. Clinical images were studied to determine X-ray beam positions and field sizes. Size and position of organs in the patient were estimated using ORNL phantoms and complementary clinical information. Conversion factors between the mean absorbed dose to various organs and entrance surface dose for five different body sizes were calculated. Direct measurements on patients estimating entrance surface dose and energy imparted for common X-ray investigations were performed. The examination technique for a number of paediatric X-ray investigations used in 19 Swedish hospitals was studied. For a simulated pelvis investigation of a 1-year old child the entrance surface dose was measured and image quality was estimated using a contrast-detail phantom. Mean absorbed doses to organs and tissues in urography, lung, pelvis, thoracic spine, lumbar spine and scoliosis investigations was calculated. Calculations of effective dose were supplemented with risk calculations for special organs e g the female breast. The work shows that the examination technique in paediatric radiology is not yet optimised, and that the non-optimised procedures contribute to a considerable variation in radiation dose. In order to optimise paediatric radiology there is a need for more standardised methods in patient dosimetry. It is especially important to relate measured quantities to the size of the patient, using e g the patient weight and length. 91 refs, 17 figs, 8 tabs

  4. Radiation dose to children in diagnostic radiology. Measurements and methods for clinical optimisation studies

    Energy Technology Data Exchange (ETDEWEB)

    Almen, A J

    1995-09-01

    A method for estimating mean absorbed dose to different organs and tissues was developed for paediatric patients undergoing X-ray investigations. The absorbed dose distribution in water was measured for the specific X-ray beam used. Clinical images were studied to determine X-ray beam positions and field sizes. Size and position of organs in the patient were estimated using ORNL phantoms and complementary clinical information. Conversion factors between the mean absorbed dose to various organs and entrance surface dose for five different body sizes were calculated. Direct measurements on patients estimating entrance surface dose and energy imparted for common X-ray investigations were performed. The examination technique for a number of paediatric X-ray investigations used in 19 Swedish hospitals was studied. For a simulated pelvis investigation of a 1-year old child the entrance surface dose was measured and image quality was estimated using a contrast-detail phantom. Mean absorbed doses to organs and tissues in urography, lung, pelvis, thoracic spine, lumbar spine and scoliosis investigations was calculated. Calculations of effective dose were supplemented with risk calculations for special organs e g the female breast. The work shows that the examination technique in paediatric radiology is not yet optimised, and that the non-optimised procedures contribute to a considerable variation in radiation dose. In order to optimise paediatric radiology there is a need for more standardised methods in patient dosimetry. It is especially important to relate measured quantities to the size of the patient, using e g the patient weight and length. 91 refs, 17 figs, 8 tabs.

  5. Systematic internal transcribed spacer sequence analysis for identification of clinical mold isolates in diagnostic mycology: a 5-year study.

    Science.gov (United States)

    Ciardo, Diana E; Lucke, Katja; Imhof, Alex; Bloemberg, Guido V; Böttger, Erik C

    2010-08-01

    The implementation of internal transcribed spacer (ITS) sequencing for routine identification of molds in the diagnostic mycology laboratory was analyzed in a 5-year study. All mold isolates (n = 6,900) recovered in our laboratory from 2005 to 2009 were included in this study. According to a defined work flow, which in addition to troublesome phenotypic identification takes clinical relevance into account, 233 isolates were subjected to ITS sequence analysis. Sequencing resulted in successful identification for 78.6% of the analyzed isolates (57.1% at species level, 21.5% at genus level). In comparison, extended in-depth phenotypic characterization of the isolates subjected to sequencing achieved taxonomic assignment for 47.6% of these, with a mere 13.3% at species level. Optimization of DNA extraction further improved the efficacy of molecular identification. This study is the first of its kind to testify to the systematic implementation of sequence-based identification procedures in the routine workup of mold isolates in the diagnostic mycology laboratory.

  6. A clinical study of thallium-201 SPECT in the diagnostic imaging of oral squamous cell carcinomas

    International Nuclear Information System (INIS)

    Satoh, Hitoshi

    2003-01-01

    Recently the usefulness of thallium 201 chloride (201Tl) as a tumor imaging agent for various tumors has been reported. However, the application of 201Tl SPECT to oral squamous cell carcinomas has not been established. The purpose of this study is to investigate the usefulness of 201Tl SPECT in the assessment of malignancy or in the differential diagnosis of oral squamous cell carcinomas from inflammatory diseases. Thirty-two patients with 33 primary oral squamous cell carcinomas and 4 patients with inflammatory disease were studied. SPECT images were acquired 15 minutes (early image) and 3 hours (delayed image) after the intravenous injection with 74 MBq 201Tl, and then early uptake ratio (ER), delayed uptake ratio (DR), and retention index (RI) were measured. The relations between these parameters and the size, the site, the degree of differentiation and the mode of invasion of the primary tumor were analyzed statistically. 201Tl SPECT correctly identified 32 of the 33 tumors, with 32 patients having oral squamous cell carcinoma, making the positive rate 97%. Significant negative correlation was observed between RI and major or minor axis of tumors; therefore, this study revealed that RI was influenced by the size of a tumor. In comparison with the average value of RI according to histopathological diagnosis, there was statistically significant difference (p=0.011) between carcinomas (0.80±0.16, n=30) and inflammatory diseases (0.58±0.04, n=4); thus, it was supposed that differential diagnosis between them could be possible. About the tumors with the range of minor-axis 20 mm-40 mm for little influence of tumor size to the RI, the tendency to decrease for the RI of well-differentiated group or low-invasive group was seen. For oral squamous cell carcinomas, 201Tl SPECT had a high positive rate. The application was suggested for use in the differential diagnosis between inflammatory disease and carcinomas, where clinical usefulness could be expected. (author)

  7. The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study

    International Nuclear Information System (INIS)

    Breen, Micheal; O'Neill, Siobhan B.; O'Donovan, Joanne P.; McWilliams, Sebastian; Murphy, Kevin P.; Maher, Michael M.; Desmond, Alan N.; Shanahan, Fergus; Quigley, Eamonn M.

    2014-01-01

    The term functional gastrointestinal disorders (FGID) describes various aggregations of chronic gastrointestinal (GI) symptoms not explained by identifiable organic pathology; accordingly, their diagnosis rests on symptom-based criteria and a process of exclusion. Evidence is lacking on the appropriate use of abdominal imaging studies (AIS) in FGIDs. We investigated the utilisation of AIS (site, modality, diagnostic yield/significance) at a tertiary FGID clinic over an 11-year period. Of 1,621 patients, 507 (31 %; 67.5 % women, mean age 43.9 ± 17.37 years) referred from primary care had 997 AIS (1.7 per patient): ultrasonography (US) 36.1 %, fluoroscopy (FLS) 28.8 %, computed tomography (CT) 19.6 %, plain radiography (PR) 13.5 %, nuclear medicine (NM) 1 %. Of the 997 AIS, 55.6 % (554/997) were normal. Of the AIS with positive findings, 9.9 % (62/625) were deemed 'probably significant' and 14.7 % (92/625) 'significant'. Of the CT and FLS studies, 12.3 % and 13.6 %, respectively, yielded 'significant' abnormalities compared to 2.2 % of the US studies and 2.1 % of the PR studies. CT identified five of seven neoplasms, associated with male sex, increasing age and symptom onset after age 50 years. This study confirmed low use of AIS in tertiary FGID clinics and a high proportion of normal studies. Barium swallow/meal and CT were more likely to identify 'probably significant' or 'significant' findings, including neoplasms. (orig.)

  8. Clinical diagnostic study by means of magnetic resonance imaging for lesions of the major salivary gland region

    International Nuclear Information System (INIS)

    Iihama, Tsuyoshi; Mataga, Izumi; Kato, Joji

    1994-01-01

    The diagnostic value of magnetic resonance imaging (MRI) for lesions situated in the major salivary glands was clinically discussed in this study. A total of 46 patients with salivary gland disorders treated in our department over the past five years were assessed by mean of MRI, and in 11 patients the findings were compared with the histopathological features of lesions sectioned at the same level postoperatively. In addition, preliminary investigations to introduce a new qualitative diagnostic procedure for estimation of salivary gland function in geriatric patients were attempted. In this investigation, T 1 and T 2 values, and signal intensity ratios of the submandibular gland were measured in elderly patients complaining of dry mouth and in healthy controls. Likewise, salivary gland function was examined by taste stimulation induced by applying citric acid to the tongue surface just before starting MRI. MRI clearly demonstrated lesions in the salivary glands. The histopathological diagnosis could not be accurately predicted by signal intensity. However, benign tumors showed higher intensity signals than did malignant tumors on T 2 -weighted images. Cystic lesions could be differentiated from tumors by signal intensity. Histopathological features of salivary gland tumors corresponded to the MRI signal intensity. Relaxation times of T 1 and T 2 values and signal intensity in each major salivary gland were diminished in elderly patients in a resting condition. Only T 1 values in healthy subjects remarkably responded to taste stimulation. These results suggest that MRI is useful and beneficial not only in the qualitative diagnosis of tumors arising from salivary glands but also in the estimation of salivary gland function. MRI should therefore be included in routine diagnostic examinations for salivary gland disorders. (author)

  9. Performance of Rapid Diagnostic Tests for Imported Malaria in Clinical Practice: Results of a National Multicenter Study

    Science.gov (United States)

    Houzé, Sandrine; Boutron, Isabelle; Marmorat, Anne; Dalichampt, Marie; Choquet, Christophe; Poilane, Isabelle; Godineau, Nadine; Le Guern, Anne-Sophie; Thellier, Marc; Broutier, Hélène; Fenneteau, Odile; Millet, Pascal; Dulucq, Stéphanie; Hubert, Véronique; Houzé, Pascal; Tubach, Florence; Le Bras, Jacques; Matheron, Sophie

    2013-01-01

    We compared the performance of four rapid diagnostic tests (RDTs) for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum ( Plasmodium histidine-rich protein 2 (PfHRP2) or Plasmodium LDH (PfLDH)) and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH)). 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%). For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%), positive predictive value (PPV) (90%) and negative predictive value (NPV) (98%). The PfLDH test showed lower sensitivity (83%) and NPV (80%), despite good PPV (98%). For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94–99% and 52–64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria. PMID:24098699

  10. Comparison Of Clinical, Parasitological And Serological Diagnostic ...

    African Journals Online (AJOL)

    Comparison Of Clinical, Parasitological And Serological Diagnostic Methods For The Definitive ... Consideringthe relative significance of these methods in the diagnosis of onchocerciasis, we ... http://dx.doi.org/10.4314/ari.v1i3.40835.

  11. Electron beam diagnostics study

    International Nuclear Information System (INIS)

    Garganne, P.

    1989-08-01

    This paper summarizes the results of a study on beam diagnostics, using carbon wire scanners and optical transition radiation (DTR) monitors. The main consideration consists in the material selection, taking their thermal properties and their effect on the beam into account [fr

  12. Diagnostic studies in amyloidosis

    NARCIS (Netherlands)

    Hazenberg, Bouke Pier Cornelis

    2007-01-01

    In this thesis two diagnostic techniques are studied in amyloidosis. Systemic amyloidosis is characterized by deposition of amyloid fibrils (tiny fibres) throughout the body resulting in damage of vital organs. Amyloid can be detected in a tissue specimen stained with Congo red: red-stained amyloid

  13. The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal; O' Neill, Siobhan B.; O' Donovan, Joanne P.; McWilliams, Sebastian [Cork University Hospital, Department of Radiology, Cork (Ireland); Murphy, Kevin P.; Maher, Michael M. [Cork University Hospital, Department of Radiology, Cork (Ireland); University College Cork, Department of Radiology, Cork (Ireland); Desmond, Alan N. [Cork University Hospital, Department of Medicine, Cork (Ireland); Shanahan, Fergus; Quigley, Eamonn M. [Cork University Hospital, Department of Medicine, Cork (Ireland); University College Cork, Alimentary Pharmabiotic Center, Cork (Ireland)

    2014-12-15

    The term functional gastrointestinal disorders (FGID) describes various aggregations of chronic gastrointestinal (GI) symptoms not explained by identifiable organic pathology; accordingly, their diagnosis rests on symptom-based criteria and a process of exclusion. Evidence is lacking on the appropriate use of abdominal imaging studies (AIS) in FGIDs. We investigated the utilisation of AIS (site, modality, diagnostic yield/significance) at a tertiary FGID clinic over an 11-year period. Of 1,621 patients, 507 (31 %; 67.5 % women, mean age 43.9 ± 17.37 years) referred from primary care had 997 AIS (1.7 per patient): ultrasonography (US) 36.1 %, fluoroscopy (FLS) 28.8 %, computed tomography (CT) 19.6 %, plain radiography (PR) 13.5 %, nuclear medicine (NM) 1 %. Of the 997 AIS, 55.6 % (554/997) were normal. Of the AIS with positive findings, 9.9 % (62/625) were deemed 'probably significant' and 14.7 % (92/625) 'significant'. Of the CT and FLS studies, 12.3 % and 13.6 %, respectively, yielded 'significant' abnormalities compared to 2.2 % of the US studies and 2.1 % of the PR studies. CT identified five of seven neoplasms, associated with male sex, increasing age and symptom onset after age 50 years. This study confirmed low use of AIS in tertiary FGID clinics and a high proportion of normal studies. Barium swallow/meal and CT were more likely to identify 'probably significant' or 'significant' findings, including neoplasms. (orig.)

  14. Clinical usefulness of 99mTc-EDDA/HYNIC-TOC scintigraphy in oncological diagnostics: a pilot study.

    Science.gov (United States)

    Plachcinska, Anna; Mikolajczak, Renata; Maecke, Helmut; Mlodkowska, Ewa; Kunert-Radek, Jolanta; Michalski, Andrzej; Rzeszutek, Katarzyna; Kozak, Jozek; Kusmierek, Jacek

    2004-04-01

    The clinical usefulness of a new 99mTc-labeled somatostatin analogue has been studied from the standpoint of oncological diagnostics. The group of patients studied included 40 individuals with diagnosed malignant neoplasms (32 primary and 8 metastatic). Among the primary tumors were 7 pituitary adenomas (5 hormonally active and 2 inactive), 1 liposarcoma, 2 carcinoids, 1 breast carcinoma, and 21 cases of lung cancer (2 small cell and 19 non-small cell) were represented. The metastatic tumors consisted of: 3 malignant melanomas, 1 pheochromocytoma, 1 prostatic cancer, 1 leiomyosarcoma, 1 pancreatic carcinoma ectopically secreting ACTH, and 1 carcinoid of the thymus. The radiopharmaceutical, 99mTc-EDDA/HYNIC-octreotide, was i.v. administered at the activity of 740-925 MBq. The imaging was comprized of a whole-body scan and single photon emission computed tomography. Positive scintigrams were obtained in 4 of 5 hormonally active pituitary adenomas, in 1 of 2 cases of carcinoid, in liposarcoma, breast cancer, and all cases of small cell (SCLC) and non-small cell lung cancer (NSCLC). The neoplastic metastases were visualized in 2 of 3 cases of melanoma and in patients with pheochromocytoma, pancreatic carcinoma secreting ACTH, and thymic carcinoid. Scintigrams were negative in both hormonally inactive pituitary adenomas, in one case of metastatic malignant melanoma, leiomyosarcoma, and in cases of metastasis from the prostatic carcinomas. The results of this pilot study indicated that 99mTc-EDDA/HYNIC-TOC is a potentially useful radiopharmaceutical for the imaging of a wide range of primary and metastatic tumors. More detailed indications for the clinical usefulness of the new tracer for the imaging of selected tumor types require studies on much larger groups of patients. Special attention should be paid to the successful imaging of all cases of NSCLC.

  15. Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

    Science.gov (United States)

    Nijman, Ruud G; Vergouwe, Yvonne; Thompson, Matthew; van Veen, Mirjam; van Meurs, Alfred H J; van der Lei, Johan; Steyerberg, Ewout W; Moll, Henriette A

    2013-01-01

    Objective To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Design Prospective observational diagnostic study. Setting Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom. Participants Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86). Conclusion A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections. PMID:23550046

  16. Advanced microarray technologies for clinical diagnostics

    NARCIS (Netherlands)

    Pierik, Anke

    2011-01-01

    DNA microarrays become increasingly important in the field of clinical diagnostics. These microarrays, also called DNA chips, are small solid substrates, typically having a maximum surface area of a few cm2, onto which many spots are arrayed in a pre-determined pattern. Each of these spots contains

  17. Multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.

    Science.gov (United States)

    Halligan, E; Edgeworth, J; Bisnauthsing, K; Bible, J; Cliff, P; Aarons, E; Klein, J; Patel, A; Goldenberg, S

    2014-08-01

    Laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. Tests are often requested sequentially and undertaken in different laboratories. This causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. A molecular multiplex test (Luminex(®) Gastrointestinal Pathogen Panel (GPP)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use of isolation facilities and user acceptability. A total of 262 (12%) patients had a pathogen detected by conventional methods compared with 483 (22.1%) by GPP. Most additional cases were detected in patients developing symptoms in the first 4 days of admission. Additional cases were detected because of presumed improved diagnostic sensitivity but also because clinicians had not requested the correct pathogen. Turnaround time (41.8 h) was faster than bacterial culture (66.5 h) and parasite investigation (66.5 h) but slower than conventional testing for Clostridium difficile (17.3 h) and viruses (27 h). The test could allow simplified requesting by clinicians and a consolidated laboratory workflow, reducing the overall number of specimens received by the laboratory. A total of 154 isolation days were saved at an estimated cost of £30 800. Consumables and labour were estimated at £150 641 compared with £63 431 for conventional testing. Multiplex molecular testing using a panel of targets allowed enhanced detection and a consolidated laboratory workflow. This is likely to be of greater benefit to cases that present within the first 4 days of hospital admission. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  18. Clinical and diagnostic aspects of lymphedema.

    Science.gov (United States)

    Keo, Hong H; Gretener, Silvia B; Staub, Daniel

    2017-07-01

    Lymphedema is a chronic, progressive, and common but often unrecognized condition. The diagnosis of lymphatic disease on clinical grounds alone remains a challenge. Without proper diagnosis, therapy is often delayed, allowing disease progression. There is a need for a practical diagnostic algorithm and its imaging technique to guide clinical decision-making. The aim of this topical review is to provide a practical approach for assessing patients with suspected lymphedema and to give a critical appraisal of currently available imaging modalities that are applied in clinical practice to diagnose and map lymphatic disease.

  19. Measures to Improve Diagnostic Safety in Clinical Practice.

    Science.gov (United States)

    Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

    2016-10-20

    Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  20. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Mallee, Wouter H.; Henny, Erik P.; van Dijk, C. Niek; Kamminga, Sjoerd P.; van Enst, Wynanda A.; Kloen, Peter

    2014-01-01

    To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies. PWe performed a systematic review of all studies assessing diagnostic characteristics of clinical evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane,

  1. A Comparative Study for Detection of EGFR Mutations in Plasma Cell-Free DNA in Korean Clinical Diagnostic Laboratories

    Directory of Open Access Journals (Sweden)

    Yoonjung Kim

    2018-01-01

    Full Text Available Liquid biopsies to genotype the epidermal growth factor receptor (EGFR for targeted therapy have been implemented in clinical decision-making in the field of lung cancer, but harmonization of detection methods is still scarce among clinical laboratories. We performed a pilot external quality assurance (EQA scheme to harmonize circulating tumor DNA testing among laboratories. For EQA, we created materials containing different levels of spiked cell-free DNA (cfDNA in normal plasma. The limit of detection (LOD of the cobas® EGFR Mutation Test v2 (Roche Molecular Systems was also evaluated. From November 2016 to June 2017, seven clinical diagnostic laboratories participated in the EQA program. The majority (98.94% of results obtained using the cobas assay and next-generation sequencing (NGS were acceptable. Quantitative results from the cobas assay were positively correlated with allele frequencies derived from digital droplet PCR measurements and showed good reproducibility among laboratories. The LOD of the cobas assay was 5~27 copies/mL for p.E746_A750del (exon 19 deletion, 35~70 copies/mL for p.L858R, 18~36 copies/mL for p.T790M, and 15~31 copies/mL for p.A767_V769dup (exon 20 insertion. Deep sequencing of materials (>100,000X depth of coverage resulted in detection of low-level targets present at frequencies of 0.06~0.13%. Our results indicate that the cobas assay is a reliable and rapid method for detecting EGFR mutations in plasma cfDNA. Careful interpretation is particularly important for p.T790M detection in the setting of relapse. Individual laboratories should optimize NGS performance to maximize clinical utility.

  2. Primary mammary tuberculosis: Clinical diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Sunder Goyal

    2015-09-01

    Conclusion: Breast Tuberculous is uncommon in countries where incidence of pulmonary and extrapulmonary tuberculosis is very high. It continues to pose a diagnostic challenge due to its rarity, atypical clinical features and non confirmatory radiological modalities. Unnecessary mastectomy can be avoided if we keep this rare but medically treatable condition on back of our mind. [Arch Clin Exp Surg 2015; 4(3.000: 153-156

  3. Williams-Beuren Syndrome: A Clinical Study of 55 Brazilian Patients and the Diagnostic Use of MLPA

    Directory of Open Access Journals (Sweden)

    Rachel Sayuri Honjo

    2015-01-01

    Full Text Available Williams-Beuren syndrome (WBS is a genetic disease caused by a microdeletion in the 7q11.23 region. It is characterized by congenital heart disease, mainly supravalvular aortic stenosis, mental retardation, mild short stature, facial dysmorphisms, and variable abnormalities in different systems. Objectives. To report the clinical findings of 55 Brazilian patients confirmed by multiplex ligation-dependent probe amplification (MLPA. Methods. Patients were followed up for 4 years at the Genetics Unit of the Instituto da Criança of the Hospital das Clínicas, FMUSP, Brazil. A kit specific for WBS was used to detect the 7q11.23 microdeletion. Results. Two patients with negative FISH results had positive MLPA results for WBS. The characteristics of the patients with the deletion were as follows: typical WBS facies (98.2%, neuropsychomotor delay (98.2%, hypersocial behavior (94.5%, hyperacusis (94.5%, and congenital heart disease (81.8%. Conclusions. MLPA was effective in detecting the microdeletion in the 7q11.23 region to confirm the diagnosis of WBS. MLPA was also able to confirm the diagnosis of WBS in two patients with typical clinical characteristics but negative FISH results. Thus, MLPA is a promising method in the diagnostic investigation of WBS. WBS is a multisystemic disorder and therefore requires multidisciplinary care and specific follow-up to prevent complications.

  4. Clinical X-ray diagnostics. v. 2

    International Nuclear Information System (INIS)

    Baudisch, E.; Becker, T.

    1981-01-01

    Principles of the general procedure in radiographic examination are the subject of the introduction. Following anatomico-clinical preliminary notes and suggestions concerning radiographic examination methods and proceeding from normal findings of the bones and from the general radiographic symptomatology of skeletal diseases, developmental disturbances, system diseases, radiogenic injuries, aseptic necroses, metabolic osteopathies, damages, inflammations and tumors as well as less frequently occuring diseases are discussed. Their pathology, clinic, diagnostics, diagnosis and differential diagnosis, their therapy and prognosis are dealt with from the clinico-radiographical point of view. The diseases of the joints of the radiographically demonstrable diseases of the soft parts of the limbs are also treated

  5. Current state of diagnostic and treatment of osteoporosis in real-life clinical practice (a pilot study

    Directory of Open Access Journals (Sweden)

    O.A. Nikitinskaya

    2014-01-01

    Full Text Available We report the results of a pilot study on physician awareness of modern diagnostic methods and drug therapy of osteoporosis (OP and the use of this knowledge in daily practice. A pilot survey among physicians demonstrated that experts (rheumatologists, endocrinologists, etc. have a high level of awareness of the OP problem and successfully use this knowledge in daily practice (modern diagnosis, prevention, and treatment methods. They widely prescribe original drugs and certain generics that were shown to be effective in post-marketing surveillance. Limitations of the study: 1 only physicians dealing with diagnosis and treatment of OP were surveyed; hence, the conclusions of this study are valid only for this group of physicians; 2 only physicians working in large cities who can use modern diagnosis methods (densitometry; determination of bone turnover markers participated in the study; 3 Prolia medication, which has been used in Russia since 2013, was not taken into account in the questionnaire. 

  6. Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

    NARCIS (Netherlands)

    Bossuyt, Patrick M. M.; Reitsma, Johannes B.; Linnet, Kristian; Moons, Karel G. M.

    2012-01-01

    Like any other medical technology or intervention, diagnostic tests should be thoroughly evaluated before their introduction into daily practice. Increasingly, decision makers, physicians, and other users of diagnostic tests request more than simple measures of a test's analytical or technical

  7. Clinical dosimetry in diagnostic and interventional radiology

    International Nuclear Information System (INIS)

    Dimcheva, M.; Sergieva, S.; Jovanovska, A.

    2012-01-01

    Full text: Introduction: Diagnostic and interventional procedures involving x-rays are the most significant contributor to total population dose form man made sources of ionizing radiation. Purpose and aim: X-ray imaging generally covers a diverse range of examination types, many of which are increasing in frequency and technical complexity. Materials and methods: The European Directives 96/29 and 97/43 EURATOM stress the importance of accurate dosimetry and require calibration of all measuring equipment related to application of ionizing radiation in medicine. Results: The paper gives and overview of current system of dosimetry of ionizing radiations that is relevant for metrology and clinical applications. It also reflects recently achieved international harmonization in the field promoted by International Atomic Energy Agency (IAEA). Discussion: Objectives of clinical dose measurements in diagnostic and interventional radiology are multiple, as assessment of equipment performance, or assessment of risk emerging from use of ionizing radiation Conclusion: Therefore, from the clinical point of view, the requirements for dosimeters and procedures to assess dose to standard dosimetry phantoms and patients in clinical diverse modalities, as computed tomography are presented

  8. THE PROBLEMS OF EARLY CLINICAL DEFECTOLOGICAL DIAGNOSTICS

    Directory of Open Access Journals (Sweden)

    Aleksandar CORDIC

    1997-06-01

    Full Text Available Clinical defectological diagnostics, related to diagnostics of each individual's impairment of his cognitive and socializing abilities, has been applied in our country for a long time. Since it is a new area in the clinical defectological work and a new form of research in defectology, it poses a series of problems which have not been met so far. We shall to recognize some of them in this paper and to aim at their solution.This time we shall consider only the most prominent problems towards which we direct our interventions:· When does defectological diagnostics take part in diagnosis as treatment of impairments of the handicapped person? When does it function in the process of rehabilitation? For example, is working with a dyslexic child treatment or rehabilitation?· When does the early diagnostics reveal a problem arising from inappropriate intersection of different development courses, which can sometimes be solved without any particular treatment (early stuttering, various convulsions, and when does it reveal actual condition, such as oligophrenia or autism. Thereby we ask ourselves if early stimulative treatment of oligophrenic children or children with early childhood psychosis is treatment or rehabilitation.We tried to classify end explain the problems of diagnostics in the context of treatment and rehabilitation and to define the theoretical grounds for our standpoints.We wanted to point out the unity of the process of any impairment of the handicapped person from early childhood to the end of his life. Treatment and rehabilitation should be a united process and follow the course of development of early disorders which sometimes end up as handicaps, and sometimes, thanks to the treatment, may end up in successful socialization, for example, persons with impaired hearing or sight.We establish defectology as a complete theoretical standpoint and expert procedure which is parallel to and complementary with medicine. The only difference we

  9. Diagnostic sensitivity and specificity in a retrospective clinical, radiographic and histopathological study of 166 cystic jaw lesions

    DEFF Research Database (Denmark)

    Therkildsen, N. M.; Andersen, Kristian; Blomlôf, J.

    2014-01-01

    , but a low diagnostic sensitivity in relation to the keratocystic odontogenic tumour (KCOT) was revealed. The radicular cyst, dentigerous cyst and KCOT were the most frequently observed cystic jaw lesions. Conclusion In general, a high diagnostic specificity for all cystic jaw lesions was observed. A low...

  10. A clinical study on diagnostic value of CT-myelography in herniated lumbar disc and related disorders

    International Nuclear Information System (INIS)

    Endo, Tohru

    1984-01-01

    In order to evaluate the diagnostic value of CT-myelography (CTM) in herniated lumbar disc and related disorders, myelography and CTM were performed on 60 patients with sciatic pain and the findings obtained were compared. Among these patients, operation was undertaken in 30 including 5 reoperated patients, and preoperative findings on CTM were compared with the grades of herniated disc observed at operation. On the basis of abnormal myelographic findings of 55 patients, excluding 5 reoperated patients, morphological changes of the CTM were classified into the following seven types; normal, anterior defect, lateral defect, antero-lateral defect, root defect or thinning, total defect, and anterior plus unilateral root defect or thinning. Agreetment between myelographic and CTM findings was found in 85.1% of the cases. While myelography permitted only an indefinite diagnosis of lumbar disc lesion, CTM permitted a define diagnosis in 8 intervertebral discs including 2 giving nomal results by CTM. In cases of reoperation, CTM provided usefull information for an analysis of the pathological changes included disc herniation, whereas myelography rarely provided usefull findings. A comparative study of CTM and surgical findings revealed that the morphological changes in CTM were closely related with the grades of herniated discs. Consequently, CTM may be performed after myelography. If findings by the two techniques are synthesized, the diagnostic rate of herniated lumbar disc and related disorders will be considerably improved. Furthermore, it is concluded that CTM is an important technique for observing bony and neural changes inside the spinal canal in the axial transverse plane. (author)

  11. Non-invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a management study

    NARCIS (Netherlands)

    ten Wolde, M.; Hagen, P. J.; Macgillavry, M. R.; Pollen, I. J.; Mairuhu, A. T. A.; Koopman, M. M. W.; Prins, M. H.; Hoekstra, O. S.; Brandjes, D. P. M.; Postmus, P. E.; Büller, H. R.

    2004-01-01

    Background: Clinicians often deviate from the recommended algorithm for the diagnosis of pulmonary embolism consisting of ventilation-perfusion scintigraphy and pulmonary angiography. Objectives: To assess the safety and feasibility of a diagnostic algorithm which reduces the need for lung

  12. [Advances of Molecular Diagnostic Techniques Application in Clinical Diagnosis.

    Science.gov (United States)

    Ying, Bin-Wu

    2016-11-01

    Over the past 20 years,clinical molecular diagnostic technology has made rapid development,and became the most promising field in clinical laboratory medicine.In particular,with the development of genomics,clinical molecular diagnostic methods will reveal the nature of clinical diseases in a deeper level,thus guiding the clinical diagnosis and treatments.Many molecular diagnostic projects have been routinely applied in clinical works.This paper reviews the advances on application of clinical diagnostic techniques in infectious disease,tumor and genetic disorders,including nucleic acid amplification,biochip,next-generation sequencing,and automation molecular system,and so on.

  13. [Magnetic resonance semiotics of prostate cancer according to the PI-RADS classification. The clinical diagnostic algorithm of a study].

    Science.gov (United States)

    Korobkin, A S; Shariya, M A; Chaban, A S; Voskanvan, G A; Vinarov, A Z

    2015-01-01

    to elaborate the magnetic resonance imaging (MRI) signs of prostate cancer (PC) in accordance with the PI-RADS classification during multiparametric MRI (mpMRI). A total of 89 men aged 20 to 82 years were examined. A control group consisted of 8 (9%) healthy volunteers younger than 30 years of age with no urological history to obtain control images and MRI plots and 20 (22.5%) men aged 26-76 years, whose morphological changes were inflammatory and hyperplastic. The second age-matched group included 61 (68.5%) patients diagnosed with prostate cancer at morphological examination. A set of studies included digital rectal examination, serum prostate-specific antigen, and transrectal ultrasound-guided prostate biopsy. All the patients underwent prostate mpMRI applying a 3.0 T Achieva MRI scanner (Philips, the Netherlands). The patients have been found to have mpMRI signs that were typical of PC; its MRI semiotics according to the PI-RADS classification is presented. Each mpMRI procedure has been determined to be of importance and informative value in detecting PC. The comprehensive mpMRI approach to diagnosing PC improves the quality and diagnostic value of prostate MRI.

  14. A field study evaluation of Petrifilm™ plates as a 24-h rapid diagnostic test for clinical mastitis on a dairy farm.

    Science.gov (United States)

    Mansion-de Vries, Elisabeth Maria; Knorr, Nicole; Paduch, Jan-Hendrik; Zinke, Claudia; Hoedemaker, Martina; Krömker, Volker

    2014-03-01

    Clinical mastitis is one of the most common and expensive diseases of dairy cattle. To make an informed treatment decision, it is important to know the causative pathogen. However, no detection of bacterial growth can be made in approximately 30% of all clinical cases of mastitis. Before selecting the treatment regimen, it is important to know whether the mastitis-causing pathogen (MCP) is Gram-positive or Gram-negative. The aim of this field study was to investigate whether using two 3M Petrifilm™ products on-farm (which conveys a higher degree of sample freshness but also bears a higher risk for contamination than working in a lab) as 24-h rapid diagnostic of clinical mastitis achieved results that were comparable to the conventional microbiological diagnostic method. AerobicCount (AC)-Petrifilm™ and ColiformCount (CC)-Petrifilm™ were used to identify the total bacterial counts and Gram-negative bacteria in samples from clinical mastitis cases, respectively. Missing growth on both plates was classified as no bacterial detection. Growth only on the AC-Petrifilm™ was assessed as Gram-positive, and growth on both Petrifilm™ plates was assessed as Gram-negative bacterial growth. Additionally, milk samples were analysed by conventional microbiological diagnostic method on aesculin blood agar as a reference method. Overall, 616 samples from clinical mastitis cases were analysed. Using the reference method, Gram-positive and Gram-negative bacteria, mixed bacterial growth, contaminated samples and yeast were determined in 32.6%, 20.0%, 2.5%, 14.1% and 1.1% of the samples, respectively. In 29.7% of the samples, microbiological growth could not be identified. Using the Petrifilm™ concept, bacterial growth was detected in 59% of the culture-negative samples. The sensitivity of the Petrifilm™ for Gram-positive and Gram-negative MCP was 85.2% and 89.9%, respectively. The specificity was 75.4% for Gram-positive and 88.4% for Gram-negative MCP. For the culture

  15. Clinical Studies

    DEFF Research Database (Denmark)

    Pallesen, Ulla

    universities and practicing dentists restore millions of teeth throughout the World with composite resin materials. Do we know enough about the clinical performance of these restorations over time? Numerous in vitro studies are being published on resin materials and adhesion, some of them attempting to imitate...... in vivo conditions. But real life is different and in vitro studies cannot include all variables. Only clinical studies can provide valid information on the clinical performance of restorations over time. What do we know about longevity of posterior resin restorations? What are the reasons for replacement...... and results from own up to 30-year prospective clinical university studies and practice based studies from Public Dental Health Service on the clinical performance of posterior composite resin restorations....

  16. Clinical usefulness of a biomarker-based diagnostic test for acute stroke: the Biomarker Rapid Assessment in Ischemic Injury (BRAIN) study.

    Science.gov (United States)

    Laskowitz, Daniel T; Kasner, Scott E; Saver, Jeffrey; Remmel, Kerri S; Jauch, Edward C

    2009-01-01

    One of the significant limitations in the evaluation and management of patients with suspected acute cerebral ischemia is the absence of a widely available, rapid, and sensitive diagnostic test. The objective of the current study was to assess whether a test using a panel of biomarkers might provide useful diagnostic information in the early evaluation of stroke by differentiating patients with cerebral ischemia from other causes of acute neurological deficit. A total of 1146 patients presenting with neurological symptoms consistent with possible stroke were prospectively enrolled at 17 different sites. Timed blood samples were assayed for matrix metalloproteinase 9, brain natriuretic factor, d-dimer, and protein S100beta. A separate cohort of 343 patients was independently enrolled to validate the multiple biomarker model approach. A diagnostic tool incorporating the values of matrix metalloproteinase 9, brain natriuretic factor, d-dimer, and S-100beta into a composite score was sensitive for acute cerebral ischemia. The multivariate model demonstrated modest discriminative capabilities with an area under the receiver operating characteristic curve of 0.76 for hemorrhagic stroke and 0.69 for all stroke (likelihood test P<0.001). When the threshold for the logistic model was set at the first quartile, this resulted in a sensitivity of 86% for detecting all stroke and a sensitivity of 94% for detecting hemorrhagic stroke. Moreover, results were reproducible in a separate cohort tested on a point-of-care platform. These results suggest that a biomarker panel may add valuable and time-sensitive diagnostic information in the early evaluation of stroke. Such an approach is feasible on a point-of-care platform. The rapid identification of patients with suspected stroke would expand the availability of time-limited treatment strategies. Although the diagnostic accuracy of the current panel is clearly imperfect, this study demonstrates the feasibility of incorporating a

  17. Diagnostic value of MRI for nerve root compression due to lumbar canal stenosis. Clinical and anatomic study

    International Nuclear Information System (INIS)

    Seki, Michihiro; Kikuchi, Shinichi; Kageyama, Kazuhiro; Katakura, Toshihiko; Suzuki, Kenji

    1995-01-01

    Magnetic resonance imaging (MRI) was undertaken in 26 patients with surgically proven nerve root compression due to lumbar canal stenosis. The findings on coronary images were compared with those of selective radiculography to assess the diagnostic ability of MRI to determine the site of nerve root compression. Intermission and partial defect, which reflect nerve root compression, were seen in only 5 (19.2%) of 26 nerve roots on MRI, as compared with 20 (76.9%) on radiculography. Thus MRI alone was difficult to diagnose nerve root compression due to lumbar canal stenosis. Furthermore, the optimum angle of coronary views was determined in 13 cadavers. Para-sagittal views were found to be optimal for the observation of the whole running of the nerve root. Three-dimensional MRI was found to have a potential to diagnose nerve root compression in the intervertebral foramen and the distal part of the intervertebral foramen. (N.K.)

  18. Infectious myocarditis (Clinic, diagnostics, principles of treatment

    Directory of Open Access Journals (Sweden)

    Yu. P. Finogeev

    2016-01-01

    Full Text Available Infective myocarditis can be considered as a case of myocardial damage caused by different infectious agents. Traditionally discusses the questions of diagnostics and treatment infectious myocarditis. The paper has repeatedly stressed the difficulty of clinical diagnosis, and the laboriousness and economic costs of laboratory tests and additional researches. Endomyocardial biopsy findings remain the gold standard for unequivocally establishing the diagnosis. However, it is technically extremely invasive test and can be performed only in specialized cardiology centers. The paper analyzes in detail not only own materials, but also results of researches published in numerous domestic and foreign sources of literature. Publication of «Infectious myocarditis» is necessary due to the fact that patients with a diagnosis of «Myocarditis » account for 11% of all cardiovascular disease in the world. Article is timely and necessary for many professionals, senior students of medical universities.

  19. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-Part II. general guidance and tips

    International Nuclear Information System (INIS)

    Kim, Kyung Won; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho; Lee, June Young

    2015-01-01

    Meta-analysis of diagnostic test accuracy studies differs from the usual meta-analysis of therapeutic/interventional studies in that, it is required to simultaneously analyze a pair of two outcome measures such as sensitivity and specificity, instead of a single outcome. Since sensitivity and specificity are generally inversely correlated and could be affected by a threshold effect, more sophisticated statistical methods are required for the meta-analysis of diagnostic test accuracy. Hierarchical models including the bivariate model and the hierarchical summary receiver operating characteristic model are increasingly being accepted as standard methods for meta-analysis of diagnostic test accuracy studies. We provide a conceptual review of statistical methods currently used and recommended for meta-analysis of diagnostic test accuracy studies. This article could serve as a methodological reference for those who perform systematic review and meta-analysis of diagnostic test accuracy studies

  20. Skeletal diseases. Diagnostic clinical radiology and differential diagnostics. 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Freyschmidt, J.

    1997-01-01

    The book focuses on the diagnostic evaluation of idiopathic diseases of the skeleton and bone joints, also including the fundamental healing processes of bone fractures, particularly of stress-induced and pathologic fractures. Ample space has been given to the description and imaging of the course of diseases under treatment by up-to-date therapies, as e.g. for ostitis deformans Paget's disease, or skeletal metastases. This second edition of the book incorporates the progress achieved over the last five years in skeletal diagnostics. The advances in this field have been resulting from basic research work, for instance in molecular biology, or from a variety of completed studies relating to clinical medicine, laboratory chemistry, histopathology and radiology of skeletal diseases, and from experience obtained with the diagnostic radiology methods and techniques, with the potentials and constraints of magnetic resonance imaging (MRI) today being more critically assessed than five years ago. MRI is a modality currently meeting with interest in the context of search for additional diagnostic information, new definition of complete pictures of diseases, or false or overinterpretation of diagnostic findings. (orig./MG). 431 figs [de

  1. Clinical application of S-Detect to breast masses on ultrasonography: A study evaluating the diagnostic performance and agreement with a dedicated breast radiologist

    International Nuclear Information System (INIS)

    Kim, Ki Wook; Kim, Eun Kyung; Yoon, Jung Hyun; Song, Mi Kyung

    2017-01-01

    The purpose of this study was to evaluate the diagnostic performance of S-Detect when applied to breast ultrasonography (US), and the agreement with an experienced radiologist specializing in breast imaging. From June to August 2015, 192 breast masses in 175 women were included. US features of the breast masses were retrospectively analyzed by a radiologist who specializes in breast imaging and S-Detect, according to the fourth edition of the American College of Radiology Breast Imaging Reporting and Data System lexicon and final assessment categories. Final assessments from S-Detect were in dichotomized form: possibly benign and possibly malignant. Kappa statistics were used to analyze the agreement between the radiologist and S-Detect. Diagnostic performance of the radiologist and S-Detect was calculated, including sensitivity, specificity, positive predictive value (PPV), negative predictive value, accuracy, and area under the receiving operator characteristics curve. Of the 192 breast masses, 72 (37.5%) were malignant, and 120 (62.5%) were benign. Benign masses among category 4a had higher rates of possibly benign assessment on S-Detect for the radiologist, 63.5% to 36.5%, respectively (P=0.797). When the cutoff was set at category 4a, the specificity, PPV, and accuracy was significantly higher in S-Detect compared to the radiologist (all P<0.05), with a higher area under the receiver operator characteristics curve of 0.725 compared to 0.653 (P=0.038). Moderate agreement (k=0.58) was seen in the final assessment between the radiologist and S-Detect. S-Detect may be used as an additional diagnostic tool to improve the specificity of breast US in clinical practice, and guide in decision making for breast masses detected on US

  2. Clinical and Diagnostic Aspects of Diabetic Ketoacidosis

    Directory of Open Access Journals (Sweden)

    Z.P. Nizhynska-Аstapenko

    2016-05-01

    Full Text Available Background. Leading criteria for laboratory diagnosis and determination of diabetic ketoacidosis severity are considered to be the levels of glucose, blood pH and blood bicarbonate. Technological capabilities of a family doctor are very limited. Therefore, knowledge of detailed clinical symptoms will help the physician to establish correctly a provisional diagnosis and refer a patient to a specialized institution. The aim of our study was to determine the prevalence and special features of certain clinical symptoms and basic laboratory parameters in order to establish the severity level of diabetic ketoacidosis (DKA and to reveal certain correlation between clinical symptoms and laboratory changes in the blood in patients with DKA. Materials and methods. The study involved 123 patients with acute critical decompensated diabetes aged from 9 to 65 years old. We studied the clinical symptoms, measured biochemical changes in blood, blood gas and acid-base state. Results. There was not determined the correlation between severity of diabetic ketoacidosis and clinical parameters and acid-base balance in patients. There were determined the peculiarities electrolyte changes and the emergence gas metabolic changes on the cell level under ketosis, which further deepened with the development of ketoacidosis. The results of the study indicate the need for a comparison of clinical symptoms and laboratory parameters of pathogenic treatment, taking into account the cumulative data. These recommendations in the protocols are often attached to a single laboratory value and can not always fully comply with the severity of the condition. Conclusions. Blood gas is the most sensitive criterion of metabolic changes in case of diabetic ketoacidosis. The level of blood potassium can be used as an indicator of DKA severity. The level of blood potassium at admission to hospital does not really reflect its deficiency in the tissues.

  3. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis).

    Science.gov (United States)

    Grumet, Pierre; Kodjikian, Laurent; de Parisot, Audrey; Errera, Marie-Hélène; Sedira, Neila; Heron, Emmanuel; Pérard, Laurent; Cornut, Pierre-Loïc; Schneider, Christelle; Rivière, Sophie; Ollé, Priscille; Pugnet, Grégory; Cathébras, Pascal; Manoli, Pierre; Bodaghi, Bahram; Saadoun, David; Baillif, Stéphanie; Tieulie, Nathalie; Andre, Marc; Chiambaretta, Frédéric; Bonin, Nicolas; Bielefeld, Philip; Bron, Alain; Mouriaux, Frédéric; Bienvenu, Boris; Vicente, Stéphanie; Bin, Sylvie; Labetoulle, Marc; Broussolle, Christiane; Jamilloux, Yvan; Decullier, Evelyne; Sève, Pascal

    2018-04-01

    ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance. ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not. Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon® (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery

  4. MDS clinical diagnostic criteria for Parkinson's disease in China.

    Science.gov (United States)

    Li, Jun; Jin, Miao; Wang, Li; Qin, Bin; Wang, Kang

    2017-03-01

    The Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (MDS-PD Criteria) was introduced by the Movement Disorder Society in 2015 for research purposes. However, its use for clinical diagnosis of Parkinson disease still needs further revision. This study compares the UK-Criteria versus MDS-PD Criteria in the clinical diagnosis of Parkinson disease referred to the China-Japan Friendship Hospital of Beijing, China. To compare the MDS-PD Criteria with the UK-Criteria and discuss the feasibility of the clinical application of MDS-PD Criteria as a general guide to clinical diagnosis of PD in Chinese PD patients. 150 patients of neurology clinic of China-Japan Friendship Hospital of Beijing were recruited in our research. They were divided into three groups: UK-Criteria group, MDS-PD Criteria group and a combined group of UK and MDS-PD Criteria. Clinical history was collected while physical and auxiliary examinations were done by a trained neurologist according to the corresponding criteria. An interrater reliability analysis using the Kappa statistic claimed substantial agreement (κ = 0.626) between the MDS-PD Criteria and the UK-Criteria. The differences between the diagnostic results of these two criteria were statistically significant by paired Chi-square test (p = 0.000). It was found that levodopa-induced dyskinesia had a good positive predictive value, while early bulbar impairment and inspiratory dysfunction presented a negative predictive value. The MDS-PD Criteria emphasize the importance of non-motor symptoms, keeping the motor symptoms as the core for the clinical diagnosis of PD, and establish categories of diagnosis features and levels of certainty which are more complete and organized to be used and replicated by non specialized physicians to evaluated patients with Parkinsonism. The higher sensitivity of MDS-PD Criteria compared with UK-Criteria is worth being widely used in clinical work.

  5. Diagnostic accuracy of age and alarm symptoms for upper GI malignancy in patients with dyspepsia in a GI clinic: a 7-year cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Hooman Khademi

    Full Text Available OBJECTIVES: We investigated whether using demographic characteristics and alarm symptoms can accurately predict cancer in patients with dyspepsia in Iran, where upper GI cancers and H. pylori infection are common. METHODS: All consecutive patients referred to a tertiary gastroenterology clinic in Tehran, Iran, from 2002 to 2009 were invited to participate in this study. Each patient completed a standard questionnaire and underwent upper gastrointestinal endoscopy. Alarm symptoms included in the questionnaire were weight loss, dysphagia, GI bleeding, and persistent vomiting. We used logistic regression models to estimate the diagnostic value of each variable in combination with other ones, and to develop a risk-prediction model. RESULTS: A total of 2,847 patients with dyspepsia participated in this study, of whom 87 (3.1% had upper GI malignancy. Patients reporting at least one of the alarm symptoms constituted 66.7% of cancer patients compared to 38.9% in patients without cancer (p<0.001. Esophageal or gastric cancers in patients with dyspepsia was associated with older age, being male, and symptoms of weight loss and vomiting. Each single predictor had low sensitivity and specificity. Using a combination of age, alarm symptoms, and smoking, we built a risk-prediction model that distinguished between high-risk and low-risk individuals with an area under the ROC curve of 0.85 and acceptable calibration. CONCLUSIONS: None of the predictors demonstrated high diagnostic accuracy. While our risk-prediction model had reasonable accuracy, some cancer cases would have remained undiagnosed. Therefore, where available, low cost endoscopy may be preferable for dyspeptic older patient or those with history of weight loss.

  6. The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study.

    LENUS (Irish Health Repository)

    Breen, Micheal

    2014-07-25

    The term functional gastrointestinal disorders (FGID) describes various aggregations of chronic gastrointestinal (GI) symptoms not explained by identifiable organic pathology; accordingly, their diagnosis rests on symptom-based criteria and a process of exclusion. Evidence is lacking on the appropriate use of abdominal imaging studies (AIS) in FGIDs.

  7. BRIEF REPORT: Beyond Clinical Experience: Features of Data Collection and Interpretation That Contribute to Diagnostic Accuracy

    Science.gov (United States)

    Nendaz, Mathieu R; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Blondon-Choa, Katherine; Herrmann, François R; Junod, Alain F; Vu, Nu V

    2006-01-01

    BACKGROUND Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success. PMID:17105525

  8. MR-based cerebral blood volume maps as a diagnostic tool of stroke: results of a clinical pilot study

    International Nuclear Information System (INIS)

    Hacklaender, T.; Hofer, M.; Binkofski, F.; Reichenbach, J.; Moedder, U.

    1996-01-01

    In this study the sensitivity of proving a stroke using regional cerebral blood volume (rCBV) maps were investigated. Another aim was to evaluate the strength of the ischaemia. Seven patients were examined during the acute phase of a stroke, eight during the subacute or chronically stage. To calculate rCBV-maps of one slice low dosed Gd-DTPA was injected as a bolus. Using the relaxation-effect the obtained signal intensity-time curves were converted pixel-wise to rCBV images. For the region of the infarction rCBV ratios were calculated relative to the corresponding area in the contralateral hemisphere. Only 63% of the investigations carried out during the acute phase were utilizable. In all those cases a decrease of rCBV was found. The infarct area could only be visually recognized if the rCBV ratio was lower than 0.7. The ratios of completely and partical necrotic areas of the infarctions were 0.481 and 1.028 respectively. With a p=0.0015 these values are even statistically different. During the acute stage the sensitivity of the rCBV measurement was not as high as that of morphological MR imaging. However, rCBV maps make it possible to estimate the strength of the ischaemia even during the first hours. (orig./MG) [de

  9. Clinical confrontation results of diagnostics and treatment of skin cancer

    International Nuclear Information System (INIS)

    Zikiryakhodjaev, D.Z.; Sanginov, D.R.

    2001-01-01

    In this chapter of book authors investigated the clinical confrontation results of diagnostics and treatment of skin cancer. They noted that diagnostic of skin cancer have to foresee the determination morphologic implements and degree of malignancy tumorous process why in general depend prognosis of illness

  10. Prevalence and Clinical Correlates of Sarcopenia, Identified According to the EWGSOP Definition and Diagnostic Algorithm, in Hospitalized Older People: The GLISTEN Study.

    Science.gov (United States)

    Bianchi, Lara; Abete, Pasquale; Bellelli, Giuseppe; Bo, Mario; Cherubini, Antonio; Corica, Francesco; Di Bari, Mauro; Maggio, Marcello; Manca, Giovanna Maria; Rizzo, Maria Rosaria; Rossi, Andrea P; Landi, Francesco; Volpato, Stefano

    2017-10-12

    Prevalence of sarcopenia is substantial in most geriatrics settings, but estimates vary greatly across studies because of difference in population characteristics, diagnostic criteria, and methods used to assess muscle mass, muscle strength, and physical performance. We investigated the feasibility of the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm assessment in hospitalized older adults and analyzed prevalence and clinical correlates of sarcopenia. Cross-sectional analysis of 655 participants enrolled in a multicenter observational study of older adults admitted to 12 acute hospital wards in Italy. Sarcopenia was assessed as low skeletal mass index (kg/m2) plus either low handgrip strength or low walking speed (EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Of the 655 patients (age 81.0 ± 6.8 years; women 51.9%) enrolled in the study, 275 (40.2%) were not able to perform the 4-m walking test because of medical problems. The overall prevalence of sarcopenia on hospital admission was 34.7% (95% confidence interval 28-37) and it steeply increased with aging (p sarcopenia on hospital admission were older and were more likely to be male and to have congestive heart failure, cerebrovascular disease, and severe basic activities of daily living disability. The prevalence of sarcopenia was inversely correlated with body mass index. Based on EWGSOP criteria, prevalence of sarcopenia is extremely high among older adults on admission to acute hospital wards. Older age, male gender, congestive heart failure, cerebrovascular disease, severe activities of daily living disability, and body mass index were the clinical variables significantly associated with the presence of sarcopenia. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Clinical and diagnostic importance of proteinuria: A review | Oni ...

    African Journals Online (AJOL)

    Clinical and diagnostic importance of proteinuria: A review. ... shown that diabetis mellitus, cardiovascular disease and hypertension could provoke secondary ... Proteinuria is also significant in some non-pathological cases such as pregnancy

  12. Diagnostic utility of clinical and biochemical parameters in ...

    African Journals Online (AJOL)

    Diagnostic utility of clinical and biochemical parameters in pancreatic head malignancy ... Department of Surgery, Sir Run Run Shaw Hospital College of Medicine, Zhejiang University, ..... technical review on the epidemiology, diagnosis, and.

  13. THE DIAGNOSTIC VALUE OF CLINICAL EXAMINATION AND ULTRASOUND STUDY OF ENTHESES FOR EARLY DETECTION OF PSORIATIC AND RHEUMATOID ARTHRITIS: REMARC STUDY

    Directory of Open Access Journals (Sweden)

    Tatiana Viktorovna Korotaeva

    2013-01-01

    Full Text Available The diagnosis of enthesitis can help in differentiating early psoriatic arthritis (ePsA from early rheumatoid arthritis (eRA.Objective. To estimate the diagnostic value of detecting enthesitis during clinical examination and ultrasound in ePsA and eRA.Subjects and methods. The trial included 36 patients with ePsA and 33 with eRA. Entheses were evaluated using the Leeds Enthesitis Index (LEI: lateral humeral epicondyle and medial femoral condyle (MFC, Achilles tendon insertion site (ATAP, and plantar fascia (PF point on the right and on the left. Enthesitis (on ultrasound presented with thickening, reduced echo density, and vascularization at Doppler energy imaging. DAS, DAS28, SDAI, CDAI, M±SD, Me [25th, 75th percentile], t-test, Fisher's exact test, χ2test, U test, and Spearman correlation coefficients (R were calculated; the value p < 0.05 was considered statistically significant.Results. Clinical examination revealed enthesitis in 41.6% of the patients with ePsA and in 39.4% of those with eRA (p >0.05. No significant differences were found between ePsA and eRA according to LEI (0.5 [0; 2] and 1 [0; 2] and to LEI+PF (1 [0; 2] and 1 [0; 2], respectively. Enthesitis of MFC and PF was significantly more frequently detected in ePsA than in eRA – 12 (33.3%/2 (6.1% and 10 (27.8%/2 (6.1% patients, respectively. In eRA versus ePsA, enthesitis of MFC was more frequently found (16 (48.4% and 8 (22.2% patients, respectively. Ultrasound revealed no significant differences between the groups in enthesitis. In ePsA, there was a significant correlation between DAS, DAS28, SDAI, CDAI, LEI, and LEI+PF.Conclusion. Enthesis ultrasound cannot differentiate ePsA from eRA. Clinical examination more frequently detects enthesitis in the knee joints in eRA and in the calcaneal region in ePsA.

  14. Clinical communication in diagnostic imaging studies: mixed-method study of pre- and post-implementation of a hospital information system.

