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Sample records for clinical icd-10 diagnoses

  1. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas;

    2005-01-01

    Concern has been expressed as to the reliability of clinical ICD-10 diagnosis of schizophrenia. This study was designed to assess the diagnostic reliability of the clinical ICD-10 diagnosis of schizophrenia in a random sample of Danish in- and outpatients with a history of psychosis. A sample...... value (87%) of ICD-10 schizophrenia and an overall good agreement between clinical and OPCRIT-derived diagnoses (kappa=0.60). An even higher positive predictive value was obtained when diagnoses were amalgamated into a diagnostic entity of schizophrenia-spectrum disorders (98%). Near perfect agreement...... was seen between OPCRIT-derived ICD-10 and DSM-IV diagnoses (kappa=0.87). Thus, this study demonstrates high reliability of the clinical diagnosis of schizophrenia and even more so of the diagnosis of schizophrenia-spectrum disorder....

  2. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas;

    2005-01-01

    value (87%) of ICD-10 schizophrenia and an overall good agreement between clinical and OPCRIT-derived diagnoses (kappa=0.60). An even higher positive predictive value was obtained when diagnoses were amalgamated into a diagnostic entity of schizophrenia-spectrum disorders (98%). Near perfect agreement...

  3. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik;

    2008-01-01

    ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted K-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative...... = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses, on bipolar vs. non-bipolar disorders was high, K = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, K = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses...

  4. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Directory of Open Access Journals (Sweden)

    Klaus Damgaard Jakobsen

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted κ-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, κ = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, κ = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, κ = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, κ = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

  5. Asperger's Syndrome: A Comparison of Clinical Diagnoses and Those Made According to the ICD-10 and DSM-IV

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    Woodbury-Smith, Marc; Klin, Ami; Volkmar, Fred

    2005-01-01

    The diagnostic criteria for Asperger Syndrome (AS) according to ICD-10 and DSM-IV have been criticized as being too narrow in view of the rules of onset and precedence, whereby autism takes precedence over AS in a diagnostic hierarchy. In order to investigate this further, cases from the DSM-IV multicenter study who had been diagnosed clinically…

  6. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial.

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    Buysse, D J; Reynolds, C F; Kupfer, D J; Thorpy, M J; Bixler, E; Manfredi, R; Kales, A; Vgontzas, A; Stepanski, E; Roth, T

    1994-10-01

    Three diagnostic classifications for sleep disorders have been developed recently: the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual, 4th edition (DSM-IV), and the International Classification of Diseases, 10th edition (ICD-10). No data have yet been published regarding the frequency of specific diagnoses within these systems or how the diagnostic systems relate to each other. To address these issues, we examined clinical sleep disorder diagnoses (without polysomnography) in 257 patients (216 insomnia patients and 41 medical/psychiatric patients) evaluated at five sleep centers. A sleep specialist interviewed each patient and assigned clinical diagnoses using ICSD, DSM-IV and ICD-10 classifications. "Sleep disorder associated with mood disorder" was the most frequent ICSD primary diagnosis (32.3% of cases), followed by "Psychophysiological insomnia" (12.5% of cases). The most frequent DSM-IV primary diagnoses were "Insomnia related to another mental disorder" (44% of cases) and "Primary insomnia" (20.2% of cases), and the most frequent ICD-10 diagnoses were "Insomnia due to emotional causes" (61.9% of cases) and "Insomnia of organic origin" (8.9% of cases). When primary and secondary diagnoses were considered, insomnia related to psychiatric disorders was diagnosed in over 75% of patients. The more narrowly defined ICSD diagnoses nested logically within the broader DSM-IV and ICD-10 categories. We found substantial site-related differences in diagnostic patterns. These results confirm the importance of psychiatric and behavioral factors in clinicians' assessments of insomnia patients across all three diagnostic systems. ICSD and DSM-IV sleep disorder diagnoses have similar patterns of use by experienced clinicians.

  7. ICD-10 and the clinical features of depressions: data of the CIRCADIAN-I program

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    O V Serdyuk; Ovchinnikov, A.; N A Kutuzova; M Y Drobizhev; K Y Retyunsky

    2011-01-01

    The data of the CIRCADIAN-I trial suggest that depressions are unsatisfactorily diagnosed in psychiatric practice. Thus, some of the ICD-10 diagnoses used to denote depressive states (dysthymia, cyclothymia) are made extremely rarely. Only comparatively short-term and reversible vital depressions are considered to be preferred for the categories of affective disorders (F.30-F.33). Any clinical deviations from this clinical presentation (sensitive, anxiety symptoms, a prolonged course, and no ...

  8. Conducting Retrospective Ontological Clinical Trials in ICD-9-CM in the Age of ICD-10-CM

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    Venepalli, Neeta K; Shergill, Ardaman; Dorestani, Parvaneh; Boyd, Andrew D

    2014-01-01

    OBJECTIVE To quantify the impact of International Classification of Disease 10th Revision Clinical Modification (ICD-10-CM) transition in cancer clinical trials by comparing coding accuracy and data discontinuity in backward ICD-10-CM to ICD-9-CM mapping via two tools, and to develop a standard ICD-9-CM and ICD-10-CM bridging methodology for retrospective analyses. BACKGROUND While the transition to ICD-10-CM has been delayed until October 2015, its impact on cancer-related studies utilizing ICD-9-CM diagnoses has been inadequately explored. MATERIALS AND METHODS Three high impact journals with broad national and international readerships were reviewed for cancer-related studies utilizing ICD-9-CM diagnoses codes in study design, methods, or results. Forward ICD-9-CM to ICD-10-CM mapping was performing using a translational methodology with the Motif web portal ICD-9-CM conversion tool. Backward mapping from ICD-10-CM to ICD-9-CM was performed using both Centers for Medicare and Medicaid Services (CMS) general equivalence mappings (GEMs) files and the Motif web portal tool. Generated ICD-9-CM codes were compared with the original ICD-9-CM codes to assess data accuracy and discontinuity. RESULTS While both methods yielded additional ICD-9-CM codes, the CMS GEMs method provided incomplete coverage with 16 of the original ICD-9-CM codes missing, whereas the Motif web portal method provided complete coverage. Of these 16 codes, 12 ICD-9-CM codes were present in 2010 Illinois Medicaid data, and accounted for 0.52% of patient encounters and 0.35% of total Medicaid reimbursements. Extraneous ICD-9-CM codes from both methods (Centers for Medicare and Medicaid Services general equivalent mapping [CMS GEMs, n = 161; Motif web portal, n = 246]) in excess of original ICD-9-CM codes accounted for 2.1% and 2.3% of total patient encounters and 3.4% and 4.1% of total Medicaid reimbursements from the 2010 Illinois Medicare database. DISCUSSION Longitudinal data analyses post-ICD-10

  9. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an Adult Autism Spectrum Disorder Diagnostic Clinic

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    Wilson, C. Ellie; Gillan, Nicola; Spain, Deborah; Robertson, Dene; Roberts, Gedeon; Murphy, Clodagh M.; Maltezos, Stefanos; Zinkstok, Janneke; Johnston, Katie; Dardani, Christina; Ohlsen, Chris; Deeley, P. Quinton; Craig, Michael; Mendez, Maria A.; Happé, Francesca; Murphy, Declan G. M.

    2013-01-01

    An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56% met DSM-5 ASD criteria. A further 19% met DSM-5 (draft)…

  10. Evaluation of inpatient clinical documentation readiness for ICD-10-CM.

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    DeAlmeida, Dilhari R; Watzlaf, Valerie J; Anania-Firouzan, Patti; Salguero, Otto; Rubinstein, Elaine; Abdelhak, Mervat; Parmanto, Bambang

    2014-01-01

    This research study examined the gaps in documentation that occur when coding in ICD-10-CM. More than 4,000 diagnoses from all chapters were coded from 656 electronic documents obtained from a large integrated healthcare facility at the time the study was conducted (2012). After the documents were coded, areas for documentation improvement were identified for chapters that resulted in deficiencies in documentation, and a quick reference guide was developed. The overall absent documentation percentage was 15.4 percent. The 10 chapters with the highest percentage of absent documentation were chapter 7 (Diseases of Eye and Adnexa), with 67.65 percent (p Diseases of Ear and Mastoid Process), with 63.64 percent (p Diseases of the Musculoskeletal System and Connective Tissue), with 46.05 percent (p Diseases of the Genitourinary System), with 40.29 percent (p Diseases of Respiratory System), with 35.52 percent (p Parasitic Diseases), with 32.88 percent (p Diseases of the Skin and Subcutaneous Tissue), with 32.35 percent (p Diseases), with 14.58 percent (p < .001); and chapter 17 (Congenital Malformations, Deformations, and Chromosomal Abnormalities), with 12.50 percent. We addressed the deficient areas in the quick reference guide developed for clinicians and technology vendors. Having complete and accurate documentation would benefit both the clinician and the patient in providing the highest quality of care.

  11. ICD-10 and the clinical features of depressions: data of the CIRCADIAN-I program

    Directory of Open Access Journals (Sweden)

    O V Serdyuk

    2011-01-01

    Full Text Available The data of the CIRCADIAN-I trial suggest that depressions are unsatisfactorily diagnosed in psychiatric practice. Thus, some of the ICD-10 diagnoses used to denote depressive states (dysthymia, cyclothymia are made extremely rarely. Only comparatively short-term and reversible vital depressions are considered to be preferred for the categories of affective disorders (F.30-F.33. Any clinical deviations from this clinical presentation (sensitive, anxiety symptoms, a prolonged course, and no well-defined seasonal and circadian rhythms of mood worsening are regarded as a guide for ruling out the diagnosis of affective disorder. At the same time depressive states are classified as schizophrenia, adjustment disorders, etc.

  12. The data quality of splenomegaly ICD-10 diagnoses in a population-based hospital discharge registry

    DEFF Research Database (Denmark)

    Rotbain, E. C.; Lund Hansen, Dennis; Frederiksen, H.

    2015-01-01

    Background Splenomegaly is a common finding in general medical patients. The cause of splenomegaly is often found outside the spleen and therefore an extensive diagnostic medical work-up is frequently required. There is very little data on the distribution of causal diagnoses and, to the best...... months; distribution can be seen in figure 1. The most common method for determining enlarged spleen, as seen in table 1, was ultrasonic imaging. Table 2 shows that hematological diseases was the most common underlying causal disease group (50%), followed by hepatic diseases (25%), other diseases (12...

  13. [The ICD-10 Symptom Rating (ISR): validation of the depression scale in a clinical sample].

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    Brandt, Wolfram Alexis; Loew, Thomas; von Heymann, Friedrich; Stadtmüller, Godehard; Georgi, Alexander; Tischinger, Michael; Strom, Frederik; Mutschler, Friederike; Tritt, Karin

    2015-06-01

    The ICD-10 Symptom Rating (ISR) 1 measures the severity of psychiatric disorders with 29 items on 5 subscales as comprehensively as possible. The following syndromes are measured: Depressive syndrome, anxiety syndrome, obsessive-compulsive syndrome, Somatoform syndrome, eating disorder syndrome as well as additional items that cover various mental syndromes, and an overall score. The study reports findings on the validity and sensitivity to change of the depression subscale (ISR-D). In a clinical sample of N=949 inpatients with depression spectrum disorders the convergent validity was determined by correlation with the Beck Depression Inventory (BDI) 3 and the subscale "depression" of the Symptom-Checklist-90-R (SCL-90-R) 4. The high correlation between the different instruments confirms the validity of the ISR-Depression Scale. The sensitivity to change of the ISR seems higher than that of the BDI and the SCL-90. Because of its economy and the good psychometric properties the ISR is recommended for use in clinical samples.

  14. 常见心绞痛病因及临床表现对ICD-10编码的影响%The Effect of Different Causes and Clinical Manifestation of Angina Pectoris on ICD-10 Classification

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    赵桐

    2011-01-01

    目的 探讨心绞痛的病因,以利于对心绞痛进行分型,作出正确的ICD-10编码.方法 对2009年至2010间各种原因引起的心绞痛资料进行回顾性分析.结果 心绞痛根据不同的病因及临床表现可分为不同类型心绞痛,其对应的ICD-10的编码也不同.结论 了解心绞痛的病因及临床表现,正确细分各型心绞痛,是正确进行ICD-10编码最关键环节.%Objective To discuss the causes of angina pectoris, and classify the angina pectoris correctly by ICD-10.Methods The different causes of angina pectoris from 2009 to 2010 were retrospectively analyzed.Results Angina Pectoris can be classified by different causes and clinical manifestation.Therefore, the code of angina pectoris are different.Conclusion Understanding the different causes and clinical manifestation of angina pectoris,and classifying the disease correctly are the key points of ICD-10 classification.

  15. Sleep-wake patterns reported by parents in hyperactive children diagnosed according to ICD-10, as compared to paired controls.

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    Gomes, Ana Allen; Parchão, Carla; Almeida, Anabela; Clemente, Vanda; Pinto de Azevedo, Maria Helena

    2014-10-01

    This study aimed primarily to compare the parent-reported sleep of children with ICD-10 hyperkinetic disorder (HKD) versus community children. Thirty children aged 5-13 years (83.3% boys) diagnosed with HKD by their child and adolescent psychiatrists took part in this study, plus 30 community children, matched for sex, age, and school year. Compared to the controls, the HKD children showed significantly later bedtimes, stronger bedtime resistance, longer sleep latency, shorter sleep; more frequent behaviors and symptoms concerning falling asleep into parents bed, needing something special to initiate sleep, nightmares, sleep talking, sleep bruxism, fear from darkness, bedwetting, and, most notably, loud snoring (26.7%); they also tended to show higher daytime somnolence. Attention deficit/hyperactivity disorder (ADHD)/HKD children may thus have more sleep-related problems than typically developing children. Alternatively, our results may reflect misdiagnoses; thus, special attention should be directed to comorbidity and differential diagnosis issues between sleep disturbances and ADHD/HKD.

  16. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations.

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    Reed, Geoffrey M; Drescher, Jack; Krueger, Richard B; Atalla, Elham; Cochran, Susan D; First, Michael B; Cohen-Kettenis, Peggy T; Arango-de Montis, Iván; Parish, Sharon J; Cottler, Sara; Briken, Peer; Saxena, Shekhar

    2016-10-01

    In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

  17. Evaluation of the multiaxial system of ICD-10 (preliminary praft): correlations between multiaxial assessment and clinical judgements of aetiology, treatment indication and prognosis.

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    Michels, R; Siebel, U; Freyberger, H J; Schönell, H; Dilling, H

    2001-01-01

    Forty-five raters in 7 German centres took part in a multicentric field trial of the multiaxial system of ICD-10, delivering a total of 488 multiaxial assessments of 12 written case summaries. In addition to the multi-axial ratings (including main and subsidiary psychiatry diagnoses, level of social dysfunctioning and psychosocial stressors), assessments were made by the raters of the aetiology, treatment indications and prognosis of the main psychiatric disorder. There were significant correlations between these judgements and the measures of the multiaxial ratings: 62% of the cases diagnosed as endogenous were assessed as having a high level of social dysfunctioning (the proportion for all cases being 50.4%) and 63.4% as having a low number of stressors (vs. 52.8% in all cases). In contrast, cases diagnosed as reactive were assessed as having a lower level of social dysfunctioning and more social stressors. Cases whose prognosis was poor showed a higher rate of comorbidity and a high level of social dysfunctioning. The results demonstrate that the multiaxial approach reflects factors important to the process of clinical treatment and decision making and delivers preliminary evidence of this system's treatment and prognostic validity.

  18. A Clinical Comparison Study of Attention Deficit/Hyperactivity Disorder (DSM-IV) and Hyperkinetic Disorder (ICD-10) in Indian children and Adolescents

    Science.gov (United States)

    Sitholey, Prabhat; Agarwal, Vivek; Bharti, Vikram

    2012-01-01

    Aims: To compare the usefulness of DSM IV and ICD-10 DCR criteria in clinic children presenting with the symptoms of inattention and hyperactivity-impulsivity. Methods: 62 children (54 boys and 8 girls) participated in the study. Children were assessed on Kiddie schedule for affective disorders and schizophrenia--present and lifetime version and…

  19. Administrative simplification: change to the compliance date for the International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) medical data code sets. Final rule.

    Science.gov (United States)

    2014-08-04

    This final rule implements section 212 of the Protecting Access to Medicare Act of 2014 by changing the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2014 to October 1, 2015. It also requires the continued use of the International Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (procedures) (ICD-9-CM), including the Official ICD-9-CM Guidelines for Coding and Reporting, through September 30, 2015.

  20. Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

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    Adornetto Carmen

    2012-12-01

    Full Text Available Abstract Background Mental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD, specific phobia, social phobia, and generalized anxiety disorder (GAD. Methods A structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified. Results DSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9 than with the adult section (F4 of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder. Conclusions The two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population is not identical with the population examined using the ICD (clinical population.

  1. [Functional dysphonia: relation with personality and ICD-10 criteria].

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    Carvajal, C; Sanfuentes, M T; Eva, P; Jara, C; Lolas Stepke, F

    1992-03-01

    The International Classification of Diseases, 10th. revision (ICD-10) in the category F45 defines the somatoform disorder as a mental disease characterized by the reiterative presentation of somatic symptoms in absence of an organic disease, or the somatic pathology being insufficient to explain the intensity of the symptoms as well as the discomfort and preoccupation of the patient. Fifteen female teachers with functional dysphonia were studied by means of a semistructured interview and psychometric evaluations. Considering dysphonia as the principal symptom, the most frequent diagnosis, in accordance with ICD-10 was "Other somatoform disorder" (F-45.8)(9/15). Five patients were diagnosed as motor dissociative disorder (F-44.4). All the patients had some abnormality of personality (5 with personality disorder and 10 with exacerbation of personality traits). The criteria of ICD-10 to classify the functional dysphonia as Somatoform disorder are discussed. It is suggested that certain personality traits are facilitators for somatization.