    Science.gov (United States)

    Pirnejad, H; Niazkhani, Z; Bal, R

    2013-01-01

    To examine how and why the quality of clinical communication between radiologists and referring physicians was changed in the inpatient imaging process after implementation of a hospital information system (HIS). A mixed-method study of the chest X-ray (CXR) requests and reports, and their involved processes within a pre- and post-HIS implementation setting. Documentation of patient age, patient ward, and name and signature of requesting physician decreased significantly in post-HIS CXR requests (Pcommunication loop between physicians and radiologists after the implementation resulted in extra steps in the workflow and more workload for them. To cope with the new workload, they adopted different workarounds that could explain the results seen in the quantitative study. The HIS improved communication of administrative and identification information but did not improve communication of clinically relevant information. The reason was traced to the complications that the inappropriate implementation of the system brought to clinical workflow and communication loop.

  15. Problems of early clinical diagnostics of pseudoexfoliation syndrome

    Directory of Open Access Journals (Sweden)

    A. Yu. Brezhnev

    2012-01-01

    Full Text Available Purpose: to study the informativeness of pseudoexfoliation syndrome (PES signs for early diagnosis improvement.Methods: 250 patients with PES were included in the study. Exclusion criteria consisted of aphakia, pseudophakia, previous eye surgery and diseases which can complicate PES diagnostics (uveitis, corneal pathology, ocular injury etc.. Each patient underwent complete ophthalmic examination, including slit-lamp examination under mydriasis, gonioscopy. Confocal microscopy was used as an additional diagnostic method in several patients (Confoscan-4, Nidek.Results: Pseudoexfoliation material was found at the pupillary margin in 64.8% of patients, and on the lens capsule (central disc in 71% of the test subjects. Peripheral depositions were present in almost all PES patients under mydriasis. Pupil dilation has been allowed to establish the diagnosis of PES additionally in 16% of patients. At the «mini-PES»-stage PES material was most frequently found in the superior-nasal quadrant of lens capsule (85.6%. Clinical asymmetry of several signs (pupil diameter, anterior chamber angle pigmentation, IOP level should be taken into consideration in early PES diagnostics.Conclusion: Examination under mydriasis and knowledge of PES micro-signs in some cases has been allowed to suspect PESeven at the preclinical stage.

  16. [Tinnitus: algorithm of diagnostics and clinical management].

    Science.gov (United States)

    Boiko, N V

    Hearing of sound, or tinnitus, can be a symptom of different diseases. The differential diagnosis should be based on the identification of subgroups with confirmed causes of the disease. Subjective and objective tinnitus groups should be isolated. Objective tinnitus can be vascular or muscular. In making a diagnosis of tinnitus, it is important to know its characteristics, laterality, circumstances of onset, duration, comorbidity with other symptoms: headache, hearing decline, dizziness, depression, etc. Urgent diagnostic and treatment measures are needed after the identification of 'red flags': acute pulsatile tinnitus, in particular after the brain injury, combination of tinnitus with acute hearing loss and depression.

  17. Angiomatous nasal polyp: Clinical diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Sunder Goyal

    2015-03-01

    Full Text Available Angiomatous polyp (Angiectatic nasal polyps is rare and its incidence is 4-5% of all nasal polyps. As it occurs with variable clinical features and there is no confirmatory preoperative investigation, clinical diagnosis can be a dilemma. Clinical picture of angiofibroma, simple antrochoanal polyp and inverted papilloma may resemble with each other. As polyps invade surrounding bone, these should be distinguished from a malignant mass. We present an interesting case of an infarcted angiectatic nasal polyp with extensive surrounding bony destruction. Correct preoperative radiological diagnosis is important to avoid unnecessary extensive surgery. Histopathological evaluation of polyps is mandatory since they require different treatment due to difference in the prognosis.

  18. Diagnostic accuracy of clinical dehydration scales in children.

    Science.gov (United States)

    Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

    2017-08-01

    The aim of this study was to evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the World Health Organization (WHO) scale, and the Gorelick scale for dehydration assessment in children. A prospective, observational study was carried out between October 2014 and December 2016. Eligible participants were children aged 1 month to 5 years with acute diarrhea. After hospital admission, each patient's weight was recorded and the degree of dehydration based on three scales was assessed. The reference standard was the percentage weight change between the discharge and admission weights. The main outcomes were the sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Of 128 children enrolled in the study, complete data were available from 118 patients for analysis. Most of children presented with no or mild dehydration. Only the CDS showed limited value in confirming a diagnosis of dehydration ≥6% (positive LR 3.9, 95% CI 1.1 to 9.1), with no value in ruling it out (negative LR 0.6, 95% CI 0.2 to 0.99). In our cohort, the CDS was of limited diagnostic value in ruling in severe dehydration in children with acute gastroenteritis. The WHO and Gorelick scales were not helpful in the assessment of dehydration. What is Known : • Treatment of acute gastroenteritis (AGE) is based on assessing and correcting the degree of dehydration. • Several scales combining various signs and symptoms have been developed, including the Clinical Dehydration Scale (CDS), and the World Health Organization (WHO) scale, and the Gorelick scale. None of these scales is internationally accepted for best accuracy in diagnosing dehydration in children. What is New: • The CDS was of limited diagnostic value in ruling in severe dehydration in children with AGE. • The WHO and Gorelick scales were not helpful in the assessment of dehydration.

  19. Diagnostic colonoscopy: performance measurement study.

    Science.gov (United States)

    Kuznets, Naomi

    2002-07-01

    This is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profit quality improvement subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC) (Performance Measurement Initiative, 1999a, 1999b, 2000a, 2000b). The IQI was created to offer clinical performance measurement and improvement opportunities to ambulatory health care organizations and others interested in quality patient care. The purpose of the study was to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure and use this information for clinical quality improvement. This article provides performance measurement information on how organizations that have demonstrated and validated differences in clinical practice can have similar outcomes, but at a dramatically lower cost. The intent of the article is to provide organizations with alternatives in practice to provide a better value to their patients.

  20. Application of Next-generation Sequencing in Clinical Molecular Diagnostics

    Directory of Open Access Journals (Sweden)

    Morteza Seifi

    2017-05-01

    Full Text Available ABSTRACT Next-generation sequencing (NGS is the catch all terms that used to explain several different modern sequencing technologies which let us to sequence nucleic acids much more rapidly and cheaply than the formerly used Sanger sequencing, and as such have revolutionized the study of molecular biology and genomics with excellent resolution and accuracy. Over the past years, many academic companies and institutions have continued technological advances to expand NGS applications from research to the clinic. In this review, the performance and technical features of current NGS platforms were described. Furthermore, advances in the applying of NGS technologies towards the progress of clinical molecular diagnostics were emphasized. General advantages and disadvantages of each sequencing system are summarized and compared to guide the selection of NGS platforms for specific research aims.

  1. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann

    2012-01-01

    -specificity) were calculated for each diagnostic strategy. RESULTS: Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold......OBJECTIVES: In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions...... and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1...

  2. Proposed Diagnostic Criteria for the DSM-5 of Nonsuicidal Self-Injury in Female Adolescents: Diagnostic and Clinical Correlates

    Directory of Open Access Journals (Sweden)

    Tina In-Albon

    2013-01-01

    Full Text Available Nonsuicidal self-injury (NSSI is included as conditions for further study in the DSM-5. Therefore, it is necessary to investigate the proposed diagnostic criteria and the diagnostic and clinical correlates for the validity of a diagnostic entity. The authors investigated the characteristics of NSSI disorder and the proposed diagnostic criteria. A sample of 73 female inpatient adolescents and 37 nonclinical adolescents (aged 13 to 19 years was recruited. Patients were classified into 4 groups (adolescents with NSSI disorder, adolescents with NSSI without impairment/distress, clinical controls without NSSI, and nonclinical controls. Adolescents were compared on self-reported psychopathology and diagnostic cooccurrences. Results indicate that adolescents with NSSI disorder have a higher level of impairment than adolescents with other mental disorders without NSSI. Most common comorbid diagnoses were major depression, social phobia, and PTSD. There was some overlap of adolescents with NSSI disorder and suicidal behaviour and borderline personality disorder, but there were also important differences. Results further suggest that the proposed DSM-5 diagnostic criteria for NSSI are useful and necessary. In conclusion, NSSI is a highly impairing disorder characterized by high comorbidity with various disorders, providing further evidence that NSSI should be a distinct diagnostic entity.

  3. Constructing diagnostic likelihood: clinical decisions using subjective versus statistical probability.

    Science.gov (United States)

    Kinnear, John; Jackson, Ruth

    2017-07-01

    Although physicians are highly trained in the application of evidence-based medicine, and are assumed to make rational decisions, there is evidence that their decision making is prone to biases. One of the biases that has been shown to affect accuracy of judgements is that of representativeness and base-rate neglect, where the saliency of a person's features leads to overestimation of their likelihood of belonging to a group. This results in the substitution of 'subjective' probability for statistical probability. This study examines clinicians' propensity to make estimations of subjective probability when presented with clinical information that is considered typical of a medical condition. The strength of the representativeness bias is tested by presenting choices in textual and graphic form. Understanding of statistical probability is also tested by omitting all clinical information. For the questions that included clinical information, 46.7% and 45.5% of clinicians made judgements of statistical probability, respectively. Where the question omitted clinical information, 79.9% of clinicians made a judgement consistent with statistical probability. There was a statistically significant difference in responses to the questions with and without representativeness information (χ2 (1, n=254)=54.45, pprobability. One of the causes for this representativeness bias may be the way clinical medicine is taught where stereotypic presentations are emphasised in diagnostic decision making. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Vibrational spectroscopy: a clinical tool for cancer diagnostics.

    Science.gov (United States)

    Kendall, Catherine; Isabelle, Martin; Bazant-Hegemark, Florian; Hutchings, Joanne; Orr, Linda; Babrah, Jaspreet; Baker, Rebecca; Stone, Nicholas

    2009-06-01

    Vibrational spectroscopy techniques have demonstrated potential to provide non-destructive, rapid, clinically relevant diagnostic information. Early detection is the most important factor in the prevention of cancer. Raman and infrared spectroscopy enable the biochemical signatures from biological tissues to be extracted and analysed. In conjunction with advanced chemometrics such measurements can contribute to the diagnostic assessment of biological material. This paper also illustrates the complementary advantage of using Raman and FTIR spectroscopy technologies together. Clinical requirements are increasingly met by technological developments which show promise to become a clinical reality. This review summarises recent advances in vibrational spectroscopy and their impact on the diagnosis of cancer.

  5. Circulating tumor cell isolation and diagnostics: toward routine clinical use

    NARCIS (Netherlands)

    Stolpe, van de A.; Pantel, K.; Sleijfer, S.; Terstappen, L.W.; Toonder, den J.M.J.

    2011-01-01

    From February 7–11, 2011, the multidisciplinary Lorentz Workshop Circulating Tumor Cell (CTC) Isolation and Diagnostics: Toward Routine Clinical Use was held in Leiden (The Netherlands) to discuss progress and define challenges and potential solutions for development of clinically useful circulating

  6. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

    Directory of Open Access Journals (Sweden)

    E. Yu. Pashkova

    2015-04-01

    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  7. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

    Directory of Open Access Journals (Sweden)

    E. Yu. Pashkova

    2015-01-01

    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  8. Clinical applications of SONIALVISION 100 digital diagnostic table system

    International Nuclear Information System (INIS)

    Shiomi, Takeshi; Shimizu, Tatsuya; Iinuma, Masao; Takemoto, Hajime; Tanaka, Shuji

    2003-01-01

    This report refers to the clinical applications of our newly developed SONIALVISION 100 fully digitalized X-ray diagnostic table system. The main design concept of the SONIALVISION 100 system is the improvement of workflow in various clinical fields. The development of digital imaging technologies has come to allow fully digitalized X-ray diagnostic table systems to be widely utilized in various clinical applications, including interventional radiology (IVR) and examinations using contrast medium. This report mainly refers to the clinical applications of the Shimadzu SONIALVISION 100 digitalized X-ray diagnostic table system, also presenting some typical image data demonstrating the high efficiency, made available through the use of this new system, in high-speed spot imaging and digital tomography. (author)

  9. PVT Degradation Studies: Acoustic Diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Dib, Gerges [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Tucker, Brian J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kouzes, Richard T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Smith, Philip J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-04-01

    Under certain environmental conditions, polyvinyl toluene (PVT) plastic scintillator has been observed to undergo internal fogging. This document reports on a study of acoustic techniques to determine whether they can provide a diagnostic for the fogging of PVT. Different ultrasound techniques were employed for detecting the level of internal fogging in PVT, including wave velocity measurements, attenuation, nonlinear acoustics, and acoustic microscopy. The results indicate that there are linear relations between the wave velocity and wave attenuation with the level of internal fogging. The effects of fogging on ultrasound wave attenuation is further verified by acoustic microscopy imaging, where regions with fog in the specimen demonstration higher levels of attenuation compared to clear regions. Results from the nonlinear ultrasound measurements were inconclusive due to high sensitivities to transducer coupling and fixture variabilities.

  10. Diagnostic accuracy of ultrasonic histogram features to evaluate radiation toxicity of the parotid glands: a clinical study of xerostomia following head-and-neck cancer radiotherapy.

    Science.gov (United States)

    Yang, Xiaofeng; Tridandapani, Srini; Beitler, Jonathan J; Yu, David S; Chen, Zhengjia; Kim, Sungjin; Bruner, Deborah W; Curran, Walter J; Liu, Tian

    2014-10-01

    To investigate the diagnostic accuracy of ultrasound histogram features in the quantitative assessment of radiation-induced parotid gland injury and to identify potential imaging biomarkers for radiation-induced xerostomia (dry mouth)-the most common and debilitating side effect after head-and-neck radiotherapy (RT). Thirty-four patients, who have developed xerostomia after RT for head-and-neck cancer, were enrolled. Radiation-induced xerostomia was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer morbidity scale. Ultrasound scans were performed on each patient's parotids bilaterally. The 34 patients were stratified into the acute-toxicity groups (16 patients, ≤ 3 months after treatment) and the late-toxicity group (18 patients, > 3 months after treatment). A separate control group of 13 healthy volunteers underwent similar ultrasound scans of their parotid glands. Six sonographic features were derived from the echo-intensity histograms to assess acute and late toxicity of the parotid glands. The quantitative assessments were compared to a radiologist's clinical evaluations. The diagnostic accuracy of these ultrasonic histogram features was evaluated with the receiver operating characteristic (ROC) curve. With an area under the ROC curve greater than 0.90, several histogram features demonstrated excellent diagnostic accuracy for evaluation of acute and late toxicity of parotid glands. Significant differences (P xerostomia monitoring and assessment. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  11. Temporomandibular disorders – validity of clinical diagnostics compared to magnetic resonance imaging

    OpenAIRE

    BADEL, TOMISLAV; MAROTTI, MILJENKO; SAVIĆ PAVIČIN, IVANA; DULČIĆ, NIKŠA; ZADRAVEC, DIJANA; KERN, JOSIPA

    2011-01-01

    Background and Purpose: Orthopedic examination techniques of the musculoskeletal system contribute to the successful diagnostics of temporomandibular disorders (TMD). The purpose of this study is to determine the validity of TMD clinical diagnostics by comparing the findings of manual functional analysis (MFA) and the results of MRI of temporomandibular joint (TMJ). The diagnostic significance of limited mouth opening and pain upon passive mouth opening were taken into consideration. M...

  12. Protease activity measurement in milk as a diagnostic test for clinical mastitis in dairy cows

    NARCIS (Netherlands)

    Koop, G.; van Werven, T.; Roffel, S.; Hogeveen, H.; Nazmi, K.; Bikker, F.J.

    2015-01-01

    Due to the increasing use of automated milking systems, automated detection of clinical mastitis is becoming more important. Various in- or on-line diagnostic tests are in use, but generally suffer from false mastitis alerts. In this study, we explored a new diagnostic approach based on measurement

  13. Different clinical presentations, diagnostic difficulties, and management of cecal duplication.

    Science.gov (United States)

    Temiz, Abdulkerim; Oğuzkurt, Pelin; Ezer, Semire Serin; İnce, Emine; Gezer, Hasan Özkan; Hiçsönmez, Akgün

    2013-03-01

    Cecal duplications (CDs) are very rare, representing 0.4% of all gastrointestinal duplications. This study evaluates the variable clinical presentations, imaging workup, and surgical management of CDs. The records of 7 patients who underwent surgery between April 2001 and December 2011 for CD were retrospectively reviewed. Sex, age, duration of complaints, diagnostic studies, surgical intervention, and pathologic findings were recorded. The median age was 8 months, and mean age was 1.65 ± 2.88 years. Complaints were abdominal pain, rectal bleeding, vomiting, cough and dyspnea, and a prenatally detected cystic mass. The patients were referred with the diagnosis of appendicular abscess, necrotizing enterocolitis, gastrointestinal lymphoma, and intraabdominal cystic mass. Abdominal distention, signs of peritonitis, substernal retraction, fullness at right lower quadrant, and normal findings were detected on physical examination. Diagnostic imaging included plain abdominal radiography (7), ultrasonography (7), computed tomography (3), and magnetic resonance imaging (2). A cystic mass was reported on radiologic studies in 6 patients and appendicular abscess in 1. Cyst and cecum were resected, ileocolostomy was performed in 6 patients, and cyst excision was performed in 1. The diagnosis of duplication cyst was made by pathologic examination in all patients. Cecal duplications may be detected incidentally; however, they may mimic appendicular abscess, a tumor mass, or necrotizing enterocolitis. Whether cystic lesions are symptomatic, they should be excised when detected because of possible complications. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. [Clinical decision making and critical thinking in the nursing diagnostic process].

    Science.gov (United States)

    Müller-Staub, Maria

    2006-10-01

    The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".

  15. [Diagnostic of secondary hypertension in clinical practice].

    Science.gov (United States)

    Somlóová, Z; Rosa, J; Petrák, O; Strauch, B; Zelinka, T; Holaj, R; Widimský, J

    2011-09-01

    Arterial hypertension is a common worldwide disease with a prevalence of approximately 26%. Secondary cause is known in 5-10% of patients with hypertension. We should think of secondary hypertension in all patients with resistant hypertension, in patients with sudden deterioration in the control of hypertension and in patients with laboratory and clinical signs of diseases associated with secondary hypertension. It is important to distinguish between secondary hypertension and pseudo-resistance (noncompliance to treatment, white coat syndrome). Secondary causes of hypertension can be divided into endocrine (primary aldosteronism, pheochromocytoma, hypercortisolism, hyperparathyreoidism), renal - renovascular and renal parenchymal hypertension, and other causes as sleep apnoe syndrome, hypertension in pregnancy, coarctation of the aorta and intracranial tumors.

  16. Cognitive development, clinical knowledge, and clinical experience related to diagnostic ability.

    Science.gov (United States)

    Aquilino, M L

    1997-01-01

    To examine the relationship among cognitive development, clinical knowledge, and clinical experience in nursing students. A survey of junior and senior baccalaureate nursing students from three Midwestern colleges (N = 55). Students' diagnostic ability increased as they gained clinical experience and clinical knowledge. However, students failed to identify many nursing diagnoses and demonstrated only moderate levels of cognitive development. Nurse educators and nursing students need to change their approaches to teaching and learning to enhance students' diagnostic ability and cognitive development.

  17. Molecular diagnostics clinical utility strategy: a six-part framework.

    Science.gov (United States)

    Frueh, Felix W; Quinn, Bruce

    2014-09-01

    The clinical utility of a molecular test rises proportional to a favorable regulatory risk/benefit assessment, and clinical utility is the driver of payer coverage decisions. Although a great deal has been written about clinical utility, debates still center on its 'definition.' We argue that the definition (an impact on clinical outcomes) is self-evident, and improved communications should focus on sequential steps in building and proving an adequate level of confidence for the diagnostic test's clinical value proposition. We propose a six-part framework to facilitate communications between test developers and health technology evaluators, relevant to both regulatory and payer decisions.

  18. Hashimoto thyroiditis: clinical and diagnostic criteria.

    Science.gov (United States)

    Caturegli, P; De Remigis, A; Rose, N R

    2014-01-01

    Hashimoto thyroiditis (HT), now considered the most common autoimmune disease, was described over a century ago as a pronounced lymphoid goiter affecting predominantly women. In addition to this classic form, several other clinico-pathologic entities are now included under the term HT: fibrous variant, IgG4-related variant, juvenile form, Hashitoxicosis, and painless thyroiditis (sporadic or post-partum). All forms are characterized pathologically by the infiltration of hematopoietic mononuclear cells, mainly lymphocytes, in the interstitium among the thyroid follicles, although specific features can be recognized in each variant. Thyroid cells undergo atrophy or transform into a bolder type of follicular cell rich in mitochondria called Hürthle cell. Most HT forms ultimately evolve into hypothyroidism, although at presentation patients can be euthyroid or even hyperthyroid. The diagnosis of HT relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features. The treatment remains symptomatic and based on the administration of synthetic thyroid hormones to correct the hypothyroidism as needed. Surgery is performed when the goiter is large enough to cause significant compression of the surrounding cervical structures, or when some areas of the thyroid gland mimic the features of a nodule whose cytology cannot be ascertained as benign. HT remains a complex and ever expanding disease of unknown pathogenesis that awaits prevention or novel forms of treatment. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. [Child sexual abuse. Epidemiology, clinical diagnostics, therapy, and prevention].

    Science.gov (United States)

    Fegert, J M; Hoffmann, U; Spröber, N; Liebhardt, H

    2013-02-01

    The article provides an overview of the research on sexual abuse and the current political developments in Germany. First, the terminology of sexual child abuse is discussed, followed by the presentation of epidemiological data. The section on diagnostics and therapy shows that--because of mostly nonspecific indicators--the diagnosis of child sexual abuse is very difficult to define. Child sexual abuse is discussed as a traumatic experience for children and adolescents with different psychiatric and physical diseases. Current studies have shown that especially cognitive behavioral therapeutic-oriented approaches are effective in curing posttraumatic stress disorders. Based on the new German Child Protection Act, the focus lies on the clarification of confidentiality for medical professionals and their right to consulting services for child protection. In conclusion, guidelines and minimum standards for a child prevention and protection model are presented as well as institutional recommendations addressed to all institutions (also clinical) that take care of or treat children and adolescents.

  20. Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease

    Science.gov (United States)

    Kallenberg, K.; Summers, D. M.; Romero, C.; Taratuto, A.; Heinemann, U.; Breithaupt, M.; Varges, D.; Meissner, B.; Ladogana, A.; Schuur, M.; Haik, S.; Collins, S. J.; Jansen, Gerard H.; Stokin, G. B.; Pimentel, J.; Hewer, E.; Collie, D.; Smith, P.; Roberts, H.; Brandel, J. P.; van Duijn, C.; Pocchiari, M.; Begue, C.; Cras, P.; Will, R. G.; Sanchez-Juan, P.

    2009-01-01

    Several molecular subtypes of sporadic Creutzfeldt–Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications have demonstrated a potentially important role for magnetic resonance imaging in the pre-mortem diagnosis of sporadic Creutzfeldt–Jakob disease. Magnetic resonance imaging signal alterations correlate with distinct sporadic Creutzfeldt–Jakob disease molecular subtypes and thus might contribute to the earlier identification of the whole spectrum of sporadic Creutzfeldt–Jakob disease cases. This multi-centre international study aimed to provide a rationale for the amendment of the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease. Patients with sporadic Creutzfeldt–Jakob disease and fluid attenuated inversion recovery or diffusion-weight imaging were recruited from 12 countries. Patients referred as ‘suspected sporadic Creutzfeldt–Jakob disease’ but with an alternative diagnosis after thorough follow up, were analysed as controls. All magnetic resonance imaging scans were assessed for signal changes according to a standard protocol encompassing seven cortical regions, basal ganglia, thalamus and cerebellum. Magnetic resonance imaging scans were evaluated in 436 sporadic Creutzfeldt–Jakob disease patients and 141 controls. The pattern of high signal intensity with the best sensitivity and specificity in the differential diagnosis of sporadic Creutzfeldt–Jakob disease was identified. The optimum diagnostic accuracy in the differential diagnosis of rapid progressive dementia was obtained when either at least two cortical regions (temporal, parietal or occipital) or both caudate nucleus and putamen displayed a high signal in fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging. Based on our analyses, magnetic

  1. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-Part I. general guidance and tips

    International Nuclear Information System (INIS)

    Kim, Kyung Won; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho; Lee, June Young

    2015-01-01

    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods

  2. A retrospective study of relevant diagnostic procedures in vulvodynia

    DEFF Research Database (Denmark)

    Petersen, Christina Damsted; Kristensen, Ellids; Lundvall, Lene

    2009-01-01

    OBJECTIVE: To identify objective clinical signs of vulvodynia and determine specific diagnostic tests for vulvodynia in women referred to a vulvar outpatient clinic for vulval complaints. STUDY DESIGN: A retrospective study was performed of the medical records of 201 consecutive Danish patients s...

  3. Pediatric Gastric Volvulus: Diagnostic and Clinical Approach

    Directory of Open Access Journals (Sweden)

    Federica Porcaro

    2013-03-01

    Full Text Available Gastric volvulus is a significant, rare cause of non-bilious vomiting and consists of a pathological rotation of the stomach of more than 180° around the axis without obstruction of the gastrointestinal tract. A definitive diagnosis is made with upper radiological gastrointestinal studies. Treatment may be conservative or surgical with anterior and fundal gastropexy in patients with ingravescent symptoms. We describe the case of a 16-month-old female admitted to our hospital for recurrent and postprandial vomiting episodes which had started at 11 months of age. A history of gastroesophageal reflux was present until 1 year of age, in association with recurrent respiratory infections. The basic metabolic panel was normal. Barium study showed stomach rotation along a horizontal plane stomach. Esophagogastroduodenoscopy showed no mucosal alterations. The diagnosis was chronic organoaxial gastric volvulus. In our patient, the surgical procedure of gastropexy, both anterior and fundal, without fundoplication was performed. She showed good improvement after surgery, with resolution of symptoms and weight gain.

  4. Should we confirm our clinical diagnostic certainty by autopsies?

    Science.gov (United States)

    Podbregar, M; Voga, G; Krivec, B; Skale, R; Pareznik, R; Gabrscek, L

    2001-11-01

    To evaluate the frequency of diagnostic errors assessed by autopsies. Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital. Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1), minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group L3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome; group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome. The overall mortality was 20.3% (270/1331 patients). Autopsies were performed in 126 patients (46.9% of deaths), more often in younger patients (66.6+/-13.9 years vs 72.7+/-12.0 years, p<0.001), in patients with shorter ICU stay (4.7+/-5.6 days vs 6.7+/-8.7 days, p=0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p<0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5%)] were found in 8.7%, 10.0%, and 10.5% of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors. Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.

  5. Teaching perceptual skills in clinical diagnostics using digital media

    NARCIS (Netherlands)

    Scheiter, Katharina; Jarodzka, Halszka

    2011-01-01

    Scheiter, K., & Jarodzka, H. (2011, May). Teaching perceptual skills in clinical diagnostics using digital media. Presentation at the 2nd International Conference “Research in Medical Education”: Shaping diamonds from bench to bedside, Universität Tübingen.

  6. Diagnostic utility of clinical and biochemical parameters in ...

    African Journals Online (AJOL)

    Diagnostic utility of clinical and biochemical parameters in pancreatic head malignancy patients with normal carbohydrate antigen 19-9 levels. Xiaoli Jin1, Yulian Wu2. 1. Department of Surgery, Sir Run Run Shaw Hospital College of Medicine, Zhejiang University, 3 Qingchun. Road East, Hangzhou, Zhejiang Province ...

  7. Evaluating online diagnostic decision support tools for the clinical setting.

    Science.gov (United States)

    Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

    2012-01-01

    Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and

  8. Evaluating next-generation sequencing for direct clinical diagnostics in diarrhoeal disease

    DEFF Research Database (Denmark)

    Joensen, Katrine Grimstrup; Engsbro, A L Ø; Lukjancenko, Oksana

    2017-01-01

    The accurate microbiological diagnosis of diarrhoea involves numerous laboratory tests and, often, the pathogen is not identified in time to guide clinical management. With next-generation sequencing (NGS) becoming cheaper, it has huge potential in routine diagnostics. The aim of this study...... was to evaluate the potential of NGS-based diagnostics through direct sequencing of faecal samples. Fifty-eight clinical faecal samples were obtained from patients with diarrhoea as part of the routine diagnostics at Hvidovre University Hospital, Denmark. Ten samples from healthy individuals were also included...

  9. Dosimetric studies in diagnostic radiology

    International Nuclear Information System (INIS)

    Mohamadain, K. E. M.

    2004-04-01

    A dosimetric study in pediatric radiology and adult patients was currently being carried out at the pediatrics units of two large hospitals in Rio de Janeiro city: IPPMG (Instituto de Pediatric e Puericultura Martagao Gesteira, University hospital of federal University of Rio de Janeiro), IFF (Instituto Fernandes Figueira, FIOCRUZ) and Hospital Geral de Bonsucesso, a large public hospital in Rio de Janeiro city (HGB) Brazil. The dosimetric study was also performed at three pediatrics units in Sudan, namely, Ahmed Gasim, Khartoum and Omdurman hospitals. For chest x-ray examination the entrance skin dose(ESD) for AP, PA and LAT projections of pediatric patients, and the scattered dose at the thyroid, ovary and gonads have been obtained with thermoluminescent dosimeters (TLD) and with use of a software package Dosecal in thr Brazilian hospitals, and with the software dosecal in the Sudanese hospitals.The aim of this work was to estimate the entrance skin dose (ESD), the effective dose (ED) and the body organ dose (BOD) for chest x-ray exposure in pediatric patients, and different exams for adults patients, and to compare the results obtained in the tow Countries Sudan and Brazil with the reference dose level. For ESD evaluation of the chest x-ray, three different TL dosimeters have been used, namely LiF: Mg, Ti (TLD 100) CaSo 4 : Dy and LiF:Mg, Cu,P (TLD 100 H). The age intervals considered were: 0-1 years, 1-5 years, 5-10 years and 10-15 years. The results obtained with all dosimeters were in good agreement with, those obtained by the dosecal software, especially for AP and PA projection. However, some discrepancies were found for the LAT projection. The results within Brazil were some what consistent while in Sudan, large difference were observed, it was also noted that the doses in Brazil hospitals were less than the reference dose levels while in Sudanese hospitals the doses were higher than the reference dose levels. For adult patients only the software dosecal

  10. Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis

    DEFF Research Database (Denmark)

    Jahn, H; Mathiesen, F K; Neckelmann, K

    1997-01-01

    , and diagnostic aids are desirable to reduce the negative appendicectomy rate. Diagnostic US performed poorly as a routine procedure. Application of an up to date scoring system might be of some help to patients with a high or low probability of acute appendicitis, but any conclusion about its clinical......OBJECTIVE: To evaluate the diagnostic accuracy of clinical judgment and diagnostic ultrasonography (US) used routinely and to create a scoring system to aid diagnosis. DESIGN: Prospective, double-blind study. SETTING: University hospital, Denmark. SUBJECTS: 222 Consecutive patients suspected...... of having acute appendicitis admitted between 0800 and midnight from June 1990 to June 1992. INTERVENTIONS: 148 Patients (67%) underwent appendicectomy and the remaining 74 patients were observed. 193 Patients (87%) had a diagnostic US examination. 21 Predictive variables were collected prospectively...

  11. CIT diagnostic computer interface studies

    International Nuclear Information System (INIS)

    Rauch, W.; Hayes, S.; Lowrance, J.; Oliaro, G.; Sauthoff, N.; Sichta, P.; Stark, W.

    1987-01-01

    This paper presents the on-going work performed in proposing instrumentation equipment and communications networks for the Diagnostic Data Acquisition and Diagnostic Instrumentation and Control System for the Compact Ignition Torus (CIT), which will begin operation in 1993. Consideration is given to the system criteria and requirements and their influence on the appropriate application of instrumentation and communication technologies to the system. This paper concentrates on the investigation of the bus communication technologies as they apply to the CIT data acquisition system. It compares CAMAC, VME, and FASTBUS as standards for data acquisition. The paper describes the connectivity between VAX equipment and CAMAC and VME instrumentation systems. Instrumentation and communication functionality and performance levels are presented as factors important to the overall data acquisition system performance

  12. Clinical-Diagnostic Features of Duchenne Muscular Dystrophy in Children

    Directory of Open Access Journals (Sweden)

    Umida T. Omonova

    2013-12-01

    Full Text Available Duchenne Muscular Dystrophy (DMD is a severe, progressive disease that affects about 1 out of every 5,000 male infants; this is the most destructive of all muscular dystrophies, which worsens rapidly. In this study, we performed a clinical analysis of 37 children with DMD. They ranged in age from 3 to 15 years, mean age being 7.8±0.48 years. The mean age at onset was 4.3±0.36 years and ranged from birth to 8 years. The biochemical examination included the determination of the serum levels of the following enzymes, AST, ALT, CPK-MM, and LDH. A genealogical analysis was conducted among 240 first-degree relatives of children with DMD. Electroneuromyography examination included registration of the biopotentials of the hand and foot muscles, measurement of the muscle response (M-wave and the late-evoked responses. The clinical-diagnostic features of DMD in children were characterized.

  13. Clinical advances of nanocarrier-based cancer therapy and diagnostics.

    Science.gov (United States)

    Luque-Michel, Edurne; Imbuluzqueta, Edurne; Sebastián, Víctor; Blanco-Prieto, María J

    2017-01-01

    Cancer is a leading cause of death worldwide and efficient new strategies are urgently needed to combat its high mortality and morbidity statistics. Fortunately, over the years, nanotechnology has evolved as a frontrunner in the areas of imaging, diagnostics and therapy, giving the possibility of monitoring, evaluating and individualizing cancer treatments in real-time. Areas covered: Polymer-based nanocarriers have been extensively studied to maximize cancer treatment efficacy and minimize the adverse effects of standard therapeutics. Regarding diagnosis, nanomaterials like quantum dots, iron oxide nanoparticles or gold nanoparticles have been developed to provide rapid, sensitive detection of cancer and, therefore, facilitate early treatment and monitoring of the disease. Therefore, multifunctional nanosystems with both imaging and therapy functionalities bring us a step closer to delivering precision/personalized medicine in the cancer setting. Expert opinion: There are multiple barriers for these new nanosystems to enter the clinic, but it is expected that in the near future, nanocarriers, together with new 'targeted drugs', could replace our current treatments and cancer could become a nonfatal disease with good recovery rates. Joint efforts between scientists, clinicians, the pharmaceutical industry and legislative bodies are needed to bring to fruition the application of nanosystems in the clinical management of cancer.

  14. Clinical diagnostic potentials of thyroid ultrasonography and scintigraphy; An evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Torizuka, Tatsuo; Kasagi, Kanji; Hatabu, Hiroto; Misaki, Takashi; Iida, Yasuhiro; Konishi, Junji (Kyoto Univ. (Japan). Hospital); Endo, Keigo

    1993-06-01

    This prospective study was designed to evaluate the potential contributions of high resolution ultrasonography (US) and Tc-99m scintigraphy in the routine diagnosis of thyroid disease. The diagnostic impacts of US and Tc-99m scintigraphy results in 177 patients visiting our thyroid clinic were assessed and scored according to the following criteria: when the information provided by either test supported, confirmed or changed the initial clinical diagnosis, they received scores of 2, 3 and 4 respectively, while score 1 was given when the test itself was useless for the differential diagnosis. US identified focal lesions that both palpation and scintigraphy had failed to detect in 14 (12.1%) of 116 patients with diffuse thyroid diseases, suggesting the necessity of Hashimoto's thyroiditis, adenoma, adenocarcinoma and adenomatous goiter, and vice versa in the diagnosis of hyperthyroid and euthyroid Graves's diseases. Thus, the advantages of US over scintigraphy for morphological evaluation were confirmed. US was particularly useful for the differential diagnosis of adenomatous goiter from Hashimoto's thyroiditis or a single nodular disease. In contrast, scintigraphy gave functional images, being especially helpful for the differential diagnosis of thyrotoxicosis. (author).

  15. Implementation of Targeted Next Generation Sequencing in Clinical Diagnostics

    DEFF Research Database (Denmark)

    Larsen, Martin Jakob; Burton, Mark; Thomassen, Mads

    Accurate mutation detection is essential in clinical genetic diagnostics of monogenic hereditary diseases. Targeted next generation sequencing (NGS) provides a promising and cost-effective alternative to Sanger sequencing and MLPA analysis currently used in most diagnostic laboratories. One...... of mutation positive controls previously characterized by Sanger/MLPA analysis. Agilent SureSelect Target-Enrichment kits were used for capturing a set of genes associated with hereditary breast and ovarian cancer syndrome and a compilation of genes involved in multiple rare single gene disorders......, respectively. For diagnostics, the sequencing coverage is essential, wherefore a minimum coverage of 30x per nucleotide in the coding regions was used as our primary quality criterion. For the majority of the included genes, we obtained adequate gene coverage, in which we were able to detect 100% of the known...

  16. Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning.

    Science.gov (United States)

    Chiffi, Daniele; Zanotti, Renzo

    2017-10-01

    Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. © 2016 John Wiley & Sons, Ltd.

  17. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

    NARCIS (Netherlands)

    van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Terwee, C.B.; Willems, W.J.

    2013-01-01

    Background: It is unknown which combination of patient information and clinical tests might beoptimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determinethe diagnostic value of individual clinical tests and to develop a prediction model that combined patient

  18. Advancing Porous Silicon Biosensor Technology for Use in Clinical Diagnostics

    Science.gov (United States)

    Bonanno, Lisa Marie

    Inexpensive and robust analytical techniques for detecting molecular recognition events are in great demand in healthcare, food safety, and environmental monitoring. Despite vast research in this area, challanges remain to develop practical biomolecular platforms that, meet the rigorous demands of real-world applications. This includes maintaining low-cost devices that are sensitive and specific in complex test specimens, are stable after storage, have short assay time, and possess minimal complexity of instrumentation for readout. Nanostructured porous silicon (PSi) material has been identified as an ideal candidate towards achieving these goals and the past decade has seen diverse proof-of-principle studies developing optical-based sensing techniques. In Part 1 of this thesis, the impact of surface chemistry and PSi morphology on detection sensitivity of target molecules is investigated. Initial proof-of-concept that PSi devices facilitate detection of protein in whole blood is demonstrated. This work highlights the importance of material stability and blocking chemistry for sensor use in real world biological samples. In addition, the intrinisic filtering capability of the 3-D PSi morphology is shown as an advantage in complex solutions, such as whole blood. Ultimately, this initial work identified a need to improve detection sensitivity of the PSI biosensor technique to facilitate clinical diagnostic use over relevant target concentration ranges. The second part of this thesis, builds upon sensitivity challenges that are highlighted in the first part of the thesis and development of a surface-bound competitive inhibition immunoassay facilitated improved detection sensitivity of small molecular weight targets (opiates) over a relevant clinical concentration range. In addition, optimization of assay protocol addressed issues of maintaining stability of sensors after storage. Performance of the developed assay (specificity and sensitivity) was then validated in a

  19. Studies on WWER core diagnostics

    International Nuclear Information System (INIS)

    Lunin, G.L.; Mitin, V.I.; Bulavin, V.V.

    1987-01-01

    The reliability and safety of nuclear power plants have decisive meaning under the situation that nuclear power generation steadily increases, and among various measures aiming at ensuring the reliability and safety in the operation of nuclear power plants, the countermeasures for protecting reactor core, main process equipment and high pressure circuits from damage have the important role, and the monitoring of condition and the organization of forecast, which are carried out continuously or periodically during the operation of nuclear power stations using the diagnostic expert system specially developed for the purpose, are included in them. Such monitoring enables the early detection of mechanical damage, increase of vibration, defects caused during operation and so on in reactor cores and primary and secondary circuits, and the continuous watching of defect developments. Also boiling in a core is detected, the place of abnormality occurrence is identified, and the intensity and characteristics of boiling are determined, thus the occurrence of dangerous condition is prevented. The developments of an in-core monitoring system and noise diagnostic systems are reported. (Kako, I.)

  20. Learning from epidemiological, clinical, and immunological studies on Mycobacterium africanum for improving current understanding of host–pathogen interactions, and for the development and evaluation of diagnostics, host-directed therapies, and vaccines for tuberculosis

    Directory of Open Access Journals (Sweden)

    Alimuddin Zumla

    2017-03-01

    Full Text Available Mycobacterium africanum comprises two phylogenetic lineages within the Mycobacterium tuberculosis complex (MTBC. M. africanum was first described and isolated in 1968 from the sputum of a Senegalese patient with pulmonary tuberculosis (TB and it has been identified increasingly as an important cause of human TB, particularly prevalent in West Africa. The restricted geographical distribution of M. africanum, in contrast to the widespread global distribution of other species of MTBC, requires explanation. Available data indicate that M. africanum may also have important differences in transmission, pathogenesis, and host–pathogen interactions, which could affect the evaluation of new TB intervention tools (diagnostics and vaccines–those currently in use and those under development. The unequal geographical distribution and spread of MTBC species means that individual research findings from one country or region cannot be generalized across the continent. Thus, generalizing data from previous and ongoing research studies on MTBC may be inaccurate and inappropriate. A major rethink is required regarding the design and structure of future clinical trials of new interventions. The West, Central, East, and Southern African EDCTP Networks of Excellence provide opportunities to take forward these pan-Africa studies. More investments into molecular, epidemiological, clinical, diagnostic, and immunological studies across the African continent are required to enable further understanding of host–M. africanum interactions, leading to the development of more specific diagnostics, biomarkers, host-directed therapies, and vaccines for TB.

  1. CLINICAL PICTURE, DIAGNOSTICS AND TREATMENT OF GIARDIASIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    E.A. Kornienko

    2009-01-01

    Full Text Available According to the WHO, giardiasis incidence rate in children in the world is 15 to 20%. In Russia, over 130,000 cases of giardiasis are registered annually, of which children under 14 years account for more than 70%. The study of 124 children with giardiasis conducted by the authors has shown that giardiasis in children always triggers development of chronic duodenitis, in 55% of cases that coupled with lymphostasis, in 45% — that with atrophy of duodenum mucous lining. In 40% of cases, chronic duodenitis with giardiasis is accompanied with duodenogastric reflux, in 88% — with development of lactase deficiency, in 81% — by functional biliary system distress and in all cases with intestinal tract microbiocenosis distress. Along with clinical manifestations of the disease, the researchers have studied immunological modifications in children with giardiasis, and have evaluated the information content of various diagnostic techniques, efficiency of medication. The authors have demonstrated that mono therapy with any of anti giardiasis drugs (metronidazole, nifuratel, albendozole has low efficiency. Saccharomyces boulardii have a powerful comprehensive effect on many links of giardiasis pathogenesis.Key words: giardiasis, infestation, scatoscopy, Saccharomyces boulardii.

  2. A clinical study on mobility of teeth as assessed through their damping characteristics and progress of periodontal disease using advanced diagnostic aids: Mobilometer and florida probe

    Directory of Open Access Journals (Sweden)

    Yogesh Doshi

    2010-01-01

    Full Text Available Aims and Objectives: Decision regarding the option to treat tooth mobility should be based on the etiology and detected severity of tooth mobility. The most widely used method of mobility assessment is to tap the tooth between two extreme positions. The study was designed to evaluate the association of Periotest values (PTV with the amount of bone, clinical attachment loss, and various clinical indices. The aim of the present study was to evaluate the association between bone loss and Periotest values. Also we evaluated the effects of attachment loss and tooth position on the Periotest values. Materials and Methods: A total number of 60 patients between the age group of 18 and 55 years were divided into subjects with healthy periodontium (Group A, and those with Chronic Generalized Periodontitis (Group B, having a generalized pocket probing depth of 3 - 8 mm, respectively. With the help of the Periotest, Florida probe, and radiographs the assessment was carried out. The data was statistically analyzed using the Student′s unpaired t-test. Results: It was found that the values were highly significant in the incisor, premolar, and molar areas. However, the value was found to be insignificant in the canine region. The anterior teeth showed higher PTV compared to the posterior teeth; and the mandibular teeth showed higher PTV compared to the maxillary teeth. There was no association between the clinical indices and Periotest values. Conclusion: The study showed that tooth mobility was dependent on bone support as well as the clinical attachment level.

  3. Case studies in diagnostic imaging

    International Nuclear Information System (INIS)

    Nisbet, A.P.; Gedroyc, W.M.W.; Rankin, S.C.

    1987-01-01

    This book presents short clinical histories and selected radiographs in a quiz format to enable readers to attempt their own diagnosis. Overleaf specimen answers, recommendations for further management and, where appropriate, further confirmatory films are displayed. The book is intended to be a tutor for candidates sitting postgraduate medical examinations, providing a means of testing themselves and obtaining an immediate answer for comparison

  4. Prostate cancer diagnostics: Clinical challenges and the ongoing need for disruptive and effective diagnostic tools.

    Science.gov (United States)

    Sharma, Shikha; Zapatero-Rodríguez, Julia; O'Kennedy, Richard

    The increased incidence and the significant health burden associated with carcinoma of the prostate have led to substantial changes in its diagnosis over the past century. Despite technological advancements, the management of prostate cancer has become progressively more complex and controversial for both early and late-stage disease. The limitations and potential harms associated with the use of prostate-specific antigen (PSA) as a diagnostic marker have stimulated significant investigation of numerous novel biomarkers that demonstrate varying capacities to detect prostate cancer and can decrease unnecessary biopsies. However, only a few of these markers have been approved for specific clinical settings while the others have not been adequately validated for use. This review systematically and critically assesses ongoing issues and emerging challenges in the current state of prostate cancer diagnostic tools and the need for disruptive next generation tools based on analysis of combinations of these biomarkers to enhance predictive accuracy which will benefit clinical diagnostics and patient welfare. Copyright © 2016. Published by Elsevier Inc.

  5. Clinical Training of Medical Physicists Specializing in Diagnostic Radiology

    International Nuclear Information System (INIS)

    2010-01-01

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area, structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for diagnostic radiology. There is a general and growing awareness that radiation medicine is increasingly dependent on well trained medical physicists based in the clinical setting. However, an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognized by the members of the Regional Cooperative Agreement (RCA) for Research, Development and Training related to Nuclear Sciences for Asia and the Pacific. Consequently, a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia-Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specializing in diagnostic radiology started in 2007 with the appointment of a core drafting committee of regional and international experts. The publication drew on the experiences of clinical training programmes in Australia and New Zealand, the UK and the USA, and was moderated by physicists working in the Asian region. This publication follows the approach of the IAEA publication Training Course Series No. 37, Clinical Training of Medical Physicists specializing in Radiation Oncology. This approach to clinical training has been successfully tested

  6. The diagnosis of urinary tract infections in young children (DUTY: protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness

    Directory of Open Access Journals (Sweden)

    Downing Harriet

    2012-07-01

    Full Text Available Abstract Background Urinary tract infection (UTI is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods/design DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results most strongly associated with a positive urine culture result. We will

  7. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness.

    Science.gov (United States)

    Downing, Harriet; Thomas-Jones, Emma; Gal, Micaela; Waldron, Cherry-Ann; Sterne, Jonathan; Hollingworth, William; Hood, Kerenza; Delaney, Brendan; Little, Paul; Howe, Robin; Wootton, Mandy; Macgowan, Alastair; Butler, Christopher C; Hay, Alastair D

    2012-07-19

    Urinary tract infection (UTI) is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY) study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted.The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens.We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results) most strongly associated with a positive urine culture result. We will then use economic evaluation to compare the cost

  8. Clinical approach to obscure GI bleeding - Diagnostic testing and management

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran

    2013-01-01

    Full Text Available Obscure gastrointestinal bleeding (OGIB can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE, balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE and single balloon enteroscopy (SBE], and overtube-assisted deep enteroscopy (spiral enteroscopy, are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

  9. Implementation of a companion diagnostic in the clinical laboratory

    DEFF Research Database (Denmark)

    Mancini, Irene; Pinzani, Pamela; Simi, Lisa

    2015-01-01

    A companion diagnostic test provides information that is essential for the safe and effective use of a corresponding therapeutic product as indicated in the drug instructions. The implementation of a companion diagnostic follows the rules of a molecular test for somatic mutations in a routine...... clinical laboratory environment and needs guidance on practical aspects, including the choice of the proper analytical method and the procedures for internal and external quality controls. Selection of the appropriate assay for detection of genetic alterations depends on several factors: the type...... on restrictions of the method used. In relation to these aspects herein we report an opinion paper of the Working Group Personalized Laboratory Medicine jointly constituted by the European Federation of Laboratory Medicine (EFLM) and by the European Society of Pharmacogenomics and Theranostics (ESPT) using...

  10. PERICARDITIS: ETIOLOGY, CLASSIFICATION, CLINIC, DIAGNOSTICS, TREATMENT. PART II

    Directory of Open Access Journals (Sweden)

    A.B. Sugak

    2009-01-01

    Full Text Available Pericarditis maybe caused by different agents: viruses, bacteria, tuberculosis, and it may be autoimmune. All these types of diseases have similar clinical signs, but differ by prevalence, prognosis and medical tactics. Due to achievements of radial methods of visualization, molecular biology, and immunology, we have an opportunity to provide early specific diagnostics and etiological treatment of inflammatory diseases of pericardium. The second part of lecture presents main principles of differential diagnostics of specific types of pericarditis, gives characteristics of several often accruing types of disease, and describes treatment and tactics of management of patients with pericarditis.Key words: children, pericarditis.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(3:76-81

  11. The Diagnostic and Prognostic Value of a Dual-Tasking Paradigm in a Memory Clinic

    DEFF Research Database (Denmark)

    Nielsen, Malene Schjnning; Simonsen, Anja Hviid; Siersma, Volkert

    2018-01-01

    -tasking paradigm, such as the Timed Up and Go-Dual Task (TUG-DT), may be useful in the diagnostic assessment of mild cognitive impairment (MCI). OBJECTIVE: To investigate the diagnostic and prognostic ability of a dual-tasking paradigm in patients with MCI or mild Alzheimer's disease (AD) and to evaluate...... the association between the dual-tasking paradigm and cerebrospinal fluid (CSF) AD biomarkers. METHODS: The study is a prospective cohort study conducted in a clinical setting in two memory clinics. Eighty-six patients were included (28 MCI, 17 AD, 41 healthy controls (HC)). The ability to perform dual...

  12. Irritable bowel syndrome: diagnostic approaches in clinical practice

    Directory of Open Access Journals (Sweden)

    Eugene J Burbige

    2010-09-01

    Full Text Available Eugene J BurbigeDivision of Gastroenterology, Gastrointestinal and Liver Research, John Muir Medical Center, Concord, CA, USABackground: Irritable bowel syndrome (IBS, a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.Objective: To review the diagnostic evaluation of patients with suspected IBS, strengths and weaknesses of current methodologies, and newer diagnostic tools that can augment current symptom-based criteria.Methods: The peer-reviewed literature (PubMed was searched for primary reports and reviews using the limiters of date (1999–2009 and English language and the search terms irritable bowel syndrome, diagnosis, gastrointestinal disease, symptom-based criteria, outcome, serology, and fecal markers. Abstracts from Digestive Disease Week 2008–2009 and reference lists of identified articles were reviewed.Results: A disconnect is apparent between practice guidelines and clinical practice. The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome. However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases. In the absence of diagnostic criteria easily usable in a busy practice, newer diagnostic methods, such as stool-form examination, fecal inflammatory markers, and serum biomarkers, have been proposed as adjunctive tools to aid in an IBS diagnosis by increasing physicians

  13. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

    Science.gov (United States)

    Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

    2017-01-08

    Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  14. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

    Directory of Open Access Journals (Sweden)

    Tivani P. Mashamba-Thompson

    2017-01-01

    Full Text Available Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  15. Study of methodology diversification in diagnostics

    International Nuclear Information System (INIS)

    Suda, Kazunori; Yonekawa, Tsuyoshi; Yoshikawa, Shinji; Hasegawa, Makoto

    1999-03-01

    There are several research activities to enhance safety and reliability of nuclear power plant operation and maintenance. We are developing a concept of an autonomous operation system where the role of operators is replaced with artificial intelligence. The purpose of the study described in this report is to develop a operator support system in abnormal plant situations. Conventionally, diagnostic modules based on individual methodology such as expert system have been developed and verified. In this report, methodology diversification is considered to integrate diagnostic modules which performance are confirmed using information processing technique. Technical issues to be considered in diagnostic methodology diversification are; 1)reliability of input data, 2)diversification of knowledge models, algorithms and reasoning schemes, 3)mutual complement and robustness. The diagnostic module utilizing the different approaches defined along with strategy of diversification was evaluated using fast breeder plant simulator. As a result, we confirmed that any singular diagnostic module can not meet accuracy criteria for the entire set of anomaly events. In contrast with this, we confirmed that every abnormality could be precisely diagnosed by a mutual combination. In other words, legitimacy of approach selected by strategy of diversification was shown, and methodology diversification attained clear efficiency for abnormal diagnosis. It has been also confirmed that the diversified diagnostic system implemented in this study is able to maintain its accuracy even in case that encountered scale of abnormality is different from reference cases embedded in the knowledge base. (author)

  16. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain.

    Science.gov (United States)

    Cadogan, Angela; McNair, Peter J; Laslett, Mark; Hing, Wayne A

    2016-01-01

    The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP) defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP. In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR) criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction)) demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity). A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100); LR+ 6.2; 95% CI 1.5, 25.7)). Imaging did not improve the ability to rule-out a PAR. Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

  17. Prostate cancer - epidemiology, etiology, diagnostics, clinical symptoms, screening

    International Nuclear Information System (INIS)

    Ondrus, D.

    2006-01-01

    Prostate cancer presents a real important medical and social problem at present. It is one of the most common malignancy in males. In global point of view it means permanent incidence increase of this disease. Despite improvement of prostate cancer diagnosis and complex treatment mortality does not decreased significantly. Knowledge of etiological factors are relatively limited. Important factors are: genetic disposition, age, life style, race, positive familial history, circulated androgens. Diagnostics is well known, based on routine clinical methods: digital rectal examination, measurement of PSA a transrectal ultrasound. Benefit of prostate cancer screening is until now unclear, controversial. (author)

  18. Effect of clinical specialist physiotherapists in orthopaedic diagnostic setting - A systematic review

    DEFF Research Database (Denmark)

    Trøstrup, Jeanette; Mikkelsen, Lone Ramer; Juhl, Carsten

    with advanced clinical competencies; Clinical Specialist Physiotherapists (CSP). The use of CSPs instead of OSs to perform diagnostic assessment of patients with musculoskeletal complaints has been implemented in several countries (1). Earlier systematic reviews have evaluated CSPs effectiveness in diagnosing...... methodological quality where one study of high methodological quality found that CSP-clinics were more expensive than OS-led clinics. Patient satisfaction (n=12) ranged from 77–100 % being satisfied (n=9) with similar satisfaction in studies of low, acceptable and high methodological quality. In three studies...

  19. Diagnostic radiography: A study in distancing

    International Nuclear Information System (INIS)

    Reeves, Pauline J.; Decker, Sola

    2012-01-01

    Aims: This article aims to explore the ways in which diagnostic radiographers use distancing as a tool for emotional management in radiography practice. Methods: This review utilises data from oral history interviews undertaken as part of a larger study documenting the oral history of the diagnostic radiography profession in the United Kingdom as recounted by 24 participants. Results: The results are presented as illustrative of various aspects of the role of the diagnostic radiographer including the initial choice of diagnostic radiography as a profession, the endemic use of particular terminology, the nature of the encounter in diagnostic radiography (including that of sectional imaging) and whether the role is really patient-centred. Conclusions: The article concludes by suggesting that distancing from the patient is mediated by the need for physical touch in order to position the patient for radiography and also makes the suggestion that those opting for diagnostic radiography as a career may do so because they want a profession which is more distanced from the patient and that, even where this is not the case initially, individuals are socialised into adopting the ‘feeling rules’ of the profession. The article concludes by outlining potential areas for further research.

  20. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews.

    Science.gov (United States)

    Petersen, Tom; Laslett, Mark; Juhl, Carsten

    2017-05-12

    Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only

  1. Comparison of the gold standard of hemoglobin measurement with the clinical standard (BGA) and noninvasive hemoglobin measurement (SpHb) in small children: a prospective diagnostic observational study.