  2. ICD-10 coding algorithms for defining comorbidities of acute myocardial infarction

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    Evans Dewey

    2006-12-01

    Full Text Available Background With the introduction of ICD-10 throughout Canada, it is important to ensure that Acute Myocardial Infarction (AMI comorbidities employed in risk adjustment methods remain valid and robust. Therefore, we developed ICD-10 coding algorithms for nine AMI comorbidities, examined the validity of the ICD-10 and ICD-9 coding algorithms in detection of these comorbidities, and assessed their performance in predicting mortality. The nine comorbidities that we examined were shock, diabetes with complications, congestive heart failure, cancer, cerebrovascular disease, pulmonary edema, acute renal failure, chronic renal failure, and cardiac dysrhythmias. Methods Coders generated a comprehensive list of ICD-10 codes corresponding to each AMI comorbidity. Physicians independently reviewed and determined the clinical relevance of each item on the list. To ensure that the newly developed ICD-10 coding algorithms were valid in recording comorbidities, medical charts were reviewed. After assessing ICD-10 algorithms' validity, both ICD-10 and ICD-9 algorithms were applied to a Canadian provincial hospital discharge database to predict in-hospital, 30-day, and 1-year mortality. Results Compared to chart review data as a 'criterion standard', ICD-9 and ICD-10 data had similar sensitivities (ranging from 7.1 – 100%, and specificities (above 93.6% for each of the nine AMI comorbidities studied. The frequencies for the comorbidities were similar between ICD-9 and ICD-10 coding algorithms for 49,861 AMI patients in a Canadian province during 1994 – 2004. The C-statistics for predicting 30-day and 1 year mortality were the same for ICD-9 (0.82 and for ICD-10 data (0.81. Conclusion The ICD-10 coding algorithms developed in this study to define AMI comorbidities performed similarly as past ICD-9 coding algorithms in detecting conditions and risk-adjustment in our sample. However, the ICD-10 coding algorithms should be further validated in external databases.

  3. Implementation and impact of ICD-10 (Part II

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    Gazanfar Rahmathulla

    2014-01-01

    Full Text Available Background: The transition from the International Classification of Disease-9 th clinical modification to the new ICD-10 was all set to occur on 1 October 2015. The American Medical Association has previously been successful in delaying the transition by over 10 years and has been able to further postpone its introduction to 2015. The new system will overcome many of the limitations present in the older version, thus paving the way to more accurate capture of clinical information. Methods: The benefits of the new ICD-10 system include improved quality of care, potential cost savings, reduction of unpaid claims, and improved tracking of healthcare data. The areas where challenges will be evident include planning and implementation, the cost to transition, a shortage of qualified coders, training and education of the healthcare workforce, and a loss of productivity when this occurs. The impacts include substantial costs to the healthcare system, but the projected long-term savings and benefits will be significant. Improved fraud detection, accurate data entry, ability to analyze cost benefits with procedures, and enhanced quality outcome measures are the most significant beneficial factors with this change. Results: The present Current Procedural Terminology and Healthcare Common Procedure Coding System code sets will be used for reporting ambulatory procedures in the same manner as they have been. ICD-10-PCS will replace ICD-9 procedure codes for inpatient hospital services. The ICD-10-CM will replace the clinical code sets. Our article will focus on the challenges to execution of an ICD change and strategies to minimize risk while transitioning to the new system. Conclusion: With the implementation deadline gradually approaching, spine surgery practices that include multidisciplinary health specialists have to anticipate and prepare for the ICD change in order to mitigate risk. Education and communication is the key to this process in spine

  4. Comparison of ICD-10 and Gillberg's Criteria for Asperger Syndrome.

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    Leekam, Susan; Libby, Sarah; Wing, Lorna; Gould, Judith; Gillberg, Christopher

    2000-01-01

    This study compared the ICD-10 criteria for Asperger syndrome with those suggested by Gillberg with 200 children and adults who met ICD-10 criteria for autism. Comparison indicated only three subjects met ICD-10 criteria for Asperger syndrome whereas 91 met Gillberg's criteria. The discrepancy appeared due to the specific "normal development"…

  5. Preparing for ICD-10 and conforming your documentation.

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    Buckholtz, Rhonda

    2013-01-01

    There are many unknowns right now with the implementation of ICD-10-CM. However, tackling a few obstacles early on along with a keen sense of ICD-10 awareness will put you ahead of the game and able to continue on after October 1, 2014. Waiting until the last minute in hopes of delays will surely hinder the financial stability of your practice. This article will take you through what is needed for ICD-10 implementation and help you jumpstart your efforts.

  6. Dollars and sense: Mitigating budget risk for ICD-10.

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    Newell, Lucy Mancini; DeSilva, Joseph J

    2013-02-01

    The extended deadline for ICD-10 implementation is time that should not be wasted. Healthcare leaders should keep three things in mind: CFOs should approach the effort knowing the costs of ICD-10 implementation will be high and spread over multiple budget years. Training, productivity, and contractual issues are among key areas that will be challenged by ICD-10 implementation. Healthcare finance leaders should work to improve cash-on-hand and cash reserves prior to the ICD-10 deadline to ensure liquidity post-compliance.

  7. Proposed ICD-10-CM Surveillance Case Definitions for Injury Hospitalizations and Emergency Department Visits.

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    Hedegaard, Holly B; Johnson, Renee L; Ballesteros, Michael F

    2017-01-01

    This report describes a collaboration between the National Center for Health Statistics and the National Center for Injury Prevention and Control to develop proposed surveillance case definitions for injury hospitalizations and emergency department (ED) visits for use with administrative data sets coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The proposed ICD-10-CM surveillance case definitions were developed by applying General Equivalence Mappings to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) definitions. As with the ICD-9-CM definitions, there are slight differences between the proposed ICD-10-CM surveillance case definition for injury hospitalizations and the one for ED visits. The inclusion criteria for an injury hospitalization requires a case to have a principal diagnosis of one of the included nature-of-injury (injury diagnosis) codes. The inclusion criteria for an injury ED visit requires the case to have either a principal diagnosis of one of the included nature-of-injury codes or the presence of selected external-cause codes. The ICD-10-CM nature-of-injury and external-cause codes included in the proposed definitions are presented and caveats for use of the proposed definitions are described.

  8. PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles

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    Tobias M. Glück

    2016-01-01

    Full Text Available Background: The proposal for ICD-11 postulates major changes for posttraumatic stress disorder (PTSD diagnosis, which needs investigation in different samples. Aims: To investigate differences of PTSD prevalence and diagnostic agreement between ICD-10 and ICD-11, factor structure of proposed ICD-11 PTSD, and diagnostic value of PTSD symptom severity classes. Method: Confirmatory factor analysis and latent profile analysis were used on data of elderly survivors of childhood trauma (>60 years, N=399. Results: PTSD rates differed significantly between ICD-10 (15.0% and ICD-11 (10.3%, z=2.02, p=0.04. Unlike previous research, a one-factor solution of ICD-11 PTSD had the best fit in this sample. High symptom profiles were associated with PTSD in ICD-11. Conclusions: ICD-11 concentrates on PTSD's core symptoms and furthers clinical utility. Questions remain regarding the tendency of ICD-11 to diagnose mainly cases with severe symptoms and the influence of trauma type and participant age on the factor structure.

  9. Line of Thinking in ICD-10 Coding of Abdominal Compartment Syndrome%腹腔间隔室综合征的ICD-10编码探讨

    Institute of Scientific and Technical Information of China (English)

    伍英; 彭志刚; 陈红; 黄俐明

    2015-01-01

    本文从概念、定义和ICD1-10编码规则入手,对室隔综合征的临床分型(创伤性骨筋膜室综合征、青光眼、颅内高压综合征、心包填塞、腹腔间隔室综合征)和ICD-10分类之间关系进行了分析对比,提出腹腔间隔室综合征也应与其他室隔综合征同理,编码到消化系统疾病相应章节,即K92.8亚目下。%Based on the concepts, definitions, and coding rules of ICD-10, our studying analyzed and compared the relationship between clinical types and ICD-10 clas ifications of abdominal compartment syndrome, and discus ed the thinking line in ICD-10 Coding of abdominal compartment syndrome . Compartment syndrome divided into the fol owing groups: abdominal compartment syndrome, intracompartment syndrome,intracranial hypertension syndrome, glaucoma, cardiac tamponade. Intracompartment syndrome should be coded to T79.6, intracranial hypertension syndrome:G93.2. glaucoma:H40.0-H40.9,H42.0-H42.8. cardiac tamponade:131.9, so abdominal compartment syndrome should be coded to K92.8 based its interestinal system .

  10. Impact of the Transition to ICD-10 on Medicare Payment

    Data.gov (United States)

    U.S. Department of Health & Human Services — Although the transition from the ICD-9-CM to the ICD-10 version of MS-DRGs resulted in 1.68 percent of the patients being assigned to a different MS-DRG, payment...

  11. DSM-IV and ICD-10: A Comparison of Clinical Features of Attention Deficit-Hyperactivity Disorder and Hyperkinetic Disorder%不同诊断标准的多动症患者临床特点比较

    Institute of Scientific and Technical Information of China (English)

    康传媛; 王玉凤; 杨莉; 钱秋谨

    2005-01-01

    目的:比较美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)和国际疾病分类第10版(ICD-10)诊断为多动症患儿的临床特征,以期为临床上选用何种诊断标准提供参考.方法:对516例门诊就诊的多动症患儿进行研究,以儿童临床诊断性会谈量表与父母进行定式访谈,仅符合DSM-Ⅳ的317例组成ADHD组(注意缺陷多动障碍,attention deficit-hyperactivity disorder,ADHD),同时符合两种诊断标准的199例组成HKD-ADHD组(多动性障碍,hyperkinetoc dosprder,HKD).结果:HKD-ADHD组以混合型为主(75.4%),ADHD组患者以注意缺陷型为主(67.2%);前者较后者起病和就诊年龄早,共患品行问题、对立违抗障碍和感觉统合失调多(P均<0.05);后者在低年龄段共患学习困难多(P<0.05).结论:HKD较ADHD患者临床症状更严重,但仅符合DSM-Ⅳ标准的患者较一般儿童在学习、行为方面已出现一些功能损害,因此在临床中推荐采用DSM-Ⅳ标准,以使患者能得到早期诊治.