    Science.gov (United States)

    Wittenmeier, Eva; Bellosevich, Sophia; Mauff, Susanne; Schmidtmann, Irene; Eli, Michael; Pestel, Gunther; Noppens, Ruediger R

    2015-10-01

    Collecting a blood sample is usually necessary to measure hemoglobin levels in children. Especially in small children, noninvasively measuring the hemoglobin level could be extraordinarily helpful, but its precision and accuracy in the clinical environment remain unclear. In this study, noninvasive hemoglobin measurement and blood gas analysis were compared to hemoglobin measurement in a clinical laboratory. In 60 healthy preoperative children (0.2-7.6 years old), hemoglobin was measured using a noninvasive method (SpHb; Radical-7 Pulse Co-Oximeter), a blood gas analyzer (clinical standard, BGAHb; ABL 800 Flex), and a laboratory hematology analyzer (reference method, labHb; Siemens Advia). Agreement between the results was assessed by Bland-Altman analysis and by determining the percentage of outliers. Sixty SpHb measurements, 60 labHb measurements, and 59 BGAHb measurements were evaluated. In 38% of the children, the location of the SpHb sensor had to be changed more than twice for the signal quality to be sufficient. The bias/limits of agreement between SpHb and labHb were -0.65/-3.4 to 2.1 g·dl(-1) . Forty-four percent of the SpHb values differed from the reference value by more than 1 g·dl(-1) . Age, difficulty of measurement, and the perfusion index (PI) had no influence on the accuracy of SpHb. The bias/limits of agreement between BGAHb and labHb were 1.14/-1.6 to 3.9 g·dl(-1) . Furthermore, 66% of the BGAHb values differed from the reference values by more than 1 g·dl(-1) . The absolute mean difference between SpHb and labHb (1.1 g·dl(-1) ) was smaller than the absolute mean difference between BGAHb and labHb (1.5 g·dl(-1) /P = 0.024). Noninvasive measurement of hemoglobin agrees more with the reference method than the measurement of hemoglobin using a blood gas analyzer. However, both methods can show clinically relevant differences from the reference method (ClinicalTrials.gov: NCT01693016). © 2015 John Wiley & Sons Ltd.

  2. Automated diagnostics scoping study. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Quadrel, R.W.; Lash, T.A.

    1994-06-01

    The objective of the Automated Diagnostics Scoping Study was to investigate the needs for diagnostics in building operation and to examine some of the current technologies in automated diagnostics that can address these needs. The study was conducted in two parts. In the needs analysis, the authors interviewed facility managers and engineers at five building sites. In the technology survey, they collected published information on automated diagnostic technologies in commercial and military applications as well as on technologies currently under research. The following describe key areas that the authors identify for the research, development, and deployment of automated diagnostic technologies: tools and techniques to aid diagnosis during building commissioning, especially those that address issues arising from integrating building systems and diagnosing multiple simultaneous faults; technologies to aid diagnosis for systems and components that are unmonitored or unalarmed; automated capabilities to assist cause-and-effect exploration during diagnosis; inexpensive, reliable sensors, especially those that expand the current range of sensory input; technologies that aid predictive diagnosis through trend analysis; integration of simulation and optimization tools with building automation systems to optimize control strategies and energy performance; integration of diagnostic, control, and preventive maintenance technologies. By relating existing technologies to perceived and actual needs, the authors reached some conclusions about the opportunities for automated diagnostics in building operation. Some of a building operator`s needs can be satisfied by off-the-shelf hardware and software. Other needs are not so easily satisfied, suggesting directions for future research. Their conclusions and suggestions are offered in the final section of this study.

  3. [Usher syndrome: clinical features, diagnostic options, and therapeutic prospects].

    Science.gov (United States)

    Seeliger, M W; Fischer, M D; Pfister, M

    2009-06-01

    Usher syndrome denotes a clinically and genetically heterogeneous combination of retinitis pigmentosa and sensorineural deafness. The division into subtypes I, II, and III is based on the degree of hearing loss: Type I is characterized by deafness from birth together with ataxia and retarded motor development, type II by a stationary deafness of a moderate degree, and type III by a progressive deafness with adult onset. In Germany, Usher syndrome currently bears particular relevance because in January 2009 a new compulsory screening of auditory function in newborn infants was introduced. Consequently, it can be expected that a higher number of patients with Usher syndrome will be identified in early childhood and referred to ophthalmologists. The focus of this work is to introduce the typical clinical picture of Usher syndrome, summarize diagnostic options, and give an overview of therapeutic strategies.

  4. Clinical and experimental studies regarding the expression and diagnostic value of carcinoembryonic antigen-related cell adhesion molecule 1 in non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Zhou, Mu-qing; Du, Yan; Liu, Yi-wen; Wang, Ying-zhi; He, Yi-qing; Yang, Cui-xia; Wang, Wen-juan; Gao, Feng

    2013-01-01

    Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a multifunctional Ig-like cell adhesion molecule that has a wide range of biological functions. According to previous reports, serum CEACAM1 is dysregulated in different malignant tumours and associated with tumour progression. However, the serum CEACAM1 expression in non-small-cell lung carcinomas (NSCLC) is unclear. The different expression ratio of CEACAM1-S and CEACAM1-L isoform has seldom been investigated in NSCLC. This research is intended to study the serum CEACAM1 and the ratio of CEACAM1-S/L isoforms in NSCLC. The expression of the serum CEACAM1 was determined by enzyme-linked immunosorbent assay. The protein expression and the location of CEACAM1 in tumours were observed by immunohistochemical staining. The CEACAM1 mRNA levels in tumour and normal adjacent tissues were measured using quantitative real-time PCR, and the expression patterns and the rate of CEACAM1-S and CEACAM1-L were analysed by reverse transcription-PCR. Serum CEACAM1 levels were significantly higher in NSCLC patients compared with that from normal healthy controls (P <0.0001). 17 patients (81%) among 21 showed high expression of CEACAM1 by immunohistochemical staining. Although no significant differences were found between tumour and normal tissues on mRNA expression levels of CEACAM1 (P >0.05), the CEACAM1-S and the CEACAM1-S/L (S: L) ratios were significantly higher in tumour than normal tissues (P <0.05). Our data indicated that the serum levels of CEACAM1 could discriminate lung cancer patients from health donors and that CEACAM1 might be a useful marker in early diagnosis of NSCLC. Moreover, our results showed that the expression patterns of CEACAM1 isoforms could be changed during oncogenesis, even when total CEACAM1 in tumour tissues did not show significant changes. Our study suggested that the expression ratios of CEACAM1-S/CEACAM1-L might be a better diagnostic indicator in NSCLC than the quantitative

  5. Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline

    NARCIS (Netherlands)

    Rosenberg, N. R.; Portegies, P.; de Visser, M.; Vermeulen, M.

    2001-01-01

    OBJECTIVE: (1) To evaluate a clinical guideline for the diagnostic investigation of patients presenting with signs and symptoms (present for longer than 6 weeks) suggesting a chronic polyneuropathy. (2) To investigate the contribution of electrophysiological studies to a focused search for aetiology

  6. Wilson's disease in children: clinical and diagnostic features

    International Nuclear Information System (INIS)

    Ayesha, H.; Choudhry, A.A.; Javed, M.T.; Javed, F.

    2002-01-01

    Objective: To study the clinical and diagnostic laboratory features of Wilsons disease in children and adolescents. Design: A prospective cohort study. Place and Duration of study: The study included patients diagnosed as Wilson s disease at the Department of Pediatrics Allied Hospital, Punjab medical College, Faisalabad from May 1997 to June 2001. Patients and methods: Patients presenting with liver or suggestive neurological disease were investigated. Others were diagnosed as a result of family screening. Diagnosis of neurologic disease was made if two of the following were present: Typical neurological findings, Kayser Fleischer corneal rings and low serum ceruloplasmin ( 100 mu gm) free serum copper (>10 mu gm/dl). In other forms and for family screening, 24 hours. Urinary copper (> 100 mu gm), free serum copper (>10 mu gm/dl), and wherever possible liver biopsy for histopathology and cytochemical staining by rubeanic acid was also done. Results: Twenty-seven patients with a mean age of 10.2 years were diagnosed as suffering from Wilson disease. Mean age for hepatic and neurological disease was 9 years and 11.5 years respectively. Youngest patient (neurologic) was 6 years old. 48% cases presented with neurological, 41% with hepatic and 4% with skeletal manifestations while 7 % were asymptomatic. Mean duration of symptoms before diagnosis was 6.1 months. Dysarthria (84.6%), tremors (69.2%), rigidity and poor school performance and hand writing (61.5%), dysphagia (46.1%) and dystonia (38.5%), were the most common neurologic findings. Chronic liver disease was seen in 73 % while acute forms were seen in 27 % cases. Two cases presented with fulminant hepatic failure. Consanguineous marriage of the parents was found in 70 % and family history of disease was present in 65 % cases. K-F (Kayser Fleischer) rings and low serum ceruloplasmin(<20 mg/dl) was found in 85% of all patients. In non neurologic types other tests of copper metabolism were done. Elevated urinary

  7. Neurogenetics in Argentina: diagnostic yield in a personalized research based clinic.

    Science.gov (United States)

    Rodríguez-Quiroga, Sergio Alejandro; Cordoba, Marta; González-Morón, Dolores; Medina, Nancy; Vega, Patricia; Dusefante, Cecilia Vazquez; Arakaki, Tomoko; Garretto, Nélida Susana; Kauffman, Marcelo Andres

    2015-01-01

    As a whole neurogenetic diseases are a common group of neurological disorders. However, the recognitionand molecular diagnosis of these disorders is not always straightforward. Besides, there is a paucity of informationregarding the diagnostic yield that specialized neurogenetic clinics could obtain. We performed a prospective,observational, analytical study of the patients seen in a neurogenetic clinic at a tertiary medicalcentre to assess the diagnostic yield of a comprehensive diagnostic evaluation that included a personalizedclinical assessment along with traditional and next-generation sequencing diagnostic tests. We included a cohortof 387 patients from May 2008 to June 2014. For sub-group analysis we selected a sample of patientswhose main complaint was the presence of progressive ataxia, to whom we applied a systematic moleculardiagnostic algorithm. Overall, a diagnostic mutation was identified in 27·4% of our cohort. However, if weonly considered those patients where a molecular test could be performed, the success rate rises to 45%. Weobtained diagnostic yields of 23·5 and 57·5% in the global group of ataxic patients and in the subset of ataxicpatients with a positive family history, respectively. Thus, about a third of patients evaluated in a neurogeneticclinic could be successfully diagnosed.

  8. [Patent ductus arteriosus in the dog: a retrospective study of clinical presentation, diagnostics and comparison of interventional techniques in 102 dogs (2003-2011)].

    Science.gov (United States)

    Meijer, M; Beijerink, N J

    2012-06-01

    A left-to-right shunting patent ductus arteriosus (PDA) is a common congenital heart defect in dogs. If it is left uncorrected, life expectancy in most cases is decreased due to the development of left-sided congestive heart failure. The aim of this study was to describe the dogs diagnosed with PDA in the Utrecht University Companion Animal Clinic from 2003 to 2011. The medical records of 102 patients were retrieved, and the clinical presentation and outcome of PDA closure by surgical ligation or transarterial catheter occlusion (TCO) were reviewed. In the TCO group, the result of coiling was compared with the placement of an Amplatz Canine Duct Occluder (ACDO). A predisposition to PDA was found in the German Brak, Stabyhoun, and Schapendoes. Dogs treated with surgical ligation were significantly older and heavier than those treated with TCO; within the TCO group, dogs treated with ACDO were significantly older and heavier The initial success rate (complete disappearance of the audible murmur in a patient that survived the procedure) was not significantly different between the different treatment modalities. Major complications were more common with surgical ligation, but the incidence of minor complications was not significantly different. There was no diference in survival between dogs treated with surgical ligation and dogs treated with TCO. This study shows a previously unreported predisposition to PDA in certain breeds. Both surgical ligation and TCO are suitable techniques for PDA closure, although major complications were more common with surgical ligation. ACDO appears to be the method with the least complications and thus can be considered the safest method.

  9. Development and clinical evaluation of a rapid diagnostic kit for feline leukemia virus infection.

    Science.gov (United States)

    Kim, Won-Shik; Chong, Chom-Kyu; Kim, Hak-Yong; Lee, Gyu-Cheol; Jeong, Wooseog; An, Dong-Jun; Jeoung, Hye-Young; Lee, Jae-In; Lee, Young-Ki

    2014-01-01

    Feline leukemia virus (FeLV) causes a range of neoplastic and degenerative diseases in cats. To obtain a more sensitive and convenient diagnosis of the disease, we prepared monoclonal antibodies specific for the FeLV p27 to develop a rapid diagnostic test with enhanced sensitivity and specificity. Among these antibodies, we identified two clones (hybridomas 8F8B5 and 8G7D1) that specifically bound to FeLV and were very suitable for a diagnostic kit. The affinity constants for 8F8B5 and 8G7D1 were 0.35 × 10⁸ and 0.86 × 10⁸, respectively. To investigate the diagnostic abilities of the rapid kit using these antibodies, we performed several clinical studies. Assessment of analytical sensitivity revealed that the detection threshold of the rapid diagnostic test was 2 ng/mL for recombinant p27 and 12.5 × 10⁴ IU/mL for FeLV. When evaluating 252 cat sera samples, the kit was found to have a kappa value of 0.88 compared to polymerase chain reaction (PCR), indicating a significant correlation between data from the rapid diagnostic test and PCR. Sensitivity and specificity of the kit were 95.2% (20/21) and 98.5% (257/261), respectively. Our results demonstrated that the rapid diagnostic test would be a suitable diagnostic tool for the rapid detection of FeLV infection in cats.

  10. A COMPARATIVE STUDY OF CLINICAL EXAMINATION, ULTRASOUND FINDINGS, DIAGNOSTIC HYSTEROSCOPY WITH HISTOPATHOLOGICAL EXAMINATION REPORT OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

    Directory of Open Access Journals (Sweden)

    Sathenahalli Devegowda Prathibha

    2016-08-01

    Full Text Available BACKGROUND AND OBJECTIVES Abnormal Uterine Bleeding (AUB is a very frequent gynaecological complaint and occurs across the entire age spectrum, approximately 75000 hysterectomies are carried out each year with 30% of these for menstrual problems alone. These menstrual aberrations occur more commonly at extremes of reproductive life. The introduction of hysteroscopy has opened a new dimension in evaluation of patient with AUB replacing the blind technique of Dilatation and Curettage. The present study was undertaken to know the accuracy of various tests with Histopathology. MATERIALS AND METHODS The present prospective study was carried out on 100 patients from reproductive, perimenopausal and postmenopausal age group with abnormal uterine bleeding in Dr. B. R. Ambedkar Medical College and Hospital. RESULTS In the present study, in relation to histopathological examination, clinical findings and hysteroscopy had better accuracy (72% as compared to ultrasound findings (41% in diagnosis of abnormal uterine bleeding. CONCLUSION Hysteroscopy guided biopsy and histopathology complements each other in the evaluation of patient with abnormal uterine bleeding for accurate diagnosis and further treatment.

  11. Tokamak physics experiment: Diagnostic windows study

    International Nuclear Information System (INIS)

    Merrigan, M.; Wurden, G.A.

    1995-11-01

    We detail the study of diagnostic windows and window thermal stress remediation in the long-pulse, high-power Tokamak Physics Experiment (TPX) operation. The operating environment of the TPX diagnostic windows is reviewed, thermal loads on the windows estimated, and cooling requirements for the windows considered. Applicable window-cooling technology from other fields is reviewed and its application to the TPX windows considered. Methods for TPX window thermal conditioning are recommended, with some discussion of potential implementation problems provided. Recommendations for further research and development work to ensure performance of windows in the TPX system are presented

  12. A new condition for assessing the clinical efficiency of a diagnostic test.

    Science.gov (United States)

    Bokhari, Ehsan; Hubert, Lawrence

    2015-09-01

    When prediction using a diagnostic test outperforms simple prediction using base rates, the test is said to be "clinically efficient," a term first introduced into the literature by Meehl and Rosen (1955) in Psychological Bulletin. This article provides three equivalent conditions for determining the clinical efficiency of a diagnostic test: (a) Meehl-Rosen (Meehl & Rosen, 1955); (b) Dawes (Dawes, 1962); and (c) the Bokhari-Hubert condition, introduced here for the first time. Clinical efficiency is then generalized to situations where misclassification costs are considered unequal (for example, false negatives are more costly than false positives). As an illustration, the clinical efficiency of an actuarial device for predicting violent and dangerous behavior is examined that was developed as part of the MacArthur Violence Risk Assessment Study. (c) 2015 APA, all rights reserved.

  13. Clinical Applications of the Eosinophilic Esophagitis Diagnostic Panel

    Directory of Open Access Journals (Sweden)

    Ting Wen

    2017-07-01

    Full Text Available Eosinophilic esophagitis (EoE is a recently recognized upper gastrointestinal allergic disorder characterized by esophageal dysfunction (e.g., dysphagia and esophageal eosinophilia of ≥15 eosinophils/high-power field in patients who have persistent esophagitis even on proton pump inhibitor (PPI therapy. The histologic method is the gold standard of EoE diagnosis. However, EoE clinical symptoms do not always correlate with histology, and the histologic method has sensitivity and specificity issues due to the patchiness of EoE and the subjective nature of the method. The “EoE transcriptome” was initially discovered in 2006, which led to the invention of the EoE diagnostic panel (EDP. In addition to providing a definitive EoE diagnosis with high accuracy, the EDP has been useful in elucidating several key elements about the disease including the efficacy of specific drugs such as swallowed glucocorticoids and anti-IL-13 humanized antibody therapy, the relationship between EoE and PPI-responsive esophageal eosinophilia, and predicting the disease course and responsiveness to therapy. The EDP’s long-term potential arises from its plasticity to incorporate new genes and uncover novel disease pathogenesis. We expect that the EDP will be increasingly helpful for personalized medicine approaches and improved diagnostics and disease monitoring.

  14. Pulmonary embolism. Clinical relevance, requirements for diagnostic and therapeutic strategies

    International Nuclear Information System (INIS)

    Nowak, F.G.; Halbfass, P.; Hoffmann, E.

    2007-01-01

    In the population the annual incidence of pulmonary embolism amounts to 1.3-2.8 per 1000 at the age of 65-89 years. Mortality reaches about 17% within the first 3 months. Acute pulmonary embolism is characterized by an increase in pulmonary arterial pressure and an impairment of the pulmonary gas exchange. Elevation of the right cardiac pressure up to right heart decompensation may follow. In addition, hypoxemia, hyperventilation, dead space ventilation, right to left shunting, bronchoconstriction, and vasoconstriction may occur. Clinical examination, ECG, laboratory findings such as elevated D-dimer, blood gas analysis, ultrasound examination of the veins of the lower extremities, and transthoracic echocardiography are acutely available diagnostic methods of an emergency department. In addition, extensive diagnostic procedures like pulmonary scintigraphy and pulmonary angiography may be required. The aim is to get a definite diagnosis as quickly as possible to direct therapy. In acute pulmonary embolism with cardiac shock, monitoring and stabilization of the circulatory function as well as an appropriate anticoagulant therapy are essential. In some cases surgery or a local fibrinolytic intervention is indicated. (orig.) [de

  15. From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis

    Directory of Open Access Journals (Sweden)

    H. Krentel

    2017-01-01

    Full Text Available Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.

  16. Diagnostic clinical parasitology: IV. Identification of the blood parasites?

    Science.gov (United States)

    Garcia, L S; Voge, M

    1981-01-01

    This is the fourth article in a series of articles entitled "Diagnostic Clinical Parasitology" and contains information on the recovery and identification of human blood parasites. The organisms covered include those that cause the diseases malaria, babesiosis, leishmaniasis, and trypanosomiasis. Some of the filarial worms, which can be considered "blood parasites," have been discussed in the third article in the series, "Identification of the Helminths." Although some of these organisms may rarely be encountered in the laboratory in clinical specimens, they will probably have to be identified in proficiency testing specimens, some of which may not always be representative of patient clinical material. The differences between potential organism recovery from patients coming from endemic areas and from those individuals who become infected with no prior exposure to the organism will also be emphasized. Often, for a number of different reasons, organism recovery and subsequent identification may be more difficult than the textbook imply. It is very important for the technologist to recognize this fact, particularly when dealing with a possibly fatal infection, ie, Plasmodium falciparum.

  17. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear

    DEFF Research Database (Denmark)

    Reiman, M P; Goode, A P; Cook, C E

    2015-01-01

    BACKGROUND: Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent...

  18. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Science.gov (United States)

    Bonilauri Ferreira, Ana Paula Ribeiro; Ferreira, Rodrigo Fernando; Rajgor, Dimple; Shah, Jatin; Menezes, Andrea; Pietrobon, Ricardo

    2010-04-20

    Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  19. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Ana Paula Ribeiro Bonilauri Ferreira

    Full Text Available BACKGROUND: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. METHOD: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. RESULTS: FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. DISCUSSION: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  20. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome

    Science.gov (United States)

    2012-01-01

    Introduction Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi-institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria. Methods The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI ≥ 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy. Results Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 ± 6.8, 14.4 ± 4.0, and 8.3 ± 2.1, respectively; P edema or pleural effusion with atelectasis patients (3.2 ± 1.4, 2.0 ± 0.8, and 1.6 ± 0.5; P edema patients. A PVPI value of 2.6 to 2.85 provided a definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95). Conclusion

  1. Molecular diagnostics of lung cancer in the clinic.

    Science.gov (United States)

    Sholl, Lynette

    2017-10-01

    According to current practice guidelines, all patients with advanced non-small cell lung cancer (NSCLC) should undergo predictive biomarker testing. For squamous cell carcinoma patients, PD-L1 immunohistochemistry is indicated to select patients for immunotherapy in the first line. For lung adenocarcinoma, all patients with advanced disease should undergo testing for epidermal growth factor receptor ( EGFR ) mutations, ALK and ROS1 rearrangements, and PD-L1 expression to predict response to EGFR, ALK, or ROS1 targeted inhibitors or immunotherapy, respectively. Besides these, a number of other biomarkers are under clinical investigation as predictors of response to targeted therapies, including BRAF , ERBB2 , MET splice mutations and amplification, and RET rearrangements. Successful testing for this complex array of molecular targets demands careful coordination between proceduralists, pathologists and molecular laboratories to ensure proper tumor tissue handling following biopsy as well as judicious use of diagnostic immunohistochemistry. Even so, sample failure rates due to inadequate tumor tissue are high in practice, particularly when using sequential testing methods. Use of next generation sequencing (NGS) in clinical practice can enable detection of multiple targets and multiple alteration types (mutation, gene copy change, and rearrangement) simultaneously even with small amounts of input nucleic acids, thus increasing molecular testing success rates. In patients with an established lung cancer diagnosis but with prohibitively limited amounts of tumor tissue or who are experiencing relapse, analyses of circulating tumor DNA (ctDNA) from the plasma can serve as an alternate testing substrate, however the more limited clinical sensitivity of this approach must be taken into account. This review will explore the indications for and pitfalls of routine NGS and plasma genotyping in the clinic, including the intersection of these technologies.

  2. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness.

    Science.gov (United States)

    Hay, Alastair D; Birnie, Kate; Busby, John; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Durbaba, Stevo; Fletcher, Margaret; Harman, Kim; Hollingworth, William; Hood, Kerenza; Howe, Robin; Lawton, Michael; Lisles, Catherine; Little, Paul; MacGowan, Alasdair; O'Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Sterne, Jonathan Ac; Thomas-Jones, Emma; van der Voort, Judith; Waldron, Cherry-Ann; Whiting, Penny; Wootton, Mandy; Butler, Christopher C

    2016-07-01

    It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. Multicentre, prospective diagnostic cohort study. Children UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. A total of 7163 children were recruited, of whom 50% were female and 49% were children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, 'clinical diagnosis' correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick

  3. How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?

    NARCIS (Netherlands)

    Meijs, A.P.; Claassen, J.A.H.R.; Olde Rikkert, M.G.M.; Schalk, B.W.M; Meulenbroek, O.V.; Kessels, R.P.C.; Melis, R.J.F.

    2015-01-01

    Background: patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and

  4. How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?

    NARCIS (Netherlands)

    Meijs, A.P.; Claassen, J.A.; Olde Rikkert, M.G.M.; Schalk, B.W.M; Meulenbroek, O.V.; Kessels, R.P.C.; Melis, R.J.F.

    2015-01-01

    BACKGROUND: patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and

  5. Facial diplegia: etiology, clinical manifestations, and diagnostic evaluation

    Directory of Open Access Journals (Sweden)

    Sefer Varol

    2015-12-01

    Full Text Available ABSTRACT Objective Facial diplegia (FD is a rare neurological manifestation with diverse causes. This article aims to systematically evaluate the etiology, diagnostic evaluation and treatment of FD. Method The study was performed retrospectively and included 17 patients with a diagnosis of FD. Results Patients were diagnosed with Guillain-Barré syndrome (GBS (11, Bickerstaff’s brainstem encephalitis (1, neurosarcoidosis (1, non-Hodgkin’s Lymphoma (1, tuberculous meningitis (1 herpes simplex reactivation (1 and idiopathic (1. In addition, two patients had developed FD during pregnancy. Conclusion Facial diplegia is an ominous symptom with widely varying causes that requires careful investigation.

  6. Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis.

    Science.gov (United States)

    Hirsch, Scott D; Reiter, Evan R; DiNardo, Laurence J; Wan, Wen; Schuman, Theodore A

    2017-05-01

    Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis. Retrospective cohort study. History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache. Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, and 34% by either modality. Applying modified RSTF diagnostic criteria, 39% lacked sinonasal inflammation by CT, 38% by endoscopy, and 24% by either modality. Using either abnormal CT or endoscopy as the reference standard, modified diagnostic criteria yielded a statistically significant increase in specificity from 37.1% to 65.1%, with a nonsignificant decrease in sensitivity from 79.2% to 70.3%. Analysis of comorbidities revealed temporomandibular joint disorder, chronic cervical pain, depression/anxiety, and psychiatric medication use to be negatively associated with objective inflammation on CT or endoscopy. Clinical diagnostic criteria overestimate the prevalence of chronic rhinosinusitis. Removing facial pain, ear pain, dental pain, and headache increased specificity without a concordant loss in sensitivity. Given the high prevalence of sinusitis, improved clinical diagnostic criteria may assist primary care providers in more accurately predicting the presence of inflammation, thereby reducing inappropriate antibiotic use or delayed referral for evaluation of primary headache syndromes. 4. Laryngoscope, 127:1011-1016, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Diagnostic Approaches to Sjögren’s Syndrome: a Literature Review and Own Clinical Experience

    Directory of Open Access Journals (Sweden)

    Pedro de Sousa Gomes

    2012-03-01

    Full Text Available Objectives: The purpose of present paper is to critically address the recent advances on diagnostic procedures of Sjögren’s syndrome, taking into account the attained local and systemic features of the disease. Material and Methods: A comprehensive review of the available literature regarding to the diagnostic approaches to Sjögren’s syndrome was conducted. Eligible studies were identified by searching the electronic literature PubMed, Medline, Embase, and ScienceDirect databases for relevant reports (last search update January 2012 combining the MESH heading term “Sjögren’s syndrome”, with the words "diagnosis, diagnostic procedures, salivary gland function, ocular tests, histopathology, salivary gland imaging, serology". The authors checked the references of the selected articles to identify additional eligible publications and contacted the authors, if necessary. Results: Presented article addresses the established diagnostic criteria for Sjögren’s syndrome and critically evaluates the most commonly used diagnostic procedures, presenting data from author’s own clinical experience. Diagnostic criteria for Sjögren’s syndrome are required both by healthcare professionals and patients, namely in order to provide a rational basis for the assessment of the symptoms, establish an individual disease prognosis, and orientate the therapeutic intervention. Conclusions: Sjögren’s syndrome is quite a common autoimmune disease of which the diagnosis and treatment are not easily established. Due to its systemic involvement, it can exhibit a wide range of clinical manifestations that contribute to confusion and delay in diagnosis. The use of proper diagnostic modalities will help to reduce the time to diagnosis and preserve the health and quality of life of patients with Sjögren’s syndrome.

  8. Autoimmune liver serology: current diagnostic and clinical challenges.

    Science.gov (United States)

    Bogdanos, Dimitrios-P; Invernizzi, Pietro; Mackay, Ian-R; Vergani, Diego

    2008-06-07

    Liver-related autoantibodies are crucial for the correct diagnosis and classification of autoimmune liver diseases (AiLD), namely autoimmune hepatitis types 1 and 2 (AIH-1 and 2), primary biliary cirrhosis (PBC), and the sclerosing cholangitis variants in adults and children. AIH-1 is specified by anti-nuclear antibody (ANA) and smooth muscle antibody (SMA). AIH-2 is specified by antibody to liver kidney microsomal antigen type-1 (anti-LKM1) and anti-liver cytosol type 1 (anti-LC1). SMA, ANA and anti-LKM antibodies can be present in de-novo AIH following liver transplantation. PBC is specified by antimitochondrial antibodies (AMA) reacting with enzymes of the 2-oxo-acid dehydrogenase complexes (chiefly pyruvate dehydrogenase complex E2 subunit) and disease-specific ANA mainly reacting with nuclear pore gp210 and nuclear body sp100. Sclerosing cholangitis presents as at least two variants, first the classical primary sclerosing cholangitis (PSC) mostly affecting adult men wherein the only (and non-specific) reactivity is an atypical perinuclear antineutrophil cytoplasmic antibody (p-ANCA), also termed perinuclear anti-neutrophil nuclear antibodies (p-ANNA) and second the childhood disease called autoimmune sclerosing cholangitis (ASC) with serological features resembling those of type 1 AIH. Liver diagnostic serology is a fast-expanding area of investigation as new purified and recombinant autoantigens, and automated technologies such as ELISAs and bead assays, become available to complement (or even compete with) traditional immunofluorescence procedures. We survey for the first time global trends in quality assurance impacting as it does on (1) manufacturers/purveyors of kits and reagents, (2) diagnostic service laboratories that fulfill clinicians' requirements, and (3) the end-user, the physician providing patient care, who must properly interpret test results in the overall clinical context.

  9. The Hampstead Clinic at work. Discussions in the Diagnostic Profile Research Group.

    Science.gov (United States)

    Koch, Ehud

    2012-01-01

    Minutes of the Hampstead Clinic's Diagnostic Profile Research Group during a fifteen-month period (1964-1965) are reviewed and discussed. A wide range of topics were considered and discussed, with a special focus on the affective life, object relations, and ego function of atypical children in comparison to the early ego functions and differentiation of normal and neurotic children. These lively clinical and theoretical discussions and their implications for therapeutic work with a wide range of children, demonstrate the multifaceted leadership and contributions of Anna Freud as teacher, clinician, and thinker, and of the Hampstead Clinic as a major center for psychoanalytic studies.

  10. Low activation diagnostic equipment design studies

    International Nuclear Information System (INIS)

    Hopkins, G.R.; Cheng, E.T.; Fisher, R.K.

    1985-01-01

    The low activation fusion concept has been applied to the diagnostic equipment in a fusion reactor. The components where fabrication from low activation materials is feasible have been identified. Other systems where higher activation elements are required can have their activation reduced by design approaches which include shielding and operation only in low flux regions of the reactor. Some components will not operate in a high flux so activation is not a major concern. This low activation diagnostic equipment study completes a series of low activation studies where all the components in a fusion power reactor have now been evaluated. It is concluded that a completely low activation fusion reactor is feasible with all components meeting the functional requirements. This provides an environmentally benign energy source with a high confidence level in meeting safety criteria in operation, maintenance and waste disposal

  11. ABDOMINAL TRAUMA- CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Vanaja Ratnakumari Billa

    2017-08-01

    Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic

  12. A study on the value of computer-assisted assessment for SPECT/CT-scans in sentinel lymph node diagnostics of penile cancer as well as clinical reliability and morbidity of this procedure.

    Science.gov (United States)

    Lützen, Ulf; Naumann, Carsten Maik; Marx, Marlies; Zhao, Yi; Jüptner, Michael; Baumann, René; Papp, László; Zsótér, Norbert; Aksenov, Alexey; Jünemann, Klaus-Peter; Zuhayra, Maaz

    2016-09-07

    Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure. Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we evaluated the results of an algorithm for SPECT/CT-data assessment of these patients. SLNB was carried out in 44 groins of 25 patients. In three patients, inguinal lymph node metastases were detected via SLNB. In one patient, bilateral lymph node recurrence of the groins occurred after negative SLNB. There was a false-negative rate of 4 % in relation to the number of patients (1/25), resp. 4.5 % in relation to the number of groins (2/44). Morbidity was 4 % in relation to the number of patients (1/25), resp. 2.3 % in relation to the number of groins (1/44). The results of computer-assisted assessment of SPECT/CT data for sentinel lymph node (SLN)-diagnostics demonstrated high sensitivity of 88.8 % and specificity of 86.7 %. SLNB is a very reliable method, associated with low morbidity. Computer-assisted assessment of SPECT/CT data of the SLN-diagnostics shows high sensitivity and specificity. While it cannot replace the assessment by medical experts, it can still provide substantial

  13. Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia

    DEFF Research Database (Denmark)

    Arendrup, Maiken Cavling; Sulim, Sofia; Holm, Anette

    2011-01-01

    This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes...... needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C...

  14. Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

    DEFF Research Database (Denmark)

    Arendrup, Maiken Cavling; Sulim, Sofia; Holm, Anette

    2011-01-01

    This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes...... needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C...

  15. Self-diagnosis of malaria by travellers: a cohort study on the use of malaria rapid diagnostic tests provided by a Swiss travel clinic.

    Science.gov (United States)

    Berthod, Delphine; Rochat, Jacynthe; Voumard, Rachel; Rochat, Laurence; Genton, Blaise; D'Acremont, Valérie

    2017-10-28

    The WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and thus, RDTs could also be provided to travellers for self-diagnosis during visits to endemic regions. RDTs were proposed during pre-travel consultations to pre-defined categories of travellers. A training run on their own blood was performed and, if carried out correctly, the traveller was given a written procedure on how to perform the test and act on its result. The travellers were then proposed to buy a malaria RDT kit and were interviewed upon their return. From February 2012 to February 2017, 744 travellers were proposed RDTs and 692 performed the training run (one could not complete it due to a hand tremor). Among the 691 subjects included, 69% travelled to moderate- or low-risk areas of malaria, 18% to high-risk areas and 13% to mixed-risk areas. The two most frequent categories of travellers to whom RDTs were proposed were long-term travellers (69%) and those travelling to remote areas (57%). 543 travellers (79%) were interviewed upon return. During their trip, 17% (91/543) had a medical problem with fever and 12% (65/543) without fever. Among 91 febrile patients, 57% (52/91) performed an RDT, 22% (20/91) consulted immediately without using the test, and 21% (19/91) did neither. Four RDTs (4/52; 8%) were positive: 2 in low-risk and 2 in high-risk areas (0.7% attack rate of self-documented malaria). Two travellers could not perform the test correctly and attended a facility or took standby emergency treatment. Four travellers with negative results repeated the test after 24 h; all were still negative. Carrying RDTs made travellers feel more secure, especially when travelling with children. 1/6 travellers experienced fever and 4/5 of those reacted appropriately: more than half used RDTs and a quarter consulted immediately. Four travellers

  16. Searching for neurodegeneration in multiple sclerosis at clinical onset: Diagnostic value of biomarkers.

    Science.gov (United States)

    Novakova, Lenka; Axelsson, Markus; Malmeström, Clas; Imberg, Henrik; Elias, Olle; Zetterberg, Henrik; Nerman, Olle; Lycke, Jan

    2018-01-01

    Neurodegeneration occurs during the early stages of multiple sclerosis. It is an essential, devastating part of the pathophysiology. Tools for measuring the degree of neurodegeneration could improve diagnostics and patient characterization. This study aimed to determine the diagnostic value of biomarkers of degeneration in patients with recent clinical onset of suspected multiple sclerosis, and to evaluate these biomarkers for characterizing disease course. This cross-sectional study included 271 patients with clinical features of suspected multiple sclerosis onset and was the baseline of a prospective study. After diagnostic investigations, the patients were classified into the following disease groups: patients with clinically isolated syndrome (n = 4) or early relapsing remitting multiple sclerosis (early RRMS; n = 93); patients with relapsing remitting multiple sclerosis with disease durations ≥2 years (established RRMS; n = 39); patients without multiple sclerosis, but showing symptoms (symptomatic controls; n = 89); and patients diagnosed with other diseases (n = 46). In addition, we included healthy controls (n = 51) and patients with progressive multiple sclerosis (n = 23). We analyzed six biomarkers of neurodegeneration: cerebrospinal fluid neurofilament light chain levels; cerebral spinal fluid glial fibrillary acidic protein; cerebral spinal fluid tau; retinal nerve fiber layer thickness; macula volume; and the brain parenchymal fraction. Except for increased cerebral spinal fluid neurofilament light chain levels, median 670 ng/L (IQR 400-2110), we could not find signs of early degeneration in the early disease group with recent clinical onset. However, the intrathecal immunoglobin G production and cerebral spinal fluid neurofilament light chain levels showed diagnostic value. Moreover, elevated levels of cerebral spinal fluid glial fibrillary acidic protein, thin retinal nerve fiber layers, and low brain parenchymal fractions were associated with

  17. Diagnostic outcome following routine genetics clinic referral for the assessment of global developmental delay.

    LENUS (Irish Health Repository)

    Shahdadpuri, R

    2012-02-01

    The aim of this study was to ascertain the diagnostic yield following a routine genetics clinic referral for the assessment of global developmental delay. Detailed retrospective review of 119 complete consecutive case notes of patients referred to one single clinical geneticist over a 14 month time period was undertaken (n = 119; 54 males, 65 females). The age at initial review ranged from 2 months to 37 years 3 months (mean 8 y 3 mo [SD 7 y 10 mo]). We made a diagnosis in 36\\/119 (30%); 21\\/36 were new diagnoses and 15\\/36 were confirmations of diagnoses. We removed a wrong diagnostic label in 8\\/119 (7%). In 3\\/8 we were able to achieve a diagnosis but in 5\\/8 no alternative diagnosis was reached. We had a better diagnostic rate where the patients were dysmorphic (odds ratio [OR] 1.825; 95% confidence interval [CI] 1.065 to 3.128, p = 0.044). In the majority, the diagnosis was made by clinical examination only. Molecular diagnosis was reached in seven cases. Five cases were confirmed by cytogenetic analysis. Brain magnetic resonance imaging (MRI) revealed a diagnosis in three cases. This study confirms the importance of a clinical genetics assessment in the investigation of global developmental delay.

  18. Is the diagnostic threshold for bulimia nervosa clinically meaningful?

    Science.gov (United States)

    Chapa, Danielle A N; Bohrer, Brittany K; Forbush, Kelsie T

    2018-01-01

    The DSM-5 differentiates full- and sub-threshold bulimia nervosa (BN) according to average weekly frequencies of binge eating and inappropriate compensatory behaviors. This study was the first to evaluate the modified frequency criterion for BN published in the DSM-5. The purpose of this study was to test whether community-recruited adults (N=125; 83.2% women) with current full-threshold (n=77) or sub-threshold BN (n=48) differed in comorbid psychopathology and eating disorder (ED) illness duration, symptom severity, and clinical impairment. Participants completed the Clinical Impairment Assessment and participated in semi-structured clinical interviews of ED- and non-ED psychopathology. Differences between the sub- and full-threshold BN groups were assessed using MANOVA and Chi-square analyses. ED illness duration, age-of-onset, body mass index (BMI), alcohol and drug misuse, and the presence of current and lifetime mood or anxiety disorders did not differ between participants with sub- and full-threshold BN. Participants with full-threshold BN had higher levels of clinical impairment and weight concern than those with sub-threshold BN. However, minimal clinically important difference analyses suggested that statistically significant differences between participants with sub- and full-threshold BN on clinical impairment and weight concern were not clinically significant. In conclusion, sub-threshold BN did not differ from full-threshold BN in clinically meaningful ways. Future studies are needed to identify an improved frequency criterion for BN that better distinguishes individuals in ways that will more validly inform prognosis and effective treatment planning for BN. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Studies on the diagnostic accuracy of lymphography

    International Nuclear Information System (INIS)

    Luening, M.; Stargardt, A.; Abet, L.

    1979-01-01

    Contradictory reports in the literature on the reliability of lymphography stimulated the authors to test the diagnostic accuracy, employing methods which are approximately analogous to practice, using carcinoma of the cervix as the model on which the study was carried out. Using 21 observers it was found that there was no correlation between their experience and on-target accuracy of the diagnosis. Good observers obtained an accuracy of 85% with good proportions between sensitivity in the recognition of detail, specificity and readiness to arrive at a decision on the basis of discriminatory ability. With the help of the concept of the ROC curves, the position taken up by the observers in respect of diagnostic decisions, and a complex manner of assessing the various characteristic factors determining diagnostic accuracy, are demonstrated. This form of test, which permits manipulation of different variants of diagnosis, is recommended, among other things, for performance control at the end of training and continuing education courses in other fields of x-ray diagnosis as well. (orig.) [de

  20. Diagnostic Consideration for Sinonasal Wegener's Granulomatosis Clinically Mistaken for Carcinoma

    Science.gov (United States)

    La Rosa, Cristina; Emmanuele, Carmela; Tranchina, Maria Grazia; Ippolito, Massimo; Cosentino, Sebastiano; Saita, Vincenzo; Fraggetta, Filippo

    2013-01-01

    We report a case of Wegener's granulomatosis clinically mistaken for carcinoma in a 21-year-old girl presenting with an ulcerated mass of the nasopharynx associated with enlarged laterocervical nodes. The lesion was clinically suspected as malignant on the basis of clinical and radiological findings (namely, computed tomography scan and positron emission tomography). However, multiple biopsies were not conclusive for malignancy showing histological change suggestive of Wegener's granulomatosis. A serum determination of cANCA supported the diagnosis of Wegener's granulomatosis. Clinical findings and image studies suggested an erroneous diagnosis of malignancy whereas a definitive diagnosis of Wegener's granulomatosis was achieved only after repeated biopsies thus leading to a correct therapeutic approach. The Wegener granulomatosis must be added to the list of the differential diagnoses of the masses of the nasopharynx associated with or without enlarged laterocervical nodes. PMID:24106630

  1. DIAGNOSTIC ACCURACY OF CLINICAL AND MAGNETIC RESONANCE IN KNEE MENISCI AND LIGAMENTOUS INJURIES

    Directory of Open Access Journals (Sweden)

    Nilesh

    2016-03-01

    Full Text Available OBJECTIVE The purpose of this study was to evaluate the reliability of clinical diagnosis compared to MRI findings in ligamentous and meniscal injuries with respect to arthroscopic confirmation as a gold standard. METHODS 485 patients with knee injuries were prospectively assessed by clinical evaluation and magnetic resonance imaging and correlated after therapeutic arthroscopy. The overall accuracy, clinically productive values of sensitivity and specificity was derived. The actual value of the test with respect to positive predictive and negative predictive value was also derived, taking arthroscopic findings as confirmatory. The overall partial and total agreement among the clinical, MRI and arthroscopy was documented. RESULTS The overall accuracy for clinical examination was 85, 92, 100 and 100 and accuracy for MRI was 90, 97, 97 and 97 for detecting medial meniscus, lateral meniscus, ACL and PCL tears respectively. Clinically lateral meniscus tears are difficult to diagnose clinically with negative predictive value (90 whereas ACL injuries do not need MRI for diagnosis as evident by a high negative predictive value (100 of clinical examination. Total agreement with the clinical findings confirmed by arthroscopy was 64.40% which was relatively high as compared to total agreement of MRI findings which was only 31.50%. We found similar total agreement versus total disagreement of both clinical and MRI to be only 2.74% indicating very high accuracy in clinical diagnosis of meniscal and ligamentous injuries combined. CONCLUSION The clinical evaluation alone is sufficient to diagnose meniscal and ACL/PCL pathologies and MRI should be considered only as a powerful negative diagnostic tool. The arthroscopy decision should not be heavily dependent on MRI for ligamentous injuries but reverse is true for meniscal lesions. MR evaluation functions as a powerful negative diagnostic tool to rule out doubtful and complex knee injuries.

  2. Cancer imaging phenomics toolkit: quantitative imaging analytics for precision diagnostics and predictive modeling of clinical outcome.

    Science.gov (United States)

    Davatzikos, Christos; Rathore, Saima; Bakas, Spyridon; Pati, Sarthak; Bergman, Mark; Kalarot, Ratheesh; Sridharan, Patmaa; Gastounioti, Aimilia; Jahani, Nariman; Cohen, Eric; Akbari, Hamed; Tunc, Birkan; Doshi, Jimit; Parker, Drew; Hsieh, Michael; Sotiras, Aristeidis; Li, Hongming; Ou, Yangming; Doot, Robert K; Bilello, Michel; Fan, Yong; Shinohara, Russell T; Yushkevich, Paul; Verma, Ragini; Kontos, Despina

    2018-01-01

    The growth of multiparametric imaging protocols has paved the way for quantitative imaging phenotypes that predict treatment response and clinical outcome, reflect underlying cancer molecular characteristics and spatiotemporal heterogeneity, and can guide personalized treatment planning. This growth has underlined the need for efficient quantitative analytics to derive high-dimensional imaging signatures of diagnostic and predictive value in this emerging era of integrated precision diagnostics. This paper presents cancer imaging phenomics toolkit (CaPTk), a new and dynamically growing software platform for analysis of radiographic images of cancer, currently focusing on brain, breast, and lung cancer. CaPTk leverages the value of quantitative imaging analytics along with machine learning to derive phenotypic imaging signatures, based on two-level functionality. First, image analysis algorithms are used to extract comprehensive panels of diverse and complementary features, such as multiparametric intensity histogram distributions, texture, shape, kinetics, connectomics, and spatial patterns. At the second level, these quantitative imaging signatures are fed into multivariate machine learning models to produce diagnostic, prognostic, and predictive biomarkers. Results from clinical studies in three areas are shown: (i) computational neuro-oncology of brain gliomas for precision diagnostics, prediction of outcome, and treatment planning; (ii) prediction of treatment response for breast and lung cancer, and (iii) risk assessment for breast cancer.

  3. Role of type-specific herpes simplex virus-1 and 2 serology as a diagnostic modality in patients with clinically suspected genital herpes: A comparative study in Indian population from a tertiary care hospital.

    Science.gov (United States)

    Patwardhan, Vrushali; Bhalla, Preena

    2016-01-01

    Type-specific serology (TSS) test for herpes simplex virus (HSV) have been used as a research tool in seroepidemiological studies for some years. However, TSS as a diagnostic modality for diagnosis of current episode of genital herpes is not well documented. To measure the seroprevalence of type-specific HSV Type 1 (HSV-1) and Type 2 (HSV-2) IgG antibodies in cases provisionally diagnosed as primary and recurrent genital herpes and to evaluate the role of TSS as a diagnostic modality for diagnosis of genital herpes versus polymerase chain reaction (PCR). A cross-sectional study was performed over a period of 10 months in which 44 adult patients with clinically suspected genital herpes were recruited. An in-house glycoprotein G gene base PCR was performed directly from the genital lesion specimen for simultaneous detection and typing of HSV. TSS was performed to detect IgG antibody against HSV-1 and 2 in all patients using commercially available kits, and the results were compared. Seroprevalence of HSV-1 IgG was 43% among primary and 65% among recurrent genital herpes cases (P = 0.22). Whereas that of HSV-2 IgG was found to be 14% and 83% in respective patient group (P = 0.0001). When compared to PCR results HSV-1 IgG detection in both primary and recurrent genital herpes diagnosis had poor specificity, positive predictive value, and sensitivity. Whereas, HSV-2 serology had a sensitivity of 13.33% and 73.33% in primary and recurrent genital herpes and specificity of 83.33% and 85.71%, respectively. HSV-2 IgG detection helps in strengthening the diagnosis of recurrent HSV-2 disease, whereas the absence of HSV-2 IgG antibody helps in excluding genital herpes as a likely cause of recurrent genital ulceration. However, detection of HSV-1 IgG antibody may not be useful for diagnosis in patients of genital ulcer disease.

  4. The diagnostic significance of clinical and radiological findings in osteogenesis imperfection

    International Nuclear Information System (INIS)

    Xu Deyong; Xu Zushan; Shen Qijie

    1997-01-01

    Purpose: To define the diagnostic criteria of osteogenesis imperfection. Materials and methods: The clinical and radiologic manifestations of 68 patients with osteogenesis imperfection were studied retrospectively. Results: (1) A generalized decrease in osseous density (osteoporosis or osteopenia) with abnormal fragility of bone (68 cases). (2) Blue sclera (61 cases). (3) Dentinogenesis imperfection with opalescent bluish-gray tint (49 cases). (4) Progressive hearing loss (prior to the age of 40 years)-premature otosclerosis (38 cases). Other abnormalities such as abnormal contour and structure (68 cases), growth retardation (49 cases), episodic diaphoresis (24 cases), with abnormal temperature regulation (16 cases), hyperplastic scars (11 cases) and tendency of subcutaneous bruise (6 cases), all these were not characteristic features. Conclusion: Among all clinical and radiological findings, osteopenia with abnormal fragility of bone; blue sclera dentinogenesis imperfection with opalescent bluish-gray tint and premature otosclerosis are the most common and characteristic findings which can be taken as the diagnostic criteria of osteogenesis imperfection

  5. Empirical evidence of design-related bias in studies of diagnostic tests

    NARCIS (Netherlands)

    Lijmer, J. G.; Mol, B. W.; Heisterkamp, S.; Bonsel, G. J.; Prins, M. H.; van der Meulen, J. H.; Bossuyt, P. M.

    1999-01-01

    CONTEXT: The literature contains a large number of potential biases in the evaluation of diagnostic tests. Strict application of appropriate methodological criteria would invalidate the clinical application of most study results. OBJECTIVE: To empirically determine the quantitative effect of study

  6. Clinical aspects of MR colonography as a diagnostic tool

    DEFF Research Database (Denmark)

    Achiam, Michael

    2010-01-01

    and that polypectomy might be curative. Colonoscopy remains the gold standard for full colon evaluation. However, the result of our studies can justify clinical use of MRC on selected indications, e.g. in the cases where colonoscopy is incomplete or technically difficult. Since up to 54% of all preoperative colon...

  7. Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals

    NARCIS (Netherlands)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.

    2015-01-01

    Background: Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in

  8. Added Diagnostic Value of 11C-PiB-PET in Memory Clinic Patients with Uncertain Diagnosis

    Directory of Open Access Journals (Sweden)

    K.S. Frederiksen

    2012-12-01

    Full Text Available Introduction: The added diagnostic value of 11C-PiB-PET for the assessment of the accumulation of cortical beta-amyloid in memory clinic patients with uncertain diagnosis remains undetermined. Methods: All patients who underwent PiB-PET at the Copenhagen Memory Clinic between March 2008 and November 2011 were included in this uncontrolled, retrospective study. The standard diagnostic evaluation program included physical and neurological examination, cognitive and functional assessment, a cranial CT or MRI, functional imaging and cerebrospinal fluid sampling. Based on anonymized case reports, three experienced clinicians reached a consensus diagnosis and rated their confidence in the diagnosis before and after disclosure of PiB-PET ratings. PiB-PET scans were rated as either positive or negative. Results: A total of 57 patients (17 females, 30 males; age 65.7 years, range 44.2–82.6 were included in the study. Twenty-seven had a positive PiB-PET scan. At the first diagnostic evaluation, 16 patients were given a clinical Alheimer’s disease diagnosis (14 PiB positive. Of the 57 patients, 13 (23% were diagnostically reclassified after PiB-PET ratings were disclosed. The clinicians’ overall confidence in their diagnosis increased in 28 (49% patients. Conclusion: PiB-PET adds to the specialist clinical evaluation and other supplemental diagnostic investigations in the diagnostic classification of patients with uncertain diagnosis in a specialized memory clinic.

  9. Hereditary neuropathies: systematization and diagnostics (clinical case of hereditary motor and sensor neuropathy of the IA type

    Directory of Open Access Journals (Sweden)

    Kolokolova A.M.

    2016-09-01

    Full Text Available Aim: to study the value of routine methods (clinical symptoms, electrophysiological findings and results of DNA analysis in diagnostics of hereditary motor sensory neuropathy type IA in outpatient clinics. Material and Methods. The review of foreign literature is represented. The phenotypic polymorphism, genetic heterogeneity and the difficulties of diagnostics are identified. A family with hereditary motor sensory neuropathy of lAtype is presented, which was diagnosed on the base of available methods in outpatient practice (clinical symptoms, genealogical method, electro-physiological findings and DNA analysis results. Results. Routine algorithm (consistent valuation of clinical symptoms, neurophysiologic findings and the results of DNA analysis helped to verify the diagnosis of hereditary motor sensory neuropathy of lAtype in outpatient practice after more than 20 years of the onset of the disease. Conclusion. The neurologists of outpatient clinics and other specialists must be informed about the availability of diagnostics of hereditary diseases of nervous system.

  10. Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism

    NARCIS (Netherlands)

    Den Exter, Paul L.; Van Es, Josien; Erkens, Petra M.G.; Van Roosmalen, Mark J.G.; Van Den Hoven, Pim; Hovens, Marcel M.C.; Kamphuisen, Pieter W.; Klok, Frederikus A.; Huisman, Menno V.

    2013-01-01

    Rationale: The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Objectives: This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: In 4,044

  11. Assessment Procedures for Narcissistic Personality Disorder: A Comparison of the Personality Diagnostic Questionnaire-4 and Best-Estimate Clinical Judgments

    Science.gov (United States)

    Miller, Joshua D.; Campbell, W. Keith; Pilkonis, Paul A.; Morse, Jennifer Q.

    2008-01-01

    This study examined the degree of correspondence between two assessments for narcissistic personality disorder (NPD) in a mixed clinical and community sample--one using a self-report measure (Personality Diagnostic Questionnaire-4) and the other using clinical judgments derived from an assessment based on the longitudinal, expert, all data (LEAD)…

  12. Clinical diagnostic system using a small cyclotron for medical use

    International Nuclear Information System (INIS)

    Yonekura, Y.; Magata, Y.; Konishi, J.

    1990-01-01

    Since a small cyclotron and a positron emission tomography (PET) scanner have been installed at the Kyoto University Hospital in 1983, a great deal of effort has been directed to the clinical application of the PET-cyclotron system. This paper outlines the experience with PET in the clinical setting, including the facility, equipments and staff involved, weekly schedule, typical clinical protocols, and some results from the patients. The system consists of small cyclotron for production of the short-lived positron emitting radionuclides, fully automated synthesis system for labeling various compounds, scanning for measurement of radioactivities, and data analysis system for calculating physiological parameters. A resolving cylinder target system with eight smaller cylinders is equipped for production of C-11, N-13, O-15, and F-18. Labeled compounds are quickly delivered to the PET scanner room by two systems--the continuous delivery system for the labeled gas and the rapid delivery system for the liquid compounds by compressed air. A PET scanner devoted for clinical studies is a multislice whole-body PET scanner. Ten PET studies are performed weekly on the average for measuring blood flow and oxygen and glucose metabolism in the brain, blood flow and glucose and fatty acid metabolism in the heart, blood flow and amino acid uptake in the pancreas, lung ventilation, and tumor glucose metabolism. The availability of PET-cyclotron system is still limited in view of cost. The previous clinical studies suggest the contribution of PET to the the understanding of the mechanism of disease pathophysiology. (N.K.)

  13. Coronary CT angiography: Diagnostic value and clinical challenges.

    Science.gov (United States)

    Sabarudin, Akmal; Sun, Zhonghua

    2013-12-26

    Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

  14. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    Science.gov (United States)

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

  15. The Diagnostic and Prognostic Value of a Dual-Tasking Paradigm in a Memory Clinic.

    Science.gov (United States)

    Nielsen, Malene Schjnning; Simonsen, Anja Hviid; Siersma, Volkert; Hasselbalch, Steen Gregers; Hoegh, Peter

    2018-01-01

    Daily living requires the ability to perform dual-tasking. As cognitive skills decrease in dementia, performing a cognitive and motor task simultaneously become increasingly challenging and subtle gait abnormalities may even be present in pre-dementia stages. Therefore, a dual-tasking paradigm, such as the Timed Up and Go-Dual Task (TUG-DT), may be useful in the diagnostic assessment of mild cognitive impairment (MCI). To investigate the diagnostic and prognostic ability of a dual-tasking paradigm in patients with MCI or mild Alzheimer's disease (AD) and to evaluate the association between the dual-tasking paradigm and cerebrospinal fluid (CSF) AD biomarkers. The study is a prospective cohort study conducted in a clinical setting in two memory clinics. Eighty-six patients were included (28 MCI, 17 AD, 41 healthy controls (HC)). The ability to perform dual-tasking was evaluated by the TUG-DT. Patients underwent a standardized diagnostic assessment and were evaluated to determine progression yearly. ROC curve analysis illustrated a high discriminative ability of the dual-tasking paradigm in separating MCI patients from HC (AUC: 0.78, AUC: 0.82) and a moderate discriminative ability in separating MCI from AD (AUC: 0.73, AUC: 0.55). Performance discriminated clearly between all groups (p paradigm for progression and rate of cognitive decline. A moderately strong correlation between the dual-tasking paradigm and CSF AD biomarkers was observed. In our study, we found that patients with MCI and mild AD have increasing difficulties in dual-tasking compared to healthy elderly. Hence, the dual-tasking paradigm may be a potential complement in the diagnostic assessment in a typical clinical setting.

  16. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness.

    Science.gov (United States)

    Hay, Alastair D; Birnie, Kate; Busby, John; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Durbaba, Stevo; Fletcher, Margaret; Harman, Kim; Hollingworth, William; Hood, Kerenza; Howe, Robin; Lawton, Michael; Lisles, Catherine; Little, Paul; MacGowan, Alasdair; O'Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Sterne, Jonathan Ac; Thomas-Jones, Emma; van der Voort, Judith; Waldron, Cherry-Ann; Whiting, Penny; Wootton, Mandy; Butler, Christopher C

    2016-01-01

    BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old

  17. Diagnostics

    DEFF Research Database (Denmark)

    Donné, A.J.H.; Costley, A.E.; Barnsley, R.

    2007-01-01

    of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

  18. Clinical impact of diagnostic SPET investigations with a dopamine re-uptake ligand

    International Nuclear Information System (INIS)

    Loekkegaard, Annemette; Werdelin, Lene M.; Friberg, Lars

    2002-01-01

    The diagnosis of Parkinson's disease is based on clinical features with pathological verification. However, autopsy has been found to confirm a specialist diagnosis in only about 75% of cases. Especially early in the course of the disease, the clinical diagnosis can be difficult. Imaging of presynaptic dopamine transporters (DAT receptors) has provided a possible diagnostic probe in the evaluation of Parkinson's disease. The cocaine analogue [ 123 I]-2-β-carboxymethoxy-3-β(4-iodophenyl)tropane ([ 123 I]-β-CIT) is one of several radioligands that have been developed for single-photon emission tomography (SPET). The purpose of this study was to evaluate the impact of [ 123 I]-β-CIT SPET on the diagnosis and clinical management of patients with a primary, tentative diagnosis of parkinsonism. We undertook a retrospective evaluation of the clinical records of 90 consecutive patients referred to [ 123 I]-β-CIT SPET from the neurological department, Bispebjerg Hospital. In 58 subjects the scans revealed altered tracer uptake consistent with Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. A significant change in the management or treatment because of the scan was found in 25 patients (28%). The sensitivity of the examination was 97% and the specificity 83%. In conclusion, a significant clinical impact of DAT receptor SPET imaging was found. DAT receptor imaging is a useful diagnostic probe in patients with a possible diagnosis of parkinsonism. (orig.)

  19. [Multi-centre clinical assessment of the Russian language version of the Diagnostic Interview for Psychoses].

    Science.gov (United States)

    Smirnova, D A; Petrova, N N; Pavlichenko, A V; Martynikhin, I A; Dorofeikova, M V; Eremkin, V I; Izmailova, O V; Osadshiy, Yu Yu; Romanov, D V; Ubeikon, D A; Fedotov, I A; Sheifer, M S; Shustov, A D; Yashikhina, A A; Clark, M; Badcock, J; Watterreus, A; Morgan, V; Jablensky, A

    2018-01-01

    The Diagnostic Interview for Psychoses (DIP) was developed to enhance the quality of diagnostic assessment of psychotic disorders. The aim of the study was the adaptation of the Russian language version and evaluation of its validity and reliability. Ninety-eight patients with psychotic disorders (89 video recordings) were assessed by 12 interviewers using the Russian version of DIP at 7 clinical sites (in 6 cities of the Russian Federation). DIP ratings on 32 cases of a randomized case sample were made by 9 interviewers and the inter-rater reliability was compared with the researchers' DIP ratings. Overall pairwise agreement and Cohen's kappa were calculated. Diagnostic validity was evaluated on the basis of comparing the researchers' ratings using the Russian version of DIP with the 'gold standard' ratings of the same 62 clinical cases from the Western Australia Family Study Schizophrenia (WAFSS). The mean duration of the interview was 47±21 minutes. The Kappa statistic demonstrated a significant or almost perfect level of agreement on the majority of DIP items (84.54%) and a significant agreement for the ICD-10 diagnoses generated by the DIP computer diagnostic algorithm (κ=0.68; 95% CI 0.53,0.93). The level of agreement on the researchers' diagnoses was considerably lower (κ=0.31; 95% CI 0.06,0.56). The agreement on affective and positive psychotic symptoms was significantly higher than agreement on negative symptoms (F(2,44)=20.72, pRussian language version of DIP was confirmed by 73% (45/62) of the Russian DIP diagnoses matching the original WAFSS diagnoses. Among the mismatched diagnoses were 80 cases with a diagnosis of F20 Schizophrenia in the medical documentation compared to the researchers' F20 diagnoses in only 68 patients and in 62 of the DIP computerized diagnostic outputs. The reported level of subjective difficulties experienced when using the DIP was low to moderate. The results of the study confirm the validity and reliability of the Russian

  20. Diagnostic accuracy of temporomandibular disorder pain tests: a multicenter study

    NARCIS (Netherlands)

    Visscher, C.M.; Naeije, M.; de Laat, A.; Michelotti, A.; Nilner, M.; Craane, B.; Ekberg, E.; Farella, M.; Lobbezoo, F.

    2009-01-01

    AIMS: To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain

  1. Morphological, clinical and radiological aspects in diagnostics of bronchopulmonary diseases and their complications in children with dysplasia of connective tissue

    Directory of Open Access Journals (Sweden)

    Palchik S.M.

    2016-06-01

    Full Text Available The article provides an overview of the literature devoted to study of radiological, morphological and clinical aspects of diagnostics of respiratory diseases and their complications in children with dysplasia of connective tissue nowadays. We made an analysis of the role of connective tissue disorders in pathogenesis of bronchopulmonary diseases. Theoretically was substantiated the importance of radiological methods in early diagnostics of this disease in children.

  2. [Genetic diagnostics of pathogenic splicing abnormalities in the clinical laboratory--pitfalls and screening approaches].

    Science.gov (United States)

    Niimi, Hideki; Ogawa, Tomomi; Note, Rhougou; Hayashi, Shirou; Ueno, Tomohiro; Harada, Kenu; Uji, Yoshinori; Kitajima, Isao

    2010-12-01

    In recent years, genetic diagnostics of pathogenic splicing abnormalities are increasingly recognized as critically important in the clinical genetic diagnostics. It is reported that approximately 10% of pathogenic mutations causing human inherited diseases are splicing mutations. Nonetheless, it is still difficult to identify splicing abnormalities in routine genetic diagnostic settings. Here, we studied two different kinds of cases with splicing abnormalities. The first case is a protein S deficiency. Nucleotide analyses revealed that the proband had a previously reported G to C substitution in the invariant AG dinucleotide at the splicing acceptor site of intronl/exon2, which produces multiple splicing abnormalities resulting in protein S deficiency. The second case is an antithrombin (AT) deficiency. This proband had a previously reported G to A substitution, at nucleotide position 9788 in intron 4, 14 bp in front of exon 5, which created a de novo exon 5 splice site and resulted in AT deficiency. From a practical standpoint, we discussed the pitfalls, attentions, and screening approaches in genetic diagnostics of pathogenic splicing abnormalities. Due to the difficulty with full-length sequence analysis of introns, and the lack of RNA samples, splicing mutations may escape identification. Although current genetic testing remains to be improved, to screen for splicing abnormalities more efficiently, it is significant to use an appropriate combination of various approaches such as DNA and/or RNA samples, splicing mutation databases, bioinformatic tools to detect splice sites and cis-regulatory elements, and in vitro and/or in vivo experimentally methods as needed.

  3. Development and Diagnostic Accuracy of the Screening of the Dimensional Clinical Personality Inventory

    Directory of Open Access Journals (Sweden)

    Lucas de Francisco Carvalho

    Full Text Available Abstract: The assessment of personality disorders assumes unquestioned clinical relevance when considering the prevalence rates in the general population. Tests assessing the typical pathological traits of these disorders has been adapted to and developed in Brazil. However, there is a gap in the country of screening tools for personality disorders. Screening tools are designed to allow a fast and informative application on the likelihood of a positive diagnosis, where the consequence should be conveyed to a diagnostic assessment. Using as a base the Dimensional Clinical Personality Inventory (IDCP, developed at the national level, the objective of this research was to develop a screening tool for personality disorders, as well as investigate its diagnostic accuracy. The study included 1,196 people, aging between 18 and 73 years (M = 26.32, SD = 8.69, and 64.1% female. The sample was divided into clinical and non-clinical group. We used an empirical approach based on criteria for selection of items similar to those adopted in the development of Minnesota Multiphasic Personality Inventory was used (MMPI. The logistic regression analysis and also the calculation of Cohen's d indicated the items that best discriminate against people with personality disorders and those without this diagnosis. We achieved a final set of 15 items with satisfactory sensitivity and specificity for screening test. We discusses the strengths and limitations of screening version of the IDCP and guidelines for further study.

  4. Dental diagnostic clinical instrument ('Canary') development using photothermal radiometry and modulated luminescence

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, R J; Sivagurunathan, K; Garcia, J; Matvienko, A; Mandelis, A [Center for Advanced Diffusion Wave Technologies (CADIFT), Department of Mechanical and Industrial Engineering, University of Toronto, 5 King' s College Road, Toronto, Ontario, M5S 3G8 (Canada); Abrams, S, E-mail: mandelis@mie.utoronto.c [Quantum Dental Technologies, 748 Briar Hill Avenue, Toronto, Ontario, M6B 1L3 (Canada)

    2010-03-01

    Since 1999, our group at the CADIFT, University of Toronto, has developed the application of Frequency Domain Photothermal Radiometry (PTR) and Luminescence (LUM) to dental caries detection. Various cases including artificial caries detection have been studied and some of the inherent advantages of the adaptation of this technique to dental diagnostics in conjunction with modulated luminescence as a dual-probe technique have been reported. Based on these studies, a portable, compact diagnostic instrument for dental clinic use has been designed, assembled and tested. A semiconductor laser, optical fibers, a thermoelectric cooled mid-IR detector, and a USB connected data acquisition card were used. Software lock-in amplifier techniques were developed to compute amplitude and phase of PTR and LUM signals. In order to achieve fast measurement and acceptable signal-to-noise ratio (SNR) for clinical application, swept sine waveforms were used. As a result sampling and stabilization time for each measurement point was reduced to a few seconds. A sophisticated software interface was designed to simultaneously record intra-oral camera images with PTR and LUM responses. Preliminary results using this instrument during clinical trials in a dental clinic showed this instrument could detect early caries both from PTR and LUM signals.

  5. Dental diagnostic clinical instrument (Canary) development using photothermal radiometry and modulated luminescence

    International Nuclear Information System (INIS)

    Jeon, R J; Sivagurunathan, K; Garcia, J; Matvienko, A; Mandelis, A; Abrams, S

    2010-01-01

    Since 1999, our group at the CADIFT, University of Toronto, has developed the application of Frequency Domain Photothermal Radiometry (PTR) and Luminescence (LUM) to dental caries detection. Various cases including artificial caries detection have been studied and some of the inherent advantages of the adaptation of this technique to dental diagnostics in conjunction with modulated luminescence as a dual-probe technique have been reported. Based on these studies, a portable, compact diagnostic instrument for dental clinic use has been designed, assembled and tested. A semiconductor laser, optical fibers, a thermoelectric cooled mid-IR detector, and a USB connected data acquisition card were used. Software lock-in amplifier techniques were developed to compute amplitude and phase of PTR and LUM signals. In order to achieve fast measurement and acceptable signal-to-noise ratio (SNR) for clinical application, swept sine waveforms were used. As a result sampling and stabilization time for each measurement point was reduced to a few seconds. A sophisticated software interface was designed to simultaneously record intra-oral camera images with PTR and LUM responses. Preliminary results using this instrument during clinical trials in a dental clinic showed this instrument could detect early caries both from PTR and LUM signals.

  6. Quality of reporting of diagnostic accuracy studies

    NARCIS (Netherlands)

    Smidt, N.; Rutjes, A.W.; Windt - Mens, van der D.A.W.M.; Ostelo, R.W.J.G.; Reitsma, J.B.; Bouter, L.M.; Vet, de H.C.W.

    2005-01-01

    PURPOSE: To evaluate quality of reporting in diagnostic accuracy articles published in 2000 in journals with impact factor of at least 4 by using items of Standards for Reporting of Diagnostic Accuracy (STARD) statement published later in 2003. MATERIALS AND METHODS: English-language articles on

  7. The frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases

    International Nuclear Information System (INIS)

    Sattar, Z.; Iqbal, M.

    2014-01-01

    Introduction: Diagnostic laparoscopy allows the visual examination and documentation of intra-abdominal organs in order to detect any pathology. It is an important tool for final minimally invasive exploration of patients with abdominal tuberculosis, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. Objective: To determine the frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases of peritoneal tuberculosis. Study Design: Cross sectional survey. Setting: The study was conducted in all the four Surgical Wards on surgical floor of Mayo Hospital Lahore. Duration of Study with Dates: Six months (1st July 2009 to 31st December 2009). Material and Methods: 35 Patients aged between 13-60 years with clinical suspicion of peritoneal tuberculosis were selected. The patients underwent the procedure accordingly. Per operative diagnosis of peritoneal tuberculosis made on the basis of presence of any or all of the operative (laparoscopic) findings such as multiple peritoneal adhesions, fibrous bands, whitish peritoneal tubercles, omental thickening and ascites. Diagnosis was confirmed with histopathology of peritoneal tissue biopsy. Also the biochemical analysis and culture sensitivity of ascetic fluid was routinely performed if any ascites is present. Results: Out of 35 patients, 40% were males and 60% females with mean age of 24.91+-6.69 years. The Laparoscopic findings of peritoneal tuberculosis were whitish peritoneal tubercles (57.2%) peritoneal adhesions (28.6%), ascites (17.2%), omental thickening (14.3%), fibrous bands (11.4%) and swollen edematous appendix (5.7%). Eighty percent were labeled with diagnosis of peritoneal tuberculosis on basis of diagnostic laparoscopy. These patients were confirmed to have peritoneal tuberculosis on histopathology of tissue biopsy. Conclusion: Diagnostic laparoscopy is useful in patients with suspected peritoneal

  8. Development of an instrument to measure the clinical learning environment in diagnostic radiology

    International Nuclear Information System (INIS)

    Bloomfield, L.; Subramaniam, R.

    2008-01-01

    A clinical learning environment survey instrument was developed that provided insights into diagnostic radiology trainees' perceptions of the culture and context of the hospital-based training programme. The survey was completed by trainees allocated to 37 important training hospitals in Australia, New Zealand and Singapore in 2006. The main findings were that most obvious strengths of the diagnostic radiology programme are the wide variety of work-based learning opportunities and the social atmosphere. These were well regarded in all training sites. Work overload was seen as a significant problem in most hospitals and will probably remain a challenge. The areas that are most likely to repay efforts to bring about change are supervision and feedback. The study provides baseline data against which the influence of changes to the training programme may be evaluated.

  9. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

    Directory of Open Access Journals (Sweden)

    Mikhailova Е.V.

    2013-09-01

    Full Text Available Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49% with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46% patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.

  10. Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Jung Wan Han

    2015-01-01

    Full Text Available Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT, small bowel follow-through (SBFT, and capsule endoscopy (CE in diagnosing small bowel tumors (SBTs. Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43% and abdominal pain (13.9%. Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4, small polyps (3, inflammatory fibroid polyp (1, and adenocarcinoma (1. These tumors were located in the proximal jejunum (5, middle jejunum (1, distal jejunum (1, and proximal ileum (1. Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum.

  11. The Diagnostic Accuracy of Clinical and External Pelvimetry in Prediction of Dystocia in Nulliparous Women

    Directory of Open Access Journals (Sweden)

    R Alijahan

    2011-08-01

    Full Text Available Introduction: Clinical pelvimetry is very uncomfortable for the patient and is associated with subjective error, while external pelvimetry is a simple and acceptable method for patients. The objective of this study was to compare the diagnostic accuracy of clinical and external pelvimetry in prediction of dystocia in nulliparous women. Methods: In this study between December 2008 and January 2009, 447 nulliparous women with a single pregnancy in vertex presentation and gestational age 38-42 weeks referring to the Ommolbanin hospital of Mashhad were included. External pelvic dimensions were assessed at the time of admission and clinical pelvimetry was performed by another examiner. These measurements were not available to the clinician in charge of the delivery. Dystocia was defined as caesarean section and vacuum or forceps delivery for abnormal progress of labor ( active uterine contractions, arrest of cervical dilatation or cervical dilatation less than 1 cm /h in the active phase for 2 hours, prolongation of second stage beyond 2 hours or fetal head descent less than 1cm/h. Statistical tests included Fisher exact test and Chi- square test. Results: The highest sensitivity obtained from clinical pelvimetry was 33.3% and related to diagonal conjugate less than 11.5 cm. The sensitivity of external pelvic dimensions was higher than clinical pelvimetry that was highest for the Michaelis transverse diameter(60.72%. Conclusion: External pelvimetry in comparison to clinical pelvimetry is a better method for identifying dystocia in nulliparous women and can replace clinical pelvimetry in antenatal care programs.

  12. The study of practices in planed diagnostic medical exposure

    International Nuclear Information System (INIS)

    Popescu, Irina-Anca; Perju, Nicoleta Ana-Maria; Cobzeanu, Camelia

    2011-01-01

    The exposure of population to ionizing radiations in medical diagnostic purposes represents a planed exposure procedure, medically justified, having a direct impact on patient health state. A justification of exposure, with a result that can confirm a clinical diagnostic, implies further important steps in treatment decisions. Optimization in patients radiological protection is the result of observing the reference levels recommendations, which maintains a reasonable individual exposure to ionizing radiation in medical purpose. In this paper we investigated the justification of 4189 exposures of patients who underwent planed diagnostic medical investigation over 36 months in a radiological unit. The most frequent investigation concerned the spinal column in 38.3% of total exposures-mainly at lumbar level (63.0% and 24.1%, respectively of total number of exposures), followed by limb bones (20.6%) and thorax (26.9%). Justification of practices included: rheumatic pains in 45.8% of exposures followed by traumatic injuries (20.6%), pleural and pulmonary pathology (19.3%), malignant processes (12.3%), ear-nose-throat investigations (1.1%) and car accidents (0.9%). The females over 40 years old were the group with the highest number of medical exposures, with 54.5% of total practices. This study revealed that the number of medical exposures justification is almost equal with non-justified examinations, confirming a not so good correlation between clinical diagnostic and the required radiological investigation. The percentages of justified versus non-justified practices indicated by specialist physicians and general practitioners were slightly equal - 59.3% vs. 40.7%, 56.9% vs. 43.1%, respectively. The analysis of data concluded that either specialist/general physicians must evaluate more rigorously the patients and all clinical signs in order to reduce as reasonable as possible the non-justified medical exposures to ionizing radiations, and thus to avoid financial and

  13. Efficient strategies to find diagnostic test accuracy studies in kidney journals.

    Science.gov (United States)

    Rogerson, Thomas E; Ladhani, Maleeka; Mitchell, Ruth; Craig, Jonathan C; Webster, Angela C

    2015-08-01

    Nephrologists looking for quick answers to diagnostic clinical questions in MEDLINE can use a range of published search strategies or Clinical Query limits to improve the precision of their searches. We aimed to evaluate existing search strategies for finding diagnostic test accuracy studies in nephrology journals. We assessed the accuracy of 14 search strategies for retrieving diagnostic test accuracy studies from three nephrology journals indexed in MEDLINE. Two investigators hand searched the same journals to create a reference set of diagnostic test accuracy studies to compare search strategy results against. We identified 103 diagnostic test accuracy studies, accounting for 2.1% of all studies published. The most specific search strategy was the Narrow Clinical Queries limit (sensitivity: 0.20, 95% CI 0.13-0.29; specificity: 0.99, 95% CI 0.99-0.99). Using the Narrow Clinical Queries limit, a searcher would need to screen three (95% CI 2-6) articles to find one diagnostic study. The most sensitive search strategy was van der Weijden 1999 Extended (sensitivity: 0.95; 95% CI 0.89-0.98; specificity 0.55, 95% CI 0.53-0.56) but required a searcher to screen 24 (95% CI 23-26) articles to find one diagnostic study. Bachmann 2002 was the best balanced search strategy, which was sensitive (0.88, 95% CI 0.81-0.94), but also specific (0.74, 95% CI 0.73-0.75), with a number needed to screen of 15 (95% CI 14-17). Diagnostic studies are infrequently published in nephrology journals. The addition of a strategy for diagnostic studies to a subject search strategy in MEDLINE may reduce the records needed to screen while preserving adequate search sensitivity for routine clinical use. © 2015 Asian Pacific Society of Nephrology.

  14. Diagnostic accuracy of organ electrodermal diagnostics | Szopinski ...

    African Journals Online (AJOL)

    Objective. To estimate the diagnostic accuracy as well as the scope of utilisation of a new bio-electronic method of organ diagnostics. Design. Double-blind comparative study of the diagnostic results obtained by means of organ electrodermal diagnostics (OED) and clinical diagnoses, as a criterion standard. Setting.

  15. Companion diagnostics and molecular imaging-enhanced approaches for oncology clinical trials.

    Science.gov (United States)

    Van Heertum, Ronald L; Scarimbolo, Robert; Ford, Robert; Berdougo, Eli; O'Neal, Michael

    2015-01-01

    In the era of personalized medicine, diagnostic approaches are helping pharmaceutical and biotechnology sponsors streamline the clinical trial process. Molecular assays and diagnostic imaging are routinely being used to stratify patients for treatment, monitor disease, and provide reliable early clinical phase assessments. The importance of diagnostic approaches in drug development is highlighted by the rapidly expanding global cancer diagnostics market and the emergent attention of regulatory agencies worldwide, who are beginning to offer more structured platforms and guidance for this area. In this paper, we highlight the key benefits of using companion diagnostics and diagnostic imaging with a focus on oncology clinical trials. Nuclear imaging using widely available radiopharmaceuticals in conjunction with molecular imaging of oncology targets has opened the door to more accurate disease assessment and the modernization of standard criteria for the evaluation, staging, and treatment responses of cancer patients. Furthermore, the introduction and validation of quantitative molecular imaging continues to drive and optimize the field of oncology diagnostics. Given their pivotal role in disease assessment and treatment, the validation and commercialization of diagnostic tools will continue to advance oncology clinical trials, support new oncology drugs, and promote better patient outcomes.

  16. Overinterpretation and misreporting of diagnostic accuracy studies: evidence of "spin".

    Science.gov (United States)

    Ochodo, Eleanor A; de Haan, Margriet C; Reitsma, Johannes B; Hooft, Lotty; Bossuyt, Patrick M; Leeflang, Mariska M G

    2013-05-01

    To estimate the frequency of distorted presentation and overinterpretation of results in diagnostic accuracy studies. MEDLINE was searched for diagnostic accuracy studies published between January and June 2010 in journals with an impact factor of 4 or higher. Articles included were primary studies of the accuracy of one or more tests in which the results were compared with a clinical reference standard. Two authors scored each article independently by using a pretested data-extraction form to identify actual overinterpretation and practices that facilitate overinterpretation, such as incomplete reporting of study methods or the use of inappropriate methods (potential overinterpretation). The frequency of overinterpretation was estimated in all studies and in a subgroup of imaging studies. Of the 126 articles, 39 (31%; 95% confidence interval [CI]: 23, 39) contained a form of actual overinterpretation, including 29 (23%; 95% CI: 16, 30) with an overly optimistic abstract, 10 (8%; 96% CI: 3%, 13%) with a discrepancy between the study aim and conclusion, and eight with conclusions based on selected subgroups. In our analysis of potential overinterpretation, authors of 89% (95% CI: 83%, 94%) of the studies did not include a sample size calculation, 88% (95% CI: 82%, 94%) did not state a test hypothesis, and 57% (95% CI: 48%, 66%) did not report CIs of accuracy measurements. In 43% (95% CI: 34%, 52%) of studies, authors were unclear about the intended role of the test, and in 3% (95% CI: 0%, 6%) they used inappropriate statistical tests. A subgroup analysis of imaging studies showed 16 (30%; 95% CI: 17%, 43%) and 53 (100%; 95% CI: 92%, 100%) contained forms of actual and potential overinterpretation, respectively. Overinterpretation and misreporting of results in diagnostic accuracy studies is frequent in journals with high impact factors. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120527/-/DC1. © RSNA, 2013.

  17. Diagnostic needs for fluctuations and transport studies

    International Nuclear Information System (INIS)

    Carreras, B.A.

    1992-01-01

    The identification of fundamental transport mechanisms in magnetically confined plasmas is a critical issue for the magnetic fusion program. Recent progress in understanding fluctuations and transport is well correlated with the development and use of new diagnostics, but there a great deal of information is still missing. Some of the required measurements are well beyond our present diagnostic capabilities, but some are within reach and could answer critical questions in this area of research. Some of these critical issues are discussed

  18. The Added Value of the Combined Use of the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule: Diagnostic Validity in a Clinical Swedish Sample of Toddlers and Young Preschoolers

    Science.gov (United States)

    Zander, Eric; Sturm, Harald; Bölte, Sven

    2015-01-01

    The diagnostic validity of the new research algorithms of the Autism Diagnostic Interview-Revised and the revised algorithms of the Autism Diagnostic Observation Schedule was examined in a clinical sample of children aged 18-47 months. Validity was determined for each instrument separately and their combination against a clinical consensus…

  19. [THE RESULTS OF CLINICAL AND PSYCHOPATHOLOGICAL AND PSYCHOLOGICAL DIAGNOSTIC INVESTIGATIONS EMPLOYEES OF FINANCIAL INSTITUTIONS WHICH WERE IDENTIFIED NEUROTIC DISORDERS].

    Science.gov (United States)

    Solovyova, M

    2014-12-01

    The article presents the results of the clinical and psychopathological and psychological diagnostic, investigations mental health employees of financial institutions, description and analysis of clinical forms identified disorders.

  20. Diagnostic accuracy of clinical breast examination for breast cancer ...

    African Journals Online (AJOL)

    All the consecutive patients with palpable breast lesions presenting at the general surgery out-patient clinics were recruited and evaluated clinically. Biopsy was performed on all the patients (open or core needle) and histology reports obtained. Data collected were recorded in a proforma and subsequently analyzed.

  1. Prolactinomas : clinical studies

    NARCIS (Netherlands)

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An

  2. Gilbert’s syndrome: clinical features, diagnostics, differential diagnosis and treatment (part 2

    Directory of Open Access Journals (Sweden)

    T.V. Sorokman

    2017-02-01

    Full Text Available We searched for published and unpublished research using PubMed as the search engine by the keywords: “Gilbert’s syndrome”, “clinical manifestation”, “diagnosis”, “treatment”, taking into consideration studies conducted in the last 10 years, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants. The criterion for the selection of articles for the study was based on their close relevance to the topic, thus, out of 75 analyzed articles, the findings of the researches covered in 28 articles were crucial. Clinical manifestations of Gilbert’s syndrome (GS are possible both in homozygous for UGT1A1, and in heterozygous status. A latent variant of the disease prevails in individuals with heterozygous status. Up to 30 % of homozygous for the defective gene of GS individuals have an asymptomatic course of the disease. Clinical types of GS: dyspeptic — 43.2 %, asthenovegetative — 15.9 %, icteric — 14.8 % and asymptomatic — 26.1 %. Dietary deviations, mental fatigue, stress, trauma, acute infections, including hepatitis, certain medications intake are the triggers for GS. In 86.4 % of children with GS, the pathology of the upper digestive tract was detected: duodenitis — in 58 % of cases, gastritis — in 56.8 %, esophagitis — in 12.5 %, duodenal ulcer — in 2.3 %, in 39.7 % of patients sphincter disorders were registered (duodenogastric and gastroesophageal bile reflux. The GS is characterized by reduced detoxification function of the liver, in particular in 2/3 of patients decreased hepatocyte metabolic activity was observed, the excretory function of liver cell suffers in another half of patients, the biliary tract disorders and increased risk of gallstones formation are described in 88 % of cases. Some patients with GS have certain psychological disorders, including anxiety. Diagnostic criteria for GS: 1. A peculiar pale yellowish

  3. Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis

    International Nuclear Information System (INIS)

    Dudau, Cristina; Salim, Fakhruddin; Jiang, Dan; Connor, Steve E.J.

    2017-01-01

    To assess the diagnostic efficacy and therapeutic impact of CT in evaluating patients with clinically suspected otosclerosis. CT scans performed over a 5-year period for clinically suspected otosclerosis were retrospectively reviewed. CT diagnoses were correlated with subsequent surgical management. For otosclerosis positive cases, clinically significant extensions of otosclerosis were correlated with audiometry and the diagnosis was correlated with surgical findings. Of 259 CT studies, 46 % of patients were positive, 49 % negative and 5 % equivocal for otosclerosis. A relevant alternative CT diagnosis was evident in 33 % of the negative studies. One targeted surgery was performed for every four CT studies. CT outcome influenced the decision to perform stapedectomy in 41 % CT-positive versus 4 % CT-negative patients. CT-positive ears for otosclerosis could not be predicted from baseline clinical or audiometric criteria. Those with endosteal extension demonstrated lower bone conduction thresholds presurgically. The positive predictive value of CT diagnosis of otosclerosis was 100 %. CT demonstrated a high rate of clinically relevant diagnoses in both CT-positive and -negative for otosclerosis patients, and this frequently influenced surgical management. CT also added value by demonstrating relevant extensions of the otosclerotic foci, some of which were predictive of audiometric parameters. (orig.)

  4. Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Dudau, Cristina [King' s College Hospital NHS Foundation Trust, Department of Neuroradiology, London (United Kingdom); Salim, Fakhruddin; Jiang, Dan [Department of Otolaryngology, Head and Neck Surgery, Auditory Implantation Centre, London (United Kingdom); Connor, Steve E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom)

    2017-03-15

    To assess the diagnostic efficacy and therapeutic impact of CT in evaluating patients with clinically suspected otosclerosis. CT scans performed over a 5-year period for clinically suspected otosclerosis were retrospectively reviewed. CT diagnoses were correlated with subsequent surgical management. For otosclerosis positive cases, clinically significant extensions of otosclerosis were correlated with audiometry and the diagnosis was correlated with surgical findings. Of 259 CT studies, 46 % of patients were positive, 49 % negative and 5 % equivocal for otosclerosis. A relevant alternative CT diagnosis was evident in 33 % of the negative studies. One targeted surgery was performed for every four CT studies. CT outcome influenced the decision to perform stapedectomy in 41 % CT-positive versus 4 % CT-negative patients. CT-positive ears for otosclerosis could not be predicted from baseline clinical or audiometric criteria. Those with endosteal extension demonstrated lower bone conduction thresholds presurgically. The positive predictive value of CT diagnosis of otosclerosis was 100 %. CT demonstrated a high rate of clinically relevant diagnoses in both CT-positive and -negative for otosclerosis patients, and this frequently influenced surgical management. CT also added value by demonstrating relevant extensions of the otosclerotic foci, some of which were predictive of audiometric parameters. (orig.)

  5. Lead intoxication: clinic and diagnostic evaluation in children

    Directory of Open Access Journals (Sweden)

    Martínez-Riera Nora

    2012-03-01

    Full Text Available Poverty, poor nutrition, environmental and social injustice prevailing in Latin America are factorsthat determine the action of pollutants on children. Lead poisoning and pollution constitute apublic health problem throughout the world. Lead affects multiple organs: nervous system particularly,hematopoietic, renal, endocrine, bone and others. Objective: to assess clinical, biochemicaland vascular effects in children exposed to known source of lead. Materials and methods: Sevenchildren with defined source lead exposure were studied, general and specific lead laboratorywere made. Endothelial function and electrocardiographic parameters were assessed. Statistic:descriptive. Results: Age average was 6,2 years (DE± 1, 6, average haematocrit 31% (DE±0,02;hemoglobin average 10,2 g/dl (DE± 0,78. 100% presented hypochromia, microcitosis, anemiaand marked anisocytosis. Lead average: 37,9 ug/dl (DE±6,22, ALA-D average: 8,9 U/L (DE±4,5.No changes were found in lipid profile and kidney function. All presented microalbuminuriaand endothelial dysfunction. Conclusion: These results show the effects of environmental leadexposure that can result in children not occupationally exposed.

  6. [Hysteroscopy clinic: diagnostic and therapeutic method in abnormal uterine bleeding].

    Science.gov (United States)

    Alanis Fuentes, José; Obregón Zegarra, Eva Haydee

    2012-12-01

    Abnormal uterine bleeding is a public health problem prevalence exceeded only by abnormal vaginal discharge as a reason for medical consultation. To describe the findings reported by the Hysteroscopy clinic of the Hospital GEA Gonzalez on patients with Abnormal Uterine bleeding diagnosis. Retrospective, transversal, descriptive study. The total 2546 records of those patient that were evaluated by Office Hysteroscopic between January 2007 and December 2008 on the Hysteroscopy Clinic of Hospital Manuel GEA Gonzalez, then we selected the 1482 records of those patients that were sended because of an Abnormal Uterine bleeding condition. We descrive the frequencies of the diagnosis and its interrelation with the age of the patients. We also report the therapeutical interventions during office hysteroscopy. The mean age of the patients was 42.15 +/- 9.30 years (from 12 a 92 years); the age groups of patients that belonged to 40-44 years and 45-49 years are the most frequent patient and they represent the 25% y el 23.3% of the records. The abnormal findings occurred on the 66% de of the patients. Those patients of 65 years old and older do not have any report of normal cavities, all of then have abnormal findings. The leiomyoma (26.9%) and the endometrial polyps (27.3%) were the most frequent findings. The postmenopausal bleeding had a rate of 90.9% abnormal findings and in this group of patients the most frequent diagnosis was atrophic endometrium (32.2%) and polyps (24.3%). Besides that the office hysteroscopy show its therapeutical usefulness because of the 67% and 77.5% of polipectomy perform for endometrial and cervical polyps respectively The office Hysteroscopy is a well tolerated diagnosis and therapeutic method that is useful for any women with abnormal uterine bleeding condition and it is the ideal technique for the examination of abnormal uterine bleeding in postmenopausal women... The office hysteroscopy is a efficient cost-effective and cost-benefic method for

  7. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

    DEFF Research Database (Denmark)

    Troelsen, Anders; Mechlenburg, Inger; Gelineck, John

    2009-01-01

    BACKGROUND AND PURPOSE: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography...... no or only slight signs of osteoarthritis (Tönnis grade 0-1). RESULTS: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best...... diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%. INTERPRETATION: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral...

  8. Three principles to define the success of a diagnostic study could be identified

    DEFF Research Database (Denmark)

    Vach, Werner; Gerke, Oke; Høilund-Carlsen, Poul Flemming

    2012-01-01

    of a diagnostic study on a single binary test and investigation of common statistical approaches in relation to these criteria. RESULTS: Three criteria for defining the overall success of a diagnostic study could be identified: a strong criterion, a liberal criterion, and a weak criterion. The strong criterion...... can be implemented by comparing the lower bounds of the confidence intervals for sensitivity and specificity with prespecified target values, as is typically done in many diagnostic studies. The liberal criterion allows a clinically meaningful compensation between sensitivity and specificity and can...... be implemented in different ways. If the liberal criterion is applied instead of the strong criterion, this can lead to a substantial reduction in the sample size required for a diagnostic study. The weak criterion is not very adequate for defining the success of a diagnostic study. CONCLUSION: When planning...

  9. A clinical perspective on the 2016 WHO brain tumor classification and routine molecular diagnostics.

    Science.gov (United States)

    van den Bent, Martin J; Weller, Michael; Wen, Patrick Y; Kros, Johan M; Aldape, Ken; Chang, Susan

    2017-05-01

    The 2007 World Health Organization (WHO) classification of brain tumors did not use molecular abnormalities as diagnostic criteria. Studies have shown that genotyping allows a better prognostic classification of diffuse glioma with improved treatment selection. This has resulted in a major revision of the WHO classification, which is now for adult diffuse glioma centered around isocitrate dehydrogenase (IDH) and 1p/19q diagnostics. This revised classification is reviewed with a focus on adult brain tumors, and includes a recommendation of genes of which routine testing is clinically useful. Apart from assessment of IDH mutational status including sequencing of R132H-immunohistochemistry negative cases and testing for 1p/19q, several other markers can be considered for routine testing, including assessment of copy number alterations of chromosome 7 and 10 and of TERT promoter, BRAF, and H3F3A mutations. For "glioblastoma, IDH mutated" the term "astrocytoma grade IV" could be considered. It should be considered to treat IDH wild-type grades II and III diffuse glioma with polysomy of chromosome 7 and loss of 10q as glioblastoma. New developments must be more quickly translated into further revised diagnostic categories. Quality control and rapid integration of molecular findings into the final diagnosis and the communication of the final diagnosis to clinicians require systematic attention. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Cultivating Humility and Diagnostic Openness in Clinical Judgment.

    Science.gov (United States)

    Stone, John R

    2017-10-01

    In this case, a physician rejects a patient's concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician's judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient's suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities. Insurgent multiculturalism is a complementary concept. Through epistemic humility-which includes both intellectual and emotional components-and admitting uncertainty, physicians can enhance patients' and families' epistemic authority and health agency. © 2017 American Medical Association. All Rights Reserved.

  11. Deafness genes in Israel: implications for diagnostics in the clinic.

    Science.gov (United States)

    Brownstein, Zippora; Avraham, Karen B

    2009-08-01

    The identification of the molecular basis of deafness in the last decade has made a remarkable impact on genetic counseling and diagnostics for the hearing impaired population. Since the discovery of the most prevalent form of deafness associated with mutations in the GJB2 (connexin 26) gene, many other genes have been found worldwide, with a subset of these, including unique mutations, in Israel. Here, we review the current status of deafness genes in Israel and report one known mutation in a syndromic form of deafness, Usher syndrome, described in the Jewish Israeli population for the first time. In the future, the identification of specific mutations may be relevant for specific types of treatment.

  12. Clinical review: Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests.

    Science.gov (United States)

    Harrington, Jennifer; Palmert, Mark R

    2012-09-01

    Determining the etiology of delayed puberty during initial evaluation can be challenging. Specifically, clinicians often cannot distinguish constitutional delay of growth and puberty (CDGP) from isolated hypogonadotropic hypogonadism (IHH), with definitive diagnosis of IHH awaiting lack of spontaneous puberty by age 18 yr. However, the ability to make a timely, correct diagnosis has important clinical implications. The aim was to describe and evaluate the literature regarding the ability of diagnostic tests to distinguish CDGP from IHH. A PubMed search was performed using key words "puberty, delayed" and "hypogonadotropic hypogonadism," and citations within retrieved articles were reviewed to identify studies that assessed the utility of basal and stimulation tests in the diagnosis of delayed puberty. Emphasis was given to a test's ability to distinguish prepubertal adolescents with CDGP from those with IHH. Basal gonadotropin and GnRH stimulation tests have limited diagnostic specificity, with overlap in gonadotropin levels between adolescents with CDGP and IHH. Stimulation tests using more potent GnRH agonists and/or human chorionic gonadotropin may have better discriminatory value, but small study size, lack of replication of diagnostic thresholds, and prolonged protocols limit clinical application. A single inhibin B level in two recent studies demonstrated good differentiation between groups. Distinguishing IHH from CDGP is an important clinical issue. Basal inhibin B may offer a simple, discriminatory test if results from recent studies are replicated. However, current literature does not allow for recommendation of any diagnostic test for routine clinical use, making this an important area for future investigation.

  13. The diagnostic value of component-resolved diagnostics in peanut allergy in children attending a Regional Paediatric Allergology Clinic.

    Science.gov (United States)

    van Veen, Leonieke N; Heron, Michiel; Batstra, Manou; van Haard, Paul M M; de Groot, Hans

    2016-06-02

    To date, diagnosing food allergies in children still presents a diagnostic dilemma, leading to uncertainty concerning the definite diagnosis of peanut allergy, as well as to the need for strict diets and the potential need for adrenalin auto-injectors. This uncertainty in particular is thought to contribute to a lower quality of life. In the diagnostic process double-blind food challenges are considered the gold standard, but they are time-consuming as well as potentially hazardous. Other diagnostic tests have been extensively studied and among these component-resolved diagnostics appeared to present a promising alternative: Ara h2, a peanut storage protein in previous studies showed to have a significant predictive value. Sixty-two out of 72 children, with suspected peanut allergy were analyzed using serum specific IgE and/or skin prick tests and specific IgE to several components of peanut (Ara h 1, 2, 3, 6, 8, 9). Subsequently, double-blind food challenges were performed. The correlation between the various diagnostic tests and the overall outcome of the double-blind food challenges were studied, in particular the severity of the reaction and the eliciting dose. The double-blind provocation with peanut was positive in 33 children (53 %). There was no relationship between the eliciting dose and the severity of the reaction. A statistically significant relationship was found between the skin prick test, specific IgE directed to peanut, Ara h 1, Ara h 2 or Ara h 6, and the outcome of the food challenge test, in terms of positive or negative (P food challenge. This study shows that component-resolved diagnostics is not superior to specific IgE to peanut extract or to skin prick testing. At present, it cannot replace double-blind placebo-controlled food challenges for determination of the eliciting dose or the severity of the peanut allergy in our patient group.

  14. Assessing variability in results in systematic reviews of diagnostic studies

    NARCIS (Netherlands)

    Naaktgeboren, Christiana A; Ochodo, Eleanor A; Van Enst, Wynanda A; de Groot, Joris A H; Hooft, Lotty; Leeflang, Mariska M G; Bossuyt, Patrick M; Moons, Karel G M; Reitsma, Johannes B

    2016-01-01

    BACKGROUND: To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area. METHODS: Meta-analyses of diagnostic test accuracy studies published between May and September

  15. GPs' perspectives on the diagnostic work-up in patients with shoulder pain: a qualitative study.

    Science.gov (United States)

    Ottenheijm, Ramon P G; Hesselmans, Nicolle J J M; Kemper, Anouk; Moser, Albine; de Bie, Rob A; Dinant, Geert-Jan; Cals, Jochen W L

    2014-06-01

    The diagnostic work-up of patients with shoulder pain in general practice is complex. General practitioners' (GPs) guidelines advise a pragmatic diagnostic work-up in which additional imaging has a limited role. However, diagnostic ultrasounds are increasingly ordered by GPs, which seems to reflect complexity in management of shoulder pain. This study aimed to explore GPs' perspectives on the diagnostic work-up of patients with shoulder pain. This study has a qualitative exploratory design with an inductive approach and was carried out in Dutch general practice. The study population consisted of 18 Dutch GPs who were sampled purposefully with a spread in clinical experience and ordering diagnostic ultrasound. Data were gathered by means of semi-structured interviews and analysed following principles of the constant comparative method. Three main categories with subcategories emerged that captured the diagnostic work-up of shoulder pain: variety in diagnostic classifications [(non-)specific diagnosis and interdisciplinary differences], establishing strategies for diagnostic work-up (use of existing tools and motives to deviate from existing tools), and strategies dealing with diagnostic uncertainties (accepting diagnostic uncertainties, diagnostic imaging tests, and interdisciplinary consultation and referral). Despite the availability of evidence-based shoulder guidelines, GPs experience uncertainties during diagnostic work-up and apply different strategies when dealing with these uncertainties. At some point, GPs as well as patients seem to have a need for a specific diagnosis. Currently, there appears to be little agreement if, or in which phase of shoulder pain, diagnostic ultrasound is useful or indicated. © 2014 John Wiley & Sons, Ltd.

  16. Effect of clinical specialist physiotherapists in orthopaedic diagnostic setting - A systematic review

    DEFF Research Database (Denmark)

    Trøstrup, Jeanette; Mikkelsen, Lone Ramer; Juhl, Carsten

    Relevance: Patients with musculoskeletal complaints are commonly referred to orthopaedic surgeons (OS) with 20 % of patients in primary care being referred to OS consultation. A high proportion of these referrals is not relevant for surgery and can potentially be managed entirely by physiotherapist...... with advanced clinical competencies; Clinical Specialist Physiotherapists (CSP). The use of CSPs instead of OSs to perform diagnostic assessment of patients with musculoskeletal complaints has been implemented in several countries (1). Earlier systematic reviews have evaluated CSPs effectiveness in diagnosing...... patients with musculoskeletal complaints and concluded that CSPs have the ability to diagnose musculoskeletal conditions (2), however since then more new studies have been published. Purpose: To evaluate the effectiveness of assessment of musculoskeletal complaints performed by CSP compared to OS...

  17. Low back pain in school-age children: risk factors, clinical features and diagnostic managment.

    Science.gov (United States)

    Boćkowski, L; Sobaniec, W; Kułak, W; Smigielska-Kuzia, J; Sendrowski, K; Roszkowska, M

    2007-01-01

    Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. On surveys, about every fifth child in the school-age reports LBP. The study objective was to analysis the natural history, risk factors, clinical symptoms, causes and diagnostic management in school-age children hospitalized with LBP. The study group consisted of 36 patients at the age between 10 and 18 years, 22 girls and 14 boys suffering from LBP hospitalized in our Department of Pediatric Neurology and Rehabilitation in years 2000-2004. The mean age of clinical onset of LBP in our group was 14.7 years, earlier in girls, later in boys. We find the family history of LBP in 50% children. Most frequent factors associated with LBP were: spina bifida (16.7%) and incorrect posture (13.9%). Half of patients pointed the factor initialising LBP: rapid, incoordinated move (39%) or heavy load rise (11%). 58% of patients present the symptoms of ischialgia. Diagnostic imaging showed disc protrusion in 11 children (31%) 6 in computed tomography, 4 in magnetic resonance imaging and 1 in X-Ray examination only. Other causes of LBP included: spondylolysis in 2 patients, Scheuermann disease in one case and juvenile reumatoid arthritis in one case. Some school-age children suffering on low back pain, particulary with sciatic neuralgia symptoms seek medical care in hospital. Althought the main causes are mechanical, associated with lack of physical activity or strenous exercise, serious diagnostic managment is strongly recommended.

  18. The Eating Disorder Diagnostic Scale: psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls

    NARCIS (Netherlands)

    Krabbenborg, M.A.M.; Danner, U.N.; Larsen, J.K.; van der Veer, N.; van Elburg, A.A.; de Ridder, D.T.; Evers, C.; Stice, E.; Engels, R.C.M.E.

    2012-01-01

    The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the

  19. Optimising the diagnostic imaging process through clinical history documentation

    International Nuclear Information System (INIS)

    Egan, I.; Baird, M.

    2003-01-01

    In the United Kingdom the 1990s were characterised by radiographer role extension including radiographic reporting and the performance of a variety of contrast examinations. In Australia where a privatised health system constrains the role of radiographers, other ways need to be found to improve professional practice and enhance patient care. One such way is for radiographers to develop knowledge and skills in clinical history taking. The paper advocates the development of a formalised approach to clinical history taking that portrays the radiographer as a professional and advocate of patient rights and welfare. The paper examines history taking approaches used by other health care professionals and proposes a clinical history template using five key areas of interview: area and type of symptoms, current history, past history, special considerations and psychosocial/occupational history. Copyright (2003) Australian Institute of Radiography

  20. Individual patient data meta-analysis of diagnostic and prognostic studies in obstetrics, gynaecology and reproductive medicine

    NARCIS (Netherlands)

    Broeze, Kimiko A.; Opmeer, Brent C.; Bachmann, Lucas M.; Broekmans, Frank J.; Bossuyt, Patrick M. M.; Coppus, Sjors F. P. J.; Johnson, Neil P.; Khan, Khalid S.; ter Riet, Gerben; van der Veen, Fulco; van Wely, Madelon; Mol, Ben W. J.

    2009-01-01

    ABSTRACT: BACKGROUND: In clinical practice a diagnosis is based on a combination of clinical history, physical examination and additional diagnostic tests. At present, studies on diagnostic research often report the accuracy of tests without taking into account the information already known from

  1. A comparison of arthrography to clinical diagnostics for diagnosing meniscal lesions

    International Nuclear Information System (INIS)

    Neuer, H.

    1982-01-01

    A comparative investigation as to the exactness of clinical and arthrographical diagnostics was carried out on 176 patients who were clinically examined and operated on in the period of 1972-1980. Using solely clinical diagnostics, the total rate of exactness was 90,9%, the exactness regarding the internal meniscal lesion being significantly higher (94.2%) than that regarding external meniscal lesion (76.7%). Using solely arthrographic diagnostics, the total rate of exactness was 82%, the rate for internal meniscus being significantly lower (83.9%) than that obtained using clinical diagnostics. As for the external meniscus, the exactness of arthrography differs only slightly from clinical diagnostics with 74.7%. The most frequent sources of error in arthorgraphy were found to be lesions of the posterior horn at the internal meniscus. In cases of external meniscal lesions, especially when an internal meniscal lesion was existing at the same time, both examination methods failed in 5 cases. For routine diagnosing of meniscal lesions, arthrography is not necessary. An accurate clinical examination and anamnesis bring very good and exact results and should therefore be given absolute priority. (orig./MG) [de

  2. ["Nervous breakdown": a diagnostic characterization study].

    Science.gov (United States)

    Salmán, E; Carrasco, J L; Liebowitz, M; Díaz Marsá, M; Prieto, R; Jusino, C; Cárdenas, D; Klein, D

    1997-01-01

    An evaluation was made of the influence of different psychiatric co-morbidities on the symptoms of the disorder popularly known as "ataque de nervios" (nervous breakdown) among the US Hispanic population. Using a self-completed instrument designed specially for both traditional nervous breakdown and for panic symptoms, and structured or semi-structured psychiatric interviews for Axis I disorders, and evaluation was made of Hispanic subjects who sought treatment for anxiety in a clinic (n = 156). This study centered on 102 subjects who presented symptoms of "nervous breakdown" and comorbidity with panic disorder, other anxiety disorders, or affective disorder. Variations in co-morbidity with "nervous breakdown" enabled the identification of different patterns of "nervous breakdown" presenting symptoms. Individuals with "nervous breakdown" and panic disorder characteristically expressed a greater sense of asphyxiation, fear of dying, and growing fear (panic-like) during their breakdowns. Subjects with "nervous breakdown" and affective disorder had a greater sensation of anger and more tendency toward screaming and aggressive behavior such as breaking things during the breakdown (emotional anger). Finally, subjects with "nervous breakdown" and co-morbidity with another anxiety disorder had fewer "paniclike" or "emotional anger" symptoms. These findings suggest that: a) the widely used term "nervous breakdown" is a popular label for different patterns of loss of emotional control; b) the type of loss of emotional control is influenced by the associated psychiatric disorder; and c) the symptoms characteristics of the "nervous breakdown" can be useful clinical markers for associated psychiatric disorders. Future research is needed to determine whether the known Hispanic entity "ataque de nervios" is simply a popular description for different aspects of well-known psychiatric disorders, or if it reflects specific demographic, environmental, personality and/or clinical

  3. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Nusbaumer Charly

    2007-03-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is the most frequent infection-related cause of death. The reference standard to diagnose CAP is a new infiltrate on chest radiograph in the presence of recently acquired respiratory signs and symptoms. This study aims to evaluate the diagnostic and prognostic accuracy of clinical signs and symptoms and laboratory biomarkers for CAP. Methods 545 patients with suspected lower respiratory tract infection, admitted to the emergency department of a university hospital were included in a pre-planned post-hoc analysis of two controlled intervention trials. Baseline assessment included history, clinical examination, radiography and measurements of procalcitonin (PCT, highly sensitive C-reactive protein (hsCRP and leukocyte count. Results Of the 545 patients, 373 had CAP, 132 other respiratory tract infections, and 40 other final diagnoses. The AUC of a clinical model including standard clinical signs and symptoms (i.e. fever, cough, sputum production, abnormal chest auscultation and dyspnea to diagnose CAP was 0.79 [95% CI, 0.75–0.83]. This AUC was significantly improved by including PCT and hsCRP (0.92 [0.89–0.94]; p Conclusion PCT, and to a lesser degree hsCRP, improve the accuracy of currently recommended approaches for the diagnosis of CAP, thereby complementing clinical signs and symptoms. PCT is useful in the severity assessment of CAP.

  4. Uptake and Diagnostic Yield of Chromosomal Microarray in an Australian Child Development Clinic

    Directory of Open Access Journals (Sweden)

    Dylan Mordaunt

    2014-05-01

    Full Text Available Autism is an etiologically heterogeneous developmental disorder for which the range of genetic investigations has expanded considerably over the past decade. Introduction of chromosomal microarray (CMA to clinical practice has expanded the range of conditions which pediatricians are able to detect. This study reviewed the utilization, yield and cost of genetic investigations in a sample of children with pervasive developmental disorders (PDD in an Australian metropolitan child development service. Six hundred and ninety eight patients with PDD were identified from the clinic population. One hundred and ten (15.7% of the clinic population had undergone investigation with chromosomal microarray, 140 (20.0% with karyotype (KT, and 167 (23.9% with Fragile X testing (FRGX. Twelve (10.9% CMA findings were reported, of which seven (6.3% were felt to be the likely cause of the child’s clinical features. Five (3.5% KT findings were reported, of which four (2.9% were felt to be the likely cause of the child’s clinical features. Two patients (1.2% were identified with Fragile X expansions. One fifth of the clinic’s recent PDD population had undergone testing with CMA. CMA appears to have increased the diagnostic yield of the genetic investigation of autism, in line with internationally reported levels. Number needed to test (NNT and cost per incremental diagnosis, were also in line with internationally reported levels.

  5. B metastases in breast cancer. Clinical, diagnostic and therapeutic aspects

    International Nuclear Information System (INIS)

    Ferrigno, R.; Petitto, J.V.

    1989-01-01

    Osseous metastases are the most frequent sites of dissemination in breast cancer and diminish the quality of patients life, being one of the most serious problems of the disease. The authors discuss the clinical, diagnosis and therapeutic aspects, based on their own experience and data from the literature. (author)

  6. Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease

    NARCIS (Netherlands)

    I. Zerr; K. Kallenberg; D.M. Summers; C. Romero; A. Taratuto; U. Heinemann; M. Breithaupt; D. Varges; B. Meissner; A. Ladogana (Anna); M. Schuur (Maaike); S. Haik; S.J. Collins (Steven); G.H. Jansen (Gerard); G.B. Stokin; J. Pimentel; E. Hewer; D. Collie; P. Smith; H. Roberts; J.P. Brandel; P. Tikka-Kleemola (Päivi); M. Pocchiari (Maurizio); C. Begue; P. Cras (Patrick); R.G. Will; P. Sanchez-Juan (Pascual)

    2009-01-01

    textabstractSeveral molecular subtypes of sporadic Creutzfeldt-Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications

  7. Schizoaffective disorder - The reliability of its clinical diagnostic use

    DEFF Research Database (Denmark)

    Vollmer-Larsen, A.; Jacobsen, T.B.; Hemmingsen, R.

    2006-01-01

    OBJECTIVE: Patients with psychoses often suffer from affective symptoms. The originally broad concept of schizoaffective disorder (SAD) has been significantly narrowed, transformed into a convoluted set of criteria both in the ICD-10 and DSM-IV. We examined the reliability of the clinical use...

  8. How to diagnose neuropathic pain? The contribution from clinical examination, pain questionnaires and diagnostic tests.