  12. Discussion on Bone Cement Implantation Syndrome ICD-10 Coding%骨水泥植入综合征ICD-10编码的探讨

    Institute of Scientific and Technical Information of China (English)

    刘颖

    2016-01-01

    Clinical syndrome is a variety of clinical manifestations characterized diagnosis name caused by different causes of unknown etiology. As an independent disease diagnosis, it brings certain difficulty of ICD coding. In this paper, we take bone cement implantation syndrome for example. We had not been found the corresponding code after looking for the main word "Syndrome", "disease" and "disorder" in ICD-10 book Ⅲ index table. Through referring to the relevant medical information, and timely communicating with the clinician, we had the further understanding for its etiology, pathogenesis, clinical manifestations, etc, stripping external representation and dig the nature of the disease, find out the most main pathogenesis of bone cement implantation syndrome, follow the ICD coding rules, eventually give correct classification of diseases T88.7. This article discussed ICD-10 code process of bone cement implantation syndrome, in order to communicate with peers, and improve the quality of diagnostic codes.%临床综合征是以病因不明或不同病因并存而引起的多种临床表现为特征的诊断名称,作为非独立的疾病诊断,给 ICD 编码的查找工作带来一定难度.本文以骨水泥植入综合征为例,在 ICD-10 卷三索引表中对主导词"综合征"、"病"、"疾患"等查询,均未查到与之对应的编码.通过查阅相关医学资料,并及时与临床医师沟通,对其病因、发病机制、临床表现等方面有了进一步了解,剥去外在表象探索疾病的本质,找出引起骨水泥植入综合征最主要的发病机制,遵循 ICD 编码规则,最终给予正确疾病分类 T88.7.通过对骨水泥植入综合征的 ICD-10 编码过程加以阐述,以期与同行交流,提高疾病诊断编码质量.

  13. Migration to the ICD-10 coding system: A primer for spine surgeons (Part 1

    Directory of Open Access Journals (Sweden)

    Gazanfar Rahmathulla

    2014-01-01

    Full Text Available Background: On 1 October 2015, a new federally mandated system goes into effect requiring the replacement of the International Classification of Disease-version 9-Clinical Modification (ICD-9-CM with ICD-10-CM. These codes are required to be used for reimbursement and to substantiate medical necessity. ICD-10 is composite with as many as 141,000 codes, an increase of 712% when compared to ICD-9. Methods: Execution of the ICD-10 system will require significant changes in the clinical administrative and hospital-based practices. Through the transition, diminished productivity and practice revenue can be anticipated, the impacts of which the spine surgeon can minimizeby appropriate education and planning. Results: The advantages of the new system include increased clarity and more accurate definitions reflecting patient condition, information relevant to ambulatory and managed care encounters, expanded injury codes, laterality, specificity, precise data for safety and compliance reporting, data mining for research, and finally, enabling pay-for-performance programs. The disadvantages include the cost per physician, training administrative staff, revenue loss during the learning curve, confusion, the need to upgrade hardware along with software, and overall expense to the healthcare system. Conclusions: With the deadline rapidly approaching, gaps in implementation result in delayed billing, delayed or diminished reimbursements, and absence of quality and outcomes data. It is thereby essential for spine surgeons to understand their role in transitioning to this new environment. Part I of this article discusses the background, coding changes, and costs as well as reviews the salient features of ICD-10 in spine surgery

  14. ICD-10: are you ready for a brave new world?

    Science.gov (United States)

    Cannon, Barbara A; Strubler, Diana L

    2014-09-01

    The ICD-10 transition will be an evolutionary process. Relying on the EHR or certified coding staff alone will not be sufficient. The EHR can facilitate easy search tools that assist the provider in selecting a diagnosis. Billing staff are an invaluable resource to help validate that coding and documentation are in sync but the burden will clearly rest on the provider. The provider will be juggling a new code structure, drilling down to new levels of complexity and ensuring their documentation supports the specificity of the new codes selected, all while managing a full patient schedule. Education for the provider will be of paramount importance as they navigate this brave new world.

  15. ICD 10 Based Medical Expert System Using Fuzzy Temporal Logic

    CERN Document Server

    Chinniah, P

    2010-01-01

    Medical diagnosis process involves many levels and considerable amount of time and money are invariably spent for the first level of diagnosis usually made by the physician for all the patients every time. Hence there is a need for a computer based system which not only asks relevant questions to the patients but also aids the physician by giving a set of possible diseases from the symptoms obtained using logic at inference. In this work, an ICD10 based Medical Expert System that provides advice, information and recommendation to the physician using fuzzy temporal logic. The knowledge base used in this system consists of facts of symptoms and rules on diseases. It also provides fuzzy severity scale and weight factor for symptom and disease and can vary with respect to time. The system generates the possible disease conditions based on modified Euclidean metric using Elders algorithm for effective clustering. The minimum similarity value is used as the decision parameter to identify a disease.

  16. Metrics and tools for consistent cohort discovery and financial analyses post-transition to ICD-10-CM.

    Science.gov (United States)

    Boyd, Andrew D; Li, Jianrong John; Kenost, Colleen; Joese, Binoy; Yang, Young Min; Kalagidis, Olympia A; Zenku, Ilir; Saner, Donald; Bahroos, Neil; Lussier, Yves A

    2015-05-01

    In the United States, International Classification of Disease Clinical Modification (ICD-9-CM, the ninth revision) diagnosis codes are commonly used to identify patient cohorts and to conduct financial analyses related to disease. In October 2015, the healthcare system of the United States will transition to ICD-10-CM (the tenth revision) diagnosis codes. One challenge posed to clinical researchers and other analysts is conducting diagnosis-related queries across datasets containing both coding schemes. Further, healthcare administrators will manage growth, trends, and strategic planning with these dually-coded datasets. The majority of the ICD-9-CM to ICD-10-CM translations are complex and nonreciprocal, creating convoluted representations and meanings. Similarly, mapping back from ICD-10-CM to ICD-9-CM is equally complex, yet different from mapping forward, as relationships are likewise nonreciprocal. Indeed, 10 of the 21 top clinical categories are complex as 78% of their diagnosis codes are labeled as "convoluted" by our analyses. Analysis and research related to external causes of morbidity, injury, and poisoning will face the greatest challenges due to 41 745 (90%) convolutions and a decrease in the number of codes. We created a web portal tool and translation tables to list all ICD-9-CM diagnosis codes related to the specific input of ICD-10-CM diagnosis codes and their level of complexity: "identity" (reciprocal), "class-to-subclass," "subclass-to-class," "convoluted," or "no mapping." These tools provide guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible.Web portal: http://www.lussierlab.org/transition-to-ICD9CM/Tables annotated with levels of translation complexity: http://www.lussierlab.org/publications/ICD10to9.

  17. Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study

    Directory of Open Access Journals (Sweden)

    Wensing Michel

    2005-02-01

    Full Text Available Abstract Background The increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which may influence physicians' documentation behaviour. For that reason it is unclear to what respect ICD-10 codes reflect the real problems of the patients in general practice. The aim of this study was to assess the appropriateness of the recorded diagnoses and to determine what diagnostic information is used to guide medical treatment. Methods All patients with lower airway symptoms (n = 857 who had attended six general practices between January and June 2003 were included into this cross sectional observational study. Patients were selected from the computerised medical record systems, focusing on ICD-10-codes concerning lower airway diseases (J20-J22, J40-J47, J98 and R05. The performed diagnostic procedures and actual medication for each identified patient were extracted manually. Then we examined the associations between recorded diagnoses, diagnostic procedures and prescribed treatment for asthma and COPD in general practice. Results Spirometry was used in 30% of the patients with a recorded diagnosis of asthma and in 58% of the patients with a recorded diagnosis of COPD. Logistic regression analysis showed an improved use of spirometry when inhaled corticosteroids were prescribed for asthma (OR = 5.2; CI 2.9–9.2 or COPD (OR = 4.7; CI 2.0–10.6. Spirometry was also used more often when sympathomimetics were prescribed (asthma: OR = 2.3; CI 1.2–4.2; COPD: OR = 4.1; CI 1.8–9.4. Conclusions This study revealed that spirometry was used more often when corticosteroids or sympathomimetics were prescribed. The findings suggest that treatment was based on diagnostic test results rather than on recorded diagnoses. The documented ICD-10 codes

  18. Clinical Holistic Medicine (Mindful Short-Term Psychodynamic Psychotherapy Complimented with Bodywork in the Treatment of Schizophrenia (ICD10-F20/DSM-IV Code 295 and Other Psychotic Mental Diseases

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Clinical holistic medicine (CHM has developed into a system that can also be helpful with mentally ill patients. CHM therapy supports the patient through a series of emotionally challenging, existential, and healing crises. The patient’s sense of coherence and mental health can be recovered through the process of feeling old repressed emotions, understanding life and self, and finally letting go of negative beliefs and delusions. The Bleuler's triple condition of autism, disturbed thoughts, and disturbed emotions that characterizes the schizophrenic patient can be understood as arising from the early defense of splitting, caused by negative learning from painful childhood traumas that made the patient lose sense of coherence and withdraw from social contact. Self-insight gained through the therapy can allow the patients to take their bodily, mental, and spiritual talents into use. At the end of therapy, the patients are once again living a life of quality centered on their life mission and they relate to other people in a way that systematically creates value. There are a number of challenges meeting the therapist who works with schizophrenic and psychotic patients, from the potential risk of experiencing a patient's violence, to the obligation to contain the most difficult and embarrassing of feelings when the emotional and often also sexual content of the patient’s unconsciousness becomes explicit. There is a long, well-established tradition for treating schizophrenia with psychodynamic therapy, and we have found that the combination of bodywork and psychotherapy can enhance and accelerate the therapy and might improve the treatment rate further.

  19. The relationship of reactive psychosis and ICD-10 acute and transient psychotic disorders: evidence from a case register-based comparison

    DEFF Research Database (Denmark)

    Castagnini, Augusto; Bertelsen, Aksel; Munk-Jørgensen, Povl

    2006-01-01

    the relationship between the concept of reactive psychosis (RP), equivalent to the ICD-8 298 category of 'other psychoses', and ATPD. SAMPLING AND METHOD: Since January 1, 1994, ICD-10 has replaced ICD-8 as official classification in Denmark. Patients given an ICD-8 298 diagnosis on their last admission in 1992......-1993 were identified from the Danish Psychiatric Central Register, and the ICD-8 diagnoses assigned were compared with their ICD-10 diagnoses when readmitted in 1994-1995. RESULTS: Diagnosis of RP was recorded in 19.2% of patients with functional psychoses in 1992-1993, whereas ATPD overall prevalence...

  20. ICD 10 Based Medical Expert System Using Fuzzy Temporal Logic

    Directory of Open Access Journals (Sweden)

    P.Chinniah

    2009-12-01

    Full Text Available Medical diagnosis process involves many levels and considerable amount of time and money are invariably spent for the first level of diagnosis usually made by the physician for all the patients every time. Hence there is a need for a computer based system which not only asks relevant questions to the patients but also aids the physician by giving a set of possible diseases from the symptoms obtained using logic at inference. In this work, an ICD10 based Medical Expert System that provides advice, information and recommendation to the physician using fuzzy temporal logic. The knowledge base used in this system consists of facts of symptoms and rules on diseases. It also provides fuzzy severity scale and weight factor for symptom and disease and can vary with respect to time. The system generates the possible disease conditions based on modified Euclidean metric using Elder’s algorithm for effective clustering. The minimum similarity value is used as the decision parameter to identify a disease. Keywords -Fuzzy clustering, symptoms, fuzzy severity scale, weight factor, Minkowski distance, ICD, WHO, Rules Base, TSQL

  1. ICD-10在中国的引进和推广%Introduction and Promotion of ICD-10 in China

    Institute of Scientific and Technical Information of China (English)

    于欣

    2009-01-01

    在1948年世界卫生组织出版的《国际疾病分类第六版》中,精神障碍被首次纳入。在1975年颁布ICD-9后,WHO着手开始ICD-10的筹备工作。筹备工作是以几项重大的科研计划开展为标志的:①编制了“复合性国际诊断交谈检查(CIDI)”,适用于在不同国家的一般人群中进行精神障碍的流行病学研究,目前CIDI的版本已经更新到3.0;②编制了适用于临床工作者使用的评定工具“神经精神病学临床评定表(SCAN)”,用于专业人员临床评估病人;③编制了适用于不同国家的人格障碍评定工具“国际人格障碍检查”(International Personality Disorder Examination,IPDE)。

  2. 双硫仑样反应ICD-10编码探讨%Discussion of Disulfiram Like Reaction of ICD-10 Code

    Institute of Scientific and Technical Information of China (English)

    江俊

    2015-01-01

    Objective To summary the key points of coding for disulfiram-like reaction in ICD-10. Methods On the base of introducing pharmacological ef ect of disulfirm and pathogenesis of disulfiram-like reaction,the ways of Coding for Disulfiram-like Reaction in ICD-10 were analyzed. Results The coding are:disulfiram poisoning T50.6,ethanol combined with antibacterial agents or disulfiram T52.8、T65.8.Conclusion It was very important for coding clerks to master the ICD-10 searching methods,learn relevant knowledge about the disease,and careful y read medical records,so as to manage accurately ICD-10 ecoding of disulfiram-like reaction.%目的总结双硫仑样反应ICD-10编码的要点。方法介绍双硫仑的药理作用及双硫仑样反应的发病机制,分析不同原因引起的双硫仑样反应ICD-10编码的方法。结果双硫仑中毒T50.6,抗生素或双硫仑与酒精联用T52.8。结论掌握ICD-10的查找方法,理解双硫仑样反应相关知识,仔细阅读分析病案,是正确编码双硫仑样反应的关键。

  3. Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry

    DEFF Research Database (Denmark)

    Berglund, Agnethe; Olsen, Morten; Andersen, Marianne

    2017-01-01

    : Patients with International Classification of Diseases (10th edition [ICD-10]) diagnoses of hypopituitarism, or other diagnoses of pituitary disorders assumed to be associated with an increased risk of hypopituitarism, recorded in the DNPR during 2000-2012 were identified. Medical records were reviewed...... to confirm or disprove hypopituitarism. RESULTS: Hypopituitarism was confirmed in 911 patients. In a candidate population of 1,661, this yielded an overall positive predictive value (PPV) of 54.8% (95% confidence interval [CI]: 52.4-57.3). Using algorithms searching for patients recorded at least one, three...... or five times with a diagnosis of hypopituitarism (E23.0x) and/or at least once with a diagnosis of postprocedural hypopituitarism (E89.3x), PPVs gradually increased from 73.3% (95% CI: 70.6-75.8) to 83.3% (95% CI: 80.7-85.7). Completeness for the same algorithms, however, decreased from 90.8% (95% CI: 88...

  4. Preparing for ICD-10-CM/PCS implementation: impact on productivity and quality.

    Science.gov (United States)

    Stanfill, Mary H; Hsieh, Kang Lin; Beal, Kathleen; Fenton, Susan H

    2014-01-01

    Coding productivity is expected to drop significantly during the lead-up to and in the initial stages of ICD-10-CM/PCS implementation, now expected to be delayed until October 1, 2015. This study examined the differences in coding productivity between ICD-9-CM and ICD-10-CM/PCS for hospital inpatient cases matched for complexity and severity. Additionally, interrater reliability was calculated to determine the quality of the coding. On average, coding of an inpatient record took 17.71 minutes (69 percent) longer with ICD-10-CM/PCS than with ICD-9-CM. A two-tailed T-test for statistical validity for independent samples was significant (p = .001). No coder characteristics such as years of experience or educational level were found to be a significant factor in coder productivity. Coders who had received more extensive training were faster than coders who had received only basic training. Though this difference was not statistically significant, it provides a strong indication of significant return on investment for staff training time. Coder interrater reliability was substantial for ICD-9-CM but only moderate for ICD-10-CM/PCS, though some ICD-10-CM/PCS cases had complete interrater (coder) agreement. Time spent coding a case was negatively correlated with interrater reliability (-0.425 for ICD-10-CM and -0.349 for ICD-10-PCS). This finding signals that increased time per case does not necessarily translate to higher quality. Adequate training for coders, as well as guidance regarding time invested per record, is important. Additionally, these findings indicate that previous estimates of initial coder productivity loss with ICD-10-CM/PCS may have been understated.

  5. Do coder characteristics influence validity of ICD-10 hospital discharge data?

    Directory of Open Access Journals (Sweden)

    Beck Cynthia A

    2010-04-01

    Full Text Available Abstract Background Administrative data are widely used to study health systems and make important health policy decisions. Yet little is known about the influence of coder characteristics on administrative data validity in these studies. Our goal was to describe the relationship between several measures of validity in coded hospital discharge data and 1 coders' volume of coding (≥13,000 vs. Methods This descriptive study examined 6 indicators of face validity in ICD-10 coded discharge records from 4 hospitals in Calgary, Canada between April 2002 and March 2007. Specifically, mean number of coded diagnoses, procedures, complications, Z-codes, and codes ending in 8 or 9 were compared by coding volume and employment status, as well as hospital type. The mean number of diagnoses was also compared across coder characteristics for 6 major conditions of varying complexity. Next, kappa statistics were computed to assess agreement between discharge data and linked chart data reabstracted by nursing chart reviewers. Kappas were compared across coder characteristics. Results 422,618 discharge records were coded by 59 coders during the study period. The mean number of diagnoses per record decreased from 5.2 in 2002/2003 to 3.9 in 2006/2007, while the number of records coded annually increased from 69,613 to 102,842. Coders at the tertiary hospital coded the most diagnoses (5.0 compared with 3.9 and 3.8 at other sites. There was no variation by coder or site characteristics for any other face validity indicator. The mean number of diagnoses increased from 1.5 to 7.9 with increasing complexity of the major diagnosis, but did not vary with coder characteristics. Agreement (kappa between coded data and chart review did not show any consistent pattern with respect to coder characteristics. Conclusions This large study suggests that coder characteristics do not influence the validity of hospital discharge data. Other jurisdictions might benefit from

  6. Women's views of their sexual difficulties: agreement and disagreement with clinical diagnoses.

    Science.gov (United States)