    Science.gov (United States)

    La Cesa, S; Tamburin, S; Tugnoli, V; Sandrini, G; Paolucci, S; Lacerenza, M; Marchettini, P; Cruccu, G; Truini, A

    2015-12-01

    Patients with peripheral and central nervous system diseases may suffer from different types of pain, namely nociceptive, neuropathic and mixed pain. Although in some cases, the distinction between these types of pain is clinically evident, yet in some patients an accurate differential diagnosis requires dedicated clinical examination, screening questionnaires and diagnostic techniques some of which are available only in specialized pain centres. This review briefly addresses the currently agreed definitions of the different types of pain and shows how clinical examination, pain questionnaires and diagnostic tests can help the clinicians in identifying neuropathic pain.

  9. 76 FR 28990 - Ultra High Throughput Sequencing for Clinical Diagnostic Applications-Approaches To Assess...

    Science.gov (United States)

    2011-05-19

    ... Web cast of the public meeting, you must register online at http://www.fda.gov/MedicalDevices/News... technologies are currently extensively used in research and are entering clinical diagnostic use; they are... technologies for clinical applications, appropriate evaluation tools (e.g., standards, well established...

  10. Single and Combined Diagnostic Value of Clinical Features and Laboratory Tests in Acute Appendicitis

    NARCIS (Netherlands)

    Laméris, Wytze; van Randen, Adrienne; Go, Peter M. N. Y. H.; Bouma, Wim H.; Donkervoort, Sandra C.; Bossuyt, Patrick M. M.; Stoker, Jaap; Boermeester, Marja A.

    2009-01-01

    Objectives: The objective was to evaluate the diagnostic accuracy of clinical features and laboratory test results in detecting acute appendicitis. Methods: Clinical features and laboratory test results were prospectively recorded in a consecutive series of 1,101 patients presenting with abdominal

  11. A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension.

    Science.gov (United States)

    You, Myung-Won; Kim, Kyung Won; Pyo, Junhee; Huh, Jimi; Kim, Hyoung Jung; Lee, So Jung; Park, Seong Ho

    2017-01-01

    We aimed to evaluate the correlation between liver stiffness measurement using transient elastography (TE-LSM) and hepatic venous pressure gradient and the diagnostic performance of TE-LSM in assessing clinically significant portal hypertension through meta-analysis. Eleven studies were included from thorough literature research and selection processes. The summary correlation coefficient was 0.783 (95% confidence interval [CI], 0.737-0.823). Summary sensitivity, specificity and area under the hierarchical summary receiver operating characteristic curve (AUC) were 87.5% (95% CI, 75.8-93.9%), 85.3 % (95% CI, 76.9-90.9%) and 0.9, respectively. The subgroup with low cut-off values of 13.6-18 kPa had better summary estimates (sensitivity 91.2%, specificity 81.3% and partial AUC 0.921) than the subgroup with high cut-off values of 21-25 kPa (sensitivity 71.2%, specificity 90.9% and partial AUC 0.769). In summary, TE-LSM correlated well with hepatic venous pressure gradient and represented good diagnostic performance in diagnosing clinically significant portal hypertension. For use as a sensitive screening tool, we propose using low cut-off values of 13.6-18 kPa in TE-LSM. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  12. Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches

    Science.gov (United States)

    de Noya, Belkisyolé Alarcón; Díaz-Bello, Zoraida; Colmenares, Cecilia; Ruiz-Guevara, Raiza; Mauriello, Luciano; Muñoz-Calderón, Arturo; Noya, Oscar

    2015-01-01

    Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas) with 249 cases (73.5% children) and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana’s signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatus has been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission. PMID:25946155

  13. Diagnostic reference levels in intraoral radiology: From the laboratory to clinical practice

    International Nuclear Information System (INIS)

    Alcaraz, M.; Velasco, E.; Martinez-Beneyto, Y.; Velasco, F.; Parra, C.; Canteras, M.

    2010-01-01

    To determine the diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice and to explain the differences between the levels found and the DRLs obtained in other experimental conditions, suggesting that there has been a reduction in the European Union (EU) recommended levels. A total of 2296 official reports on dental surgeries from 16 Spanish autonomous regions compiled during 2008 were studied. A mean DRL of 3.3 mGy was determined: 2.6 mGy for installations using direct digital systems, 3.4 mGy for those using indirect systems, 4.4 mGy for those using Ultra-speed film and 3.7 mGy for those using Insight. The DRLs found in this survey are below the EU recommended values but far above previously described values, possibly because all the different systems were considered and because values refer to those of the normal work conditions of clinical practice. (authors)

  14. Molecular Diagnostics for the Study of Hypersonic Flows

    Science.gov (United States)

    2000-04-01

    UNCLASSIFIED Defense Technical Information Center Compilation Part Notice ADPO10744 TITLE: Molecular Diagnostics for the Study of Hypersonic Flows...following component part numbers comprise the compilation report: ADP010736 thru ADPO10751 UNCLASSIFIED 5-1 Molecular Diagnostics for the Study of

  15. [Critical reading of articles about diagnostic tests (part I): Are the results of the study valid?].

    Science.gov (United States)

    Arana, E

    2015-01-01

    In the era of evidence-based medicine, one of the most important skills a radiologist should have is the ability to analyze the diagnostic literature critically. This tutorial aims to present guidelines for determining whether primary diagnostic articles are valid for clinical practice. The following elements should be evaluated: whether the study can be applied to clinical practice, whether the technique was compared to the reference test, whether an appropriate spectrum of patients was included, whether expectation bias and verification bias were limited, the reproducibility of the study, the practical consequences of the study, the confidence intervals for the parameters analyzed, the normal range for continuous variables, and the placement of the test in the context of other diagnostic tests. We use elementary practical examples to illustrate how to select and interpret the literature on diagnostic imaging and specific references to provide more details. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  16. Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study.

    Science.gov (United States)

    Nishizaki, Yuji; Shinozaki, Tomohiro; Kinoshita, Kensuke; Shimizu, Taro; Tokuda, Yasuharu

    2018-04-01

    Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience. Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores. The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p ITE scores correlated with ED rotations (≥6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p ITE scores (ß = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations (ß = 0.06, 95% CI: 0.02-0.10), inpatient caseload (ß = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study (ß = 0.13, 95% CI: 0.09-0.17). Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.

  17. Clinical and radiological diagnostic of foreign bodies in companion birds

    International Nuclear Information System (INIS)

    Kummerfeld, N.; Erhorn, I.

    1991-01-01

    Sometimes curious foreign bodies placed in the proventriculus/ventriculus of companion birds are causes of single case diseases. Clinical signs include untypical symptoms such as distress, lameness, vomiting and diarrhoe. In cases of heavy metal intoxication, e.g. lead poisoning, CNS-disorders are found. Radiographs taken in a ventro-dorsal and a latero-lateral view show the presence of foreign bodies in suspicion. In most cases of foreign bodies in birds a surgical intervention (Gastrotomy) is indicated

  18. Clinical and diagnostic characteristics of hyperprolactinemia in childhood and adolescence.

    Science.gov (United States)

    Catli, Gonul; Abaci, Ayhan; Bober, Ece; Büyükgebiz, Atilla

    2013-01-01

    Pituitary adenoma is the most common cause of hyperprolactinemia, which is a rare endocrine disorder encountered in pediatric patient care. Epidemiological and clinical information about hyperprolactinemia in childhood and adolescence is limited. Clinical signs of hyperprolactinemia are very heterogeneous. In girls, disturbances in menstrual function and galactorrhea may be seen, whereas in boys, headache, visual disturbances, delayed pubertal development and hypogonadism are often present. Owing to the ease of ordering a serum prolactin measurement, an evidence-based, cost-effective approach to the management of this endocrine disorder is required. Before a diagnosis of hyperprolactinemia is made, drug use, renal insufficiency, hypothyroidism, and parasellar tumors should be excluded. The main objectives of treatment are normalization of prolactin level, adenoma shrinkage, and recovery from clinical signs related to hyperprolactinemia. In patients with microadenoma, invasive or non-invasive macroadenoma, and even in patients with visual field defects, dopamine agonists are the first-line treatment. Surgical treatment is indicated in patients who are unresponsive or intolerant to medical treatment or who have persistent neurological signs. Radiotherapy should be considered as a supportive treatment for patients in whom surgery fails or medical response is not achieved.

  19. Autoimmune hepatitis: diagnostic criteria, subclassifications, and clinical features.

    Science.gov (United States)

    McFarlane, Ian G

    2002-08-01

    The diagnosis of AIH depends on the finding of several suggestive features together with careful exclusion of liver diseases of other etiologies. Wherever possible, the diagnosis should be confirmed histologically by an experienced hepatopathologist. Seronegativity for the conventional autoantibodies at presentation does not exclude a diagnosis of AIH. It is important to test for anti-LKM1 antibodies to avoid missing a diagnosis of type 2 AIH, with potentially serious consequences. Although the syndrome is associated with characteristic biochemical abnormalities, and biochemical parameters are commonly used for monitoring response to therapy, it should be borne in mind that neither these nor autoantibody titers are completely reliable indices of disease activity. Although the various systems that have been promulgated for classification of the disease may identify different groups of patients on pathogenetic or clinical criteria and are useful for research purposes, none is yet sufficiently exclusive in terms of defining prognosis or planning treatment strategies to be applicable to the individual patient seen in the clinic. Clinical management should therefore continue to be individually tailored.

  20. Autoimmune thyroiditis goitrogenic. Aspects of clinical and laboratorial diagnostic

    International Nuclear Information System (INIS)

    Costa, H.F.Z. da.

    1986-01-01

    To asses the accuracy achieved by the A.C.A.T. and other clinical and laboratorial criterion in the diagnoses of T.A.I.B. we investigated twenty patients with goiter and antimicrossomal antibodies titres of 1/1.600 or more. Analysing the parameters useful in the diagnosis, we found a significant correlation between the antimicrossomal antibodies titres and the basal TSH concentration, an elevated basal TSH and an exaggerated response to TRH independent of the patient clinical status reflecting in the majority of the cases a state of subclinical hypotyroidism; an irregular appearance of the radioisotope thyroid scan and a positive response to a perchlorate discharge test. We conclude that from the parameters useful in the T.A.I.B. diagnosis, the A.C.A.T. detection mainly the antimicrossomal antibodies, is an excellent tool to detect patients with a clinical suspect of thyroid auto-immune disease and when we found high tires in a patient with goiter and an elevated basal TSH concentration we can suggest T.A.I.B. diagnosis. (author)

  1. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis

    NARCIS (Netherlands)

    Heijboer, H.; Jongbloets, L. M.; Büller, H. R.; Lensing, A. W.; ten Cate, J. W.

    1992-01-01

    In the diagnostic management of patients with clinically suspected recurrent deep-vein thrombosis (DVT), there are potential limitations to all available diagnostic techniques. Since venous abnormalities may persist for some time after an acute thrombosis, the usefulness of compression

  2. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI.

    Science.gov (United States)

    Trend, Stephanie; Jones, Anderson P; Geldenhuys, Sian; Byrne, Scott N; Fabis-Pedrini, Marzena J; Nolan, David; Booth, David R; Carroll, William M; Lucas, Robyn M; Kermode, Allan G; Hart, Prue H

    2017-06-15

    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS.

  3. Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals

    Science.gov (United States)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.

    2015-01-01

    Background: Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods: A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results: The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. Conclusion: There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA

  4. Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals.

    Science.gov (United States)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S

    2015-05-20

    Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA strategies in practice, and the application of

  5. Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin

    2015-10-01

    Full Text Available Background Iran has a widespread diagnostics and clinical support services (DCSS network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%, pharmacopoeia availability (92%, equipment calibration (87% and identifying responsibilities (86%. Least reported was external auditing of the DCSS (57%. The clinical chemistry and microbiology laboratories (84%, pharmacies, blood bank services (83% reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%. There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO and private-for-profit hospitals than in governmental hospitals. Conclusion There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits can be improved. Both the effectiveness of QA

  6. A computational framework for converting textual clinical diagnostic criteria into the quality data model.

    Science.gov (United States)

    Hong, Na; Li, Dingcheng; Yu, Yue; Xiu, Qiongying; Liu, Hongfang; Jiang, Guoqian

    2016-10-01

    Constructing standard and computable clinical diagnostic criteria is an important but challenging research field in the clinical informatics community. The Quality Data Model (QDM) is emerging as a promising information model for standardizing clinical diagnostic criteria. To develop and evaluate automated methods for converting textual clinical diagnostic criteria in a structured format using QDM. We used a clinical Natural Language Processing (NLP) tool known as cTAKES to detect sentences and annotate events in diagnostic criteria. We developed a rule-based approach for assigning the QDM datatype(s) to an individual criterion, whereas we invoked a machine learning algorithm based on the Conditional Random Fields (CRFs) for annotating attributes belonging to each particular QDM datatype. We manually developed an annotated corpus as the gold standard and used standard measures (precision, recall and f-measure) for the performance evaluation. We harvested 267 individual criteria with the datatypes of Symptom and Laboratory Test from 63 textual diagnostic criteria. We manually annotated attributes and values in 142 individual Laboratory Test criteria. The average performance of our rule-based approach was 0.84 of precision, 0.86 of recall, and 0.85 of f-measure; the performance of CRFs-based classification was 0.95 of precision, 0.88 of recall and 0.91 of f-measure. We also implemented a web-based tool that automatically translates textual Laboratory Test criteria into the QDM XML template format. The results indicated that our approaches leveraging cTAKES and CRFs are effective in facilitating diagnostic criteria annotation and classification. Our NLP-based computational framework is a feasible and useful solution in developing diagnostic criteria representation and computerization. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Informativity of proteinograms as a clinical-diagnostic test at dispoteinemia in the age aspect

    Directory of Open Access Journals (Sweden)

    R. F. Yeriomenko

    2017-02-01

    Full Text Available The article analyzed dates of the usefulness of proteinograms as a clinical diagnostic test at dysproteinemia in age aspect. Established that proteinograms has  differences that depending on age, so these aspects should be considered in the diagnosis of certain pathological conditions in different age groups. Studying of children’s proteinograms in various pathological conditions indicates the appropriate changes in the fractional part of albumin and globulin, that characterized the development of inflammation and destruction of connective tissue. Besides diagnostic tests that help in the diagnosis, determine the stage of disease and the effectiveness of therapy is to study proteins "acute phase" and rheumatoid factor. Established the feasibility of proteinograms on the studying of dysproteinemia in different pathological conditions in adult age. It is found correlation between changes in protein fractions and stage of pathological process in connective tissue diseases (rheumatoid arthritis and systemic lupus erythema. At skin diseases, urinary, respiratory and hepatobiliary systems were recorded proteinograms changes depending on the damage of a system. Analysis of the results allows more accurate founded the diagnosis, determine the stage of the pathological process and evaluate the effectiveness of the pharmacotherapy.

  8. BALANOPOSTHITIS: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Raju

    2015-01-01

    Full Text Available INTRODUCTION: The inflammation of the non - keratinized epithelium of the glans penis (i.e., Balanities and that of prepuce (i.e., posthitis together comprise the term Balanoposthitis. AIMS AND OBJECTIVES: To determine the aetiological and p redisposing factors for the development of Balanoposthitis, and to know its relation with venereal and non - venereal disease, local and systemic precipitatin g factors. To know the prevalence of Balanoposthitis in STD clinic. Study design - retrospective study . MATERIALS AND METHODS: The study material consists of 75 cases of balanoposthitis attending out - patient department Skin & STD clinic during a period exten din g from Feb, 1998 to Feb, 1999 . CRITERIA FOR SELECTION OF A CASE: Only those cases which have a history of redness of glans or mucous surface of prepuce, with or without genital discharge or ulcer on glans or mucosal surface of prepuce with or without discharge or growth on the penis or fissuring of fore skin were selected for the study. RESULTS: Incidence of balanoposthitis during the period from Feb. 98 to Feb.99 was – 11.53%, out of 650 new STD cases. It was observed that maximum number of pat i ents w as in the 21 - 30 age group (33.34%. The next predominant groups affected were 17 - 20 & 31 - 40 age group (20% each. The third most common age group affected was 41 - 50 (16%. In this study 69 patients (92% who presented with balanoposthitis of whatever cause were found to be uncircumcised, only 6 cases (8% were found to be circumcised. Most cases who presented with balanoposthitis gave a history of exposure to STD risk. CONCLUSIONS: Balanoposthitis is very commonly encountered condition in the STD clinics wi th a multi factorial aetiology. Infective causes dominated over the other possible causes, and 30% of the candidial infection had diabetes mellitus as a predisposing factor.

  9. Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis.

    Science.gov (United States)

    Kok, Shi Xian Shawn; Tan, Tien Jin

    2017-08-01

    A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed. Copyright: © Singapore Medical Association.

  10. [Diagnostic strategy in patients with clinically suspected deep vein thrombosis

    DEFF Research Database (Denmark)

    Mantoni, Margit Yvonne; Kristensen, M.; Brogaard, M.H.

    2008-01-01

    INTRODUCTION: The standard method for diagnosing deep vein thrombosis (DVT) involves determination of D-dimer and ultrasound scanning. In an attempt to reduce the number of ultrasound examinations we have supplemented this with a clinical probability estimate for DVT (DVT-score) over one year....... MATERIALS AND METHODS: A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal...... patients with normal D-dimer had high DVT-scores, none had DVT, so that the benefit from determining DVT-scores was modest. Ultrasound scanning revealed DVT in 85 out of 397 patients with elevated D-dimer. A repeat examination was performed in 91 patients with persisting symptoms, and disclosed DVT in two...

  11. Severe scrub typhus infection: Clinical features, diagnostic challenges and management

    Science.gov (United States)

    Peter, John Victor; Sudarsan, Thomas I; Prakash, John Anthony J; Varghese, George M

    2015-01-01

    Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%. PMID:26261776

  12. Evidence of clinical utility: an unmet need in molecular diagnostics for patients with cancer.

    Science.gov (United States)

    Parkinson, David R; McCormack, Robert T; Keating, Susan M; Gutman, Steven I; Hamilton, Stanley R; Mansfield, Elizabeth A; Piper, Margaret A; Deverka, Patricia; Frueh, Felix W; Jessup, J Milburn; McShane, Lisa M; Tunis, Sean R; Sigman, Caroline C; Kelloff, Gary J

    2014-03-15

    This article defines and describes best practices for the academic and business community to generate evidence of clinical utility for cancer molecular diagnostic assays. Beyond analytical and clinical validation, successful demonstration of clinical utility involves developing sufficient evidence to demonstrate that a diagnostic test results in an improvement in patient outcomes. This discussion is complementary to theoretical frameworks described in previously published guidance and literature reports by the U.S. Food and Drug Administration, Centers for Disease Control and Prevention, Institute of Medicine, and Center for Medical Technology Policy, among others. These reports are comprehensive and specifically clarify appropriate clinical use, adoption, and payer reimbursement for assay manufacturers, as well as Clinical Laboratory Improvement Amendments-certified laboratories, including those that develop assays (laboratory developed tests). Practical criteria and steps for establishing clinical utility are crucial to subsequent decisions for reimbursement without which high-performing molecular diagnostics will have limited availability to patients with cancer and fail to translate scientific advances into high-quality and cost-effective cancer care. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development." ©2014 AACR.

  13. NSTX Diagnostics for Fusion Plasma Science Studies

    International Nuclear Information System (INIS)

    Kaita, R.; Johnson, D.; Roquemore, L.; Bitter, M.; Levinton, F.; Paoletti, F.; Stutman, D.

    2001-01-01

    This paper will discuss how plasma science issues are addressed by the diagnostics for the National Spherical Torus Experiment (NSTX), the newest large-scale machine in the magnetic confinement fusion (MCF) program. The development of new schemes for plasma confinement involves the interplay of experimental results and theoretical interpretations. A fundamental requirement, for example, is a determination of the equilibria for these configurations. For MCF, this is well established in the solutions of the Grad-Shafranov equation. While it is simple to state its basis in the balance between the kinetic and magnetic pressures, what they are as functions of space and time are often not easy to obtain. Quantities like the plasma pressure and current density are not directly measurable. They are derived from data that are themselves complex products of more basic parameters. The same difficulties apply to the understanding of plasma instabilities. Not only are the needs for spatial and temporal resolution more stringent, but the wave parameters which characterize the instabilities are difficult to resolve. We will show how solutions to the problems of diagnostic design on NSTX, and the physics insight the data analysis provides, benefits both NSTX and the broader scientific community

  14. Automatic Decision Support for Clinical Diagnostic Literature Using Link Analysis in a Weighted Keyword Network.

    Science.gov (United States)

    Li, Shuqing; Sun, Ying; Soergel, Dagobert

    2017-12-23

    We present a novel approach to recommending articles from the medical literature that support clinical diagnostic decision-making, giving detailed descriptions of the associated ideas and principles. The specific goal is to retrieve biomedical articles that help answer questions of a specified type about a particular case. Based on the filtered keywords, MeSH(Medical Subject Headings) lexicon and the automatically extracted acronyms, the relationship between keywords and articles was built. The paper gives a detailed description of the process of by which keywords were measured and relevant articles identified based on link analysis in a weighted keywords network. Some important challenges identified in this study include the extraction of diagnosis-related keywords and a collection of valid sentences based on the keyword co-occurrence analysis and existing descriptions of symptoms. All data were taken from medical articles provided in the TREC (Text Retrieval Conference) clinical decision support track 2015. Ten standard topics and one demonstration topic were tested. In each case, a maximum of five articles with the highest relevance were returned. The total user satisfaction of 3.98 was 33% higher than average. The results also suggested that the smaller the number of results, the higher the average satisfaction. However, a few shortcomings were also revealed since medical literature recommendation for clinical diagnostic decision support is so complex a topic that it cannot be fully addressed through the semantic information carried solely by keywords in existing descriptions of symptoms. Nevertheless, the fact that these articles are actually relevant will no doubt inspire future research.

  15. Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Munck, L K; Andersen, J R

    1985-01-01

    The irritable bowel syndrome is the commonest diagnosis in gastroenterological clinics, although diagnostic criteria and investigatory programs vary. To elucidate the diagnostic safety and prognosis of the syndrome, a retrospective study was conducted. One hundred and twelve consecutive patients...... with irritable bowel syndrome as the final and only abdominal diagnosis in the period 1977-79 were followed up in 1984. Seventeen patients died during the follow-up period; two of these were considered diagnostic failures (chronic pancreatitis and pancreatic cancer). Of the remaining 95 patients, 93 were...

  16. Procalcitonin in cerebrospinal fluid in meningitis : a prospective diagnostic study

    NARCIS (Netherlands)

    Alons, Imanda M E; Verheul, Rolf J; Kuipers, Irma; Jellema, Korné; Wermer, Marieke J H; Algra, Ale; Ponjee, Gabriëlle

    2016-01-01

    OBJECTIVES: Bacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in bacterial infection. We aimed to assess the value

  17. Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness

    Science.gov (United States)

    Piker, Erin G.; Schulz, Kris; Parham, Kourosh; Vambutas, Andrea; Witsell, David; Tucci, Debara; Shin, Jennifer J.; Pynnonen, Melissa A.; Nguyen-Huynh, Anh; Crowson, Matthew; Ryan, Sheila E.; Langman, Alan; Roberts, Rhonda; Wolfley, Anne; Lee, Walter T.

    2016-01-01

    Objective We used a national otolaryngology practice–based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder. Study Design Database review. Setting The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers Subjects and Methods Dizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit. Results A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics. Conclusion There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing. PMID:27371625

  18. DIAGNOSTIC IMAGING IN A DIRECT-ACCESS SPORTS PHYSICAL THERAPY CLINIC: A 2-YEAR RETROSPECTIVE PRACTICE ANALYSIS.

    Science.gov (United States)

    Crowell, Michael S; Dedekam, Erik A; Johnson, Michael R; Dembowski, Scott C; Westrick, Richard B; Goss, Donald L

    2016-10-01

    While advanced diagnostic imaging is a large contributor to the growth in health care costs, direct-access to physical therapy is associated with decreased rates of diagnostic imaging. No study has systematically evaluated with evidence-based criteria the appropriateness of advanced diagnostic imaging, including magnetic resonance imaging (MRI), when ordered by physical therapists. The primary purpose of this study was to describe the appropriateness of magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) exams ordered by physical therapists in a direct-access sports physical therapy clinic. Retrospective observational study of practice. Greater than 80% of advanced diagnostic imaging orders would have an American College of Radiology (ACR) Appropriateness Criteria rating of greater than 6, indicating an imaging order that is usually appropriate. A 2-year retrospective analysis identified 108 MRI/MRA examination orders from four physical therapists. A board-certified radiologist determined the appropriateness of each order based on ACR appropriateness criteria. The principal investigator and co-investigator radiologist assessed agreement between the clinical diagnosis and MRI/surgical findings. Knee (31%) and shoulder (25%) injuries were the most common. Overall, 55% of injuries were acute. The mean ACR rating was 7.7; scores from six to nine have been considered appropriate orders and higher ratings are better. The percentage of orders complying with ACR appropriateness criteria was 83.2%. Physical therapist's clinical diagnosis was confirmed by MRI/MRA findings in 64.8% of cases and was confirmed by surgical findings in 90% of cases. Physical therapists providing musculoskeletal primary care in a direct-access sports physical therapy clinic appropriately ordered advanced diagnostic imaging in over 80% of cases. Future research should prospectively compare physical therapist appropriateness and utilization to other groups of providers and

  19. HYPOPARATHYROIDISM: ETIOLOGY, CLINICAL MANIFESTATION, CURRENT DIAGNOSTICS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    N. G. Mokrysheva

    2016-01-01

    treatment with recombinant PTH is not widely used. Replacement therapy with recombinant human PTH is a  promising area, especially in severe clinical cases, refractory to conventional treatment.

  20. An empirical operationalization study of DSM-IV diagnostic criteria for premature ejaculation

    NARCIS (Netherlands)

    Waldinger, M. D.; Hengeveld, M. W.; Zwinderman, A. H.; Olivier, B.

    1998-01-01

    The DSM-IV diagnostic criteria for premature ejaculation remain to be investigated by a clinical study. A prospective study was therefore conducted to investigate the DSM-IV definition and to provide an empirical operationalization of premature ejaculation. In this study 140 men suffering from

  1. [Diagnostics of the genetic causes of autism spectrum disorders - a clinical geneticist's view].

    Science.gov (United States)

    Szczaluba, Krzysztof

    2014-01-01

    Explanation of the genetic basis of autism spectrum disorders has, for many decades, been a part of interest of researchers and clinicians. In recent years, thanks to modern molecular and cytogenetic techniques, a significant progress has been achieved in the diagnosis of genetic causes of autism. This applies particularly, but not exclusively, to those cases of autism that are accompanied by other clinical signs (i. e. complex phenotypes). The important clinical markers belong to different categories, and include congenital defects/anomalies, dysmorphism and macro-/microcephaly, to name the few. Thus, the choice of the diagnostic strategy depends on the clinical and pedigree information and, under Polish circumstances, the availability of specific diagnostic techniques and the amount of reimbursement under the National Health Service. Overall, the identification of the genetic causes of autism spectrum disorders is possible in about 10-30% of patients. In this paper the practical aspects of the use of different diagnostic techniques are briefly described. Some clinical examples and current recommendations for the diagnosis of patients with autism spectrum disorders are also presented. The point of view of a specialist in clinical genetics, increasingly involved, as part of the multidisciplinary care team, in the diagnostics of an autistic child has been demonstrated.

  2. Clinical application and evaluation of the diagnostic significance of NMR-tomography

    International Nuclear Information System (INIS)

    Bielke, G.; Higer, P.

    1987-01-01

    Aim of the project was the clinical application and evaluation of the diagnostic significance of NMR-tomography. About 3 000 patients have been examined especially with diseases of the brain. In 75% of all cases pathological findings could be detected. A subgroup of these patients was used for comprehensive studies with regard to tissue characterization based on the calculation of relaxation time parameters. With methods of image processing and classification techniques we tried to get a clear correlation between combined NMR-parameters and human tissue types. The results show that this procedure is able to improve the detectibility and the association to finding groups and tumorgradings in certain cases. (orig./ECB) With 134 refs., 17 tabs., 86 figs [de

  3. Introduction of spirometry into clinical practice in Georgetown, Guyana: quality and diagnostic outcomes.

    Science.gov (United States)

    Johnston, J C; Rempel, C; Sanders, C; Piggott, E; Maxwell, Y; Jaipersaud, K; Luknauth, R; Persaud, D; Rambaran, M; Levy, R D

    2016-09-01

    Georgetown Public Hospital Corporation (GPHC), a 600-bed publicly funded referral hospital in Georgetown, Guyana. To assess spirometry quality and diagnostic outcomes 2 years after the introduction of spirometry into routine clinical practice at GPHC. We performed a retrospective review of 476 consecutive spirometry assessments performed from November 2013 to November 2015. We assessed the proportion and trend of spirometry tests meeting acceptability criteria, along with diagnostic interpretations and spirometry laboratory referral patterns. Overall, 80.4% of the 454 initial spirometry measurements on unique patients met the acceptability criteria, with no significant change in the proportion of acceptable spirometry over the study period (P = 0.450). Of the 369 (81.3%) first tests considered interpretable, 139 (30.6%) were normal, 151 (33.3%) were obstructive, 54 (11.9%) were suggestive of a restrictive pattern, 25 (5.5%) were suggestive of a mixed disorder and 119 (26.2%) tests met the definition of reversibility. Over a 2-year period, high-quality spirometry was performed in GPHC, a publicly funded hospital in a middle-income country with no pre-existing specialised respiratory service.

  4. Clinicians' emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation.

    Science.gov (United States)

    Gazzillo, Francesco; Lingiardi, Vittorio; Del Corno, Franco; Genova, Federica; Bornstein, Robert F; Gordon, Robert M; McWilliams, Nancy

    2015-06-01

    The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed. (c) 2015 APA, all rights reserved).

  5. Neonatal hemochromatosis and patent ductus venosus: clinical course and diagnostic pitfalls

    International Nuclear Information System (INIS)

    Tsai, Andy; Paltiel, Harriet J.; Sena, Laureen M.; Kim, Heung Bae; Fishman, Steven J.; Alomari, Ahmad I.

    2009-01-01

    Neonatal hemochromatosis is a rare metabolic disorder characterized by excessive iron deposition within the liver leading to hepatic failure and portal hypertension. We describe the clinical course and imaging findings in three infants with neonatal hemochromatosis associated with patent ductus venosus. We paid special attention to the diagnostic challenges encountered in these patients in order to emphasize some of the potential diagnostic pitfalls. We conducted a comprehensive search of our radiology database of the last 10 years (1999-2008) for the keywords ''neonatal hemochromatosis.'' Medical records and imaging studies of various modalities were reviewed. Three neonates were found to have neonatal hemochromatosis; all of them were associated with patent ductus venosus. Two of these patients were referred to our tertiary center for embolization of an inaccurately diagnosed hepatic vascular malformation. Two patients underwent successful liver transplantation and one died shortly after referral. The awareness and inclusion of neonatal hemochromatosis in the differential diagnosis of newborns with liver failure and patent ductus venosus has critical treatment implications. (orig.)

  6. Neonatal hemochromatosis and patent ductus venosus: clinical course and diagnostic pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Paltiel, Harriet J.; Sena, Laureen M. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Kim, Heung Bae; Fishman, Steven J. [Children' s Hospital Boston and Harvard Medical School, Department of Surgery, Boston, MA (United States); Alomari, Ahmad I. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Children' s Hospital Boston, Division of Vascular and Interventional Radiology, Boston, MA (United States)

    2009-08-15

    Neonatal hemochromatosis is a rare metabolic disorder characterized by excessive iron deposition within the liver leading to hepatic failure and portal hypertension. We describe the clinical course and imaging findings in three infants with neonatal hemochromatosis associated with patent ductus venosus. We paid special attention to the diagnostic challenges encountered in these patients in order to emphasize some of the potential diagnostic pitfalls. We conducted a comprehensive search of our radiology database of the last 10 years (1999-2008) for the keywords ''neonatal hemochromatosis.'' Medical records and imaging studies of various modalities were reviewed. Three neonates were found to have neonatal hemochromatosis; all of them were associated with patent ductus venosus. Two of these patients were referred to our tertiary center for embolization of an inaccurately diagnosed hepatic vascular malformation. Two patients underwent successful liver transplantation and one died shortly after referral. The awareness and inclusion of neonatal hemochromatosis in the differential diagnosis of newborns with liver failure and patent ductus venosus has critical treatment implications. (orig.)

  7. Diagnostic yield of preoperative computed tomography imaging and the importance of a clinical decision for lung cancer surgery

    International Nuclear Information System (INIS)

    Sato, Shuichi; Koike, Teruaki; Yamato, Yasushi

    2010-01-01

    This study aimed to evaluate the diagnostic yield of preoperative computed tomography (CT) imaging and the validity of surgical intervention based on the clinical decision to perform surgery for lung cancer or suspected lung cancer. We retrospectively evaluated 1755 patients who had undergone pulmonary resection for lung cancer or suspected lung cancer. CT scans were performed on all patients. Surgical intervention to diagnose and treat was based on a medical staff conference evaluation for the suspected lung cancer patients who were pathologically undiagnosed. We evaluated the relation between resected specimens and preoperative CT imaging in detail. A total of 1289 patients were diagnosed with lung cancer by preoperative pathology examination; another 466 were not pathologically diagnosed preoperatively. Among the 1289 patients preoperatively diagnosed with lung cancer, the diagnoses were confirmed postoperatively in 1282. Among the 466 patients preoperatively undiagnosed, 435 were definitively diagnosed with lung cancer, and there were 383 p-stage I disease patients. There were 38 noncancerous patients who underwent surgery with a diagnosis of confirmed or suspected lung cancer. Among the 1755 patients who underwent surgery, 1717 were pathologically confirmed with lung cancer, and the diagnostic yield of preoperative CT imaging was 97.8%. Among the 466 patients who were preoperatively undiagnosed, 435 were compatible with the predicted findings of lung cancer. Diagnostic yields of preoperative CT imaging based on clinical evaluation are sufficiently reliable. Diagnostic surgical intervention was acceptable when the clinical probability of malignancy was high and the malignancy was pathologically undiagnosed. (author)

  8. MYCOPLASMA INFECTION: CLINICAL TYPES, VARIATIONS OF CLINICAL COURSE AND DIAGNOSTIC MISTAKES

    Directory of Open Access Journals (Sweden)

    M.S. Savenkova

    2013-01-01

    Full Text Available Aim: to assess clinical course of various types of mycoplasma infection during the last epidemic (September 2012 – February 2013 according to the positive results of serological analyses. Patients and methods: 3553 laboratory tests were performed, 177 (20% positive results of mycoplasma were detected. During the study clinical types, gender and age of patients were analyzed; special characteristics of clinical course of mycoplasma pneumonia were identified. Results: among 78 patients with pneumonia severe form was detected only in one. Twenty five percent of patients had ENT-diseases. The authors performed comparative analysis of antibacterial treatment (first-line and macrolides. The duration of X-ray changes depended on treatment scheme; the best results were achieved in children who were administered combined treatment with first-line (cephalosporin and macrolide in suspension. Conclusions: during the period of 2012–2013 yy pneumonia has had a moderate clinical course, rarely — with complications. In 25% of children diseases of ENT organs were diagnosed. Mycoplasma was most often associated with chlamydia and types 1 and 2 of herpes simplex viruses, which is necessary to be considered in determination of therapy regimen. In treatment it is preferably to use combination of cephalosporin and macrolide in suspension.

  9. A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: psychometric properties.

    Science.gov (United States)

    Sharifi, Vandad; Assadi, Seyed Mohammad; Mohammadi, Mohammad Reza; Amini, Homayoun; Kaviani, Hossein; Semnani, Yousef; Shabani, Amir; Shahrivar, Zahra; Davari-Ashtiani, Rozita; Shooshtari, Mitra Hakim; Seddigh, Arshia; Jalali, Mohsen

    2009-01-01

    The aim of this study is to assess the reliability and validity of a Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders (SCID-I) through a multicenter study in a clinical population in Iran. The sample consisted of 299 subjects admitted to outpatient or inpatient services of 3 psychiatric centers in Tehran, Iran. The SCID was administered by trained interviewers. To study the test-retest reliability, a second independent SCID interview was administered to 104 of the entire sample within 3 to 7 days of the first interviews. For the assessment of validity, the SCID diagnoses were compared with the consensus clinical diagnoses made by 2 psychiatrists for all 299 patients. Diagnostic agreements between test and retest SCID administration were fair to good for most diagnostic categories. Overall weighted kappa was 0.52 for current diagnoses and 0.55 for lifetime diagnoses. Specificity values for most psychiatric disorders were high (>0.85); the sensitivity values were somewhat lower. The Persian translation of the SCID yields diagnoses with acceptable to good reliability and validity in a clinical population in Iran. This supports the cross-cultural use of the instrument.

  10. Early lymphoid lesions: conceptual, diagnostic and clinical challenges

    OpenAIRE

    Ganapathi, Karthik A.; Pittaluga, Stefania; Odejide, Oreofe O.; Freedman, Arnold S.; Jaffe, Elaine S.

    2014-01-01

    There are no “benign lymphomas”, a fact due to the nature of lymphoid cells to circulate and home as part of their normal function. Thus, benign clonal expansions of lymphocytes are only rarely recognized when localized. Recent studies have identified a number of lymphoid proliferations that lie at the interface between benign and malignant. Some of these are clonal proliferations that carry many of the molecular hallmarks of their malignant counterparts, such as BCL2/IGH and CCND1/IGH transl...

  11. Diagnostic Accuracy of Clinical Methods for Detection of Diabetic Sensory Neuropathy

    International Nuclear Information System (INIS)

    Arshad, A. R.; Alvi, K. Y.

    2016-01-01

    Objective: To determine the accuracy of clinical methods for detection of sensory neuropathy as compared to biothesiometry. Study Design: Cross-sectional analytical study. Place and Duration of Study: 1 Mountain Medical Battalion, Azad Kashmir, from October 2013 to September 2014. Methodology: Patients with type 2 diabetes were enrolled by convenience sampling. Exclusion criteria included other identifiable causes of neuropathy, extensive ulceration of feet, amputated feet, those on treatment for neuropathy and unwilling patients. Average of 3 vibration perception threshold values measured with a biothesiometer on distal hallux was calculated. Ten gm monofilament was used to examine touch sensation over dorsal surfaces of great toes. Vibration sensation was checked over the tips of great toes using 128Hz tuning fork. Ankle jerks were checked bilaterally. Result: Neuropathy (vibration perception threshold > 25 volts) was present in 34 (21.12 percentage) out of 161 patients and 93 (57.76 percentage) were symptomatic. Measures of diagnostic accuracy for monofilament, tuning fork and ankle jerks were: sensitivity 41.18 percentage, 55.88 percentage and 64.71 percentage; specificity 92.91 percentage, 93.70 percentage and 80.31 percentage; positive predictive value (PPV) 60.87 percentage, 70.37 percentage and 46.81 percentage; negative predictive value (NPV) 85.51 percentage, 88.81 percentage and 89.47 percentage; and, diagnostic accuracy 81.99 percentage, 85.71 percentage and 77.02 percentage, respectively. Values for any 1 positive sign, any 2 positive signs or all 3 positive signs were: sensitivity 35.29 percentage, 14.71 percentage and 32.35 percentage; specificity 81.89 percentage, 93.70 percentage and 99.21 percentage; PPV 34.29 percentage, 38.46 percentage and 91.67 percentage; NPV 82.54 percentage, 80.41 percentage and 84.56 percentage; and, diagnostic accuracy 72.05 percentage, 77.02 percentage and 85.09 percentage, respectively. Conclusion: Clinical methods are

  12. A Practical Approach to Tumor Heterogeneity in Clinical Research and Diagnostics.

    Science.gov (United States)

    Stanta, Giorgio; Bonin, Serena

    2018-01-01

    This Pathobiology issue tries to better define the complex phenomenon of intratumor heterogeneity (ITH), mostly from a practical point of view. This topic has been chosen because ITH is a central issue in tumor development and has to be investigated directly in patient tissue and immediately applied in the treatment of the presenting patient. Different types of ITH should be considered: clonal genetic and epigenetic evolution, morphological heterogeneity, and tumor sampling, heterogeneity resulting from microenvironmental autocrine and paracrine interaction, and stochastic plasticity related to different functional cell efficiencies. For a higher level of reproducibility in clinical research and diagnostics, it is necessary to establish standardized analytical methods, including microdissection. In situ techniques can be pivotal to explore tumor microenvironment and can be improved with associated digital analysis. Liquid biopsies for plasma DNA analysis are at present the best method to study recurrent tumors with treatment adaptation, and widespread clinical use could be beneficial. The different types of tumor genomic instabilities could have pragmatic applications to rank ITH for clinical applications: treatment approaches differ in patients with a high nucleotide mutation rate and patients with high copy number alterations. © 2017 S. Karger AG, Basel.

  13. Malaria Laboratory Diagnostic Performance: Case studies of two ...

    African Journals Online (AJOL)

    Advantages of rapid diagnostic tests when compared with microscopy are simple to perform, fast, low ... The study was conducted to establish the performance of laboratory diagnosis of malaria in local Malawi .... Government of Malawi.

  14. Clinical data miner: an electronic case report form system with integrated data preprocessing and machine-learning libraries supporting clinical diagnostic model research.

    Science.gov (United States)

    Installé, Arnaud Jf; Van den Bosch, Thierry; De Moor, Bart; Timmerman, Dirk

    2014-10-20

    Using machine-learning techniques, clinical diagnostic model research extracts diagnostic models from patient data. Traditionally, patient data are often collected using electronic Case Report Form (eCRF) systems, while mathematical software is used for analyzing these data using machine-learning techniques. Due to the lack of integration between eCRF systems and mathematical software, extracting diagnostic models is a complex, error-prone process. Moreover, due to the complexity of this process, it is usually only performed once, after a predetermined number of data points have been collected, without insight into the predictive performance of the resulting models. The objective of the study of Clinical Data Miner (CDM) software framework is to offer an eCRF system with integrated data preprocessing and machine-learning libraries, improving efficiency of the clinical diagnostic model research workflow, and to enable optimization of patient inclusion numbers through study performance monitoring. The CDM software framework was developed using a test-driven development (TDD) approach, to ensure high software quality. Architecturally, CDM's design is split over a number of modules, to ensure future extendability. The TDD approach has enabled us to deliver high software quality. CDM's eCRF Web interface is in active use by the studies of the International Endometrial Tumor Analysis consortium, with over 4000 enrolled patients, and more studies planned. Additionally, a derived user interface has been used in six separate interrater agreement studies. CDM's integrated data preprocessing and machine-learning libraries simplify some otherwise manual and error-prone steps in the clinical diagnostic model research workflow. Furthermore, CDM's libraries provide study coordinators with a method to monitor a study's predictive performance as patient inclusions increase. To our knowledge, CDM is the only eCRF system integrating data preprocessing and machine-learning libraries

  15. Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications.

    Science.gov (United States)

    Schiffman, Eric; Ohrbach, Richard

    2016-06-01

    In this executive summary, the authors describe a protocol for assessing patients with temporomandibular disorder (TMD). It is based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications. The DC/TMD was developed using published Axis I physical diagnoses for the most common TMDs. Axis I diagnostic criteria were derived from pertinent clinical TMD signs and symptoms. Axis II consists of psychosocial and behavioral questionnaires already in the public domain. A panel of experts vetted and modified the Axis I and Axis II diagnostic protocols. Recommended changes were assessed for diagnostic accuracy by using the Validation Project's data set, which formed the basis for the development of the DC/TMD. Axis I diagnostic criteria for TMD pain-related disorders have acceptable validity and provide definitive diagnoses for pain involving the temporomandibular joint (TMJ) and masticatory muscles. Axis I diagnostic criteria for the most common TMJ intra-articular disorders are appropriate for screening purposes only. A definitive diagnosis for TMJ intra-articular disorders requires computed tomography or magnetic resonance imaging. Axis II questionnaires provide valid assessment of psychosocial and behavioral factors that can affect management of TMD. The DC/TMD provides a questionnaire for the pain history in conjunction with validated clinical examination criteria for diagnosing the most common TMDs. In addition, it provides Axis II questionnaires for assessing psychosocial and behavioral factors that may contribute to the onset and perpetuation of the patient's TMD. The DC/TMD is appropriate for use in clinical and research settings to allow for a comprehensive assessment of patients with TMD. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

  16. Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain

    Science.gov (United States)

    2013-01-01

    Background Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Methods Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O’Brien’s test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Results Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0

  17. A Review of the Giant Protein Titin in Clinical Molecular Diagnostics of Cardiomyopathies

    Directory of Open Access Journals (Sweden)

    Marta Gigli

    2016-07-01

    Full Text Available Titin (TTN is known as the largest sarcomeric protein that resides within the heart muscle. Due to alternative splicing of TTN the heart expresses two major isoforms (N2B and N2BA that incorporate four distinct regions termed the Z-line, I-band, A-band, and M-line. Next-generation sequencing allows a large number of genes to be sequenced simultaneously and provides the opportunity to easily analyze giant genes such as TTN. Mutations in the TTN gene can cause cardiomyopathies, in particular dilated cardiomyopathy (DCM. DCM is the most common form of cardiomyopathy and it is characterized by systolic dysfunction and dilation of the left ventricle. TTN truncating variants have been described as the most common cause of DCM while the real impact of TTN missense variants in the pathogenesis of DCM is still unclear. In a recent population screening study, rare missense variants potentially pathogenic based on bioinformatic filtering represented only 12.6% of the several hundred rare TTN missense variants found, suggesting that missense variants are very common in TTN and frequently benign. The aim of this review is to understand the clinical role of TTN mutations in DCM and in other cardiomyopathies. Whereas TTN truncations are common in DCM, there is evidence that TTN truncations are rare in the HCM phenotype. Furthermore TTN mutations can also cause arrhythmogenic right ventricular cardiomyopathy (ARVC with distinct clinical features and outcomes. Finally, the identification of a rare missense variant in TTN cosegregating with the restrictive cardiomyopathy (RCM phenotype suggests that TTN is a novel gene in this disease. Clinical diagnostic testing is currently able to analyze over 100 cardiomyopathy genes, including TTN, however, the size and presence of extensive genetic variation in TTN presents clinical challenges in determining significant disease-causing mutations. This review discusses the current knowledge of TTN genetic variations in

  18. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications

    DEFF Research Database (Denmark)

    Schiffman, Eric; Ohrbach, Richard; Truelove, Edmond

    2014-01-01

    and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I...

  19. Outbreak!: Teaching Clinical and Diagnostic Microbiology Methodologies with an Interactive Online Game

    Science.gov (United States)

    Clark, Sherri; Smith, Geoffrey Battle

    2004-01-01

    Outbreak! is an online, interactive educational game that helps students and teachers learn and evaluate clinical microbiology skills. When the game was used in introductory microbiology laboratories, qualitative evaluation by students showed very positive responses and increased learning. Outbreak! allows students to design diagnostic tests and…

  20. Anatomicopathological basis and clinical diagnostic significance of Kerley's A line

    International Nuclear Information System (INIS)

    Wang Zhenguang; Ma Daqing; Chen Budong; He Wen; Wang Xinlian; Guan Yansheng; Zhang Yansong

    2007-01-01

    Objective: To study anatomic and pathological basis of Kerley's A line, and to evaluate the role of Kerley's A line in differential diagnosis of diffuse lung diseases (DLD). Methods: HRCT scans, gross specimen section(50-100 μm thickness) and histologic section(5-8 μm thickness) were performed and analyzed comparatively on 28 dry lung specimens from the patients with coal worker's pneumoconiosis and occupational exposure history to coal dusts. At the same time, HRCT images of 176 patients with DLD were retrospectively reviewed for the detection of Kerley's A line. Results: Kerley's A lines were seen in 17 of 28 lung specimens on coronal HRCT images. The anatomic basis of Kerley's A line represented the continuity of two or more thickened interlobular septa (14 eases) and incomplete fibrotic septa between segments or subsegments (3 cases). Histologically, the linear opacities represented the deposits of coal dust, fibrosis, edema, inflammation, thickened vessel wall within interlobular septa. Kerley's A lines were present in 11 of 176 patients (6.3%) including interstitial pulmonary edema (5 cases), viral pneumonia (2 cases), lymphangitic carcinomatosis (2 cases), sarcoidosis (1 cases) and pulmonary alveolar proteinosis (1 cases). Conclusion: Kerley's A line has a limited usefulness in the differential diagnosis of DLD because it is seen infrequently and not discermable. (authors)

  1. Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis

    DEFF Research Database (Denmark)

    Walsh, Simon L. F.; Maher, Toby M.; Kolb, Martin

    2017-01-01

    -index.A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53-0.72, pmeetings (κw=0.54, IQR 0.45-0.64, p....0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.......052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75).Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners...

  2. Biofluid infrared spectro-diagnostics: pre-analytical considerations for clinical applications.

    Science.gov (United States)

    Lovergne, L; Bouzy, P; Untereiner, V; Garnotel, R; Baker, M J; Thiéfin, G; Sockalingum, G D

    2016-06-23

    Several proof-of-concept studies on the vibrational spectroscopy of biofluids have demonstrated that the methodology has promising potential as a clinical diagnostic tool. However, these studies also show that there is a lack of a standardised protocol in sample handling and preparation prior to spectroscopic analysis. One of the most important sources of analytical errors is the pre-analytical phase. For the technique to be translated into clinics, it is clear that a very strict protocol needs to be established for such biological samples. This study focuses on some of the aspects of the pre-analytical phase in the development of the high-throughput Fourier Transform Infrared (FTIR) spectroscopy of some of the most common biofluids such as serum, plasma and bile. Pre-analytical considerations that can impact either the samples (solvents, anti-coagulants, freeze-thaw cycles…) and/or spectroscopic analysis (sample preparation such as drying, deposit methods, volumes, substrates, operators dependence…) and consequently the quality and the reproducibility of spectral data will be discussed in this report.

  3. Efficacy of clinical diagnostic procedures utilized in nuclear medicine. Nine month progress report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-01-01

    This study is designed to determine the efficacy of nuclear medicine procedures in clinical practice. Several methods of determining efficacy will be evaluated to determine those most suitable. Nuclear medicine methods will be confined to the study of lung diseases by pulmonary perfusion and ventilation. In addition to evaluating the above methods data will be obtained to determine the sensitivity, specificity, predictive value and efficiency of the test under consideration. These values, corrected for prevalence of the disease processes under consideration will then be compared to the values obtained by the MACRO and MICRO methods and will help to bound the clinical reliability of the diagnostic method depending on the degree to which the several methods trend together. Depending on the practicality of these two methods, in addition to the determination of efficacy, cost effectiveness factors and benefit-risk estimates which are used to apply to radiation effects will be determined for nuclear medicine studies of the brain, bone, heart, liver and thyroid subsequently. The measurement techniques will then be utilized to establish guidelines for the most useful applications of the given procedure so that clinicians will be able to obtain a pretest estimate of the utility of the nuclear medicine test.

  4. Isolated clinic hypertension: diagnostic criteria based on 24-h blood pressure definition.

    Science.gov (United States)

    Vinyoles, Ernest; Rodriguez-Blanco, Teresa; de la Sierra, Alejandro; Felip, Angela; Banegas, José R; de la Cruz, Juan J; Gorostidi, Manuel; Sobrino, Javier; Segura, Julián; Roca-Cusachs, Alex; Ruilope, Luís M

    2010-12-01

    The use of diagnostic criteria based on 24-h ambulatory blood pressure (BP) values could improve prognostic value by incorporating night BP, minimize biases and improve the diagnostic reproducibility of isolated clinic hypertension (ICH). We estimate the 24-h BP cut-off points that best discriminate and predict the two diagnostic thresholds of mean daytime BP for ICH (135/85 and 130/80 mmHg). Cross-sectional, comparative, multicentre study in 6176 untreated hypertensive patients, whose BP was measured by ambulatory BP monitoring. ICH was defined with an office BP of ≥140/≥90 mmHg and a daytime BP of <135/<85 mmHg (ICH1) or <130/80 mmHg (ICH2). Sensitivity, specificity, positive likelihood ratio (LR+), odds ratio (OR), error rate, predictive values, κ values and 95% confidence interval were calculated for each possible cut-off point for ICH1 and ICH2. One thousand eight hundred and seven patients (29.2%) and 960 patients (15.5%) met ICH1 and ICH2 criteria, respectively. The 24-h BP cut-off points that best predict ICH1 and ICH2 are less than 132/82 mmHg (sensitivity: 93.6%, specificity: 94.3%, LR+: 16.6, OR: 1367.1, error rate: 5.9, κ 0.86) and less than 127/77 mmHg (sensitivity: 90.8%, specificity: 97.4%, LR+: 34.6, OR: 1041.5, error rate: 3.6,κ 0.86), respectively. These values achieved the best balance of sensitivity and specificity, together with the highest values of LR+ and OR and the lowest error rate. The 24-h BP cut-off point that best predicts the daytime criterion of less than 135/85 and less than 130/80 mmHg are 132/82 and 127/77 mmHg, respectively. These 24-h cut-off points may add value to ambulatory blood pressure monitoring for both diagnostic and management future decisions.

  5. A Clinical Study on Hypothyroidism

    International Nuclear Information System (INIS)

    Park, Keun Jo; Park, Sun Yang; Park, Jung Sik; Lee, Myung Chul; Koh, Chang Soon; Lee, Mun Ho

    1976-01-01

    A clinical study was made on 263 patients of hypothyroidism among the 5,970 patients of Various thyroid diseases diagnosed and treated at the Radioisotope Clinic and Laboratory, Seoul National University Hospital from May, 1960 to Aug, 1975. The results obtained with this study are as follows: 1) The etiological classification of hypothyroidism revealed 244 cases (93%) of primary hypothyroidism and 19 cases (7%) of secondary hypothyroidism. 2) The most frequent cause of the thyroprivic primary hypothyroidism was post radioiodine therapy with 109 cases (41.4%). 3) There were 37 cases (14%) of male and 226 cases (86%) of female, showing a ratio of 1 : 6. 4) The majority of patients were between the ages of 30 and 60 with the peak incidence (87 cases, 33%) in their fourth decades of lives. 5) The major symptoms and signs were weakness (97%), edema of face and extremities (92%); Decreased Achilles tendon reflex (87%), cold intolerance (82%), gain in weight (76%), constipation (58%) and cold skin (51%). 6) The cumulative incidence of hypothyroidism in patient treated with 131 I (3-8 mci) was 7.2% at first year, 33.3% at tenth year and the 50% at fourteenth year and the annual increment was 2.9%. 7) The incidence of hypothyroidism related to the numbers of 131 I therapy was not linear. 8) The diagnostic compatibilities of the various tests to hypothyroidism were TSH (100%), T 4 (93.8%), 24-hour-RNIU (91.5%), ATR (86.7%), T 3 RU (66.1%) and BMR (64.9%).

  6. A Clinical Study on Hypothyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Park, Keun Jo; Park, Sun Yang; Park, Jung Sik; Lee, Myung Chul; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1976-03-15

    A clinical study was made on 263 patients of hypothyroidism among the 5,970 patients of Various thyroid diseases diagnosed and treated at the Radioisotope Clinic and Laboratory, Seoul National University Hospital from May, 1960 to Aug, 1975. The results obtained with this study are as follows: 1) The etiological classification of hypothyroidism revealed 244 cases (93%) of primary hypothyroidism and 19 cases (7%) of secondary hypothyroidism. 2) The most frequent cause of the thyroprivic primary hypothyroidism was post radioiodine therapy with 109 cases (41.4%). 3) There were 37 cases (14%) of male and 226 cases (86%) of female, showing a ratio of 1 : 6. 4) The majority of patients were between the ages of 30 and 60 with the peak incidence (87 cases, 33%) in their fourth decades of lives. 5) The major symptoms and signs were weakness (97%), edema of face and extremities (92%); Decreased Achilles tendon reflex (87%), cold intolerance (82%), gain in weight (76%), constipation (58%) and cold skin (51%). 6) The cumulative incidence of hypothyroidism in patient treated with {sup 131}I (3-8 mci) was 7.2% at first year, 33.3% at tenth year and the 50% at fourteenth year and the annual increment was 2.9%. 7) The incidence of hypothyroidism related to the numbers of {sup 131}I therapy was not linear. 8) The diagnostic compatibilities of the various tests to hypothyroidism were TSH (100%), T{sub 4} (93.8%), 24-hour-RNIU (91.5%), ATR (86.7%), T{sub 3}RU (66.1%) and BMR (64.9%).

  7. Clinical and diagnostic methods for evaluation of sharp foreign body syndrome in buffaloes

    Directory of Open Access Journals (Sweden)

    Nasr-Eldin M. Aref

    2013-06-01

    Full Text Available Aim: The present study was designed to evaluate clinically and under laboratory condition the sharp foreign body syndrome (SFBS in buffaloes with special emphasis on the diagnostic value of radiography, ultrasonography and blood gases and acidbase balance. Materials and Methods: 196 buffaloes with a history of anorexia, reduction of milk production and no response to previous medical treatment were included in the present study. These animals were subjected to clinical and radiographical examinations. Positive cases for SFBS were further evaluated by sonography, hemato-biochemical and blood gas and acid base balance analysis.Results: Out of 196 admitted cases, 49 (25% cases were confirmed as SFBS by clinical and radiographical examination. Positive cases were subsequently divided into two main categories (complicated and non complicated according to radiographical and sonographical findings. SFBS with no complication was diagnosed in 16 cases while 33 cases showed various degrees of complication including reticular adhesion (abdominal and diaphragmatic, n= 23, diaphragmatic hernia (n = 6 and traumatic pericarditis (n = 4. Leukocytosis, hyperprotenemia and increased activity of AST and ALT were of additional values in the diagnosis of SFBS. A consistent finding of primary metabolic alkalosis was recorded in all cases except one with advanced traumatic pericarditis that showed metabolic acidosis. Conclusion: While there is no substitution for clinical examination, using of ultrasonography and radiography simultaneously are essential for proper evaluation and differentiation between various sequelae of SFBS in buffaloes. Radiography is an efficient tool for visualization of metallic foreign body while ultrasonography is an excellent device in assessing fibrinous deposits. Hemato-biochemical and blood gases and acid base balance are of additional values in discriminating between various outcomes of SFBS.

  8. Impact of molecular imaging on the diagnostic process in a memory clinic.

    Science.gov (United States)

    Ossenkoppele, Rik; Prins, Niels D; Pijnenburg, Yolande A L; Lemstra, Afina W; van der Flier, Wiesje M; Adriaanse, Sofie F; Windhorst, Albert D; Handels, Ron L H; Wolfs, Claire A G; Aalten, Pauline; Verhey, Frans R J; Verbeek, Marcel M; van Buchem, Mark A; Hoekstra, Otto S; Lammertsma, Adriaan A; Scheltens, Philip; van Berckel, Bart N M

    2013-07-01

    [(11)C]Pittsburgh compound B ([(11)C]PIB) and [(18)F]-2-fluoro-2-deoxy-D-glucose ([(18)F]FDG) PET measure fibrillar amyloid-β load and glucose metabolism, respectively. We evaluated the impact of these tracers on the diagnostic process in a memory clinic population. One hundred fifty-four patients underwent paired dynamic [(11)C]PIB and static [(18)F]FDG PET scans shortly after completing a standard dementia screening. Two-year clinical follow-up data were available for 39 patients. Parametric PET images were assessed visually and results were reported to the neurologists responsible for the initial diagnosis. Outcome measures were (change in) clinical diagnosis and confidence in that diagnosis before and after disclosing PET results. [(11)C]PIB scans were positive in 40 of 66 (61%) patients with a clinical diagnosis of Alzheimer's disease (AD), 5 of 18 (28%) patients with frontotemporal dementia (FTD), 4 of 5 (80%) patients with Lewy body dementia, and 3 of 10 (30%) patients with other dementias. [(18)F]FDG uptake patterns matched the clinical diagnosis in 38 of 66 (58%) of AD patients, and in 6 of 18 (33%) FTD patients. PET results led to a change in diagnosis in 35 (23%) patients. This only occurred when prior diagnostic certainty was Diagnostic confidence increased from 71 ± 17% before to 87 ± 16% after PET (p diagnostic work-up, especially when prior diagnostic confidence is low. Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  9. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

    Directory of Open Access Journals (Sweden)

    Nurgul Ceran

    Full Text Available Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83% and fever (44%. All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

  10. European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

    Science.gov (United States)

    Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

    2011-11-01

    The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

  11. NONTUBERCULOUS MYCOBACTERIOSES: EPIDEMIOLOGY, CLINIC AND POSSIBILITIES OF LABORATORY DIAGNOSTICS IN MODERN CONDITIONS

    Directory of Open Access Journals (Sweden)

    Shevchenko OS

    2017-03-01

    Full Text Available Introduction. Today there are more than 150 species of nontuberculous mycobacteria (NTMB known, of which 99 were registered in Europe. Due to the similar clinical picture with tuberculosis, mycobacterioses are difficult to diagnose and often occur with TB as a mixed infection. Also, there are cases of NTMB detection in the sputum of persons previously suffered with tuberculosis, which can lead to a false diagnosis of recurrent disease. Currently, the role of atypical mycobacteria in human pathology is increasing. Atypical mycobacteria are characterized by a wide spectrum of sustainability and potential pathogenicity to humans and animals. It is generally accepted that the reservoir of infection are animals and the environment (water, soil. NTMB presence in water can lead to the erroneous diagnosis of mycobacteriosis due to laboratory contamination of samples with nontuberculous mycobacteria from the outside. Moreover recently it has been found the possibility of transferring NTMB from person to person on the background of existing lung disease. For many types of infections reservoir still has not been found. Aim of this work was to study identified in the Kharkiv region cases of non-tuberculous mycobacterioses, features of their clinical manifestations and laboratory diagnostic options. Materials and Methods. We examined 32 patients (25 men and 7 women, residents of Kharkiv and Kharkiv region, Ukraine, who were diagnosed with "non-tuberculous mycobacteriosis of lungs" during 2014-2016. Patients were examined with routine diagnostic algorithm for TB. Nontuberculous mycobacteriosis was diagnosed on the basis of NTMB growth in BACTEC system, after which the diagnosis was verified by the following criteria: 1. Smear: the absence of formation of Cord-factor (in the smear NTMB are located scattering; 2. Negative immunoassay (ID-test; 3. Negative GeneXpert MTB/RIF Then non-tuberculous mycobacteria were identificated by investigation on solid media

  12. Development and clinical applications of a small peptide as a radiolabeled in vivo diagnostic probe

    International Nuclear Information System (INIS)

    Reubi, J.C.; Lamberts, S.W.; Krenning, E.

    1995-01-01

    Several dozens of small peptides, widely distributed in the human body, highly potent and important regulators of biological processes in numerous tissues, have been identified in the past several years. One of those, somatostatin, the first of such peptides used in the nuclear medicine field, has been developed as an in vivo labeled diagnostic probe for a variety of pathologies. Basic knowledge on somatostatin, somatostatin receptors and somatostatin target tissues as well as on the clinical implications of this diagnostic tool are briefly reviewed. (authors). 9 refs., 3 figs

  13. Feasibility of streamlining an interactive Bayesian-based diagnostic support tool designed for clinical practice

    Science.gov (United States)

    Chen, Po-Hao; Botzolakis, Emmanuel; Mohan, Suyash; Bryan, R. N.; Cook, Tessa

    2016-03-01

    In radiology, diagnostic errors occur either through the failure of detection or incorrect interpretation. Errors are estimated to occur in 30-35% of all exams and contribute to 40-54% of medical malpractice litigations. In this work, we focus on reducing incorrect interpretation of known imaging features. Existing literature categorizes cognitive bias leading a radiologist to an incorrect diagnosis despite having correctly recognized the abnormal imaging features: anchoring bias, framing effect, availability bias, and premature closure. Computational methods make a unique contribution, as they do not exhibit the same cognitive biases as a human. Bayesian networks formalize the diagnostic process. They modify pre-test diagnostic probabilities using clinical and imaging features, arriving at a post-test probability for each possible diagnosis. To translate Bayesian networks to clinical practice, we implemented an entirely web-based open-source software tool. In this tool, the radiologist first selects a network of choice (e.g. basal ganglia). Then, large, clearly labeled buttons displaying salient imaging features are displayed on the screen serving both as a checklist and for input. As the radiologist inputs the value of an extracted imaging feature, the conditional probabilities of each possible diagnosis are updated. The software presents its level of diagnostic discrimination using a Pareto distribution chart, updated with each additional imaging feature. Active collaboration with the clinical radiologist is a feasible approach to software design and leads to design decisions closely coupling the complex mathematics of conditional probability in Bayesian networks with practice.

  14. The Oncogenic Risks of Diagnostic CT Scam Studies in Children

    International Nuclear Information System (INIS)

    Brent, R.

    2004-01-01

    Brenner et al (2001) reported that estimates of the exposure to children from CT scans indicates that the exposures are both higher than from conventional radiographic studies and higher than is necessary to obtain quality examinations. utilizing the oncogenic risk data from the RERF study in Japan, Brenner et al estimated that the oncogenic risk in this population of CT exposed children exposed each year would result in an additional 500 cases of cancer. This risk estimate is supported by the RERF epidemiological data obtained from the populations exposed in Hiroshima and Nagasaki. the increased risks associated with the increased exposure from CT scans have raised concern and stimulated discussion. Although there is little doubt about the benefits of CT scans in improving the health care of children, there is concern about the estimated oncogenic risk, especially since the frequency of CT studies has been increasing. Applying the oncogenic risks of ionizing radiation from the RERF data may not be appropriate for all types of radiation exposure for accurately predicting the incidence of cancer in exposed children because of the impact of 1) partial versus whole-body irradiation, and 2) the protraction of the exposure. Other population of children who have been exposed to radiation and whose incidence of cancer has been studied will be presented and those studies indicate that the risk of cancer is much lower or not increased at all with exposures in the diagnostic range. finally, the dramatic impact of the use of CT scans in clinical pediatric practice saves lives and improves diagnostic accuracy. Therefore, it is crucial that a scholarly evaluation of the risks and benefits should be initiated. The radiology community and the manufacturers have already initiated programs to decrease the exposure significantly. But it is essential that well-planned, retrospective and prospective epidemiology studies should be initiated to study the oncogenic risks. If you want to

  15. Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    Henrike J Schouten

    Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

  16. Efficiency of the Clinical Veterinary Diagnostic Practices and Drug Choices for Infectious Diseases in Livestock in Bangladesh

    DEFF Research Database (Denmark)

    Haider, Najmul; Khan, S. U.; Islam, A.

    2017-01-01

    ) and foot-and-mouth disease (FMD). We conducted the study from May 2009 to August 2010 in three government veterinary hospitals where veterinarians collected samples from sick livestock and recorded the presumptive diagnosis on the basis of clinical presentations. Samples were tested for PPR and FMD using...... competency of these veterinarians needs to be improved and access to laboratory diagnostic facilities could help veterinarians to improve the diagnostics and outcomes. The rational use of antibiotics by veterinarians in animals must be ensured....... validation process for PPR (kappa: 0.25) and FMD (kappa 0.36) indicated a poor performance of the presumptive diagnoses. Most of the animals (93%) were treated with antibiotics. Our findings indicate that veterinarians can detect animals not infected with FMD or PPR but miss the true cases. The clinical...

  17. Newborn Congenital Cytomegalovirus Screening Based on Clinical Manifestations and Evaluation of DNA-based Assays for In Vitro Diagnostics.

    Science.gov (United States)

    Fujii, Tomoyuki; Oka, Akira; Morioka, Ichiro; Moriuchi, Hiroyuki; Koyano, Shin; Yamada, Hideto; Saito, Shigeru; Sameshima, Hiroshi; Nagamatsu, Takeshi; Tsuchida, Shinya; Inoue, Naoki

    2017-10-01

    To establish a strategy for congenital cytomegalovirus (cCMV) screening and to establish confirmatory assays approved as in vitro diagnostics by the regulatory authorities, we evaluated the clinical risks and performance of diagnostic assays developed by commercial companies, since cCMV infection has significant clinical consequences. Newborns with clinical manifestations considered to be consequences of cCMV infection (n = 575) were screened for the presence of cytomegalovirus (CMV) DNA in urine specimens collected onto filter paper placed in their diapers using the polymerase chain reaction-based assay reported previously. Liquid urine specimens were obtained from all of 20 CMV-positive newborns and 107 of the CMV-negative newborns identified in the screening. We used these 127 specimens, as well as 12 from cCMV cases identified in a previous study and 41 from healthy newborns, to compare the performance of 2 commercial assays and 1 in-house assay. The risk-based screening allowed the identification of cCMV cases at least 10-fold more efficiently than our previous universal screening, although there appears to be a limit to the identification of asymptomatically infected newborns. Although CMV-specific IgM during pregnancy was found frequently in mothers of cCMV newborns, CMV-IgM alone is not an effective diagnostic marker. The urine-filter-based assay and the 3 diagnostic assays yielded identical results. Although risk-based and universal newborn screening strategies for cCMV infection each have their respective advantages and disadvantages, urine-filter-based assay followed by confirmatory in vitro diagnostics assays is able to identify cCMV cases efficiently.

  18. [Diagnostic imaging of high-grade astrocytoma: heterogeneity of clinical manifestation, image characteristics, and histopathological findings].

    Science.gov (United States)

    Okajima, Kaoru; Ohta, Yoshio

    2012-10-01

    Recent developments in diagnostic radiology, which have enabled accurate differential diagnoses of brain tumors, have been well described in the last three decades. MR and PET imaging can also provide information to predict histological grades and prognoses that might influence treatment strategies. However, high-grade astrocytomas consist of many different subtypes that are associated with different imaging and histological characteristics. Hemorrhage and necrosis results in a variety of imaging features, and infiltrative tumor growth entrapping normal neurons may cause different clinical manifestations. We reviewed patients with high-grade astrocytomas that showed various imaging characteristics, with special emphasis on initial symptoms and histological features. Clinicopathological characteristics of astrocytomas were also compared with other malignant tumors. Neurological deficits were not notable in patients with grade 3-4 astrocytomas when they showed infiltrative tumor growth, while brain metastases with compact cellular proliferation caused more neurological symptoms. Infiltrative tumors did not show any enhancing masses on MR imaging, but these tumors may show intratumor heterogeneity. Seizures were reported to be more frequent in low-grade glioma and in secondary glioblastoma. Tumor heterogeneity was also reported in molecular genetic profile, and investigators identified some subsets of astrocytomas. They investigated IHD1/2 mutation, EGFR amplification, TP53 mutation, Ki-67 index, etc. In summary, high-grade astrocytomas are not homogenous groups of tumors, and this is associated with the heterogeneity of clinical manifestation, image characteristics, and histopathological findings. Molecular studies may explain the tumor heterogeneity in the near future.

  19. Diagnostic and clinical observation on the infectious bronchitis virus strain Q1 in Italy

    Directory of Open Access Journals (Sweden)

    Anna Toffan

    2013-12-01

    Full Text Available This paper describes the diagnostic and clinical observations of an infectious bronchitis virus (IBV variant, referred to as Q1, in clinically ill chickens in Italy. This IBV variant was described for the first time in 1998 in China. In the autumn of 2011 it caused a small-scale epidemic in non-vaccinated meat chickens in farms located in Northern Italy. The disease was characterized by increased mortality, kidney lesions and proventriculitis. Histopatological observations confirmed the nephritis and described an unusual erosive/necrotic proventriculitis with infiltration of lymphocytes, plasma cells and heterophils, as well as fibroplasia in the lamina propria. Despite these findings and the isolation of the Q1 IB virus directly from proventricular tissue, further studies are necessary to confirm the role of this IBV strain in the development of proventricular lesions. Phylogenetic analysis revealed that all the IBV isolates were very similar and probably had a common origin. The IBV Q1 variant appears to be now endemic in the North of Italy and at times it is detected in vaccinated backyard and commercial broiler farms. The importance of continuous monitoring in controlling the spread of known or emerging IBV variants is underlined.

  20. Does analgesia affect the diagnostic process in acute abdomen? a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Khashayar P.

    2008-03-01

    Full Text Available Background: About one-forth of the patients admitted to the emergency department complain of acute abdominal pain. According to surgical records, most surgeons believe that pain relief for these patients may interfere with the clinical examinations and the final diagnoses. As a result, analgesics are withheld in patients with acute abdominal pain until the determination of a definite diagnosis and suitable management plan. The purpose of this study was to evaluate the effect of analgesics on the evaluation course and treatment in acute abdomen.Methods: Two hundred patients at a surgical emergency department with acute abdominal pain were enrolled in this prospective study and randomly divided into two groups at the time of admission. The case group consisted of 98 patients who received intravenous analgesia immediately after admission. The other 102 patients in the control group did not receive analgesia until a definite diagnosis was made. Diagnostic and therapeutic procedures were similar between the two groups. The primary and final diagnoses, and the time intervals between the admission and definite diagnosis, and that between admission and surgery were gathered and analyzed.Results: The mean time to definitive diagnosis was 1.7 and 2.04 hours in the case and control groups, respectively. There was no statistically significant relationship between analgesic use and gender, age, time to definite diagnosis, or accuracy of the diagnosis. In fact, the time required to achieve a definite diagnosis and the time between admission and surgery were less in the group that had received analgesics. Conclusions: In spite of the fact that analgesics remove the very symptoms that brings patients to the emergency room, appropriate use of analgesics does not reduce diagnostic efficiency for patients with acute abdominal pain.

  1. Kinetics of circulating antibody response to Trichomonas vaginalis: clinical and diagnostic implications.

    Science.gov (United States)

    Ton Nu, Phuong Anh; Rappelli, Paola; Dessì, Daniele; Nguyen, Vu Quoc Huy; Fiori, Pier Luigi

    2015-12-01

    Persistence of antibodies against pathogens after antimicrobial treatment is a marker of therapy failure or evolution to a chronic infection. The kinetics of antibody production decrease following antigen elimination is highly variable, and predicting the duration of soluble immunity in infectious diseases is often impossible. This hampers the development and use of immunoassays for diagnostic and seroepidemiological purposes. In the case of Trichomonas vaginalis infection, the kinetics of antibody levels decrease following therapy has never been studied. We thus investigated the clearance of circulating anti-T. vaginalis IgGs after pharmacological treatment in patients affected by trichomoniasis. 18 female patients affected by acute trichomoniasis were enrolled in this study. After metronidazole therapy administration, subjects were followed up monthly up to 5 months, and serum levels of anti-T. vaginalis IgGs were measured by ELISA. We showed that a successful therapy is characterised by a relatively fast decline of specific antibodies, until turning into negative by ELISA in 1-3 months. In a few patients we observed that the persistence of anti-T. vaginalis antibodies was associated with an evolution to chronic infection, which may be due to treatment failure or to reinfection by untreated sexual partners. Our results describe the direct correlation between the decline of a specific humoral anti-T. vaginalis response and an effective antimicrobial therapy. These findings may facilitate the follow-up approach to circumvent limitations in developing new diagnostic tools and techniques routinely used in microbiology laboratories to assess the presence of T. vaginalis in clinical samples. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Precision diagnostics: moving towards protein biomarker signatures of clinical utility in cancer.

    Science.gov (United States)

    Borrebaeck, Carl A K

    2017-03-01

    Interest in precision diagnostics has been fuelled by the concept that early detection of cancer would benefit patients; that is, if detected early, more tumours should be resectable and treatment more efficacious. Serum contains massive amounts of potentially diagnostic information, and affinity proteomics has risen as an accurate approach to decipher this, to generate actionable information that should result in more precise and evidence-based options to manage cancer. To achieve this, we need to move from single to multiplex biomarkers, a so-called signature, that can provide significantly increased diagnostic accuracy. This Opinion article focuses on the progress being made in identifying protein biomarker signatures of clinical utility, using blood-based proteomics.

  3. Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism.

    Science.gov (United States)

    den Exter, Paul L; van Es, Josien; Erkens, Petra M G; van Roosmalen, Mark J G; van den Hoven, Pim; Hovens, Marcel M C; Kamphuisen, Pieter W; Klok, Frederikus A; Huisman, Menno V

    2013-06-15

    The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. In 4,044 consecutive patients with suspected PE, patients presenting more than 7 days from the onset of symptoms were contrasted with those presenting within 7 days as regards the safety of excluding PE on the basis of a clinical decision rule combined with D-dimer testing. Patients were followed for 3 months to assess the rates of recurrent venous thromboembolism and mortality. A delayed presentation (presentation >7 d) was present in 754 (18.6%) of the patients. The failure rate of an unlikely clinical probability and normal D-dimer test was 0.5% (95% confidence interval [CI], 0.01-2.7) for patients with and 0.5% (95% CI, 0.2-1.2) for those without diagnostic delay. D-dimer testing yielded a sensitivity of 99% (95% CI, 96-99%) and 98% (95% CI, 97-99%) in these groups, respectively. Patients with PE with diagnostic delay more frequently had centrally located PE (41% vs. 26%; P presentation. PE can be safely excluded based on a clinical decision rule and D-dimer testing in patients with a delayed clinical presentation. A delayed presentation for patients who survived acute PE was associated with a more central PE location, although this did not affect the clinical outcome at 3 months.

  4. A clinical audit programme for diagnostic radiology: The Approach adopted by the international atomic energy agency

    International Nuclear Information System (INIS)

    Faulkner, K.; Jaervinen, H.; Butler, P.; McLean, I. D.; Pentecost, M.; Rickard, M.; Abdullah, B.

    2010-01-01

    The International Atomic Energy Agency (IAEA) has a mandate to assist member states in areas of human health and particularly in the use of radiation for diagnosis and treatment. Clinical audit is seen as an essential tool to assist in assuring the quality of radiation medicine, particularly in the instance of multidisciplinary audit of diagnostic radiology. Consequently, an external clinical audit programme has been developed by the IAEA to examine the structure and processes existent at a clinical site, with the basic objectives of: (1) improvement in the quality of patient care; (2) promotion of the effective use of resources; (3) enhancement of the provision and organisation of clinical services; (4) further professional education and training. These objectives apply in four general areas of service delivery, namely quality management and infrastructure, patient procedures, technical procedures and education, training and research. In the IAEA approach, the audit process is initiated by a request from the centre seeking the audit. A three-member team, comprising a radiologist, medical physicist and radiographer, subsequently undertakes a 5-d audit visit to the clinical site to perform the audit and write the formal audit report. Preparation for the audit visit is crucial and involves the local clinical centre completing a form, which provides the audit team with information on the clinical centre. While all main aspects of clinical structure and process are examined, particular attention is paid to radiation-related activities as described in the relevant documents such as the IAEA Basic Safety Standards, the Code of Practice for Dosimetry in Diagnostic Radiology and related equipment and quality assurance documentation. It should be stressed, however, that the clinical audit does not have any regulatory function. The main purpose of the IAEA approach to clinical audit is one of promoting quality improvement and learning. This paper describes the background to

  5. A clinical audit programme for diagnostic radiology: the approach adopted by the International Atomic Energy Agency.

    Science.gov (United States)

    Faulkner, K; Järvinen, H; Butler, P; McLean, I D; Pentecost, M; Rickard, M; Abdullah, B

    2010-01-01

    The International Atomic Energy Agency (IAEA) has a mandate to assist member states in areas of human health and particularly in the use of radiation for diagnosis and treatment. Clinical audit is seen as an essential tool to assist in assuring the quality of radiation medicine, particularly in the instance of multidisciplinary audit of diagnostic radiology. Consequently, an external clinical audit programme has been developed by the IAEA to examine the structure and processes existent at a clinical site, with the basic objectives of: (1) improvement in the quality of patient care; (2) promotion of the effective use of resources; (3) enhancement of the provision and organisation of clinical services; (4) further professional education and training. These objectives apply in four general areas of service delivery, namely quality management and infrastructure, patient procedures, technical procedures and education, training and research. In the IAEA approach, the audit process is initiated by a request from the centre seeking the audit. A three-member team, comprising a radiologist, medical physicist and radiographer, subsequently undertakes a 5-d audit visit to the clinical site to perform the audit and write the formal audit report. Preparation for the audit visit is crucial and involves the local clinical centre completing a form, which provides the audit team with information on the clinical centre. While all main aspects of clinical structure and process are examined, particular attention is paid to radiation-related activities as described in the relevant documents such as the IAEA Basic Safety Standards, the Code of Practice for Dosimetry in Diagnostic Radiology and related equipment and quality assurance documentation. It should be stressed, however, that the clinical audit does not have any regulatory function. The main purpose of the IAEA approach to clinical audit is one of promoting quality improvement and learning. This paper describes the background to

  6. Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry.

    Directory of Open Access Journals (Sweden)

    Maria Karanika

    Full Text Available BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM were collected from the Meningitis Registry (MR. Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta and SPSS (version 15.0-Chicago software. Statistically significant (p or = 15000/microL (OR 2.19 with a PPV of 77.8% (95%CI 40.0-97.2. For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61, age > or = 1 year (OR 2.04, absence of headache (OR 3.01, CSF Glu < 40 mg/dL (OR 3.62 and peripheral WBC < 15,000/microL (OR 1.74 with a PPV of 58.5% (95%CI 42.1-73.7. CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.

  7. Compounding diagnostic delays: a qualitative study of point-of-care testing in South Africa.

    Science.gov (United States)

    Engel, Nora; Davids, Malika; Blankvoort, Nadine; Pai, Nitika Pant; Dheda, Keertan; Pai, Madhukar

    2015-04-01

    Successful point-of-care (POC) testing (completion of test-and-treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve patient and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful POC testing. This qualitative research study examined POC testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi-structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers. In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as POC tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to POC testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays. For POC testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account. © 2014 John Wiley & Sons Ltd.

  8. Diagnostic techniques in deflagration and detonation studies.

    Science.gov (United States)

    Proud, William G; Williamson, David M; Field, John E; Walley, Stephen M

    2015-12-01

    Advances in experimental, high-speed techniques can be used to explore the processes occurring within energetic materials. This review describes techniques used to study a wide range of processes: hot-spot formation, ignition thresholds, deflagration, sensitivity and finally the detonation process. As this is a wide field the focus will be on small-scale experiments and quantitative studies. It is important that such studies are linked to predictive models, which inform the experimental design process. The stimuli range includes, thermal ignition, drop-weight, Hopkinson Bar and Plate Impact studies. Studies made with inert simulants are also included as these are important in differentiating between reactive response and purely mechanical behaviour.

  9. Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

    Directory of Open Access Journals (Sweden)

    Pilar Cacho-Martínez

    2013-01-01

    Full Text Available Purpose. To analyze the diagnostic validity of accommodative and binocular tests in a sample of patients with a large near exophoria with moderate to severe symptoms. Methods. Two groups of patients between 19 and 35 years were recruited from a university clinic: 33 subjects with large exophoria at near vision and moderate or high visual discomfort and 33 patients with normal heterophoria and low visual discomfort. Visual discomfort was defined using the Conlon survey. A refractive exam and an exhaustive evaluation of accommodation and vergence were assessed. Diagnostic validity by means of receiver operator characteristic (ROC curves, sensitivity (S, specificity (Sp, and positive and negative likelihood ratios (LR+, LR− were assessed. This analysis was also carried out considering multiple tests as serial testing strategy. Results. ROC analysis showed the best diagnostic accuracy for receded near point of convergence (NPC recovery (area = 0.929 and binocular accommodative facility (BAF (area = 0.886. Using the cut-offs obtained with ROC analysis, the best diagnostic validity was obtained for the combination of NPC recovery and BAF (S  =  0.77, Sp = 1, LR+ = value tending to infinity, LR− = 0.23 and the combination of NPC break and recovery with BAF (S  =  0.73, Sp = 1, LR+ = tending to infinity, LR− = 0.27. Conclusions. NPC and BAF tests were the tests with the best diagnostic accuracy for subjects with large near exophoria and moderate to severe symptoms.

  10. The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice.

    Science.gov (United States)

    Möller, Hans-Jürgen; Bandelow, Borwin; Volz, Hans-Peter; Barnikol, Utako Birgit; Seifritz, Erich; Kasper, Siegfried

    2016-12-01

    According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

  11. Clinical performance of dual-source computerized tomography (DSCT) in primary diagnostics of coronary heart diseases

    International Nuclear Information System (INIS)

    Brunner, H.; Froehner, S.; Wagner, M.; Schmitt, R.; Brunn, J.; Gietzen, F.H.; Kerber, S.

    2008-01-01

    Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83 ms per heart-phase. In this study, the clinical performance of this new method is evaluated. Materials and Methods: In fifty patients (33 male, 17 female; age 50±13 years) with suspected coronary heart disease, CT angiography (slice thickness 0,75 mm, contrast-agent 60-80 ml iomeprol) was performed with a Somatom Definition scanner. Based on the coronary 15-segment-model of the AHA, scores for image quality and lumen reduction were established to enable the observer, to give recommendations for further therapy. Results: Out of 750 possible AHA-segments, 655 were depicted (87,3%). 591 segments (90,2%) were assessed without any limitation of quality, 49 (7,5%) segments showed moderate, and 15 (2,3%) segments severe limitation in image quality. 508 (77,6%) segments were without pathological findings, 92 (14,0%) segments had minimal atherosclerotic lesions, 42 (6,4%) segments suffered from stenoses with lumen reduction less than 70%, and 13 (2,0%) showed significant stenoses of more than 70%. In 31 patients (62%), coronary heart disease was ruled out by CT angiography without any need for further non-invasive or invasive diagnostics. 8 patients (16%) underwent stress-testing for ischemia. In 11 (22%) patients coronary angiography was recommended, and DSCT findings were confirmed in 10 cases. Only one LCx stenosis was overestimated in DSCT. Conclusion: Contrast-enhanced DSCT is a powerful tool in diagnosis of coronary heart disease. 98% of coronary segments could be assessed in diagnostic quality, and at least 90% of haemodynamically significant coronary stenoses were detected. (orig.)

  12. Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)

    International Nuclear Information System (INIS)

    2011-01-01

    Interest in quality assurance processes and quality improvement in diagnostic radiology is being driven by a number of factors. These include the high cost and complexity of radiological equipment, acknowledgement of the possibility of increasing doses to patients, and the importance of radiological diagnosis to patient management within the health care environment. To acknowledge these interests, clinical audits have been introduced and, in Europe, mandated under a European Directive (Council Directive 97/47/EURATOM). Comprehensive clinical audits focus on clinical management and infrastructure, patient related and technical procedures, and education and research. This publication includes a structured set of standards appropriate for diagnostic radiology, an audit guide to their clinical review, and data collection sheets for the rapid production of reports in audit situations. It will be a useful guide for diagnostic radiology facilities wishing to improve their service to patients through timely diagnosis with minimal radiation dose.

  13. Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)

    International Nuclear Information System (INIS)

    2010-01-01

    Interest in quality assurance processes and quality improvement in diagnostic radiology is being driven by a number of factors. These include the high cost and complexity of radiological equipment, acknowledgement of the possibility of increasing doses to patients, and the importance of radiological diagnosis to patient management within the health care environment. To acknowledge these interests, clinical audits have been introduced and, in Europe, mandated under a European Directive (Council Directive 97/47/EURATOM). Comprehensive clinical audits focus on clinical management and infrastructure, patient related and technical procedures, and education and research. This publication includes a structured set of standards appropriate for diagnostic radiology, an audit guide to their clinical review, and data collection sheets for the rapid production of reports in audit situations. It will be a useful guide for diagnostic radiology facilities wishing to improve their service to patients through timely diagnosis with minimal radiation dose.

  14. The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear

    NARCIS (Netherlands)

    van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Scholtes, V.A.B.; Terwee, C.B.; Willems, W.J.

    2014-01-01

    Background: It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for

  15. Diagnostic imaging capabilities of the Ocelot -Optical Coherence Tomography System, ex-vivo evaluation and clinical relevance

    International Nuclear Information System (INIS)

    Dohad, Suhail; Shao, John; Cawich, Ian; Kankaria, Manish; Desai, Arjun

    2015-01-01

    Optical coherence tomography (OCT) is a high-resolution sub-surface imaging modality using near-infrared light to provide accurate and high contrast intra-vascular images. This enables accurate assessment of diseased arteries before and after intravascular intervention. This study was designed to corroborate diagnostic imaging equivalence between the Ocelot and the Dragonfly OCT systems with regards to the intravascular features that are most important in clinical management of patients with atherosclerotic vascular disease. These intravascular features were then corroborated in vivo during treatment of peripheral arterial disease (PAD) pathology using the Ocelot catheter. In order to compare the diagnostic information obtained by Ocelot (Avinger Inc., Redwood City, CA) and Dragonfly (St. Jude Medical, Minneapolis, MN) OCT systems, we utilized ex-vivo preparations of arterial segments. Ocelot and Dragonfly catheters were inserted into identical cadaveric femoral peripheral arteries for image acquisition and interpretation. Three independent physician interpreters assessed the images to establish accuracy and sensitivity of the diagnostic information. Histologic evaluation of the corresponding arterial segments provided the gold standard for image interpretation. In vivo clinical images were obtained during therapeutic interventions that included crossing of peripheral chronic total occlusions (CTOs) using the Ocelot catheter. Strong concordance was demonstrated when matching image characteristics between both OCT systems and histology. The Dragonfly and Ocelot system’s vessel features were interpreted with high sensitivity (91.1–100 %) and specificity (86.7–100 %). Inter-observer concordance was documented with excellent correlation across all vessel features. The clinical benefit that the Ocelot OCT system provided was demonstrated by comparable procedural images acquired at the point of therapy. The study demonstrates equivalence of image acquisition and

  16. Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study.

    Science.gov (United States)

    Bell, J J; Bauer, J D; Capra, S; Pulle, R C

    2014-03-01

    Differences in malnutrition diagnostic measures impact malnutrition prevalence and outcomes data in hip fracture. This study investigated the concurrent and predictive validity of commonly reported malnutrition diagnostic measures in patients admitted to a metropolitan hospital acute hip fracture unit. A prospective, consecutive level II diagnostic accuracy study (n=142; 8 exclusions) including the International Classification of Disease, 10th Revision, Australian Modification (ICD10-AM) protein-energy malnutrition criteria, a body mass index (BMI) Patients were predominantly elderly (median age 83.5, range 50-100 years), female (68%), multimorbid (median five comorbidities), with 15% 4-month mortality. Malnutrition prevalence was lowest when assessed by BMI (13%), followed by MNA-SF (27%), ICD10-AM (48%), albumin (53%) and geriatrician assessment (55%). Agreement between measures was highest between ICD10-AM and geriatrician assessment (κ=0.61) followed by ICD10-AM and MNA-SF measures (κ=0.34). ICD10-AM diagnosed malnutrition was the only measure associated with 48-h mobilisation (35.0 vs 55.3%; P=0.018). Reduced likelihood of home discharge was predicted by ICD-10-AM (20.6 vs 57.1%; P=0.001) and MNA-SF (18.8 vs 47.8%; P=0.035). Bivariate analysis demonstrated ICD10-AM (relative risk (RR)1.2; 1.05-1.42) and MNA-SF (RR1.2; 1.0-1.5) predicted 4-month mortality. When adjusted for age, usual place of residency, comorbidities and time to surgery only ICD-10AM criteria predicted mortality (odds ratio 3.59; 1.10-11.77). Albumin, BMI and geriatrician assessment demonstrated limited concurrent and predictive validity. Malnutrition prevalence in hip fracture varies substantially depending on the diagnostic measure applied. ICD-10AM criteria or the MNA-SF should be considered for the diagnosis of protein-energy malnutrition in frail, multi-morbid hip fracture inpatients.

  17. Clinical Approach to the Standardization of Oriental Medical Diagnostic Pattern Identification in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Han Jung Kim

    2011-01-01

    Full Text Available In Korea, many stroke patients receive oriental medical care, in which pattern-identification plays a major role. Pattern-identification is Oriental Medicine's unique diagnostic system. This study attempted to standardize oriental medical pattern-identification for stroke patients. This was a community-based multicenter study that enrolled stroke patients within 30 days after their ictus. We assessed the patients' general characteristics and symptoms related to pattern-identification. Each patient's pattern was determined when two doctors had the same opinion. To determine which variables affect the pattern-identification, binary logistic regression analysis was used with the backward method. A total of 806 stroke patients were enrolled. Among 480 patients who were identified as having a certain pattern, 100 patients exhibited the Fire Heat Pattern, 210 patients the Phlegm Dampness Pattern, nine patients the Blood Stasis Pattern, 110 patients the Qi Deficiency Pattern, and 51 patients the Yin Deficiency Pattern. After the regression analysis, the predictive logistic equations for the Fire Heat, Phlegm Dampness, Qi Deficiency, and Yin Deficiency patterns were determined. The Blood Stasis Pattern was omitted because the sample size was too small. Predictive logistic equations were suggested for four of the patterns. These criteria would be useful in determining each stroke patient's pattern in clinics. However, further studies with large samples are necessary to validate and confirm these criteria.

  18. Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations.

    Science.gov (United States)

    Kocak, Burak; Tureci, Ercan; Kizilkilic, Osman; Islak, Civan; Kocer, Naci

    2013-09-01

    Posterior communicating artery (PCoA) itself is an unusual location for intracranial aneurysms in that isolated dissections or dissecting aneurysms are extremely rare. In the way of correct diagnosis of dissecting aneurysms of PCoA itself, a proper understanding of (1) the anatomy of the PCoA and its perforator branches, (2) some particular diagnostic features, and (3) related clinical aspects is of significant importance. Although there are no established treatment strategies for this particular type of aneurysms, the endovascular approach might be considered as a plausible one. In this paper, our scope was to report five cases with dissecting aneurysm of the PCoA itself and to discuss this rare vascular pathology from anatomical, diagnostic, clinical, and therapeutical perspectives.

  19. New laser sources for clinical treatment and diagnostics of neonatal jaundice

    Science.gov (United States)

    Hamza, Mostafa; El-Ahl, Mohammad H. S.; Hamza, Ahmad M.

    2001-06-01

    An elevated serum bilirubin concentration in the newborn infant presents a therapeutic as well as a diagnostic problem to the physician. It has long been recognized that high levels of bilirubin cause irreversible brain damage and even death. The authors introduce the use of semiconductor diode lasers and diode-pumped solid-state lasers that can be used for solving such diagnostic and therapeutic problems. These new laser sources can improve the ergonomics of using laser, enhance performance capabilities and reduce the cost of employing laser energy to pump bilirubin out of an infant's body. The choice of laser wavelengths follows the principles of bilirubinometry and phototherapy of neonatal jaundice. The wide spread use of these new laser sources for clinical monitoring and treatment of neonatal hyperbilirubinemia will be made possible as each incremental or quantum jump cost reduction is achieved. Our leading clinical experience as well as the selection rules of laser wavelengths will be presented.

  20. New technology for ultrasensitive detection and isolation of rare cells for clinical diagnostics and therapeutics

    Science.gov (United States)

    Leary, James F.; McLaughlin, Scott R.

    1995-04-01

    A high-speed, 11-parameter, 6-color fluorescence, laser flow cytometer/cell sorter with a number of special and unique features has been built for ultrasensitive detection and isolation of rare cells for clinical diagnostics and therapeutics. The software for real-time data acquisition and sort control, written as C++ programming language modules with a WindowsTM graphical user interface, runs on a 66-MHz 80486 computer joined by an extended bus to 23 sophisticated multi-layered boards of special data acquisition and sorting electronics. Special features include: high-speed (> 100,000 cells/sec) real-time data classification module (U.S. Patent 5,204,884 (1993)); real-time principal component cell sorting; multi-queue signal-processing system with multiple hardware and software event buffers to reduce instrument dead time, LUT charge-pulse definition, high-resolution `flexible' sorting for optimal yield/purity sort strategies (U.S. Patent 5,199,576); pre-focusing optical wavelength correction for a second laser beam; and two trains of three fluorescence detectors-- each adjustable for spatial separation to interrogate only one of two laser beams, syringe- driven or pressure-driven fluidics, and time-windowed parameters. The system has been built to be both expandable and versatile through the use of LUT's and a modular hardware and software design. The instrument is especially useful at detection and isolation of rare cell subpopulations for which our laboratory is well-known. Cell subpopulations at frequencies as small as 10-7 have been successfully studied with this system. Current applications in clinical diagnostics and therapeutics include detection and isolation of (1) fetal cells from material blood for prenatal diagnosis of birth defects, (2) hematopoietic stem and precursor cells for autologous bone marrow transplantation, (3) metastatic breast cancer cells for molecular characterization, and (4) HIV-infected maternal cells in newborn blood to study mother

  1. Schwartz–jampel syndrome: Clinical and diagnostic phenotype of a rare genetic disorder

    Directory of Open Access Journals (Sweden)

    Bhaskara P Shelley

    2016-01-01

    Full Text Available The distinctive phenotypic, clinical, skeletal characteristics with the typical electrophysiological features of an 11-year-old male child who presented to the neurology outpatient service are described, with the objective of emphasizing the diagnostic awareness of chondrodystrophic myotonia or Schwartz–Jampel syndrome, a very rare genetic disorder. This autosomal recessive disorder due to mutations in the gene Perlecan leads to abnormal cartilage development and anomalous neuromuscular activity.

  2. The human immune response to streptococcal extracellular antigens: clinical, diagnostic, and potential pathogenetic implications.

    Science.gov (United States)

    Johnson, Dwight R; Kurlan, Roger; Leckman, James; Kaplan, Edward L

    2010-02-15

    Determination of an immune response to group A Streptococcus (GAS) antigens, frequently anti-streptolysin O and anti-DNase B, is crucial for documentation of bona fide GAS infection. Although the importance of immunologic confirmation of infection is widely accepted, the immediate and long-term immunokinetics of the human antibody response are incompletely documented and poorly understood. Pediatric study participants (n = 160) were followed during a 2-year study with monthly throat cultures (n = 3491) and blood samples (n = 1679) obtained every 13 weeks. Recovered GAS were characterized; serum anti-streptolysin O and anti-DNase B antibody titers were determined. Antibody titers and GAS culture results were temporally correlated and analyzed. The analyses clearly document, in some instances for the first time, that an increase in antibody titer more accurately defines infection than does an absolute titer (eg, "upper limit of normal"), that antibody titers can remain elevated for many months even without GAS, and that some individuals may harbor GAS continuously for months or years without symptoms of infection and without an associated immune response. Measuring 2 different antibodies is more accurate in defining infection. Single time-point cultures and single antibody titers are often misleading. Sequential samples more accurately define infection, allowing correlation of titer increases with temporal confirmation of GAS acquisition. Understanding kinetics of the immune response(s) to GAS infection is necessary in formulating accurate clinical diagnostic conclusions, to appropriate design of clinical and epidemiological studies examining the association of GAS with subsequent sequelae, and to providing insight into pathogenetic mechanisms associated with this important human pathogen.

  3. Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis

    LENUS (Irish Health Repository)

    Billington, Jennifer

    2012-08-07

    AbstractBackgroundThe STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings.MethodsA literature search was performed to identify all studies that validated the STRATIFY rule. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A STRATIFY score of ≥2 points was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled sensitivity and specificity of STRATIFY at ≥2 points. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity.ResultsSeventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score ≥2 points, the STRATIFY rule is more useful at ruling out falls in those classified as low risk, with a greater pooled sensitivity estimate (0.67, 95% CI 0.52–0.80) than specificity (0.57, 95% CI 0.45 – 0.69). The sensitivity analysis which examined the performance of the rule in different settings and subgroups also showed broadly comparable results, indicating that the STRATIFY rule performs in a similar manner across a variety of different ‘at risk’ patient groups in different clinical settings.ConclusionThis systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice.

  4. How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?

    Science.gov (United States)

    Meijs, Anouk P; Claassen, Jurgen A H R; Rikkert, Marcel G M Olde; Schalk, Bianca W M; Meulenbroek, Olga; Kessels, Roy P C; Melis, René J F

    2015-01-01

    patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and how it influences the initial diagnosis. the initial diagnosis after standard clinical assessment (history, laboratory tests, cognitive screening and physical and neurological examination) and the final diagnosis after additional testing of 752 memory clinic patients were collected. We specifically registered if, and what type of, additional testing was requested. additional testing was performed in 518 patients (69%), 67% of whom underwent magnetic resonance imaging, 45% had neuropsychological assessment, 14% had cerebrospinal fluid analysis and 49% had (combinations of) other tests. This led to a modification of the initial diagnosis in 17% of the patients. The frequency of change was highest in patients with an initial non-Alzheimer's disease (AD) dementia diagnosis (54%, compared with 11 and 14% in patients with AD and 'no dementia'; P testing 44% was diagnosed with AD, 9% with non-AD dementia and 47% with 'no dementia'. additional testing should especially be considered in non-AD patients. In the large group of patients with an initial AD or 'no dementia' diagnosis, additional tests have little diagnostic impact and may perhaps be used with more restraint. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Nuclear power plant diagnostics study at the Midland training simulator

    International Nuclear Information System (INIS)

    Reifman, J.; Rank, P.; Lee, J.C.

    1991-01-01

    Training simulators provide a real world environment for testing advanced diagnostic and control systems as an aid to nuclear power plant operators. The simulators not only duplicate the hardware din the actual control room, allowing for analysis of man-machine interface, but also represent the dynamic behavior of the reference plant in real-time, in a realistic manner. Training simulators provide the means to representing the reference plant operations in a wide range of operation conditions including off-normal and emergency conditions. Transient events with very low probability of occurrence can then be represented and used to test the capabilities of advanced diagnostic and control systems. For these reasons, full-scope operator training simulators have been used as a test bed for a number of advanced diagnostic concepts. The University of Michigan and Consumers Power Company have been collaborating in a program devoted to the development and study of advanced concepts for automatic diagnostics and control of nuclear power plants. The program has been focused on the use of the full-scope operator training Midland Nuclear Power Plant Unit 2 (MNP-2) Simulator for development, testing, and verification of advanced diagnostics concepts. In their current efforts, the authors have developed two artificial intelligent (AI) diagnostic concepts that have been applied to the MNP-2 Simulator: the systematic generation and updating of a rule-based knowledge system for nuclear power plant diagnostics and a nonlinear parameter estimation algorithm called the simulation filter. The simulation filter algorithm is used with the MNP-2 Simulator to improve the simulation of the Three Mile Island Unit 2 (TMI-2) accident. 11 refs., 4 figs

  6. Effective choices for diagnostic imaging in clinical practice. Excerpts from a report of a WHO Scientific Group on Clinical Diagnostic Imaging

    International Nuclear Information System (INIS)

    1992-01-01

    There are so many different methods of diagnostic imaging that medical practitioners may need guidance to choose the best through the maze of options for each clinical problem. Advice may be required for more than just the first choice, because the first imaging procedure does not always give the desired answer and, depending on the results, further imaging may have to undertaken. The alternative is to submit the patient to a barrage of imaging and hope that one type, at least provides the diagnosis. This is a quite unacceptable way to practice medicine because of the cost and the risk of radiation damage from unnecessary examinations. The choice of the most effective imaging is often difficult and frequently controversial. The sequence to be followed vries with many factors: the equipment available, the skills of the practitioner, the expected quality of the results, the quality of interpretation, and conclusion which can be drawn

  7. Agreement between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the proposed DSM-V attention deficit hyperactivity disorder diagnostic criteria: an exploratory study.

    Science.gov (United States)

    Ghanizadeh, Ahmad

    2013-01-01

    There is no empirical literature about the American Psychiatry Association proposed new diagnostic criteria for attention deficit hyperactivity disorder (ADHD). This study examined the agreement between ADHD diagnosis derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and DSM-V diagnostic criteria. It also reports sensitivity, specificity, and agreement for ADHD diagnosis. A clinical sample of 246 children and adolescents were interviewed face to face using both ADHD diagnostic criteria for DSM-V and DSM-IV by interviewing clinician. Comorbid psychiatric disorders were screened using DSM-IV criteria. The rate of ADHD diagnosis using DSM-V was significantly higher than the rate detected by using DSM-IV diagnostic criteria. The sensitivity of DSM-V diagnostic criteria was 100%, while its specificity was 71.1%. The kappa agreement between DSM-IV and DSM-V was 0.75. In addition, positive predictive value was 85.1%. All the four newly added symptoms to ADHD diagnostic criteria are statistically more common in the children with ADHD than those in the comparison group. However, these symptoms are also very common in the children without ADHD. It is expected that the rate of ADHD would increase using the proposed ADHD DSM-V criteria. Moreover, the newly added symptoms have a low specificity for ADHD diagnosis. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Bibliometric analysis of journal of clinical and diagnostic research (dentistry section; 2007-2014).

    Science.gov (United States)

    Jain, Swati; Basavaraj, P; Singla, Ashish; Singh, Khushboo; Kundu, Hansa; Vashishtha, Vaibhav; Pandita, Venisha; Malhi, Ravneet

    2015-04-01

    The role of scientific journals in diffusion of data concerning researches in the field of Public Health Dentistry is of premier importance. Bibliometric analysis involves analysis of publications reflecting the type of research work. The present study was conducted with an aim to determine the number and trends of published articles in Journal of Clinical and Diagnostic Research (JCDR) from Feb. 2007 to Oct.2014. A retrospective observational study was conducted for JCDR. All issues of JCDR were electronically searched for the parameters : study design, area of interest of research, state /college where research was conducted, authorship pattern, source of articles published each year, changing study trends, disease under study and publication bias. The data was organized and analyzed using software SPSS - version 21.0; descriptive statistics was used. Bibliometric analysis was done for 601 articles of JCDR published from Feb. 2007 to Oct. 2014. The total number of articles published under Dentistry section have tremendously increased from mere 2 articles in 2007 to 328 articles in 2014.Majority of the study designs published in both the journal were case reports (42.6%) followed by cross sectional studies (24.8%). 96.3% of the articles were from India. Majority of the articles published were of multi authors (65.2%) and from Educational institutes (98.4%). The trends of the articles published indicated that the case reports/series formed the major bulk (others=59.1%) followed by research studies (21.3%). It was concluded that most articles published were case reports followed by researches indicating an inclination towards better quality methodology. The SJR and the citation count of the articles published also indicated the quality of the scientific articles published.

  9. Study for the design method of multi-agent diagnostic system to improve diagnostic performance for similar abnormality

    International Nuclear Information System (INIS)

    Minowa, Hirotsugu; Gofuku, Akio

    2014-01-01

    Accidents on industrial plants cause large loss on human, economic, social credibility. In recent, studies of diagnostic methods using techniques of machine learning such as support vector machine is expected to detect the occurrence of abnormality in a plant early and correctly. There were reported that these diagnostic machines has high accuracy to diagnose the operating state of industrial plant under mono abnormality occurrence. But the each diagnostic machine on the multi-agent diagnostic system may misdiagnose similar abnormalities as a same abnormality if abnormalities to diagnose increases. That causes that a single diagnostic machine may show higher diagnostic performance than one of multi-agent diagnostic system because decision-making considering with misdiagnosis is difficult. Therefore, we study the design method for multi-agent diagnostic system to diagnose similar abnormality correctly. This method aimed to realize automatic generation of diagnostic system where the generation process and location of diagnostic machines are optimized to diagnose correctly the similar abnormalities which are evaluated from the similarity of process signals by statistical method. This paper explains our design method and reports the result evaluated our method applied to the process data of the fast-breeder reactor Monju

  10. The diagnostic accuracy of Clinical Dehydration Scale in identifying dehydration in children with acute gastroenteritis: a systematic review.

    Science.gov (United States)

    Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

    2014-10-01

    To systematically update diagnostic accuracy of the Clinical Dehydration Scale (CDS) in clinical recognition of dehydration in children with acute gastroenteritis. Six databases were searched for diagnostic accuracy studies in which population were children aged 1 to 36 months with acute gastroenteritis; index test was the CDS; and reference test was post-illness weight gain. Three studies involving 360 children were included. Limited evidence showed that in high-income countries the CDS provides strong diagnostic accuracy for ruling in moderate and severe (>6%) dehydration (positive likelihood ratio 5.2-6.6), but has limited value for ruling it out (negative likelihood ratio 0.4-0.55). In low-income countries, the CDS has limited value either for ruling moderate or severe dehydration in or out. In both settings, the CDS had limited value for ruling in or out dehydration dehydration 3% to 6%. The CDS can help assess moderate to severe dehydration in high-income settings. Given the limited data, the evidence should be viewed with caution. © The Author(s) 2014.

  11. Clinical impact of recurrently mutated genes on lymphoma diagnostics: state-of-the-art and beyond.

    Science.gov (United States)

    Rosenquist, Richard; Rosenwald, Andreas; Du, Ming-Qing; Gaidano, Gianluca; Groenen, Patricia; Wotherspoon, Andrew; Ghia, Paolo; Gaulard, Philippe; Campo, Elias; Stamatopoulos, Kostas

    2016-09-01

    Similar to the inherent clinical heterogeneity of most, if not all, lymphoma entities, the genetic landscape of these tumors is markedly complex in the majority of cases, with a rapidly growing list of recurrently mutated genes discovered in recent years by next-generation sequencing technology. Whilst a few genes have been implied to have diagnostic, prognostic and even predictive impact, most gene mutations still require rigorous validation in larger, preferably prospective patient series, to scrutinize their potential role in lymphoma diagnostics and patient management. In selected entities, a predominantly mutated gene is identified in almost all cases (e.g. Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma and hairy-cell leukemia), while for the vast majority of lymphomas a quite diverse mutation pattern is observed, with a limited number of frequently mutated genes followed by a seemingly endless tail of genes with mutations at a low frequency. Herein, the European Expert Group on NGS-based Diagnostics in Lymphomas (EGNL) summarizes the current status of this ever-evolving field, and, based on the present evidence level, segregates mutations into the following categories: i) immediate impact on treatment decisions, ii) diagnostic impact, iii) prognostic impact, iv) potential clinical impact in the near future, or v) should only be considered for research purposes. In the coming years, coordinated efforts aiming to apply targeted next-generation sequencing in large patient series will be needed in order to elucidate if a particular gene mutation will have an immediate impact on the lymphoma classification, and ultimately aid clinical decision making. Copyright© Ferrata Storti Foundation.

  12. Diagnostics for studies of novel laser ion acceleration mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Senje, Lovisa; Aurand, Bastian; Wahlström, Claes-Göran [Department of Physics, Lund University, P. O. Box 118, S-221 00 Lund (Sweden); Yeung, Mark; Kuschel, Stephan; Rödel, Christian [Helmholtz-Institut Jena, D-07743 Jena (Germany); Wagner, Florian; Roth, Markus [Technische Universität Darmstadt, D-64289 Darmstadt (Germany); Li, Kun; Neumayer, Paul [ExtreMe Matter Institut, D-64291 Darmstadt (Germany); Dromey, Brendan; Jung, Daniel [Department of Physics and Astronomy, Queen' s University, Belfast BT7 1NN (United Kingdom); Bagnoud, Vincent [Helmholtz-Institut Jena, D-07743 Jena (Germany); GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt (Germany); Zepf, Matthew [Helmholtz-Institut Jena, D-07743 Jena (Germany); Department of Physics and Astronomy, Queen' s University, Belfast BT7 1NN (United Kingdom); Kuehl, Thomas [ExtreMe Matter Institut, D-64291 Darmstadt (Germany); GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt (Germany); Universität Mainz, D-55099 Mainz (Germany)

    2014-11-15

    Diagnostic for investigating and distinguishing different laser ion acceleration mechanisms has been developed and successfully tested. An ion separation wide angle spectrometer can simultaneously investigate three important aspects of the laser plasma interaction: (1) acquire angularly resolved energy spectra for two ion species, (2) obtain ion energy spectra for multiple species, separated according to their charge to mass ratio, along selected axes, and (3) collect laser radiation reflected from and transmitted through the target and propagating in the same direction as the ion beam. Thus, the presented diagnostic constitutes a highly adaptable tool for accurately studying novel acceleration mechanisms in terms of their angular energy distribution, conversion efficiency, and plasma density evolution.