    King, Michael; Holt, Victoria; Nazareth, Irwin

    2007-04-01

    There is controversy about how to conceptualize sexual problems in women. Our purpose in this study was to compare ICD-10 diagnoses of sexual dysfunction in women with whether or not the woman perceived she had a sexual problem, her views on its origins, and its impact on her life. Participants (N = 401, M age, 37.8 years) were consecutive attendees to general practices in London, England. Our main measures were an ICD-10 diagnosis of sexual dysfunction and the woman's own perception of a sexual problem. Based on reported symptoms and behavior, 38% of women had at least one ICD-10 diagnosis of sexual dysfunction. Prevalence fell to 18% in women who also perceived they had a problem and to 6% in women who regarded the problem as moderate or severe. A total of 73 (18%) women were assigned an ICD-10 diagnosis and agreed that they had a problem, 80 (20%) were assigned a diagnosis but reported no problem, 78 (19%) had no diagnosis but reported a sexual problem, and 170 (42%) had no diagnosis and reported no problem. For women with sexual partners, reported sexual satisfaction was lowest in those assigned an ICD-10 diagnosis who also perceived they had a problem and highest in those with no diagnosis and no perceived problem. Relationship and emotional difficulties were the most common perceived causes of sexual difficulties, whether or not an ICD-10 diagnosis was assigned. There were three aspects to sexual difficulties in women. The first concerned symptoms and behavior that clinicians used to make a diagnosis, the second was the woman's own perception that she had a sexual difficulty, and the third was her level of sexual satisfaction. All three appear to be important and may explain why published prevalence rates of sexual dysfunction and associated factors are so conflicting.

  7. Implementing the K-SADS-PL as a standard diagnostic tool: Effects on clinical diagnoses.

    Science.gov (United States)

    Matuschek, Tina; Jaeger, Sonia; Stadelmann, Stephanie; Dölling, Katrin; Grunewald, Madlen; Weis, Steffi; von Klitzing, Kai; Döhnert, Mirko

    2016-02-28

    Diagnostic interviews are valuable tools for generating reliable and valid psychiatric diagnoses. However, little is known about the diagnostic effects of implementing such an interview into the standard diagnostic procedure of a child psychiatric clinic. Therefore, we reviewed discharge diagnoses of psychiatric patients (age: 8-12 years; combined sample of inpatients and day hospital patients) over two intervals before and after implementing the semi-structured diagnostic interview K-SADS-PL as a diagnostic tool during intake. Each interval was a two year period spanning from 2009-2010 (pre sample; n=177) and from 2012-2013 (post sample; n=132). The number of diagnoses per patient and the co-morbidity rate increased significantly in the post sample. Furthermore, the percentage of children with a nonspecific diagnosis "other mixed disorders of conduct and emotions" (ICD-10: F92.8) decreased significantly after using the K-SADS-PL. Regarding the main diagnostic categories, a significant increase in the number of anxiety disorders and stress-related and somatoform disorders was found in the post sample. The results suggest that implementing a semi-structured interview into the daily routine of child psychiatry may have a substantial impact on discharge diagnoses. Practical implications are discussed and ideas for future research are given.

  8. Validation of a Turkish Version of the ICD-10 Symptom Rating (ISR

    Directory of Open Access Journals (Sweden)

    Jan Ilhan Kizilhan

    2013-05-01

    Full Text Available Numerous psychiatric and psychosomatic clinics in Turkey and Germany use the Symptom Checklist 90 Revised (SCL-90-R developed by Derogatis (1977 or the validated Turkish version by Dag (1991 for assessing psychological symptoms. Many patients informed us during numerous studies and visits to these clinics that this test with its 90 questions took too long and that they were unable to sufficiently concentrate on it. In the meantime, the much more economical ICD-10 Symptom Rating (ISR (Tritt et al., 2008 self-rating questionnaire, comprising 29 questions, has been developed in Germany in 2008. In 2008 and 2009 we therefore decided to translate the ISR into Turkish, to analyse it for its reliability and validity and compare it with the SCL-90-R and the BDI. In an analysis of 277 Turkish subjects – 127 of whom were inpatients, 36 outpatients and 104 clinically unremarkable healthy participants – very good psychometric characteristics were achieved in terms of high internal consistency of individual, additional and overall scales. The results of the factor analysis conducted showed that the ISR Measure has satisfactory construct validity. In a random sample of inpatients, the Cronbach’s alpha values ranged from 0.66 (scale: Compulsive syndrome to 0.93 (overall scale. The advantage of this instrument over BDI and SCL-90-R lies in its shorter processing time. The German version of the ISR promises lesser use of time and good empirical quality, which we double-checked with a translated Turkish version tested on persons of Turkish origin in Germany.

  9. 关于Castleman病ICD-10编码的探讨%Discussion on the ICD-10 Coding of Castleman Disease

    Institute of Scientific and Technical Information of China (English)

    赵晶

    2015-01-01

    目的 通过分析Castleman病的原因、病理和临床表现,探讨正确查找castleman病ICD-10编码思路与方法.方法 查阅某院2004年-2014年血液科“淋巴结肿大”为主要诊断的185份病例资料中确诊的castleman病例.分析该病的病因、病理及临床表现,按照国际疾病分类原则,灵活替换不同主导词.结果 对于发病原因不明又没有特异性临床表现的一类疾病,应了解该病的发生、发展过程,与临床医生沟通,详细分析病案情况,寻找其实验室检查、影像学检查、病理组织学检查等相关医学确诊依据,确定该病ICD-10编码局灶性(LCD)为R59.0,多中心型(MCD)为R59.1.结论 Castleman病ICD-10编码的查找,应以“增生、扩大”为主导词,不能简单认定其为肿瘤或淋巴系统疾病,同时认真阅读病案资料,查找其他伴发疾病的编码.

  10. Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry

    Science.gov (United States)

    Berglund, Agnethe; Olsen, Morten; Andersen, Marianne; Nielsen, Eigil Husted; Feldt-Rasmussen, Ulla; Kistorp, Caroline; Gravholt, Claus Højbjerg; Stochhholm, Kirstine

    2017-01-01

    Objective Routinely collected health data may be valuable sources for conducting research. This study aimed to evaluate the validity of algorithms detecting hypopituitary patients in the Danish National Patient Registry (DNPR) using medical records as reference standard. Study design and setting Patients with International Classification of Diseases (10th edition [ICD-10]) diagnoses of hypopituitarism, or other diagnoses of pituitary disorders assumed to be associated with an increased risk of hypopituitarism, recorded in the DNPR during 2000–2012 were identified. Medical records were reviewed to confirm or disprove hypopituitarism. Results Hypopituitarism was confirmed in 911 patients. In a candidate population of 1,661, this yielded an overall positive predictive value (PPV) of 54.8% (95% confidence interval [CI]: 52.4–57.3). Using algorithms searching for patients recorded at least one, three or five times with a diagnosis of hypopituitarism (E23.0x) and/or at least once with a diagnosis of postprocedural hypopituitarism (E89.3x), PPVs gradually increased from 73.3% (95% CI: 70.6–75.8) to 83.3% (95% CI: 80.7–85.7). Completeness for the same algorithms, however, decreased from 90.8% (95% CI: 88.7–92.6) to 82.9% (95% CI: 80.3–85.3) respectively. Including data of hormone replacement in the same algorithms PPVs increased from 73.2% (95% CI: 70.6–75.7) to 82.6% (95% CI: 80.1–84.9) and completeness decreased from 94.3% (95% CI: 92.6–95.7) to 89.7% (95% CI: 87.5–91.6) with increasing records of E23.0x. Conclusion The DNPR is a valuable data source to identify hypopituitary patients using a search criteria of at least five records of E23.0x and/or at least one record of E89.3x. Completeness is increased when including hormone replacement data in the algorithm. The consequences of misclassification must, however, always be considered. PMID:28223847

  11. Administrative simplification: adoption of a standard for a unique health plan identifier; addition to the National Provider Identifier requirements; and a change to the compliance date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) medical data code sets. Final rule.

    Science.gov (United States)

    2012-09-05

    This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.

  12. Evaluating Open-Source Full-Text Search Engines for Matching ICD-10 Codes.

    Science.gov (United States)

    Jurcău, Daniel-Alexandru; Stoicu-Tivadar, Vasile

    2016-01-01

    This research presents the results of evaluating multiple free, open-source engines on matching ICD-10 diagnostic codes via full-text searches. The study investigates what it takes to get an accurate match when searching for a specific diagnostic code. For each code the evaluation starts by extracting the words that make up its text and continues with building full-text search queries from the combinations of these words. The queries are then run against all the ICD-10 codes until a match indicates the code in question as a match with the highest relative score. This method identifies the minimum number of words that must be provided in order for the search engines choose the desired entry. The engines analyzed include a popular Java-based full-text search engine, a lightweight engine written in JavaScript which can even execute on the user's browser, and two popular open-source relational database management systems.

  13. 关于Fahr综合征及其ICD-10编码

    Institute of Scientific and Technical Information of China (English)

    佘璇瑜; 陈丹霞; 陈彩芳

    2011-01-01

    目的 探讨Fahr综合征的ICD-10编码.方法 通过阅读医学文献,深入了解Fahr综合征的临床与病因,按ICD-10分类规则进行编码.结果 对Fahr综合征的的临床与病因有了进一步的认识,并给予相应的编码.结论 编码员一定要按正确操作步骤进行编码,还要阅读病史,有疑问须多方查阅资料进行综合分析,并依据编码原则做出正确编码.