  13. Diagnostics for studies of novel laser ion acceleration mechanisms

    International Nuclear Information System (INIS)

    Senje, Lovisa; Aurand, Bastian; Wahlström, Claes-Göran; Yeung, Mark; Kuschel, Stephan; Rödel, Christian; Wagner, Florian; Roth, Markus; Li, Kun; Neumayer, Paul; Dromey, Brendan; Jung, Daniel; Bagnoud, Vincent; Zepf, Matthew; Kuehl, Thomas

    2014-01-01

    Diagnostic for investigating and distinguishing different laser ion acceleration mechanisms has been developed and successfully tested. An ion separation wide angle spectrometer can simultaneously investigate three important aspects of the laser plasma interaction: (1) acquire angularly resolved energy spectra for two ion species, (2) obtain ion energy spectra for multiple species, separated according to their charge to mass ratio, along selected axes, and (3) collect laser radiation reflected from and transmitted through the target and propagating in the same direction as the ion beam. Thus, the presented diagnostic constitutes a highly adaptable tool for accurately studying novel acceleration mechanisms in terms of their angular energy distribution, conversion efficiency, and plasma density evolution

  14. SEMIOTICS, DIAGNOSTICS AND THERAPY TACTICS OF DEPRESSIVE DISORDERS IN CLINICAL MEDICINE

    Directory of Open Access Journals (Sweden)

    N. A. Kornetov

    2014-01-01

    Full Text Available Study objectives are dedicated to brief synthesized establishment of diagnostics general standard, management and therapy of major depressive disorders (MDD in clinical medicine to provide education in medical practice.Study methods are based on short-term, medium-term and long-term educational programs in 24 Russian and Ukraine cities, which were based on original educational programs under the direction of World Psychiatric Association (WPA and International Committee For Prevention and Treatment of Depression (PTD. There, about 1450 doctors of different occupations were acquainted with the detection, management and treatment of MDD. The Russian version of WPA/PTD programs was created. The program of education included 4 modules. The Core module included an overview of the epidemiology, impact, concepts and classification, and etiology of depressive disorders as well as their recognition, diagnosis, and management in the primary care setting. The second module focused on depressive disorders in physical illness and covered those major illnesses for which is reasonable evidence for an association with depressive disorders. The third module included the development of the depressive disorders in older persons. The forth module included training physicians in mental health skills. 39 theme improvements for 858 primary care setting physicians within the framework of faculty training program of physicians’ development were the part of other programs of physicians’ occupations.Results. A number of highlights were included in the general algorithm of the educational programs. The creation of optimum «physician-depressive patient» contact demands a number of new skills to establish effective communication. These skills involve training of meeting of depressive patient and physician, the ability to follow a certain communication style; identify emotional, cognitive, psychomotor and nonverbal patterns of behavior. Besides that, the education

  15. Usefulness of clinical data and rapid diagnostic tests to identify bacterial etiology in adult respiratory infections

    Directory of Open Access Journals (Sweden)

    Pilar Toledano-Sierra

    2015-01-01

    Full Text Available Respiratory tract infections are a common complaint and most of them, such as common cold and laryngitis, are viral in origin, so antibiotic use should be exceptional. However, there are other respiratory tract infections (sinusitis, pharyngitis, lower respiratory tract infections, and exacerbations of chronic obstructive pulmonary disease where a bacterial etiology is responsible for a non-negligible percentage, and antibiotics are often empirically indicated. The aim of the study is to identify the strength of the data obtained from the symptoms, physical examination and rapid diagnostic methods in respiratory infections in which antibiotic use is frequently proposed in order to improve diagnosis and influence the decision to prescribe these drugs. The review concludes that history, physical examination and rapid tests are useful to guide the need for antibiotic treatment in diseases such as acute sinusitis, acute pharyngitis, exacerbation of lower respiratory tract infection and chronic obstructive pulmonary disease. However, no isolated data is accurate enough by itself to confirm or rule out the need for antibiotics. Therefore, clinical prediction rules bring together history and physical examination, thereby improving the accuracy of the decision to indicate or not antibiotics.

  16. Diagnostic criteria and treatment of discogenic pain: a systematic review of recent clinical literature.

    Science.gov (United States)

    Malik, Khalid M; Cohen, Steven P; Walega, David R; Benzon, Honorio T

    2013-11-01

    Pain innate to intervertebral disc, often referred to as discogenic pain, is suspected by some authors to be the major source of chronic low back and neck pain. Current management of suspected discogenic pain lacks standardized diagnosis, treatment, and terminology. In an attempt to determine whether patterns existed that may facilitate standardization of care, we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain. A systematic review of the recent literature. A Medline search was performed using the terms degenerative disc disease, discogenic pain, internal disc disruption while using the limits of human studies, English language, and clinical trials, for the last 10 years. The search led to a total of 149 distinct citations, of which 53 articles, where the intervertebral disc itself was considered the principal source of patient's pain and was the main target of the treatment, were retained for further analysis. The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain. Our findings show that suspected discogenic pain, despite its extensive affirmation in the literature and enormous resources regularly devoted to it, currently lacks clear diagnostic criteria and uniform treatment or terminology. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. The urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in Africa.

    Science.gov (United States)

    O'Brien, Daniel P; Comte, Eric; Serafini, Micaela; Ehounou, Geneviève; Antierens, Annick; Vuagnat, Hubert; Christinet, Vanessa; Hamani, Mitima D; du Cros, Philipp

    2014-05-01

    Despite great advances in the diagnosis and treatment of Buruli ulcer, it is one of the least studied major neglected tropical diseases. In Africa, major constraints in the management of Buruli ulcer relate to diagnosis and treatment, and accessibility, feasibility, and delivery of services. In this Personal View, we outline key areas for clinical, diagnostic, and operational research on this disease in Africa and propose a research agenda that aims to advance the management of Buruli ulcer in Africa. A model of care is needed to increase early case detection, to diagnose the disease accurately, to simplify and improve treatment, to reduce side-effects of treatment, to deal with populations with HIV and tuberculosis appropriately, to decentralise care, and to scale up coverage in populations at risk. This approach will require commitment and support to strategically implement research by national Buruli ulcer programmes and international technical and donor organisations, combined with adaptations in programme design and advocacy. A critical next step is to build consensus for a research agenda with WHO and relevant groups experienced in Buruli ulcer care or related diseases, and we call on on them to help to turn this agenda into reality. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. School Psychologist Diagnostic Decision-Making: A Pilot Study

    Science.gov (United States)

    Barnard-Brak, Lucy; Stevens, Tara; Robinson, Eric; Holt, Ann

    2013-01-01

    The current study examined the diagnostic decision-making of school psychologists as a function of a student's disability and academic performance with three research questions using a randomly-selected sample of school psychologists from the state of Texas. Results from the first research question indicated that school psychologists significantly…

  19. Optical diagnostics based on elastic scattering: An update of clinical demonstrations with the Optical Biopsy System

    Energy Technology Data Exchange (ETDEWEB)

    Bigio, I.J.; Boyer, J.; Johnson, T.M.; Lacey, J.; Mourant, J.R. [Los Alamos National Lab., NM (United States); Conn, R. [Lovelace Medical Center, Albuquerque, NM (United States); Bohorfoush, A. [Wisconsin Medical School, Milwaukee, WI (United States)

    1994-10-01

    The Los Alamos National Laboratory has continued the development of the Optical Biopsy System (OBS) for noninvasive, real-time in situ diagnosis of tissue pathologies. Our clinical studies have expanded since the last Biomedical Optics Europe conference (Budapest, September 1993), and we report here on the latest results of clinical tests in gastrointestinal tract. The OBS invokes a unique approach to optical diagnosis of tissue pathologies based on the elastic scattering properties, over a wide range of wavelengths, of the tissue. The use of elastic scattering as the key to optical tissue diagnostics in the OBS is based on the fact that many tissue pathologies, including a majority of cancer forms, manifest significant architectural changes at the cellular and sub-cellular level. Since the cellular components that cause elastic scattering have dimensions typically on the order of visible to near-IR wavelengths, the elastic (Mie) scattering properties will be wavelength dependent. Thus, morphology and size changes can be expected to cause significant changes in an optical signature that is derived from the wavelength-dependence of elastic scattering. The OBS employs a small fiberoptic probe that is amenable to use with any endoscope or catheter, or to direct surface examination. The probe is designed to be used in optical contact with the tissue under examination and has separate illuminating and collecting fibers. Thus, the light that is collected and transmitted to the analyzing spectrometer must first scatter through a small volume of the tissue before entering the collection fiber(s). Consequently, the system is also sensitive to the optical absorption spectrum of the tissue, over an effective operating range of <300 to 950 nm, and such absorption adds valuable complexity to the scattering spectral signature.

  20. Statistical Issues in TBI Clinical Studies

    Directory of Open Access Journals (Sweden)

    Paul eRapp

    2013-11-01

    Full Text Available The identification and longitudinal assessment of traumatic brain injury presents several challenges. Because these injuries can have subtle effects, efforts to find quantitative physiological measures that can be used to characterize traumatic brain injury are receiving increased attention. The results of this research must be considered with care. Six reasons for cautious assessment are outlined in this paper. None of the issues raised here are new. They are standard elements in the technical literature that describes the mathematical analysis of clinical data. The purpose of this paper is to draw attention to these issues because they need to be considered when clinicians evaluate the usefulness of this research. In some instances these points are demonstrated by simulation studies of diagnostic processes. We take as an additional objective the explicit presentation of the mathematical methods used to reach these conclusions. This material is in the appendices. The following points are made:1. A statistically significant separation of a clinical population from a control population does not ensure a successful diagnostic procedure.2. Adding more variables to a diagnostic discrimination can, in some instances, actually reduce classification accuracy.3. A high sensitivity and specificity in a TBI versus control population classification does not ensure diagnostic successes when the method is applied in a more general neuropsychiatric population. 4. Evaluation of treatment effectiveness must recognize that high variability is a pronounced characteristic of an injured central nervous system and that results can be confounded by either disease progression or spontaneous recovery. A large pre-treatment versus post-treatment effect size does not, of itself, establish a successful treatment.5. A procedure for discriminating between treatment responders and nonresponders requires, minimally, a two phase investigation. This procedure must include a

  1. Opto-electronic DNA chip-based integrated card for clinical diagnostics.

    Science.gov (United States)

    Marchand, Gilles; Broyer, Patrick; Lanet, Véronique; Delattre, Cyril; Foucault, Frédéric; Menou, Lionel; Calvas, Bernard; Roller, Denis; Ginot, Frédéric; Campagnolo, Raymond; Mallard, Frédéric

    2008-02-01

    Clinical diagnostics is one of the most promising applications for microfluidic lab-on-a-chip or lab-on-card systems. DNA chips, which provide multiparametric data, are privileged tools for genomic analysis. However, automation of molecular biology protocol and use of these DNA chips in fully integrated systems remains a great challenge. Simplicity of chip and/or card/instrument interfaces is amongst the most critical issues to be addressed. Indeed, current detection systems for DNA chip reading are often complex, expensive, bulky and even limited in terms of sensitivity or accuracy. Furthermore, for liquid handling in the lab-on-cards, many devices use complex and bulky systems, either to directly manipulate fluids, or to ensure pneumatic or mechanical control of integrated valves. All these drawbacks prevent or limit the use of DNA-chip-based integrated systems, for point-of-care testing or as a routine diagnostics tool. We present here a DNA-chip-based protocol integration on a plastic card for clinical diagnostics applications including: (1) an opto-electronic DNA-chip, (2) fluid handling using electrically activated embedded pyrotechnic microvalves with closing/opening functions. We demonstrate both fluidic and electric packaging of the optoelectronic DNA chip without major alteration of its electronical and biological functionalities, and fluid control using novel electrically activable pyrotechnic microvalves. Finally, we suggest a complete design of a card dedicated to automation of a complex biological protocol with a fully electrical fluid handling and DNA chip reading.

  2. Clinical neuroanatomy and diagnostic imaging of the skull. 2. rev. and enlarged ed.

    International Nuclear Information System (INIS)

    Kretschmann, H.J.; Weinrich, W.

    1991-01-01

    In the last few years, the techniques of CT, MRI, PET and utrasonography have been improved in their diagnostic efficiency, but in spite of the much enhanced resolution achievable with the new techniques, a large part of the neurofunctional systems that are of great significance to clinical diagnostic evaluation remains in the dark. The local structure of the neurofunctional systems is derived from the data describing the position of the conductive structures such as cerebral ventricles or typical cerebral sulci or gyri. A good knowledge of the three-dimensional topography of the neuroanatomy in the skull is required for this purpose, and this is what the book at hand is intended to confer. The arteries and their vascular environment are shown in the frontal, sagittal and axial plane and are compared with drawings produced from angiographies. The information given covers the cranium viscerale, the craniocervical neighbouring areas, and the motor innervation areas of the skull. The term 'diagnostic imaging of the skull' comprises the whole head and the transitional zones. The illustration of the neurofunctional system anatomy in the tomogram presented in this book is a source of information that may serve as a guide for pathfinding in CT, MRI, PET and ultrasonography. In addition, the knowledge found in the book will help to assign clinical data to pathologic findings revealed by CT or MRI. (orig.) With 596 mostly coloured figs [de

  3. Clinical Diagnostic and Sociocultural Dimensions of Deliberate Self-Harm in Mumbai, India

    Science.gov (United States)

    Parkar, Shubhangi R.; Dawani, Varsha; Weiss, Mitchell G.

    2006-01-01

    Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression…

  4. A Comparison of DSM-IV-TR and DSM-5 Diagnostic Classifications in the Clinical Diagnosis of Autistic Spectrum Disorder.

    Science.gov (United States)

    Yaylaci, Ferhat; Miral, Suha

    2017-01-01

    Aim of this study was to compare children diagnosed with Pervasive Developmental Disorder (PDD) according to DSM-IV-TR and DSM-5 diagnostic systems. One hundred fifty children aged between 3 and 15 years diagnosed with PDD by DSM-IV-TR were included. PDD symptoms were reviewed through psychiatric assessment based on DSM-IV-TR and DSM-5 criteria. Clinical severity was determined using Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). A statistically significant decrease (19.3 %) was detected in the diagnostic ratio with DSM-5. Age and symptom severity differed significantly between those who were and were not diagnosed with PDD using DSM-5. B4 criteria in DSM-5 was most common criterion. Results indicate that individuals diagnosed with PDD by DSM-IV-TR criteria may not be diagnosed using DSM-5 criteria.

  5. Clinical Training of Medical Physicists Specializing in Diagnostic Radiology (French Edition)

    International Nuclear Information System (INIS)

    2012-01-01

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area, structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for diagnostic radiology. There is a general and growing awareness that radiation medicine is increasingly dependent on well trained medical physicists based in the clinical setting. However, an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognized by the members of the Regional Cooperative Agreement (RCA) for Research, Development and Training related to Nuclear Sciences for Asia and the Pacific. Consequently, a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia-Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specializing in diagnostic radiology started in 2007 with the appointment of a core drafting committee of regional and international experts. The publication drew on the experiences of clinical training programmes in Australia and New Zealand, the UK and the USA, and was moderated by physicists working in the Asian region. This publication follows the approach of the IAEA publication Training Course Series No. 37, Clinical Training of Medical Physicists specializing in Radiation Oncology. This approach to clinical training has been successfully tested

  6. Clinical Training of Medical Physicists Specializing in Diagnostic Radiology (Spanish Edition)

    International Nuclear Information System (INIS)

    2013-01-01

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area, structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for diagnostic radiology. There is a general and growing awareness that radiation medicine is increasingly dependent on well trained medical physicists based in the clinical setting. However, an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognized by the members of the Regional Cooperative Agreement (RCA) for Research, Development and Training related to Nuclear Sciences for Asia and the Pacific. Consequently, a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia-Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specializing in diagnostic radiology started in 2007 with the appointment of a core drafting committee of regional and international experts. The publication drew on the experiences of clinical training programmes in Australia and New Zealand, the UK and the USA, and was moderated by physicists working in the Asian region. This publication follows the approach of the IAEA publication Training Course Series No. 37, Clinical Training of Medical Physicists specializing in Radiation Oncology. This approach to clinical training has been successfully tested

  7. Diagnostic accuracy of clinical and blood examination for sepsis in potentially infected neonates

    Directory of Open Access Journals (Sweden)

    Ari Mulyani

    2006-10-01

    Full Text Available Background Neonatal sepsis remains a diagnostic challenge due to its nonspesific symptoms and signs. Blood culture as the gold standard is still a problem because it takes time, is expensive, and not every health facility is able to perionn. Objective To evaluate the diagnostic accuracy of clinical symptoms, hematologic findings, and C-reactive protein (CRP in neonatal sepsis. Methods Samples were taken from potentially infected neonates admitted to the Matemal-Perinatal Unit of Sardjito Hospital, between December 1st, 2000 and March 31st, 2001 using at least one of the criteria: prematurity, very low birth weight infants, matemal pyrexia during delivery, premature membrane rupture, or thick, cloudy amniotic fluid. Clinical symptoms, total leukocyte, neutrophil, platelet count, CRP, and blood culture as the gold standard were examined. Results Among 99 neonates enrolled, the sensitivity, specificity, positive and negative predictive value of clinical symptoms were 79.3%, 75.7%, 57.5%, and 89.9%, respectively; leukopenia/leukocytosis were 27.6%, 85.7%, 44.4%, and 74.1%; neutropenia! neutrophilia were 41.4%, 71.4%, 37.5%, and 74.6%; thrombocytopenia were 79.3%, 51.8%, 40.4%, and 85.7%; positive CRP were 58.6%,78.6%,53.1%, and 82.1%. Parallel tests increased the sensitivity up to 89.7%. Specificity, positive and negative predictive value, and likelihood ratio were 44.3%, 40%, 91.2%, and 1.6, respectively. Serial tests increased the specificity up to 88.6%. Sensitivity, positive and negative predictive value, and likelihood ratio were 58.6%, 68%, 83.8%, and 5.1, respectively. Conclusion Clinical sepsis, thrombocytopenia, and CRP are sufficiently accurate as diagnostic tests for sepsis in potentially infected neonates. Parallel tests will increase the sensitivity, while serial tests increase the specificity.

  8. A Diagnostic Model for Dementia in Clinical Practice-Case Methodology Assisting Dementia Diagnosis.

    Science.gov (United States)

    Londos, Elisabet

    2015-04-02

    Dementia diagnosis is important for many different reasons. Firstly, to separate dementia, or major neurocognitive disorder, from MCI (mild cognitive impairment), mild neurocognitive disorder. Secondly, to define the specific underlying brain disorder to aid treatment, prognosis and decisions regarding care needs and assistance. The diagnostic method of dementias is a puzzle of different data pieces to be fitted together in the best possible way to reach a clinical diagnosis. Using a modified case methodology concept, risk factors affecting cognitive reserve and symptoms constituting the basis of the brain damage hypothesis, can be visualized, balanced and reflected against test results as well as structural and biochemical markers. The model's origin is the case method initially described in Harvard business school, here modified to serve dementia diagnostics.

  9. Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation.

    Science.gov (United States)

    Wagner-Bartak, Nicolaus A; Baiomy, Ali; Habra, Mouhammed Amir; Mukhi, Shalini V; Morani, Ajaykumar C; Korivi, Brinda R; Waguespack, Steven G; Elsayes, Khaled M

    2017-07-01

    Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.

  10. Diagnostic reasoning strategies and diagnostic success.

    Science.gov (United States)

    Coderre, S; Mandin, H; Harasym, P H; Fick, G H

    2003-08-01

    Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

  11. Moving beyond quality control in diagnostic radiology and the role of the clinically qualified medical physicist.

    Science.gov (United States)

    Delis, H; Christaki, K; Healy, B; Loreti, G; Poli, G L; Toroi, P; Meghzifene, A

    2017-09-01

    Quality control (QC), according to ISO definitions, represents the most basic level of quality. It is considered to be the snapshot of the performance or the characteristics of a product or service, in order to verify that it complies with the requirements. Although it is usually believed that "the role of medical physicists in Diagnostic Radiology is QC", this, not only limits the contribution of medical physicists, but is also no longer adequate to meet the needs of Diagnostic Radiology in terms of Quality. In order to assure quality practices more organized activities and efforts are required in the modern era of diagnostic radiology. The complete system of QC is just one element of a comprehensive quality assurance (QA) program that aims at ensuring that the requirements of quality of a product or service will consistently be fulfilled. A comprehensive Quality system, starts even before the procurement of any equipment, as the need analysis and the development of specifications are important components under the QA framework. Further expanding this framework of QA, a comprehensive Quality Management System can provide additional benefits to a Diagnostic Radiology service. Harmonized policies and procedures and elements such as mission statement or job descriptions can provide clarity and consistency in the services provided, enhancing the outcome and representing a solid platform for quality improvement. The International Atomic Energy Agency (IAEA) promotes this comprehensive quality approach in diagnostic imaging and especially supports the field of comprehensive clinical audits as a tool for quality improvement. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  12. SPECT Myocardial Blood Flow Quantitation Concludes Equivocal Myocardial Perfusion SPECT Studies to Increase Diagnostic Benefits.

    Science.gov (United States)

    Chen, Lung-Ching; Lin, Chih-Yuan; Chen, Ing-Jou; Ku, Chi-Tai; Chen, Yen-Kung; Hsu, Bailing

    2016-01-01

    Recently, myocardial blood flow quantitation with dynamic SPECT/CT has been reported to enhance the detection of coronary artery disease in human. This advance has created important clinical applications to coronary artery disease diagnosis and management for areas where myocardial perfusion PET tracers are not available. We present 2 clinical cases that undergone a combined test of 1-day rest/dipyridamole-stress dynamic SPECT and ECG-gated myocardial perfusion SPECT scans using an integrated imaging protocol and demonstrate that flow parameters are capable to conclude equivocal myocardial perfusion SPECT studies, therefore increasing diagnostic benefits to add value in making clinical decisions.

  13. Study of the performance of diagnostic radiology instruments during calibration

    International Nuclear Information System (INIS)

    Freitas, Rodrigo N. de; Vivolo, Vitor; Potiens, Maria da Penha A.

    2008-01-01

    Full text: The instruments used in diagnostic radiology measurements represent 8 % of the tested instruments by the calibration laboratory of IPEN annually (approximately 1600 in 2007). Considering that the calibration of this kind of instrument is performed biannually it is possible to conclude that almost 300 instruments are being used to measure the air kerma in diagnostic radiology clinics to determine the in beam values (in front of the patient), attenuated measurements (behind the patient) and scattered radiation. This work presents the results of the calibration of the instruments used in mammography, computed tomography, dental and conventional diagnostic radiology dosimetry, performed during the period of 2005 to 2007. Their performances during the calibrations measurements were evaluated. Although at the calibration laboratory there are three available series of radiation quality to this type of calibration (RQR, N and M, according to standards IEC 61267 and ISO 4037-1.), the applications can be assorted (general radiology, computed tomography, mammography, radiation protection and fluoroscopy). Depending on its design and behaviour , one kind of instrument can be used for one or more type of applications. The instruments normally used for diagnostic radiology measurements are ionization chambers with volumes varying from 3 to 1800 cm 3 , and can be cylindrical, spherical or plane parallel plates kind. They usually are sensitive to photon particles, with energies greater than 15 keV and can be used up to 1200 keV. In this work they were tested in X radiation fields from 25 to 150 kV, in specific qualities depending on the utilization of the instrument. The calibration results of 390 instruments received from 2005 to 2007 were analyzed. About 20 instruments were not able to be calibrated due to bad functioning. The calibration coefficients obtained were between 0.88 and 1.24. The uncertainties were always less than ± 3.6% to instruments used in scattered

  14. Are CSF Biomarkers Useful as Prognostic Indicators in Diagnostically Unresolved Cognitively Impaired Patients in a Normal Clinical Setting

    DEFF Research Database (Denmark)

    Nielsen, Malene Schjønning; Simonsen, Anja Hviid; Siersma, Volkert

    2016-01-01

    in diagnostically unresolved patients. METHODS: Data on 348 patients were retrospectively evaluated. All participants had a standardized diagnostic workup and follow-up in a memory clinic. RESULTS: Aβ42 levels and Aβ42/p-tau ratios were reduced and levels of t-tau and p-tau as well as the t-tau × p-tau/Aβ42 ratio...

  15. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

    Science.gov (United States)

    Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

    2012-05-15

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

  16. Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

    Science.gov (United States)

    Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire

    2012-01-01

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023

  17. clinical and experimental study

    OpenAIRE

    Tornow, Christoph

    2011-01-01

    Posterior capsule opacity (PCO) is a frequent complication in extracapsular cataract extraction in conjunction with an intraocular lens implant. Different studies have shown that a reduction in PCO frequency can be achieved via a number of factors. Lens design is a significant criterion in this process. In this study, two multifocal intraocular lenses (MIOLs) were compared. The design of these lenses differed due to their varying optical principles. They are the refractive MIOL A...

  18. The architecture of diagnostic research

    DEFF Research Database (Denmark)

    Colli, Agostino; Fraquelli, Mirella; Casazza, Giovanni

    2014-01-01

    The diagnostic research process can be divided into five phases, designed to establish the clinical utility of a new diagnostic test - the index test. The aim of the present review is to illustrate the study designs that are appropriate for each diagnostic phase, using clinical examples regarding...

  19. Symptom severity scale of the DSM5 for schizophrenia, and other psychotic disorders: diagnostic validity and clinical feasibility.

    Science.gov (United States)

    Ritsner, Michael S; Mar, Maria; Arbitman, Marina; Grinshpoon, Alexander

    2013-06-30

    Innovations in DSM5 include dimensional diagnosis of schizophrenia (SZ) and other psychotic (OP) disorders using the symptom severity scale (SS-DSM5). We evaluated the psychometric properties and diagnostic validity of the SS-DSM5 scale using a cross-sectional design and an unselected convenience unselected sample of 314 inpatients and outpatients with SZ/OP and mood disorders who received standard care in routine clinical practice. The SS-DSM5 scale, the Clinical Global Impression-Severity scale (CGI-S), the Positive and Negative Syndrome Scale (PANSS), and the Bech-Rafaelsen Mania Scale (BRMS) were administered. Factor structure, reliability, internal consistency, convergent and diagnostic ability of the DSM5-SS were evaluated. Factor analysis indicated two latent factors underlying the SS-DSM5 (Psychotic and Deficit sub-scales). Cronbach's alpha was >0.70. Convergent validity of the SS-DSM5 was highly significant. Patients with SZ/PO disorders were correctly diagnosed (77.9%) using the SS-DSM5 scale (72% using PANSS). The agreement of the diagnostic decisions between the SS-DSM5 and PANSS was substantial for SZ/PO disorders (Kappa=0.75). Classifying participants with SZ/PO versus mood disorders using SS-DSM5 provided a sensitivity of 95%, and specificity of 34%. Thus, this study suggests that the SS-DSM5 has acceptable psychometric properties and that its use in clinical practice and research is feasible in clinical settings. The dimensional option for the diagnosis of schizophrenia and related disorders using SS-DSM5 is discussed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial.

    Science.gov (United States)

    O'Connor, Daniel M; Jew, Olivia S; Perman, Marissa J; Castelo-Soccio, Leslie A; Winston, Flaura K; McMahon, Patrick J

    2017-12-01

    Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that are reliant on parent-provided photographs has not been formally compared with diagnoses made in person. To assess whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis. A prospective study was conducted among 40 patient-parent dyads at a pediatric dermatology clinic at the Children's Hospital of Philadelphia from March 1 to September 30, 2016, to assess concordance between diagnoses made by an independent pediatric dermatologist based on in-person examination and those based on parental photographs. Half of the patient-parent dyads were randomized for a secondary analysis to receive instructions on how best to take photographs with smartphones. Clinicians were blinded to whether parents had received photography instructions. Half of the patient-parent dyads received a simple, 3-step instruction sheet on how best to take photographs using a smartphone (intervention group); the other half did not (control group). Concordance between photograph-based vs in-person diagnosis in the intervention vs control groups, as quantified using Cohen κ, a measure of interrater agreement that takes into account the possibility of agreement occurring by chance. Among the 40 patient-parent dyads (22 female children and 18 male children; mean [SD] age, 6.96 [5.23] years), overall concordance between photograph-based vs in-person diagnosis was 83% (95% CI, 71%-94%; κ = 0.81). Diagnostic concordance was 89% (95% CI, 75%-97%; κ = 0.88) in a subgroup of 37 participants with photographs considered of high enough quality to make a diagnosis. No statistically significant effect of photography instructions on concordance was detected (group that received instructions, 85%; group that did not receive instructions, 80%; P

  1. Evolution of modern nuclear medicine tumor-imaging diagnostics in clinical oncology

    International Nuclear Information System (INIS)

    Piperkova, E.

    2000-01-01

    The evolution of current nuclear medicine diagnostic is closely related to the technical progress in imaging equipment development, and application of radiopharmaceuticals (Rphs) with a different tumor-uptake mechanism. It is the aim of the study to present groups of tumor-imaging Rphs differing by tumor uptake mechanisms, used in clinical oncology. The obtained results are described, and compared with the ones reported by other researchers. Sensitivity and specificity of Rphs for cardio-scintigraphy with 99m Tc - MIBI and 201 Tl are relatively high, amounting to 93.7% and 60% respectively, in the various tumors. These indicators depend on the stage, location, histopathology, level of malignancy and biological activity of the neoplasm. 99m Tc - MIBI scintigraphy is endowed with considerable diagnostic potential for assaying multiple drug resistance (MDR), and is also a good criterion for its elimination following anti-MDR therapy. The obtained results show that radioimmunoscintigraphy (RIS) using different radiolabeled monoclonal antibodies (MoAb) have high sensitivity and specificity respectively: 86% and 80% in ovarian carcinoma with B72.3 antiTAG; 68.6% and 92.5% in colorectal carcinoma with B73.2 antiTAG, antiCEA, antiCA 19-9; 92% and 83% in breast cancer with antiCEA, 86.8% and 67-69% in malignant melanoma with 225.28s. Receptor scintigraphy may reach up to 86% sensitivity and 100% specificity in tumors saturated with somatostatin receptors. Positron emission tomography (PET) with 18F-FDG enhances the metabolic activity of tumor cells, and attains tumor-detecting rate amounting to 97%. Tumor imaging evolution characterized by the introduction and practical implementation of different Rphs, visualizing the functional and biochemical activity of tumor cells in the primary neoplasm, sentinel lymph nodes and distant metastases. radiolabelling of a variety of new biochemical substances, including DNA and RNA, drugs and lysosomes contributes to a successful imaging

  2. Radiation exposure and image quality in X-ray diagnostic radiology. Physical principles and clinical applications. 2. ed.

    International Nuclear Information System (INIS)

    Saebel, Manfred; Aichinger, Horst; Dierker, Joachim; Joite-Barfuss, Sigrid

    2012-01-01

    Diagnostic X-rays are the largest contributor to radiation exposure to the general population, and protecting the patient from radiation damage is a major aim of modern health policy. Once the decision has been taken to use ionising radiation for imaging in a particular patient, it is necessary to optimize the image acquisition process taking into account the diagnostic quality of the images and the radiation dose to the patient. Both image quality and radiation dose are affected by a number of parameters, knowledge of which permits scientifically based decision making. The authors of this second edition of Radiation Exposure and Image Quality in X-ray Diagnostic Radiology have spent many years studying the optimization of radiological imaging. In this book they present in detail the basic physical principles of diagnostic radiology and their application to clinical problems. Particular attention is devoted to evaluation of the dose to the patient, the influence of scattered radiation on image quality, the use of antiscatter grids, and optimization of image quality and dose. The final section is a supplement containing tables of data and graphical depictions of X-ray spectra, interaction coefficients, characteristics of X-ray beams, and other aspects relevant to patient dose calculations. In addition, a complementary CD-ROM contains a user-friendly Excel file database covering these aspects that can be used in the reader's own programs. Since the first edition, the text, figures, tables, and references have all been thoroughly updated, and more detailed attention is now paid to image quality and radiation exposure when using digital imaging and computed tomography. This book will be an invaluable aid to medical physicists when performing calculations relating to patient dose and image quality, and will also prove useful for diagnostic radiologists and engineers. (orig.)

  3. Evaluation of the Ortho-Clinical Diagnostics Vitros ECi Anti-HCV test: comparison with three other methods.

    Science.gov (United States)

    Watterson, Jeannette M; Stallcup, Paulina; Escamilla, David; Chernay, Patrick; Reyes, Alfred; Trevino, Sylvia C

    2007-01-01

    After observing a high incidence of low positive hepatitis C virus (HCV) antibody screens by the Ortho-Clinical Vitros ECi test (Orthoclinical Diagnostics, Raritan, NJ), we compared results against those obtained using another chemiluminescent analyzer, as well as two U.S. Food and Drug Administration (FDA)-approved confirmatory methodologies. To ascertain the true anti-HCV status of samples deemed low-positive by the Ortho-Clinical Vitros ECi test, we tested samples using the ADVIA Centaur HCV screen test (Siemens Medical Solutions Diagnostics), the Chiron recombinant immunoblot assay (RIBA) test (Chiron Corp., Emeryville, CA), and the Roche COBAS Amplicor HCV qualitative test (Roche Diagnostics, Indianapolis, IN) in a series of studies. Of 94 specimens positive by Vitros ECi, 19% were observed to be negative by Centaur. A separate study of 91 samples with signal-to-cutoff (s/co) values less than 8.0 showed that all but one was negative for HCV ribonucleic acid (RNA). In comparison with RIBA, 100% (77) samples positive by the Vitros ECi test with s/co values less than 12.0 were negative or indeterminate by RIBA. A final study comparing all four methods side-by-side showed 63% disagreement by Centaur for Vitros ECi low-positive samples, 75% disagreement by RIBA, and 97% disagreement by polymerase chain reaction (PCR). In conclusion, the Ortho-Clinical Vitros ECi Anti-HCV test yields a high rate of false-positive results in the low s/co range in our patient population. (c) 2007 Wiley-Liss, Inc.

  4. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.

    Science.gov (United States)

    Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H

    2017-01-01

    The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

  5. Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of the rotator cuff.

    Science.gov (United States)

    Brockmeyer, Matthias; Schmitt, Cornelia; Haupert, Alexander; Kohn, Dieter; Lorbach, Olaf

    2017-12-01

    The reliable diagnosis of partial-thickness tears of the rotator cuff is still elusive in clinical practise. Therefore, the purpose of the study was to determine the diagnostic accuracy of MR imaging and clinical tests for detecting partial-thickness tears of the rotator cuff as well as the combination of these parameters. 334 consecutive shoulder arthroscopies for rotator cuff pathologies performed during the time period between 2010 and 2012 were analyzed retrospectively for the findings of common clinical signs for rotator cuff lesions and preoperative MR imaging. These were compared with the intraoperative arthroscopic findings as "gold standard". The reports of the MR imaging were evaluated with regard to the integrity of the rotator cuff. The Ellman Classification was used to define partial-thickness tears of the rotator cuff in accordance with the arthroscopic findings. Descriptive statistics, sensitivity, specificity, positive and negative predictive value were calculated. MR imaging showed 80 partial-thickness and 70 full-thickness tears of the rotator cuff. The arthroscopic examination confirmed 64 partial-thickness tears of which 52 needed debridement or refixation of the rotator cuff. Sensitivity for MR imaging to identify partial-thickness tears was 51.6%, specificity 77.2%, positive predictive value 41.3% and negative predictive value 83.7%. For the Jobe-test, sensitivity was 64.1%, specificity 43.2%, positive predictive value 25.9% and negative predictive value 79.5%. Sensitivity for the Impingement-sign was 76.7%, specificity 46.6%, positive predictive value 30.8% and negative predictive value 86.5%. For the combination of MR imaging, Jobe-test and Impingement-sign sensitivity was 46.9%, specificity 85.4%, positive predictive value 50% and negative predictive value 83.8%. The diagnostic accuracy of MR imaging and clinical tests (Jobe-test and Impingement-sign) alone is limited for detecting partial-thickness tears of the rotator cuff. Additionally

  6. Statistical physics of medical diagnostics: Study of a probabilistic model.

    Science.gov (United States)

    Mashaghi, Alireza; Ramezanpour, Abolfazl

    2018-03-01

    We study a diagnostic strategy which is based on the anticipation of the diagnostic process by simulation of the dynamical process starting from the initial findings. We show that such a strategy could result in more accurate diagnoses compared to a strategy that is solely based on the direct implications of the initial observations. We demonstrate this by employing the mean-field approximation of statistical physics to compute the posterior disease probabilities for a given subset of observed signs (symptoms) in a probabilistic model of signs and diseases. A Monte Carlo optimization algorithm is then used to maximize an objective function of the sequence of observations, which favors the more decisive observations resulting in more polarized disease probabilities. We see how the observed signs change the nature of the macroscopic (Gibbs) states of the sign and disease probability distributions. The structure of these macroscopic states in the configuration space of the variables affects the quality of any approximate inference algorithm (so the diagnostic performance) which tries to estimate the sign-disease marginal probabilities. In particular, we find that the simulation (or extrapolation) of the diagnostic process is helpful when the disease landscape is not trivial and the system undergoes a phase transition to an ordered phase.

  7. Statistical physics of medical diagnostics: Study of a probabilistic model

    Science.gov (United States)

    Mashaghi, Alireza; Ramezanpour, Abolfazl

    2018-03-01

    We study a diagnostic strategy which is based on the anticipation of the diagnostic process by simulation of the dynamical process starting from the initial findings. We show that such a strategy could result in more accurate diagnoses compared to a strategy that is solely based on the direct implications of the initial observations. We demonstrate this by employing the mean-field approximation of statistical physics to compute the posterior disease probabilities for a given subset of observed signs (symptoms) in a probabilistic model of signs and diseases. A Monte Carlo optimization algorithm is then used to maximize an objective function of the sequence of observations, which favors the more decisive observations resulting in more polarized disease probabilities. We see how the observed signs change the nature of the macroscopic (Gibbs) states of the sign and disease probability distributions. The structure of these macroscopic states in the configuration space of the variables affects the quality of any approximate inference algorithm (so the diagnostic performance) which tries to estimate the sign-disease marginal probabilities. In particular, we find that the simulation (or extrapolation) of the diagnostic process is helpful when the disease landscape is not trivial and the system undergoes a phase transition to an ordered phase.

  8. DIAGNOSTIC BLOCKS OF THE TIBIAL NERVE IN SPASTIC HEMIPARESIS - EFFECTS ON CLINICAL, ELECTROPHYSIOLOGICAL AND GAIT PARAMETERS

    NARCIS (Netherlands)

    ARENDZEN, JH; VANDUIJN, H; BECKMANN, MKF; HARLAAR, J; VOGELAAR, TW; PREVO, AJH

    The value of a diagnostic block (DB) of the tibial nerve in 17 hemiparetic patients with gait disturbances was investigated. The purpose of this study was to find instruments that help to select patients who will benefit from a long lasting peripheral nerve block. The manually elicited ankle clonus

  9. panelcn.MOPS: Copy-number detection in targeted NGS panel data for clinical diagnostics.

    Science.gov (United States)

    Povysil, Gundula; Tzika, Antigoni; Vogt, Julia; Haunschmid, Verena; Messiaen, Ludwine; Zschocke, Johannes; Klambauer, Günter; Hochreiter, Sepp; Wimmer, Katharina

    2017-07-01

    Targeted next-generation-sequencing (NGS) panels have largely replaced Sanger sequencing in clinical diagnostics. They allow for the detection of copy-number variations (CNVs) in addition to single-nucleotide variants and small insertions/deletions. However, existing computational CNV detection methods have shortcomings regarding accuracy, quality control (QC), incidental findings, and user-friendliness. We developed panelcn.MOPS, a novel pipeline for detecting CNVs in targeted NGS panel data. Using data from 180 samples, we compared panelcn.MOPS with five state-of-the-art methods. With panelcn.MOPS leading the field, most methods achieved comparably high accuracy. panelcn.MOPS reliably detected CNVs ranging in size from part of a region of interest (ROI), to whole genes, which may comprise all ROIs investigated in a given sample. The latter is enabled by analyzing reads from all ROIs of the panel, but presenting results exclusively for user-selected genes, thus avoiding incidental findings. Additionally, panelcn.MOPS offers QC criteria not only for samples, but also for individual ROIs within a sample, which increases the confidence in called CNVs. panelcn.MOPS is freely available both as R package and standalone software with graphical user interface that is easy to use for clinical geneticists without any programming experience. panelcn.MOPS combines high sensitivity and specificity with user-friendliness rendering it highly suitable for routine clinical diagnostics. © 2017 The Authors. Human Mutation published by Wiley Periodicals, Inc.

  10. Clinical, diagnostic and therapeutic management of patients with breast tuberculosis: Analysis of 46 Cases

    Directory of Open Access Journals (Sweden)

    Murat Ozgur Kilic

    2016-01-01

    Full Text Available Breast tuberculosis is a rare form of extrapulmonary tubercular infection. Our aim is to highlight the nonspecific clinical presentations, diagnostic difficulties and therapeutic approaches of mammarian tuberculosis. Forty-six patients diagnosed with breast tuberculosis between 2005 and 2015 were reviewed retrospectively. Clinical features, all diagnostic methods, and the outcomes of treatment were analysed. All cases were female with a mean age of 36.4 years. Breast mass and pain were the most common complaints. While 34.8% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BI-RADS 4 or 5 lesions suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy (n = 29, excisional biopsy (n = 12, and open biopsy (n = 5 taken from the abscess wall during drainage. Standard antiTB therapy for 6 months was given to all cases. Thirty-three patients recovered with standard 6-month therapy while extended treatment for 9–12 months was needed in 13 (28.2% cases. Surgery was carried out in 17 cases. Two patients developed recurrence. Breast tuberculosis can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although antiTB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.

  11. MODIFIED ALVARADO SCORING AS A DIAGNOSTIC TOOL IN ACUTE APPENDICITIS- A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    V. K. Arun Kumar

    2017-02-01

    Full Text Available BACKGROUND Acute Appendicitis commonest community-acquired intra-abdominal infections. Acute appendicitis and its associated complications are significant source of morbidity and sometimes mortality. The Modified Alvarado Scoring System (MASS has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. Diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. The aim of the study is to evaluate the efficacy of the modified Alvarado score as a diagnostic tool in Acute Appendicitis, as the diagnosis of appendicitis depends on the onset of symptoms and the subjective interpretation of the physical examination. MATERIALS AND METHODS This was a prospective study carried out in Pondicherry Institute of Medical Science during the period of November 2013 to May 2015. This study was done on 50 patients diagnosed with Acute Appendicitis and admitted in General Surgery. RESULTS In this study, there were a total of 50 patients who were taken up for surgery based on clinical and radiological diagnosis. Our study demonstrates that modified Alvarado score applied to all adult patients of acute appendicitis in adults with a sensitivity of 60% and a specificity of 40% only. Showing it wasn’t efficient in diagnosing acute appendicitis. The positive predictive value shown by our study was 80% which is marginally lower than that explained in literature which reports 87.5%. Negative appendicectomy rate in this study is 12%. CONCLUSION Alvarado score is a non-invasive, safe diagnostic procedure, which is simple, fast reliable and repeatable; it can be used in all conditions, without expensive and complicated supportive diagnostic methods. Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of

  12. CLINICAL MANIFESTATION, DIAGNOSTICS AND TREATMENT OF KAWASAKI DISEASE: KNOWN DATA AND UNSOLVED QUESTIONS

    Directory of Open Access Journals (Sweden)

    G. А. Lyskina

    2013-01-01

    Full Text Available The lecture deals with the most common systemic vasculitis in pediatric practice — Kawasaki disease. This disorder is associated with risk of myocardial infarction and sudden cardiac death in children and young adults and at present is considered to be the main cause of the acquired heard diseases in children. The authors give historical aspects and modern opinions on etiology, pathogenesis, clinical manifestation, diagnostics and treatment of Kawasaki disease. The data were summarized from Russian and foreign literature as well as from the own authors’ experience.

  13. Clinical findings and diagnostic imaging of small intestinal rupture due to blunt abdominal trauma

    International Nuclear Information System (INIS)

    Takahashi, Hitoshi; Sakata, Ikuhiro; Ogawa, Masaaki; Izumoto, Gentaro; Kim, Akio; Maeda, Shigenari; Yasutomi, Masayuki; Yamamoto, Toshio

    1987-01-01

    Eight patients with small intestinal rupture due to blunt abdominal trauma were analyzed by their clinical findings and diagnostic imaging (plain film, ultrasound and computed tomography). Computed tomography was most useful for identification of intraabdominal extraluminal free air (pneumoperitoneum) and this finding was obtained in seven out of the eight patients (87.5 %). Intraabdominal fluid collection was observed in All the patients and was most clearly detectable by ultrasound and computed tomography. These examinations may be applied to identification of properties of the fluid collection. All the patients eventually developed peritonitis when laparotomy was decided. Thus, close follow up observation of abdominal physical signs was also of critical importance. (author)

  14. Malignant otitis externa: Variability of clinical course and difficulties of diagnostics

    Directory of Open Access Journals (Sweden)

    Janićijević Miloš

    2014-01-01

    Full Text Available This paper shows the case of a 70-year-old diabetic patient who was admitted to the ORL and MFS clinic as an emergency case with the right ear otalgia, in the right mastoid extension, facialis paralysis and the right ear suppuration all of which lasted for a month before the hospitalization. On admission, the initial diagnostics stated canal skin edema of the external hearing canal which made the eardrum impossible to visualize. Granulations at the bottom of the canal were visible. During the admission, the patient was submitted to conservative and surgical treatments which confirmed that it was the case of malignant otitis externa.

  15. Transcriptomics in cancer diagnostics: developments in technology, clinical research and commercialization.

    Science.gov (United States)

    Sager, Monica; Yeat, Nai Chien; Pajaro-Van der Stadt, Stefan; Lin, Charlotte; Ren, Qiuyin; Lin, Jimmy

    2015-01-01

    Transcriptomic technologies are evolving to diagnose cancer earlier and more accurately to provide greater predictive and prognostic utility to oncologists and patients. Digital techniques such as RNA sequencing are replacing still-imaging techniques to provide more detailed analysis of the transcriptome and aberrant expression that causes oncogenesis, while companion diagnostics are developing to determine the likely effectiveness of targeted treatments. This article examines recent advancements in molecular profiling research and technology as applied to cancer diagnosis, clinical applications and predictions for the future of personalized medicine in oncology.

  16. [The challenges of standardization in clinical diagnostic laboratories of medical organizations].

    Science.gov (United States)

    Men'shikov, V V

    2013-04-01

    The generalized data concerning the conditions of application of regulations of national standards in clinical diagnostic laboratories of medical organizations is presented. The primary information was provided by 14 regions of 6 federal administrative okrugs of Russia. The causes of challenges of application of requirements of standards are presented. They are mostly related with insufficient financial support, lacking of manpower, difficulties with reagents supply, inadequate technical maintenance of devices and absence of support of administration of medical organizations. The recommendations are formulated concerning the necessity of publishing the document of Minzdrav of Russia to determine the need in application of standards in laboratory practice.

  17. Principles of dispensary observation of patients with Parkinson's disease in a specialized clinical diagnostic room

    Directory of Open Access Journals (Sweden)

    Krivonos О.V.

    2013-12-01

    Full Text Available Aim: to develop and implement of the order of the dispensary observation of Parkinson's disease patients. Material and methods, the dispensary observation of Parkinson's disease patients had been performed by neurologist and diagnostic room (CDR based on the outpatient department of health care institutions obeyed by FMBA of Russia in six Closed Administrative-Territorial Units: Seversk, Zarechniy, Ozersk, Lesnoy, Sarov and Zheleznogorsk. Neurologist examined of patients and put data to the Register's database. Register's database had 588 Parkinson's disease examined patients, 112 of them (19,1% had stage II of the disease by Hoehn and Yahr, 231 (39,3% patients — stage III by Hoehn and Yahr, 187 (31,8% patients — stage IV byHoehn and Yahr, 58 (9,9% patients — stage V by Hoehn and Yahr. The duration of the dispensary observation of Parkinson's disease patients was 4 years (2009-2012. Results. There are and implement the order of the observed and accounting of adult's group of Parkinson's disease patients were developed, who are registered in the clinical and diagnostic rooms, including the frequency of physician's visits, the list of diagnostic and treatment activities and efficiency endpoint of the dispensary observation. Conclusion. Implementation of the order of the dispensary observation according to the Register allowed to identify the main disabling PD's symptoms (depression, dementia, motor fluctuations and dyskinesia and timely correction of therapy.

  18. Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: clinical, diagnostic and epidemiological characteristics.

    Science.gov (United States)

    Bruchfeld, Judith; Aderaye, Getachew; Palme, Ingela Berggren; Bjorvatn, Bjarne; Britton, Sven; Feleke, Yewenhareg; Källenius, Gunilla; Lindquist, Lars

    2002-01-01

    In a setting with a high prevalence of HIV we studied (i) the prevalence of pulmonary tuberculosis (PTB) and HIV; (ii) clinical and epidemiological characteristics of PTB; and (iii) the usefulness of standard procedures for diagnosing PTB. Of 509 consecutive outpatients evaluated on clinical suspicion of PTB in Addis Ababa, 33.0% were culture-verified as having PTB. PTB patients, non-TB patients and controls were HIV-1-positive in 57.1%, 38.5% and 8.3% of cases, respectively. Predictors for culture-verified PTB were age infection. Diagnosis of PTB based on clinical symptoms, sputum microscopy for acid-fast bacilli and chest radiography was sensitive (86.7%) but unspecific (64.1%). In HIV-positive patients both sensitivity and specificity were significantly lower (p infections are often misinterpreted as smear-negative PTB. HIV screening is therefore warranted not only in cases of verified TB but also as part of the diagnostic work-up in patients with respiratory symptoms suggestive of PTB. Also, increased awareness of, and improved diagnostic tools for, HIV-related pulmonary infections other than PTB are required, together with algorithms for patients with suspected PTB.

  19. The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A

    2016-08-01

    The Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term "somatic symptoms" reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research.

  20. MO-C-BRB-06: Translating NIH / NIBIB funding to clinical reality in quantitative diagnostic imaging

    International Nuclear Information System (INIS)

    Jackson, E.

    2015-01-01

    Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration

  1. MO-C-BRB-06: Translating NIH / NIBIB funding to clinical reality in quantitative diagnostic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, E. [University of Wisconsin (United States)

    2015-06-15

    Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration

  2. Non invasive radiofrequency diagnostics of cancer. The Bioscanner — Trimprob technology and clinical applications

    Science.gov (United States)

    Vedruccio, Clarbruno; Ricci Vedruccio, Carla

    2011-12-01

    A new paper by Pokorny, Vedruccio, Cifra, Kucera, titled Cancer physics: Diagnostics based on damped cellular elasto-electrical vibrations in microtubules, recently available on Eur. Biophys. J., discloses the mechanism of active grown cancer tissues interaction with a Non- Linear Resonance Interaction (NLRI) Bioscanner Trimprob diagnostic device that is certified and ready to be used to investigate suspected cases of disease and cancer. This technology spreads early capabilities of cancer detection by means of low level radiofrequency oscillations in UHF band. The system is based on an unique and extremely innovative non- linear radiofrequency oscillator working on 462-465 MHz plus the harmonics. The diseased tissues suspected of cancer, are irradiated by means of a handy probe near field emission, while a spectrum analyzer placed in the far field detects by means of a small antenna, the oscillator interaction within the tissues. The Bioscanner is characterized by a high dynamic range, in the order of 30 or more decibel, and is useful for detection of small cancer agglomerates, if used by a well trained operator. At the resonance, the free running oscillator locks-in on the specific interaction frequency, in a sharp frequency window centered on 462 MHz; the resulting effect is evidenced by a deep decrease of the 462 MHz spectral line propagation in the far field around the oscillator probe. The NLRI provides a selective characterization, like a sort of a electronic biopsy response of biologic tissues in support of modern imaging diagnostics. Further to existing literature describing methods for cancer detections by means of electromagnetic fields this paper shows this innovative in vivo medical diagnostic equipment and some clinical applications.

  3. Non invasive radiofrequency diagnostics of cancer. The Bioscanner — Trimprob technology and clinical applications

    International Nuclear Information System (INIS)

    Vedruccio, Clarbruno; Vedruccio, Carla Ricci

    2011-01-01

    A new paper by Pokorny, Vedruccio, Cifra, Kucera, titled Cancer physics: Diagnostics based on damped cellular elasto-electrical vibrations in microtubules, recently available on Eur. Biophys. J., discloses the mechanism of active grown cancer tissues interaction with a Non- Linear Resonance Interaction (NLRI) Bioscanner Trimprob diagnostic device that is certified and ready to be used to investigate suspected cases of disease and cancer. This technology spreads early capabilities of cancer detection by means of low level radiofrequency oscillations in UHF band. The system is based on an unique and extremely innovative non- linear radiofrequency oscillator working on 462-465 MHz plus the harmonics. The diseased tissues suspected of cancer, are irradiated by means of a handy probe near field emission, while a spectrum analyzer placed in the far field detects by means of a small antenna, the oscillator interaction within the tissues. The Bioscanner is characterized by a high dynamic range, in the order of 30 or more decibel, and is useful for detection of small cancer agglomerates, if used by a well trained operator. At the resonance, the free running oscillator locks-in on the specific interaction frequency, in a sharp frequency window centered on 462 MHz; the resulting effect is evidenced by a deep decrease of the 462 MHz spectral line propagation in the far field around the oscillator probe. The NLRI provides a selective characterization, like a sort of a electronic biopsy response of biologic tissues in support of modern imaging diagnostics. Further to existing literature describing methods for cancer detections by means of electromagnetic fields this paper shows this innovative in vivo medical diagnostic equipment and some clinical applications.

  4. State of malaria diagnostic testing at clinical laboratories in the United States, 2010: a nationwide survey

    Directory of Open Access Journals (Sweden)

    Abanyie Francisca A

    2011-11-01

    Full Text Available Abstract Background The diagnosis of malaria can be difficult in non-endemic areas, such as the United States, and delays in diagnosis and errors in treatment occur too often. Methods A nationwide survey of laboratories in the United States and its nine dependent territories was conducted in 2010 to determine factors that may contribute to shortcomings in the diagnosis of malaria. This survey explored the availability of malaria diagnostic tests, techniques used, and reporting practices. Results The survey was completed by 201 participants. Ninety percent reported that their laboratories had at least one type of malaria diagnostic test available on-site. Nearly all of the respondents' laboratories performed thick and thin smears on-site; approximately 50% had access to molecular testing; and only 17% had access to rapid diagnostic tests on-site. Seventy-three percent reported fewer than five confirmed cases of malaria in their laboratory during the 12-month period preceding the survey. Twenty-eight percent stated that results of species identification took more than 24 hours to report. Only five of 149 respondents that performed testing 24 hours a day, 7 days a week complied with all of the Clinical and Laboratory Standards Institute (CLSI guidelines for analysis and reporting of results. Conclusion Although malaria diagnostic testing services were available to a majority of U.S. laboratories surveyed, very few were in complete compliance with all of the CLSI guidelines for analysis and reporting of results, and most respondents reported very few cases of malaria annually. Laboratories' difficulty in adhering to the rigorous CLSI guidelines and their personnel's lack of practice and proficiency may account for delays and errors in diagnosis. It is recommended that laboratories that infrequently process samples for malaria seek opportunities for practice and proficiency training annually and take advantage of available resources to assist in

  5. Indications and new diagnostic techniques in micturating cystourethrographic studies

    International Nuclear Information System (INIS)

    Schuster, W.; Bruenger, J.