  14. [Retest-reliability and sensitivity to change of the ICD-10-Symptom-Rating (ISR) in different samples].

    Science.gov (United States)

    Fischer, Herbert Felix; Schirmer, Nicole; Tritt, Karin; Klapp, Burghard F; Fliege, Herbert

    2011-03-01

    Assessment of the retest-reliability and sensitivity to change of the ICD-10-Symptom-Rating (ISR) is provided. The ISR was filled out repeatedly by a non-clinical as well as different samples of psychosomatic patients. Between the two measurements either no or an integrated psychosomatic treatment took place. During the treatment free phase a high degree of stability of the test scores was expected, whereas a significant improvement of test scores was expected for the respective scales over the treatment phase. The retest-reliability for the individual scales ranges from 0.70 to 0.94. Between admission to a psychosomatic treatment and discharge significant differences were found for all scales. The retest-reliability showed satisfactory results comparable to similar, symptom-oriented instruments. Furthermore, the instruments reproduces symptomatic changes consistently and is - from our point of view - suitable for the assessment of change.

  15. Identity, personality and their disorders in DSM-V and ICD-10

    OpenAIRE

    Güell, F. (Francisco); Bernacer, J. (Javier); Castro, P.; Murillo, J.I. (José Ignacio)

    2012-01-01

    The terms “identity” and “personality” are frequently used in medical literature in the attempt to classify certain dissociative disorders. The main diagnostic manuals used in psychiatry, the DSM-5 and the ICD-10, use the term “dissociative identity disorder” (DID) and “multiple personality disorder” (MPD) respectively, to define a disruption of identity characterized by two or more distinct personality states, or an experience of possession, as evidenced by discontinuities in sense of self, ...

  16. 基于ICD-10的药用植物种类统计分析%Statistical Analysis of Medicinal Plants Based on ICD-10

    Institute of Scientific and Technical Information of China (English)

    杨林; 卢大丽; 袁万清; 钱津; 熊源新

    2013-01-01

    A total of 4 258 species of medicinal plants in Guizhou Province, are analyzed according to the Tenth Revision of International Classification of Diseases (ICD - 10) in the current investigation. Dominant families, genera, species of medical plants in Guizhou province are carried out statistical analysis. Twenty one families contain more than 50 species play a role in most diseases. The most proportion of dominant family is Polygonaceae. The genera of the most species including Polygonum, Rubus, Rhododendron etc. The most proportion of dominant genera including Asplenium and Selaginella. Among which 21 species including Aristolo-chia debilis, Polygonum chinense, Croton tiglium and Rhodomyrtus tomentosa etc show curative effect for more than 15 diseases.%根据世界卫生组织ICD-10(《国际疾病分类系统》第十次修订本International Classification of Diseases)的分类内容对贵州4258种药用植物进行了统计分析.对其中涉及疾病最多的科、属、种进行了分析;对重要的科、属、种涉及的疾病也进行了分析.含药用植物种数大于50种的有21科,涉及疾病最多、疾病种类比例最高的科是蓼科Polygonaceae.含药用植物种类最多的属包括蓼属(Polygonum)、悬钩子属(Rubus)、杜鹃花属(Rhododendron)等,涉及疾病种类属的比例最高的是铁角蕨属Asplenium和卷柏属Selaginella.能对15种以上的疾病有疗效的药用植物有21种,包括马兜铃Aristolochia debilis、火炭母Polygonum chinense、巴豆Croton tiglium、桃金娘Rhodomyrtus tomentosa等.

  17. Neurodevelopmental Disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11.

    Science.gov (United States)

    Doernberg, Ellen; Hollander, Eric

    2016-08-01

    Neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have undergone considerable diagnostic evolution in the past decade. In the United States, the current system in place is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), whereas worldwide, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) serves as a general medical system. This review will examine the differences in neurodevelopmental disorders between these two systems. First, we will review the important revisions made from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to the DSM-5, with respect to ASD and ADHD. Next, we will cover the similarities and differences between ASD and ADHD classification in the DSM-5 and the ICD-10, and how these differences may have an effect on neurodevelopmental disorder diagnostics and classification. By examining the changes made for the DSM-5 in 2013, and critiquing the current ICD-10 system, we can help to anticipate and advise on the upcoming ICD-11, due to come online in 2017. Overall, this review serves to highlight the importance of progress towards complementary diagnostic classification systems, keeping in mind the difference in tradition and purpose of the DSM and the ICD, and that these systems are dynamic and changing as more is learned about neurodevelopmental disorders and their underlying etiology. Finally this review will discuss alternative diagnostic approaches, such as the Research Domain Criteria (RDoC) initiative, which links symptom domains to underlying biological and neurological mechanisms. The incorporation of new diagnostic directions could have a great effect on treatment development and insurance coverage for neurodevelopmental disorders worldwide.

  18. Schizoaffective disorder-- the reliability of its clinical diagnostic use

    DEFF Research Database (Denmark)

    Vollmer-Larsen, Anne; Jacobsen, TB; 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....... Diagnoses were allocated by OPCRIT algorithm and by consensus of two psychiatrists. RESULTS: No patients fulfilled the SAD lifetime diagnosis according to DSM-IV criteria and the raters diagnosed only six patients as possible ICD-10 SAD. CONCLUSION: A moratorium on the clinical use of the SAD diagnosis...

  19. Clinically and electrophysiologically diagnosed botulinum intoxication.

    Science.gov (United States)

    Kotan, Dilcan; Aygul, Recep; Ceylan, Mustafa; Yilikoglu, Yalcin

    2013-01-03

    In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

  20. [Differential diagnostic considerations using ICD-10 in chronic back pain with special regard to persistent somatoform pain disorder with somatic and psychological factors (ICD-10 F45.41)].

    Science.gov (United States)

    Wolff, D

    2016-06-01

    It is often difficult to pass an expert opinion in cases of chronic back pain. This article analyses the differential diagnostic considerations related to coding various causes in line with ICD-10. It emphasises the I importance of making a careful distinction between orthopoedic and psychiatric conditions and disorders. Simultaneous coding of orthopoedic and psychiatric illnesses and disorders based on a distinct cluster of symptoms necessitates an interdisciplinary approach that consistently applies the ICD-10 definitions of mental an behavioural disorders in order to clearly identify the main reason for a functional impairment in the insurance and sociomedical context. Persistant somatoform pain disorder with somatic and psychological factors (ICD-10 F45.41) should be regarded as related to the underlying disease and be used primarily as an additional and descriptive diagnosis.

  1. [Factor structure and psychometric properties of the ICD-10-Symptom-Rating (ISR) in samples of psychosomatic patients].

    Science.gov (United States)

    Fischer, Herbert Felix; Tritt, Karin; Klapp, Burghard F; Fliege, Herbert

    2010-08-01

    The ICD-10-Symptom-Rating (ISR) is a self-rating questionnaire for patients. According to its conceptualization, the instrument was developed to closely represent the syndrome structure of the ICD-10 while assessing the extent of psychological distress an individual suffers from. The results of different factor analyses testing the postulated syndrome structure as well as item and scale characteristics are reported here. Data was collected from a consecutive sample of 1 057 psychosomatic patients of the University Hospital Charité Berlin. Evaluation of the dimensional structure of the questionnaire included exploratory and confirmatory factor analyses each computed with a randomized half of the sample. Multi-Sample-Analyses with different subgroups of the sample were performed to test the stability of the factor structure. The individual factors were constituted by the postulated syndrome units of the ICD-10 involving a high and uniform distribution of accounted variance. They also proved themselves satisfactorily stable over the different subsamples. The scales showed a high degree of internal consistency with relatively small gender and age effects, while psychological disorders had a large effect on the means of the scales. Taking a perspective of test theory, the ICD-10-Symptom-Rating is in accordance with the syndrome structure of the ICD-10 and suitable for the assessment of psychological symptoms. Other aspects pertaining to the reliability and validity of the ISR remain to be proven in future research.

  2. Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study

    Directory of Open Access Journals (Sweden)

    Ansha Patel

    2016-01-01

    Full Text Available BACKGROUND: According to the existing literature on infertility, stress appears to be inevitably associated with infertility diagnosis and treatment in sub-fertile individuals. The epidemiological data on the prevalence and predictors of infertility-specific stress in cultural specific scenario are scarce. The objective of the present study was to estimate the prevalence of infertility-specific stress and identify predictors of infertility-specific stress in women diagnosed with primary infertility. MATERIALS AND METHODS: This cross-sectional study was conducted on 300 infertile married women, diagnosed with primary infertility. The tools used for the assessment were “semi-structured questionnaire ” compiled by the authors, “ICD-10 Classification of Mental and Behavioral Disorders (Clinical Descriptions and Diagnostic Guidelines, ” and “Psychological Evaluation Test for infertility. ” STATISTICAL ANALYSIS: Data were analyzed using SPSS (version 15. Chi-square test was used for univariate analysis followed by multiple logistic regressions between stress and the predictor variables. RESULTS AND DISCUSSION: The prevalence of stress among women was 80%. Univariate analysis revealed that predictors of stress were years of marital life, duration of infertility, infertility type, history of gynecological surgery, cycles of ovulation induction with timed intercourse and intra-uterine inseminations, present and past psychiatric morbidity, coping difficulties, gynecological diagnosis, and severity of premenstrual dysphoria. Multivariate analysis showed leading associations of stress with infertility type and coping difficulties.