    1978-01-01

    Urological radiographic procedures on children are of great importance. The frequency of examinations is comparable to the number of Gl tract studies. In diagnosing chronically recurrent urinary tract infections, micturating cystourethrography is a valuable addition to excretory urography. Indications and performance of micturating cystourethrography at juvenile age are described. All measures reducing radiation exposure must be taken into consideration. New technological devices grant improved diagnostic information with a minimal radiation exposure for patients. (orig.) [de

  6. Infections in orthopaedic surgery : clinical and experimental studies

    NARCIS (Netherlands)

    Vogely, Henri Charles

    2000-01-01

    The diagnostic difficulties, variability in outcome and the heterogeinity of the problem of orthopaedic infections stimulated the author to a study of the literature, and several clinical and experimental studies. The diagnosis prosthesis-related infection can only be reached with an acceptable

  7. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

    Science.gov (United States)

    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (pdiagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (pdiagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (pdiagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), pdiagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  8. Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

    Science.gov (United States)

    Salimi, Fereshteh; Shahabi, Shahab; Talebzadeh, Hamid; Keshavarzian, Amir; Pourfakharan, Mohammad; Safaei, Mansour

    2017-01-01

    Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis ( P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

  9. Adult Attention Deficit Hyperactivity Disorder: Neurobiology, Diagnostic Problems and Clinical Features

    Directory of Open Access Journals (Sweden)

    Cengiz Tuglu

    2010-04-01

    Full Text Available Attention-deficit/hyperactivity disorder (ADHD is a chronic, lifelong neurobeha-vioral disorder with childhood-onset, which seriously impairs the affected adults in a variety of daily living functions like academic, social and occupational functioning. Prevalence of ADHD declines with age in the general population. The approximate prevalence rates of ADHD is 8% in childhood, 6% in adolescence and 4% in adulthood. The unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD. The disorder is characterized by behavioral symptoms of inattention, hyperactivity, and impulsivity across the life cycle and is associated with considerable morbidity and disability. Although its etiology remains unclear, considerable evidence documents its strong neurobiological and genetic underpinnings. ADHD is associated with a high percentage of comorbid psychiatric disorders in every lifespan. In adulthood between 65-89% of all patients with ADHD suffer from one or more additional psychiatric disorders, above all mood and anxiety disorders, substance use disorders and personality disorders, which complicate the clinical picture in terms of diagnostics, treatment and outcome issues. The high comorbidity with other psychiatric disorders, the resulting deficits in social competences and risky health behavior that often go along with a diminished life quality must be stressed in these patients. Preventive and therapeutic interventions should be taken at an early stage to counteract the possible negative influences of ADHD on functioning and relationships. In this paper, we reviewed the historical aspects, epidemiology, neurobiology, comorbidity, diagnostic difficulties and clinical features of adult ADHD.

  10. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    Directory of Open Access Journals (Sweden)

    Manzar Vakili

    2015-01-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2 less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 % in the 24 hours and 4 (1.33% patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937 and sex (P

  11. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol

    International Nuclear Information System (INIS)

    Gomes, Mafalda; Matias, Alexandra; Macedo, Filipe

    2015-01-01

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting. (orig.)

  12. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol.

    Science.gov (United States)

    Gomes, Mafalda; Matias, Alexandra; Macedo, Filipe

    2015-12-01

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.

  13. Next-Generation Sequencing in Clinical Molecular Diagnostics of Cancer: Advantages and Challenges

    Directory of Open Access Journals (Sweden)

    Rajyalakshmi Luthra

    2015-10-01

    Full Text Available The application of next-generation sequencing (NGS to characterize cancer genomes has resulted in the discovery of numerous genetic markers. Consequently, the number of markers that warrant routine screening in molecular diagnostic laboratories, often from limited tumor material, has increased. This increased demand has been difficult to manage by traditional low- and/or medium-throughput sequencing platforms. Massively parallel sequencing capabilities of NGS provide a much-needed alternative for mutation screening in multiple genes with a single low investment of DNA. However, implementation of NGS technologies, most of which are for research use only (RUO, in a diagnostic laboratory, needs extensive validation in order to establish Clinical Laboratory Improvement Amendments (CLIA and College of American Pathologists (CAP-compliant performance characteristics. Here, we have reviewed approaches for validation of NGS technology for routine screening of tumors. We discuss the criteria for selecting gene markers to include in the NGS panel and the deciding factors for selecting target capture approaches and sequencing platforms. We also discuss challenges in result reporting, storage and retrieval of the voluminous sequencing data and the future potential of clinical NGS.

  14. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Mafalda; Matias, Alexandra [University of Porto, Faculty of Medicine, Porto (Portugal); Macedo, Filipe [SMIC, Porto (Portugal)

    2015-12-15

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting. (orig.)

  15. NRASQ61K mutated primary leptomeningeal melanoma in a child: case presentation and discussion on clinical and diagnostic implications

    International Nuclear Information System (INIS)

    Angelino, Giulia; De Pasquale, Maria Debora; De Sio, Luigi; Serra, Annalisa; Massimi, Luca; De Vito, Rita; Marrazzo, Antonio; Lancella, Laura; Carai, Andrea; Antonelli, Manila; Giangaspero, Felice; Gessi, Marco; Menchini, Laura; Scarciolla, Laura; Longo, Daniela; Mastronuzzi, Angela

    2016-01-01

    Primary melanocytic neoplasms are rare in the pediatric age. Among them, the pattern of neoplastic meningitis represents a peculiar diagnostic challenge since neuroradiological features may be subtle and cerebrospinal fluid analysis may not be informative. Clinical misdiagnosis of neoplastic meningitis with tuberculous meningitis has been described in few pediatric cases, leading to a significant delay in appropriate management of patients. We describe the case of a child with primary leptomeningeal melanoma (LMM) that was initially misdiagnosed with tuberculous meningitis. We review the clinical and molecular aspects of LMM and discuss on clinical and diagnostic implications. A 27-month-old girl with a 1-week history of vomiting with mild intermittent strabismus underwent Magnetic Resonance Imaging, showing diffuse brainstem and spinal leptomeningeal enhancement. Cerebrospinal fluid analysis was unremarkable. Antitubercular treatment was started without any improvement. A spinal intradural biopsy was suggestive for primary leptomeningeal melanomatosis. Chemotherapy was started, but general clinical conditions progressively worsened and patient died 11 months after diagnosis. Molecular investigations were performed post-mortem on tumor tissue and revealed absence of BRAF V600E , GNAQ Q209 and GNA11 Q209 mutations but the presence of a NRAS Q61K mutation. Our case adds some information to the limited experience of the literature, confirming the presence of the NRAS Q61K mutation in children with melanomatosis. To our knowledge, this is the first case of leptomeningeal melanocytic neoplasms (LMN) without associated skin lesions to harbor this mutation. Isolated LMN presentation might be insidious, mimicking tuberculous meningitis, and should be suspected if no definite diagnosis is possible or if antitubercular treatment does not result in dramatic clinical improvement. Leptomeningeal biopsy should be considered, not only to confirm diagnosis of LMN but also to study

  16. The Clinical Utility and Diagnostic Performance of MRI for Identification of Early and Advanced Knee Osteoarthritis: A Systematic Review

    Science.gov (United States)

    Quatman, Carmen E.; Hettrich, Carolyn M.; Schmitt, Laura C.; Spindler, Kurt P.

    2013-01-01

    Background Current diagnostic strategies for detection of structural articular cartilage abnormalities, the earliest structural signs of osteoarthritis, often do not capture the condition until it is too far advanced for the most potential benefit of non-invasive interventions. Purpose Systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate and reliable instrument to identify knee articular cartilage abnormalities compared to arthroscopy? (2) Is MRI a sensitive tool that can be utilized to identify early cartilage degeneration? Study Design Systematic Review Methods A systematic search was performed in November 2010 using PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), and SCOPUS (from 1996) databases. Results Fourteen level I and 13 level II studies were identified that met inclusion criteria and provided information related to diagnostic performance of MRI compared to arthroscopic evaluation. The diagnostic performance of MRI demonstrated a large range of sensitivities, specificities, and accuracies. The sensitivity for identifying articular cartilage abnormalities in the knee joint was reported between 26–96%. Specificity and accuracy was reported between 50–100% and 49–94%, respectively. The sensitivity, specificity, and accuracy for identifying early osteoarthritis were reported between 0–86%, 48–95%, and 5–94%, respectively. As a result of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed and it was difficult to fully synthesize the information to state firm conclusions about the diagnostic performance of MRI. Conclusions There is evidence in some MRI protocols that MRI is a relatively valid, sensitive, specific, accurate, and reliable clinical tool for identifying articular cartilage degeneration. Due to heterogeneity of MRI sequences it is not possible to make definitive

  17. Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods

    International Nuclear Information System (INIS)

    Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H.; Wimmer, G.; Wahl, G.; Fridrik, M.

    2000-01-01

    Aim of the present retrospective study was to validate the clinical value of F-18-FDG PET imaging in lymphoma patients with a dual head camera modified for coincidence detection. Staging before and after oncological treatment was compared with a conservative diagnostic approach. Methods: 48 patients (28 non-Hodgkin lymphoma, 20 Hodgkin's disease) received FDG-Hybrid-PET scans. Pretherapeutic staging was realized in 28 patients, 9 of them had control studies after they had completed therapy. Totally 29 persons were examined for posttherapeutic restaging. Computed tomography imaging and lymph node sonography was performed in all cases. Results were validated by clinical follow-up, in three cases a recidive was proven by biopsy. Results: CT and ultrasound detected 77 lesions in 28 patients compared with 100 visualized by PET, but this difference in pretherapeutic staging did not reach significance at p>0.05 by Fisher's t-test. Hybrid-PET obtained a sensitivity of 93%, a specifity of 79%, a positive of 82% and a negative predictive value of 92% for detection of residual disease. The values for CT+US were 87%, 64%, 72% and 88% respectively. Conclusion: FDG Hybrid-PET is as or even more accurate than standard morphologic diagnostic methods for prestaging in malignant lymphoma. Additionally, there is a substancial benefit for therapy monitoring of residual disease using coincidence detection PET with a 3/4-inch crystal gamma camera. (orig.) [de

  18. Efficacy of clinical diagnostic procedures utilized in nuclear medicine. Technical progress report, 1 December 1981-30 November 1982

    International Nuclear Information System (INIS)

    Saenger, E.L.

    1982-07-01

    The efficacy of nuclear medicine diagnostic procedures was measured. Three levels of efficacy were defined. However, two different methods of evaluating efficacy itself were first compared. Using two methods, logistic regression and entropy-minimax pattern detection, substantial agreement was found between them in several clinical observations. (1) There are no attributes that indicate that any grouping of symptoms, signs, and laboratory findings is capable of suggesting that a patient does or does not have a pulmonary embolus. (2) The lung scan test is the only reliable method which indicates that a patient may have a pulmonary embolus or does not have a pulmonary embolus. (3) The validity of these conclusions and the ability to apply them widely to ongoing clinical practice is based on the prospective design of the Study which included an appropriate distribution of institutions by type, size, and geographic location. Also, the only judgement samples was that of the referring physician

  19. Research at ITER towards DEMO: Specific reactor diagnostic studies to be carried out on ITER

    Science.gov (United States)

    Krasilnikov, A. V.; Kaschuck, Y. A.; Vershkov, V. A.; Petrov, A. A.; Petrov, V. G.; Tugarinov, S. N.

    2014-08-01

    In ITER diagnostics will operate in the very hard radiation environment of fusion reactor. Extensive technology studies are carried out during development of the ITER diagnostics and procedures of their calibration and remote handling. Results of these studies and practical application of the developed diagnostics on ITER will provide the direct input to DEMO diagnostic development. The list of DEMO measurement requirements and diagnostics will be determined during ITER experiments on the bases of ITER plasma physics results and success of particular diagnostic application in reactor-like ITER plasma. Majority of ITER diagnostic already passed the conceptual design phase and represent the state of the art in fusion plasma diagnostic development. The number of related to DEMO results of ITER diagnostic studies such as design and prototype manufacture of: neutron and γ-ray diagnostics, neutral particle analyzers, optical spectroscopy including first mirror protection and cleaning technics, reflectometry, refractometry, tritium retention measurements etc. are discussed.

  20. Research at ITER towards DEMO: Specific reactor diagnostic studies to be carried out on ITER

    International Nuclear Information System (INIS)

    Krasilnikov, A. V.; Kaschuck, Y. A.; Vershkov, V. A.; Petrov, A. A.; Petrov, V. G.; Tugarinov, S. N.

    2014-01-01

    In ITER diagnostics will operate in the very hard radiation environment of fusion reactor. Extensive technology studies are carried out during development of the ITER diagnostics and procedures of their calibration and remote handling. Results of these studies and practical application of the developed diagnostics on ITER will provide the direct input to DEMO diagnostic development. The list of DEMO measurement requirements and diagnostics will be determined during ITER experiments on the bases of ITER plasma physics results and success of particular diagnostic application in reactor-like ITER plasma. Majority of ITER diagnostic already passed the conceptual design phase and represent the state of the art in fusion plasma diagnostic development. The number of related to DEMO results of ITER diagnostic studies such as design and prototype manufacture of: neutron and γ–ray diagnostics, neutral particle analyzers, optical spectroscopy including first mirror protection and cleaning technics, reflectometry, refractometry, tritium retention measurements etc. are discussed

  1. Research at ITER towards DEMO: Specific reactor diagnostic studies to be carried out on ITER

    Energy Technology Data Exchange (ETDEWEB)

    Krasilnikov, A. V.; Kaschuck, Y. A.; Vershkov, V. A.; Petrov, A. A.; Petrov, V. G.; Tugarinov, S. N. [Institution Project center ITER, Moscow (Russian Federation)

    2014-08-21

    In ITER diagnostics will operate in the very hard radiation environment of fusion reactor. Extensive technology studies are carried out during development of the ITER diagnostics and procedures of their calibration and remote handling. Results of these studies and practical application of the developed diagnostics on ITER will provide the direct input to DEMO diagnostic development. The list of DEMO measurement requirements and diagnostics will be determined during ITER experiments on the bases of ITER plasma physics results and success of particular diagnostic application in reactor-like ITER plasma. Majority of ITER diagnostic already passed the conceptual design phase and represent the state of the art in fusion plasma diagnostic development. The number of related to DEMO results of ITER diagnostic studies such as design and prototype manufacture of: neutron and γ–ray diagnostics, neutral particle analyzers, optical spectroscopy including first mirror protection and cleaning technics, reflectometry, refractometry, tritium retention measurements etc. are discussed.

  2. Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility

    International Nuclear Information System (INIS)

    Lee, Tain; Tsai, I.C.; Chen, Min-Chi; Fu, Yun-Ching; Jan, Sheng-Lin; Wang, Chung-Chi; Chang, Yen

    2006-01-01

    Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions. To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease. Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated. A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed. The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates. (orig.)

  3. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys.

    Science.gov (United States)

    Akamizu, Takashi; Satoh, Tetsurou; Isozaki, Osamu; Suzuki, Atsushi; Wakino, Shu; Iburi, Tadao; Tsuboi, Kumiko; Monden, Tsuyoshi; Kouki, Tsuyoshi; Otani, Hajime; Teramukai, Satoshi; Uehara, Ritei; Nakamura, Yosikazu; Nagai, Masaki; Mori, Masatomo

    2012-07-01

    /dL. TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.

  4. Analyzing paired diagnostic studies by estimating the expected benefit

    DEFF Research Database (Denmark)

    Gerke, Oke; Høilund-Carlsen, Poul Flemming; Vach, Werner

    2015-01-01

    is of an indirect nature as test results do influence downstream clinical decisions, but test performance (as characterized by sensitivity, specificity, and the predictive values of a procedure) is, at best, only a surrogate endpoint for patient outcome and does not necessarily translate into it. Not many...... randomized controlled trials have been conducted so far in diagnostic research, and, hence, we need alternative approaches to close the gap between test characteristics and patient outcomes. Several informal approaches have been suggested in order to close this gap, and decision modeling has been advocated...... as a means of obtaining formal approaches. Recently, the expected benefit has been proposed as a quantity that allows a simple formal approach, and we take up this suggestion in this paper. We regard the expected benefit as an estimation problem and consider two approaches to statistical inference. Moreover...

  5. Rational diagnostic studies of hyperthyroidism - can they be rationalized

    International Nuclear Information System (INIS)

    Schuemichen, C.; Bernhard, G.; Aurnhammer, R.

    1983-01-01

    The value of various diagnostic tests for recognizing hyperthyroidism was assessed in 285 patients. The prevalence of hyperthyroidism was 33% altogether: 21.8% diffuse hyperthyroidism (Graves' disease and disseminated autonomy) and 11.2% autonomous adenoma. A negative TRH-test was found in 29.5% of the euthyroid patients, 11.4% in patients younger and 40.7% in patients older than 50 years. In one patient with thyrotoxicosis the TRH-test was positive in the beginning. In 29% of the patients with diffuse hyperthyroidism and in 50% of the patients with hyperthyroid autonomous adenoma only one hormone level was elevated (T 3 , T 4 or FT 4 ). The radioioine test contributed primarily to the final diagnosis in 1.6% of diffuse hyperthyroidism and in 6.2% of hyperthyroid autonomous adenoma. Because of its high sensitivity the TRH-test remains the basic test in the diagnosis of thyrotoxicosis. The diagnostic value of T 3 and FT 4 is equivalent with slight advantages of FT 4 . In order to lower costs, the total T 4 measurements can, and the radioiodine test has to be, omitted. However, it ought to be kept in mind that if only the TRH test and T 3 and FT 4 are included in the diagnostic study, the final diagnosis is not substantiated adequately in one third of the patients with thyrotoxicosis. (orig.) [de

  6. Effect of patient age awareness on diagnostic agreement of chronic or aggressive periodontitis between clinicians; a pilot study.

    Science.gov (United States)

    Oshman, Sarah; El Chaar, Edgard; Lee, Yoonjung Nicole; Engebretson, Steven

    2016-07-25

    The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

  7. Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine

    DEFF Research Database (Denmark)

    Kurande, Vrinda Hitendra; Waagepetersen, Rasmus; Toft, Egon

    2013-01-01

    as prakriti classification), method development (pulse diagnosis), quality assurance for diagnosis and treatment and in the conduct of clinical studies. Several reliability studies are conducted in western medicine. The investigation of the reliability of traditional Chinese, Japanese and Sasang medicine...

  8. Accuracy of a Diagnostic Algorithm to Diagnose Breakthrough Cancer Pain as Compared With Clinical Assessment.

    Science.gov (United States)

    Webber, Katherine; Davies, Andrew N; Cowie, Martin R

    2015-10-01

    Breakthrough cancer pain (BTCP) is a heterogeneous condition, and there are no internationally agreed standardized criteria to diagnose it. There are published algorithms to assist with diagnosis, but these differ in content. There are no comparative data to support use. To compare the diagnostic ability of a simple algorithm against a comprehensive clinical assessment to diagnose BTCP and to assess if verbal rating descriptors can adequately discriminate controlled background pain. Patients with cancer pain completed a three-step algorithm with a researcher to determine if they had controlled background pain and BTCP. This was followed by a detailed pain consultation with a clinical specialist who was blinded to the algorithm results and determined an independent pain diagnosis. The sensitivity, specificity, and positive and negative predictive values were calculated for the condition of BTCP. Further analysis determined which verbal pain severity descriptors corresponded with the condition of controlled background pain. The algorithm had a sensitivity of 0.54 and a specificity of 0.76 in the identification of BTCP. The positive predictive value was 0.7, and the negative predictive value was 0.62. The sensitivity of a background pain severity rating of mild or less to accurately categorize controlled background pain was 0.69 compared with 0.97 for severity of moderate or less; however, this was balanced by a higher specificity rating for mild or less, 0.78 compared with 0.2. The diagnostic breakthrough pain algorithm had a good positive predictive value but limited sensitivity using a cutoff score of "mild" to define controlled background pain. When the cutoff level was changed to moderate, the sensitivity increased, but specificity reduced. A comprehensive clinical assessment remains the preferred method to diagnose BTCP. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner.

    Science.gov (United States)

    Sanfilippo, Paul G; Hewitt, Alex W; Mackey, David A

    2017-04-01

    To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

  10. Clinical study of CT colonography

    International Nuclear Information System (INIS)

    Nakazawa, Saburo; Hattori, Toshiyuki; Inui, Kazuo

    2011-01-01

    We studied the usefulness of CT colonography (CTC) for colon cancer diagnosis. CTC and optical colonoscopy were performed for 150 cases mainly including patients with a positive fecal occult blood test (FOBT). The results were compared and analyzed. The following are the final diagnoses given to the patients: advanced colon cancer: 41 cases; early cancer: 25 cases; adenoma: 74 cases; hyperplasia: 3 cases; submucosal tumor: 1 case; and no lesion: 6 cases. In terms of diagnostic performance of CTC, accuracy was found to be 96%, sensitivity was found to be 97.9%, and specificity was found to be 50%. Cancer stage-specific sensitivity was as follows: advanced colon cancer: 100%; early cancer: 96.3%; adenoma: 71.2%; and hyperplasia: 47.4%. Lesion site-specific sensitivity was as follows: caecum: 76.2%; ascending colon: 57.6%; transverse colon: 66.2%; descending colon: 83.3%; sigmoid colon: 85.1%; and rectum: 78.0%. Lesion size-specific sensitivity was as follows: 2 to 5 mm: 56.7%; 6 to 9 mm: 88.1%; 10 mm or more: 92.5%; and 6 mm or more: 90.9%. Therefore, the diagnostic sensitivity of CTC was confirmed to be high. The results suggest that CTC would be useful for colon cancer screening. (author)

  11. Diagnostic and prognostic value of asphyxia, Sarnat's clinical classification, and CT-scan in perinatal brain damage

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Toshihide; Wakita, Yoshiharu; Kubonishi, Sakae; Yoshikawa, Seishi (Kochi Prefectural Central Hospital (Japan)); Ito, Toshiyuki; Okada, Yasusuke

    1990-11-01

    A retrospective review was made of 145 babies, excluding those with congenital heart disease or chromosome aberration, admitted for CT scanning. The study was done to determine the diagnostic and prognostic value of CT findings, as well as the presence of asphyxia and the clinical stage based on the Sarnat's classification, in perinatal brain damage. The patients had a minimum follow up of 2 years for the evaluation of neurologic manifestations, such as cerebral palsy, epilepsy and mental retardation. Among babies weighing 2,000 g or more at birth, neonatal asphyxia was significantly correlated with neurologic prognosis. In addition, both clinical stages and CT findings were significantly correlated with neurologic prognosis, irrespective of birth weight. The correlation between clinical stages and CT findings was significant, irrespective of body weight, however, a significant correlation between clinical stages and neonatal asphyxia was restricted to those weighing 2,000 g or more. These findings suggest that the presence of asphyxia, clinical stages and CT findings are complementary in the diagnosis and prognosis evaluation of perinatal brain damage. (N.K.).

  12. [The 8-year follow-up study for clinical diagnostic potentials of frequency-doubling technology perimetry for perimetrically normal eyes of open-angle glaucoma patients with unilateral visual field loss].

    Science.gov (United States)

    Fan, X; Wu, L L; Xiao, G G; Ma, Z Z; Liu, F

    2018-03-11

    Objective: To analyze potentials of frequency-doubling technology perimetry (FDP) for diagnosing open-angle glaucoma (OAG) in perimetrically normal eyes of OAG patients diagnosed with standard automated perimetry (SAP) and relating factors from abnormalities on FDP to visual field loss on SAP. Methods: A prospective cohort study. Sixty-eight eyes of 68 OAG patients visiting the ophthalmic clinic of Peking University Third Hospital during November 2003 and October 2007 [32 primary open-angle glaucoma patients and 36 normal tension glaucoma patients, 32 males and 36 females, with an average age of (59±13) years] with unilateral field loss detected by SAP (Octopus101 tG2 program) were examined with the FDP N-30 threshold program (Humphrey Instruments) at baseline. Two groups, FDP positive group and FDP negative group, were divided based on the FDP results, and visual field examinations were followed by a series of SAP examinations for the perimetrically normal eyes over 8 years. During the follow-up, the difference of the converting rate of SAP tests between the two groups was analyzed. Differences between "convertors" and "non-convertors" of SAP tests in the FDP positive group, such as the cup-to-disk ratio and glaucomatous optic neuropathy rate, were also compared with the independent-sample t test or Wilcoxon two-sample test for continuous variable data and the χ(2) test or Fisher exact test for classified variable data and rates. Results: Forty-eight perimetrically normal eyes of 48 participants had complete data and a qualifying follow-up. Baseline FDP results were positive in 33 eyes and negative in 15 eyes. Of the eyes with positive FDP results, 22 eyes developed abnormal SAP results after 4.0 to 90.0 months (median 14.5 months) , whereas none of the eyes with negative FDP results developed abnormal SAP results. For perimetrically normal eyes in the FDP positive group, "converters" showed a greater cup-to-disk ratio (0.73±0.09 vs . 0.63±0.14, Wilcoxon two

  13. Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism

    NARCIS (Netherlands)

    Den Exter, P. L.; Van Es, J.; Erkens, P. G. M.; Roosmalen, M.; Hoven, P.; Hovens, M.; Kamphuisen, P. W.; Klok, F. A.; Huisman, M.

    Background: The non-specific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Aims: To assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: For this post-hoc analysis, we used

  14. The value of the clinical geneticist caring for adults with congenital heart disease: diagnostic yield and patients' perspective

    NARCIS (Netherlands)

    van Engelen, Klaartje; Baars, Marieke J. H.; Felix, Joyce P.; Postma, Alex V.; Mulder, Barbara J. M.; Smets, Ellen M. A.

    2013-01-01

    For adult patients with congenital heart disease (CHD), knowledge about the origin and inheritance of their CHD is important. Clinical geneticists may play a significant role in their care. We explored the diagnostic yield of clinical genetic consultation of adult CHD patients, patients' motivations

  15. CLASSIFICATION OF TEMPOROMANDIBULAR-JOINT OSTEOARTHROSIS AND INTERNAL DERANGEMENT .1. DIAGNOSTIC-SIGNIFICANCE OF CLINICAL AND RADIOGRAPHIC SYMPTOMS AND SIGNS

    NARCIS (Netherlands)

    STEGENGA, B; DEBONT, LGM; VANDERKUIJL, B; BOERING, G

    In the clinical setting, diagnosis primarily depends on the history and present status of the patient, and on the examiner's expertise in physical examination and interpretation of conventional radiographs. In order to evaluate the diagnostic significance of clinical and radiographic variables, the

  16. Clinical and Demographic Stratification of Test Performance: A Pooled Analysis of Five Laboratory Diagnostic Methods for American Cutaneous Leishmaniasis

    Science.gov (United States)

    Boggild, Andrea K.; Ramos, Ana P.; Espinosa, Diego; Valencia, Braulio M.; Veland, Nicolas; Miranda-Verastegui, Cesar; Arevalo, Jorge; Low, Donald E.; Llanos-Cuentas, Alejandro

    2010-01-01

    We evaluated performance characteristics of five diagnostic methods for cutaneous leishmaniasis. Patients who came to the Leishmania Clinic of Hospital Nacional Cayetano Heredia in Lima, Peru, were enrolled in the study. Lesion smears, culture, microculture, polymerase chain reaction (PCR), and leishmanin skin test (LST) were performed. A total of 145 patients with 202 lesions were enrolled: 114 patients with 161 lesions fulfilled criteria for cutaneous leishmaniasis. Sensitivity and specificity were 57.8% (95% confidence interval [CI] = 50.2–65.4%) and 100.0% for culture, 78.3% (95% CI = 71.9–84.7%) and 100.0% for microculture, 71.4% (95% CI = 64.4–78.4%) and 100.0% for smears, 78.2% (95% CI = 70.6–85.8%) and 77.4% (95% CI = 62.7–92.1%) for LST, and 96.9% (95% CI = 94.2–99.6%) and 65.9% (95% CI = 51.4–80.4%) for PCR. PCR was more sensitive than the other assays (P < 0.001). Sensitivities of culture, smears, and LST varied by lesion duration and appearance. PCR offers performance advantages over other assays, irrespective of patient age, sex, lesion duration, or appearance. That clinical factors influence performance of non-molecular assays offers clinicians a patient-focused approach to diagnostic test selection. PMID:20682880

  17. Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain

    Science.gov (United States)

    Konstantinou, Kika; Ogollah, Reuben; Hay, Elaine M.; Dunn, Kate M.

    2018-01-01

    Background Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. Methods Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. Results Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). Conclusion Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients. PMID:29621243

  18. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    Science.gov (United States)

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

  19. Optical diagnostics based on elastic scattering: Recent clinical demonstrations with the Los Alamos Optical Biopsy System

    Energy Technology Data Exchange (ETDEWEB)

    Bigio, I.J.; Loree, T.R.; Mourant, J.; Shimada, T. [Los Alamos National Lab., NM (United States); Story-Held, K.; Glickman, R.D. [Texas Univ. Health Science Center, San Antonio, TX (United States). Dept. of Ophthalmology; Conn, R. [Lovelace Medical Center, Albuquerque, NM (United States). Dept. of Urology

    1993-08-01

    A non-invasive diagnostic tool that could identify malignancy in situ and in real time would have a major impact on the detection and treatment of cancer. We have developed and are testing early prototypes of an optical biopsy system (OBS) for detection of cancer and other tissue pathologies. The OBS invokes a unique approach to optical diagnosis of tissue pathologies based on the elastic scattering properties, over a wide range of wavelengths, of the microscopic structure of the tissue. The use of elastic scattering as the key to optical tissue diagnostics in the OBS is based on the fact that many tissue pathologies, including a majority of cancer forms, manifest significant architectural changes at the cellular and sub-cellular level. Since the cellular components that cause elastic scattering have dimensions typically on the order of visible to near-IR wavelengths, the elastic (Mie) scattering properties will be strongly wavelength dependent. Thus, morphology and size changes can be expected to cause significant changes in an optical signature that is derived from the wavelength dependence of elastic scattering. The data acquisition and storage/display time with the OBS instrument is {approximately}1 second. Thus, in addition to the reduced invasiveness of this technique compared with current state-of-the-art methods (surgical biopsy and pathology analysis), the OBS offers the possibility of impressively faster diagnostic assessment. The OBS employs a small fiber-optic probe that is amenable to use with any endoscope, catheter or hypodermic, or to direct surface examination (e.g. as in skin cancer or cervical cancer). It has been tested in vitro on animal and human tissue samples, and clinical testing in vivo is currently in progress.

  20. Clinical application of optical coherence tomography in combination with functional diagnostics: advantages and limitations for diagnosis and assessment of therapy outcome in central serous chorioretinopathy.

    Science.gov (United States)

    Schliesser, Joshua A; Gallimore, Gary; Kunjukunju, Nancy; Sabates, Nelson R; Koulen, Peter; Sabates, Felix N

    2014-01-01

    While identifying functional and structural parameters of the retina in central serous chorioretinopathy (CSCR) patients, this study investigated how an optical coherence tomography (OCT)-based diagnosis can be significantly supplemented with functional diagnostic tools and to what degree the determination of disease severity and therapy outcome can benefit from diagnostics complementary to OCT. CSCR patients were evaluated prospectively with microperimetry (MP) and spectral domain optical coherence tomography (SD-OCT) to determine retinal sensitivity function and retinal thickness as outcome measures along with measures of visual acuity (VA). Patients received clinical care that involved focal laser photocoagulation or pharmacotherapy targeting inflammation and neovascularization. Correlation of clinical parameters with a focus on functional parameters, VA, and mean retinal sensitivity, as well as on the structural parameter mean retinal thickness, showed that functional measures were similar in diagnostic power. A moderate correlation was found between OCT data and the standard functional assessment of VA; however, a strong correlation between OCT and MP data showed that diagnostic measures cannot always be used interchangeably, but that complementary use is of higher clinical value. The study indicates that integrating SD-OCT with MP provides a more complete diagnosis with high clinical relevance for complex, difficult to quantify diseases such as CSCR.

  1. Fundamentals and commercial aspects of nanobiosensors in point-of-care clinical diagnostics.

    Science.gov (United States)

    Mahato, Kuldeep; Maurya, Pawan Kumar; Chandra, Pranjal

    2018-03-01

    Among various problems faced by mankind, health-related concerns are prevailing since long which are commonly found in the form of infectious diseases and different metabolic disorders. The clinical cure and management of such abnormalities are greatly dependent on the availability of their diagnoses. The conventional diagnostics used for such purposes are extremely powerful; however, most of these are limited by time-consuming protocols and require higher volume of test sample, etc. A new evolving technology called "biosensor" in this context shows an enormous potential for an alternative diagnostic device, which constantly compliments the conventional diagnoses. In this review, we have summarized different kinds of biosensors and their fundamental understanding with various state-of-the-art examples. A critical examination of different types of biosensing mechanisms is also reported highlighting the advantages of electrochemical biosensors for its great potentials in next-generation commercially viable modules. In recent years, a number of nanomaterials are extensively used to enhance not only the performance of biosensing mechanism, but also obtain robust, cheap, and fabrication-friendly durable mechanism. Herein, we have summarized the importance of nanomaterials in biosensing mechanism, their syntheses as well as characterization techniques. Subsequently, we have discussed the probe fabrication processes along with various techniques for assessing its analytical performances and potentials for commercial viability.

  2. Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

    Directory of Open Access Journals (Sweden)

    Jan Kiesewetter

    2016-11-01

    Full Text Available Abstract Background Clinical reasoning is a key competence in medicine. There is a lack of knowledge, how non-experts like medical students solve clinical problems. It is known that they have difficulties applying conceptual knowledge to clinical cases, that they lack metacognitive awareness and that higher level cognitive actions correlate with diagnostic accuracy. However, the role of conceptual, strategic, conditional, and metacognitive knowledge for clinical reasoning is unknown. Methods Medical students (n = 21 were exposed to three different clinical cases and instructed to use the think-aloud method. The recorded sessions were transcribed and coded with regards to the four different categories of diagnostic knowledge (see above. The transcripts were coded using the frequencies and time-coding of the categories of knowledge. The relationship between the coded data and accuracy of diagnosis was investigated with inferential statistical methods. Results The use of metacognitive knowledge is correlated with application of conceptual, but not with conditional and strategic knowledge. Furthermore, conceptual and strategic knowledge application is associated with longer time on task. However, in contrast to cognitive action levels the use of different categories of diagnostic knowledge was not associated with better diagnostic accuracy. Conclusions The longer case work and the more intense application of conceptual knowledge in individuals with high metacognitive activity may hint towards reduced premature closure as one of the major cognitive causes of errors in medicine. Additionally, for correct case solution the cognitive actions seem to be more important than the diagnostic knowledge categories.

  3. An evaluation of the diagnostic value of different skin tests with egg in clinically egg-allergic children having atopic dermatitis

    DEFF Research Database (Denmark)

    Hansen, Tine K; Høst, Arne; Bindslev-Jensen, Carsten

    2004-01-01

    Skin testing is a common diagnostic procedure in food allergy, but the final diagnosis of food allergy is based on the clinical response to food challenge. We studied the value of the skin prick-prick test (SPT), skin application food test (SAFT) and atopy patch test (APT) with fresh egg extract......-allergic children were positive in SPT and 40-60% in APT. In APT and in SPT false-positive reactions to egg were observed. In this study comprising a small number of patients including control subjects, neither SAFT nor APT with fresh whole egg extract were able to increase the diagnostic accuracy in detecting egg...

  4. Rett syndrome diagnostic criteria: lessons from the Natural History Study.

    Science.gov (United States)

    Percy, Alan K; Neul, Jeffrey L; Glaze, Daniel G; Motil, Kathleen J; Skinner, Steven A; Khwaja, Omar; Lee, Hye-Seung; Lane, Jane B; Barrish, Judy O; Annese, Fran; McNair, Lauren; Graham, Joy; Barnes, Katherine

    2010-12-01

    Analysis of 819 participants enrolled in the Rett syndrome (RTT) Natural History Study validates recently revised diagnostic criteria. 765 females fulfilled 2002 consensus criteria for classic (653/85.4%) or variant (112/14.6%) RTT. All participants classified as classic RTT fulfilled each revised main criterion; supportive criteria were not uniformly present. All variant RTT participants met at least 3 of 6 main criteria in the 2002, 2 of 4 main criteria in the current format, and 5 of 11 supportive criteria in both. This analysis underscores the critical role of main criteria for classic RTT; variant RTT requires both main and supportive criteria.

  5. Studies of neutron measurement methods for fusion plasma diagnostics

    International Nuclear Information System (INIS)

    Beimer, K.H.

    1986-03-01

    This thesis comprises several studies mainly devoted to neutron measurement systems for plasma diagnostics at JET (Joint European Torus). An in situ calibration of the U-235 fission chamber detectors located at JET is presented. These detectors are used for measuring the neutron yield from the thermonuclear reactions in the plasma. The energy spectrum of the neutrons from the reactions D(d,n) 3 He has been studied by means of a 3 He spectrometer. Especially, it was found that by measuring the width of the full energy peak in the response spectrum of the 3 He-spectrometer, the deuterium distribution in the deuterium targets used can be estimated. In order to measure different neutron energies it is necessary to obtain a detailed knowledge of the response of the spectrometer. Therefore, the response function to monoenergetic neutrons in the energy range 130-3030 keV was experimentally determined. Some work has been related to a design study of a 14 MeV spectrometer for neutron diagnostics. It is a combined proton-recoil and time-of-flight spectrometer for high resolution measurements. The main parts of it are the collimator, the scattering foil, and the detectors for the recoil protons and the scattered neutrons. The influence of proton straggling in the foil on the resolution and efficiency of the spectrometer has been studied. Furthermore, a three dimensional Monte Carlo code has been written and used for the design of the collimator. (author)

  6. The main challenges that remain in applying high-throughput sequencing to clinical diagnostics.

    Science.gov (United States)

    Loeffelholz, Michael; Fofanov, Yuriy

    2015-01-01

    Over the last 10 years, the quality, price and availability of high-throughput sequencing instruments have improved to the point that this technology may be close to becoming a routine tool in the diagnostic microbiology laboratory. Two groups of challenges, however, have to be resolved in order to move this powerful research technology into routine use in the clinical microbiology laboratory. The computational/bioinformatics challenges include data storage cost and privacy concerns, requiring analysis to be performed without access to cloud storage or expensive computational infrastructure. The logistical challenges include interpretation of complex results and acceptance and understanding of the advantages and limitations of this technology by the medical community. This article focuses on the approaches to address these challenges, such as file formats, algorithms, data collection, reporting and good laboratory practices.

  7. Clinical cognition and diagnostic error: applications of a dual process model of reasoning.

    Science.gov (United States)

    Croskerry, Pat

    2009-09-01

    Both systemic and individual factors contribute to missed or delayed diagnoses. Among the multiple factors that impact clinical performance of the individual, the caliber of cognition is perhaps the most relevant and deserves our attention and understanding. In the last few decades, cognitive psychologists have gained substantial insights into the processes that underlie cognition, and a new, universal model of reasoning and decision making has emerged, Dual Process Theory. The theory has immediate application to medical decision making and provides an overall schema for understanding the variety of theoretical approaches that have been taken in the past. The model has important practical applications for decision making across the multiple domains of healthcare, and may be used as a template for teaching decision theory, as well as a platform for future research. Importantly, specific operating characteristics of the model explain how diagnostic failure occurs.

  8. Carbon Nanotube Biosensors for Space Molecule Detection and Clinical Molecular Diagnostics

    Science.gov (United States)

    Han, Jie

    2001-01-01

    Both space molecule detection and clinical molecule diagnostics need to develop ultra sensitive biosensors for detection of less than attomole molecules such as amino acids for DNA. However all the electrode sensor systems including those fabricated from the existing carbon nanotubes, have a background level of nA (nanoAmp). This has limited DNA or other molecule detection to nA level or molecules whose concentration is, much higher than attomole level. A program has been created by NASA and NCI (National Cancer Institute) to exploit the possibility of carbon nanotube based biosensors to solve this problem for both's interest. In this talk, I will present our effort on the evaluation and novel design of carbon nanotubes as electrode biosensors with strategies to minimize background currents while maximizing signal intensity.The fabrication of nanotube electrode arrays, immobilization of molecular probes on nanotube electrodes and in vitro biosensor testing will also be discussed.

  9. Clinical diagnostic criteria for typical and atypical variants of Rett syndrome in children

    Directory of Open Access Journals (Sweden)

    S. Ya. Volgina

    2016-01-01

    Full Text Available Rett Syndrome is one of the most socially significant neuropsychiatric hereditary diseases in children. This syndrome is mainly found in girls: its frequency is 1:10000–15000. Currently mutations in X-linked gene MESR2 considered as the main cause of the syndrome. Diagnosis of typical and atypical variants of the syndrome is based on the use of clinical criteria, determining gene mutations МЕСР2, CDKL5 and FOXG1. In 2010, the Expert Consortium for Rett syndrome have revised the existing diagnostic criteria for the syndrome and come to a new consensus. If there is a regression of mental development for the diagnosis of Rett syndrome exemplary embodiment only four basic criteria for the diagnosis of atypical variant — two of the four main criteria, and five of the eleven additional criteria. 

  10. Indications, applications and future prospects of diagnostic examinations in clinical cardiology

    International Nuclear Information System (INIS)

    Sugishita, Yasuro; Koseki, Susumu; Matsuda, Mitsuo

    1982-01-01

    Nowadays there are various kinds of diagnostic examinations in the field of clinical cardiology. In this field, information concerning structure, dimension (hypertrophy and dilatation) and cardiac function is essentially imporant. For the diagnosis of valvular and congenital heart diseases and of cardiomyopathy, ultrasonic examinations are more useful; for ischemic heart disease, nuclear medicine is superior. Angiocardiography provides us much information but it is invasive. A combination of an exercise-test with the examinations mentioned above is useful for the detection of left ventricular and coronary reserves. The determinants of left ventricular reserve, being related to the prognosis of the patients, can be analyzed by exercise echocardiography. Exercise echocardiography can reveal instantaneous changes in myocardial ischemia during exercise. Regional and global left ventricular performances revealed by exercise radionuclide angiocardiography can lead us to a new interpretation of an exercise ECG. (author)

  11. Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2005-01-01

    BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice. METHODS: All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from...... psychiatric hospitalisation in Denmark were identified in a nationwide register. RESULTS: Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later...... and behavioural disorder due to psychoactive substance use and got a diagnosis of bipolar disorder later on. Especially younger but also female patients were at increased risk of delay of the diagnosis of bipolar disorder. LIMITATIONS: Only patients from psychiatric settings were included. CONCLUSIONS: Clinicians...

  12. [Penicillin allergy as a diagnostic problem. Overview and personal studies].

    Science.gov (United States)

    Walker, T; Jung, E G; Bayerl, C

    2000-11-01

    Penicillin allergy is a common clinical problem. The distinction between penicillin and para-infectious exanthems is difficult. We investigated the reliability of the history, as well as the sensitivity and specificity of skin tests and specific IgE levels. 160 patients with a history of penicillin allergy were retrospectively evaluated in the outpatient department of a dermatological clinic. Nearly 50% were diagnosed as allergic to penicillin by detection of specific IgE or skin test. About 60% of the patients with immediate type reactions, and 72% with maculo-papular erythema showed positive reactions in skin tests. Significantly more patients were diagnosed as allergic to penicillin by intradermal testing than by prick testing (p sensitivity of the specific IgE RAST was 17.9%; the specifity, 89.5%. For the prick test the sensitivity was 8.2%; the specificity 90.8%. For the intradermal test the sensitivity was 26%; the specifity 69.7%. We suggest a step by step procedure to detect penicillin allergy making the diagnostic results as valid as possible.

  13. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study

    Science.gov (United States)

    2014-01-01

    Background The aim of the study was to construct a new scoring system for more accurate diagnostics of acute appendicitis. Applying the new score into clinical practice could reduce the need of potentially harmful diagnostic imaging. Methods This prospective study enrolled 829 adults presenting with clinical suspicion of appendicitis, including 392 (47%) patients with appendicitis. The collected data included clinical findings and symptoms together with laboratory tests (white cell count, neutrophil count and C-reactive protein), and the timing of the onset of symptoms. The score was constructed by logistic regression analysis using multiple imputations for missing values. Performance of the constructed score in patients with complete data (n = 725) was compared with Alvarado score and Appendicitis inflammatory response score. Results 343 (47%) of patients with complete data had appendicitis. 199 (58%) patients with appendicitis had score value at least 16 and were classified as high probability group with 93% specificity.Patients with score below 11 were classified as low probability of appendicitis. Only 4% of patients with appendicitis had a score below 11, and none of them had complicated appendicitis. In contrast, 207 (54%) of non-appendicitis patients had score below 11. There were no cases with complicated appendicitis in the low probability group. The area under ROC curve was significantly larger with the new score 0.882 (95% CI 0.858 – 0.906) compared with AUC of Alvarado score 0.790 (0.758 – 0.823) and Appendicitis inflammatory response score 0.810 (0.779 – 0.840). Conclusions The new diagnostic score is fast and accurate in categorizing patients with suspected appendicitis, and roughly halves the need of diagnostic imaging. PMID:24970111

  14. Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice

    Directory of Open Access Journals (Sweden)

    Haage Patrick

    2010-04-01

    Full Text Available Abstract Background In patients with osteoarthritis, a detailed assessment of degenerative cartilage disease is important to recommend adequate treatment. Using a representative sample of patients, this study investigated whether MRI is reliable for a detailed cartilage assessment in patients with osteoarthritis of the knee. Methods In a cross sectional-study as a part of a retrospective case-control study, 36 patients (mean age 53.1 years with clinically relevant osteoarthritis received standardized MRI (sag. T1-TSE, cor. STIR-TSE, trans. fat-suppressed PD-TSE, sag. fat-suppressed PD-TSE, Siemens Magnetom Avanto syngo MR B 15 on a 1.5 Tesla unit. Within a maximum of three months later, arthroscopic grading of the articular surfaces was performed. MRI grading by two blinded observers was compared to arthroscopic findings. Diagnostic values as well as intra- and inter-observer values were assessed. Results Inter-observer agreement between readers 1 and 2 was good (kappa = 0.65 within all compartments. Intra-observer agreement comparing MRI grading to arthroscopic grading showed moderate to good values for readers 1 and 2 (kappa = 0.50 and 0.62, respectively, the poorest being within the patellofemoral joint (kappa = 0.32 and 0.52. Sensitivities were relatively low at all grades, particularly for grade 3 cartilage lesions. A tendency to underestimate cartilage disorders on MR images was not noticed. Conclusions According to our results, the use of MRI for precise grading of the cartilage in osteoarthritis is limited. Even if the practical benefit of MRI in pretreatment diagnostics is unequivocal, a diagnostic arthroscopy is of outstanding value when a grading of the cartilage is crucial for a definitive decision regarding therapeutic options in patients with osteoarthritis.

  15. Systematic Internal Transcribed Spacer Sequence Analysis for Identification of Clinical Mold Isolates in Diagnostic Mycology: a 5-Year Study▿ †

    Science.gov (United States)

    Ciardo, Diana E.; Lucke, Katja; Imhof, Alex; Bloemberg, Guido V.; Böttger, Erik C.

    2010-01-01

    The implementation of internal transcribed spacer (ITS) sequencing for routine identification of molds in the diagnostic mycology laboratory was analyzed in a 5-year study. All mold isolates (n = 6,900) recovered in our laboratory from 2005 to 2009 were included in this study. According to a defined work flow, which in addition to troublesome phenotypic identification takes clinical relevance into account, 233 isolates were subjected to ITS sequence analysis. Sequencing resulted in successful identification for 78.6% of the analyzed isolates (57.1% at species level, 21.5% at genus level). In comparison, extended in-depth phenotypic characterization of the isolates subjected to sequencing achieved taxonomic assignment for 47.6% of these, with a mere 13.3% at species level. Optimization of DNA extraction further improved the efficacy of molecular identification. This study is the first of its kind to testify to the systematic implementation of sequence-based identification procedures in the routine workup of mold isolates in the diagnostic mycology laboratory. PMID:20573873

  16. The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

    International Nuclear Information System (INIS)

    Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.; Turpie, A.G.

    1982-01-01

    We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value of 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

  17. The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

    International Nuclear Information System (INIS)

    Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.

    1982-01-01

    We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

  18. Clinically relevant diagnostic research in primary care: the example of B-type natriuretic peptides in the detection of heart failure.

    Science.gov (United States)

    Kelder, Johannes C; Rutten, Frans H; Hoes, Arno W

    2009-02-01

    With the emergence of novel diagnostic tests, e.g. point-of-care tests, clinically relevant empirical evidence is needed to assess whether such a test should be used in daily practice. With the example of the value of B-type natriuretic peptides (BNP) in the diagnostic assessment of suspected heart failure, we will discuss the major methodological issues crucial in diagnostic research; most notably the choice of the study population and the data analysis with a multivariable approach. BNP have been studied extensively in the emergency care setting, and also several studies in the primary care are available. The usefulness of this test when applied in combination with other readily available tests is still not adequately addressed in the relevant patient domain, i.e. those who are clinically suspected of heart failure by their GP. Future diagnostic research in primary care should be targeted much more at answering the clinically relevant question 'Is it useful to add this (new) test to the other tests I usually perform, including history taking and physical examination, in patients I suspect of having a certain disease'.

  19. Laser diagnodent: a comparative study with other diagnostic techniques

    International Nuclear Information System (INIS)

    Godinho, Reugma Rego

    2002-01-01

    An evaluation of the Diagnodent equipment (Kavo Company, Germany) for the occlusal caries detection was dane through the comparison with other conventional diagnostic techniques, such as visual inspection, intra-oral micro camera and digital X-ray. The effectiveness of the equipment in the detection of hidden caries and its viability as a diagnosis method for caries in their initial stage was also studied. Fifty eight permanent molars and premolars teeth from patients with age between 6 and 30 years were studied. The obtained results indicated that the conventional methods employed for the caries diagnosis are unable to detect the carious lesion in its initial stage. The Diagnodent equipment has this capability to detect caries presenting a flawless surface, specially the hidden caries, allowing the dentist to decide between a preventive ar a conservative procedure. The main advantage of the Diagnodent is to be an objective method, compared to the visual and radiographic ones, that are dependent on the professional interpretation. The Diagnodent is, therefore, a promising alternative as an objective and standardized diagnosis method for the final diagnostic. (author)

  20. Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis.

    Science.gov (United States)

    Bandinelli, F; Salvadorini, G; Delle Sedie, A; Riente, L; Bombardieri, S; Matucci-Cerinic, M

    2016-02-01

    The variability of demographic, social, genetic, and clinical factors might influence the time between the onset of symptoms and the diagnosis [diagnostic delay (DD)] of ankylosing spondylitis (AS) in different geographic areas. Different clinical manifestations in men and women affected by AS might indicate a possible role of gender in DD. The aim of the present study was to investigate the influence of demographic, social, genetic, and clinical factors on DD and the differences of DD between men and women related to the presence of different demographic, social, clinical, and genetic parameters in an Italian cohort of primary AS patients. A total of 135 Italian primary AS patients (45 female and 90 male, 27.9 ± 0.89 years old at onset) were studied. The DD, gender, education and work (manual or non-manual) levels, and type of first clinical presentation (inflammatory back pain, arthritis, enthesitis) at onset, family history of AS, and HLA B27 presence were analyzed. The DD (8.744 mean ±0.6869) was significantly higher in men (p = 0.0023), in axial presentation (p = 0.0021), and in manual work (even if with low significance, p = 0.047). The lower DD in women in comparison to that in men was likely related to higher education (p = 0.0045) and work (p = 0.0186) levels, peripheral involvement (p = 0.0009), and HLA B27 positivity (p = 0.0231). DD was higher in AS patients: male, employed in manual jobs, and with axial symptoms at onset. In men, DD seemed to be negatively influenced by lower level of education and work, axial clinical presentation, and HLA B27.

  1. Clinical and Diagnostic Features of Bronchial Asthma in Children on the Background of Latent Food Allergy

    Directory of Open Access Journals (Sweden)

    V.M. Levytskyi

    2015-09-01

    Full Text Available Based on clinical and paraclinical examination of 112 children with bronchial asthma, there were studied the features of its course against the background of food allergy. It was found that only a set of clinical and paraclinical signs is the most important for the diagnosis of bronchial asthma in children on the background of latent food allergy.

  2. Short-Term Memory and Auditory Processing Disorders: Concurrent Validity and Clinical Diagnostic Markers

    Science.gov (United States)

    Maerlender, Arthur

    2010-01-01

    Auditory processing disorders (APDs) are of interest to educators and clinicians, as they impact school functioning. Little work has been completed to demonstrate how children with APDs perform on clinical tests. In a series of studies, standard clinical (psychometric) tests from the Wechsler Intelligence Scale for Children, Fourth Edition…

  3. Nail disorders in children, a clinical study

    Directory of Open Access Journals (Sweden)

    Ayşe Akbaş

    2016-04-01

    Full Text Available Introduction: Aims of the study to investigate the frequency and the nature ofnail disorders in children significant clinical data is available. Nail disorders although common in children in some parts of our country. This study was carried out to document the clinical and demographic pattern of nail disorders in a dermatology outpatient clinic of a pediatric hospital in Ankara, Turkey. Material and Methods: All consecutive patients a total of 3000 children from age 0-16 were admitted to dermatology outpatient clinic of Ankara Pediatric Hematology and Oncology Education and Research Hospital during January 2011 to December 2011 were studied and retrospectively evaluated for age, gender, drug use, diseases, systemic or genetic disorders and demographic features. Diagnostic evaluation results were noted and patients were categorized for demographic features and diagnosis. Results: These 133 patients (M: F 58:75, %44 vs 56, respectively were under 16 years of age and have 17 different dermatological disorders related with nail symptoms. Fifty three of (39,8% these patient were under 2 years of age, 31 (23.3% were between 3-5 years, 30 (22.5% were between 6-11 years old, 19 of 133 (14%, 2 were between 11-16 years of age. Through all of ages and independent of gender the most etiologies of nail disorders were, onychomadesis, paronychia, onycholysis, onychomycosis and systemic nail presentation of systemic dermatosis. Conclusion: Nail disorders are different in children than in adults. In our study, the first 5 years of age was found in 53% of nail disorders. Nail disorders are uncommon but may be seen as a part of a systemic disease and may be associated with cosmetic and psychologic problem.

  4. Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: A clinical practice guideline

    Science.gov (United States)

    Mehta, Sanjay; Helmersen, Doug; Provencher, Steeve; Hirani, Naushad; Rubens, Fraser D; De Perrot, Marc; Blostein, Mark; Boutet, Kim; Chandy, George; Dennie, Carole; Granton, John; Hernandez, Paul; Hirsch, Andrew M; Laframboise, Karen; Levy, Robert D; Lien, Dale; Martel, Simon; Shoemaker, Gerard; Swiston, John; Weinkauf, Justin

    2010-01-01

    BACKGROUND Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. METHODS A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. RESULTS Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/ perfusion lung scanning, not computed tomography angiography. Pulmonary endarterectomy surgery is the treatment of choice in patients with surgically accessible CTEPH, and may also be effective in CTEPH patients with disease in more ‘distal’ pulmonary arteries. The anatomical extent of CTEPH for surgical pulmonary endarterectomy is best assessed by contrast pulmonary angiography, although positive computed tomography angiography may be acceptable. Novel medications indicated for the treatment of pulmonary hypertension may be effective for selected CTEPH patients. CONCLUSIONS The present guideline requires formal dissemination to relevant target user groups, the development of tools for implementation into routine clinical practice and formal evaluation of the impact of the guideline on the quality of care of CTEPH patients. Moreover, the guideline will be updated periodically to reflect new evidence or clinical approaches. PMID:21165353

  5. Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up.

    Science.gov (United States)

    Mauri, M C; Di Pace, C; Reggiori, A; Paletta, S; Colasanti, A

    2017-10-01

    The study reports a follow-up assessment of 48 patients with concomitant drug abuse at the first admission for psychosis. We focused on the diagnostic distinction between primary psychosis with concomitant drug abuse and drug induced psychosis, to observe whether the diagnoses are stable over time and whether the clinical course significantly differs. The study examined 25 primary psychotic disorder with comorbid drug abuse and 23 drug-induced psychotic disorder patients. Diagnostic and psychopathological assessments were made at baseline and at follow-up. Mean follow-up period was 4.96 years. Patients with comorbid Drug Abuse exhibited higher scores in the item Unusual Content of Thought at baseline than drug-induced psychotic disorder patients: 5.48 vs 4.39 while the two patients groups did not differ in any of the BPRS items evaluated at follow-up. The primary psychosis with comorbid drug abuse and the substance induced psychosis groups were similar regarding diagnostic stability, and a diagnosis of schizophrenia at follow-up occurred similarly. There was no evidence that Drug Induced psychotic patients' symptoms tend to improve more after cessation of drug abuse. An earlier age of onset was found in primary psychotic patients, particularly for patients diagnosed as affected by schizophrenia at follow up. These results might reflect the uncertainty of the distinction between Primary and Drug Induced Psychosis and the difficulties in applying the DSM IV-TR criteria for diagnosing comorbid drug use disorders and psychotic disorders. Copyrig