  3. Predictive Validity of ICD-10 Hyperkinetic Disorder Relative to DSM-IV Attention-Deficit/Hyperactivity Disorder among Younger Children

    Science.gov (United States)

    Lahey, Benjamin B.; Pelham, William E.; Chronis, Andrea; Massetti, Greta; Kipp, Heidi; Ehrhardt, Ashley; Lee, Steve S.

    2006-01-01

    Background: Little is known about the predictive validity of hyperkinetic disorder (HKD) as defined by the Diagnostic Criteria for Research for mental and behavioral disorders of the tenth edition of the International Classification of Diseases (ICD-10; World Health Organization, 1993), particularly when the diagnosis is given to younger children.…

  4. Automatic ICD-10 multi-class classification of cause of death from plaintext autopsy reports through expert-driven feature selection

    Science.gov (United States)

    Mujtaba, Ghulam; Shuib, Liyana; Raj, Ram Gopal; Rajandram, Retnagowri; Shaikh, Khairunisa; Al-Garadi, Mohammed Ali

    2017-01-01

    Objectives Widespread implementation of electronic databases has improved the accessibility of plaintext clinical information for supplementary use. Numerous machine learning techniques, such as supervised machine learning approaches or ontology-based approaches, have been employed to obtain useful information from plaintext clinical data. This study proposes an automatic multi-class classification system to predict accident-related causes of death from plaintext autopsy reports through expert-driven feature selection with supervised automatic text classification decision models. Methods Accident-related autopsy reports were obtained from one of the largest hospital in Kuala Lumpur. These reports belong to nine different accident-related causes of death. Master feature vector was prepared by extracting features from the collected autopsy reports by using unigram with lexical categorization. This master feature vector was used to detect cause of death [according to internal classification of disease version 10 (ICD-10) classification system] through five automated feature selection schemes, proposed expert-driven approach, five subset sizes of features, and five machine learning classifiers. Model performance was evaluated using precisionM, recallM, F-measureM, accuracy, and area under ROC curve. Four baselines were used to compare the results with the proposed system. Results Random forest and J48 decision models parameterized using expert-driven feature selection yielded the highest evaluation measure approaching (85% to 90%) for most metrics by using a feature subset size of 30. The proposed system also showed approximately 14% to 16% improvement in the overall accuracy compared with the existing techniques and four baselines. Conclusion The proposed system is feasible and practical to use for automatic classification of ICD-10-related cause of death from autopsy reports. The proposed system assists pathologists to accurately and rapidly determine underlying

  5. PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles

    OpenAIRE

    Glück, Tobias M.; Knefel, Matthias; Tran, Ulrich S.; Lueger-Schuster, Brigitte

    2016-01-01

    Background: The proposal for ICD-11 postulates major changes for posttraumatic stress disorder (PTSD) diagnosis, which needs investigation in different samples.Aims: To investigate differences of PTSD prevalence and diagnostic agreement between ICD-10 and ICD-11, factor structure of proposed ICD-11 PTSD, and diagnostic value of PTSD symptom severity classes.Method: Confirmatory factor analysis and latent profile analysis were used on data of elderly survivors of childhood trauma (>60 years...

  6. The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients

    Directory of Open Access Journals (Sweden)

    Lash Timothy L

    2011-05-01

    Full Text Available Abstract Background The Charlson comorbidity index is often used to control for confounding in research based on medical databases. There are few studies of the accuracy of the codes obtained from these databases. We examined the positive predictive value (PPV of the ICD-10 diagnostic coding in the Danish National Registry of Patients (NRP for the 19 Charlson conditions. Methods Among all hospitalizations in Northern Denmark between 1 January 1998 and 31 December 2007 with a first-listed diagnosis of a Charlson condition in the NRP, we selected 50 hospital contacts for each condition. We reviewed discharge summaries and medical records to verify the NRP diagnoses, and computed the PPV as the proportion of confirmed diagnoses. Results A total of 950 records were reviewed. The overall PPV for the 19 Charlson conditions was 98.0% (95% CI; 96.9, 98.8. The PPVs ranged from 82.0% (95% CI; 68.6%, 91.4% for diabetes with diabetic complications to 100% (one-sided 97.5% CI; 92.9%, 100% for congestive heart failure, peripheral vascular disease, chronic pulmonary disease, mild and severe liver disease, hemiplegia, renal disease, leukaemia, lymphoma, metastatic tumour, and AIDS. Conclusion The PPV of NRP coding of the Charlson conditions was consistently high.

  7. ICD-10心境障碍诊断标准在中国的应用与修改建议%Application and Amendment of ICD-10 Diagnostic Criteria for Mood Disorders in Mainland of China

    Institute of Scientific and Technical Information of China (English)

    刘铁榜; 杨海晨; 沈其杰

    2009-01-01

    @@ 1 概述 影响中国(未包括香港、澳门、台湾)精神卫生专业人员的诊断分类系统主要有3个,分别是中国的CCMD-3、美国的DSM-IV及WHO的ICD-10(V).本文统计了2003-2007年发表的有关心境障碍的论文中所使用的分类诊断系统(见表1).

  8. Trends in Gastroenteritis-associated Mortality in the United States 1985-2005: Variations by ICD-9 and ICD-10 Codes

    Science.gov (United States)

    BackgroundTrends in gastroenteritis-associated mortality are changing over time with development of antibiotic resistant strains of certain pathogens, improved diagnostic methods, and changing healthcare. In 1999, ICD-10 coding was introduced for mortality records which can also ...

  9. Distribution of Severity of Injury/Illness Index according to ICD-10 groups

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Dahl, Michael; Rostgaard-Knudsen, Martin;

    be dispatched to the SIII groups 4-7 (severe illness/injury). Choosing six main groups of diagnoses we describe the individual distribution of SIII to reveal their severity.  METHODS: The local Emergency Medical Service (EMS) system in Aalborg, a small-sized urban city with approximately 200.000 inhabitants...

  10. Clinical practice guideline: screening and diagnosing autism.

    Science.gov (United States)

    Blackwell, J

    2001-12-01

    The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism.

  11. How to compare scores from different depression scales: equating the Patient Health Questionnaire (PHQ) and the ICD-10-Symptom Rating (ISR) using Item Response Theory.

    Science.gov (United States)

    Fischer, H Felix; Tritt, Karin; Klapp, Burghard F; Fliege, Herbert

    2011-12-01

    A wide range of questionnaires for measuring depression are available. Item Response Theory models can help to evaluate the questionnaires exceeding the boundaries of Classical Test Theory and provide an opportunity to equate the questionnaires. In this study after checking for unidimensionality, a General Partial Credit Model was applied to data from two different depression scales [Patient Health Questionnaire (PHQ-9) and ICD-10-Symptom Rating (ISR)] obtained in clinical settings from a consecutive sample, including 4517 observations from a total of 2999 inpatients and outpatients of a psychosomatic clinic. The precision of each questionnaire was compared and the model was used to transform scores based on the assumed underlying latent trait. Both instruments were constructed to measure the same construct and their estimates of depression severity are highly correlated. Our analysis showed that the predicted scores provided by the conversion tables are similar to the observed scores in a validation sample. The PHQ-9 and ISR depression scales measure depression severity across a broad range with similar precision. While the PHQ-9 shows advantages in measuring low or high depression severity, the ISR is more parsimonious and also suitable for clinical purposes. Furthermore, the equation tables derived in this study enhance the comparability of studies using either one of the instruments, but due to substantial statistical spread the comparison of individual scores is imprecise.

  12. Differences in the ICD-10 diagnostic subtype of depression in bipolar disorder compared to recurrent depressive disorder

    DEFF Research Database (Denmark)

    Jensen, H.M.; Christensen, E.M.; Kessing, Lars Vedel

    2008-01-01

    Background: The aim of the study was to investigate whether patients with bipolar depression and patients with recurrent depressive disorder present with different subtypes of depressive episode as according to ICD-10. Sampling and Methods: All patients who got a diagnosis of bipolar affective......: Totally, 389 patients got a diagnosis of bipolar disorder, current episode of depression, and 5.391 patients got a diagnosis of recurrent depressive disorder, current episode of depression, at first contact. Compared with patients with a diagnosis of recurrent depressive disorder, patients with bipolar...... for patients with bipolar disorder, current episode of depression, compared with patients with a current depression as part of a recurrent depressive disorder (HR = 1.50, 95% CI = 1.20-1.86). Conclusions: The results consistently indicate that a depressive episode is severer and/or more often associated...

  13. Dementia DSM-IV/ICD-10 or neurocognitive disorder DSM-5?

    Directory of Open Access Journals (Sweden)

    Joaquim Pujol Domenech

    Full Text Available Background and Objectives: According to existing data the term dementia was invented in the first century BC. It was introduced in the European literature in the 17th and 18th centuries AC. At the end of the 17th century, the French Encyclopedia points at ethiological implications which would later shape legal concepts. In the 19th century the Centroeuropean research develops specific nosologies until, in the 20th century, senile dementia is gradually discredited. Methods: Slightly over ten years ago, the Mild Cognitive Disorder (MCD conceptualization was introduced as an early stage of Alzheimer's disease (AD, but the lack of coherence in relation to lesions sparked a still ongoing controversy, as the author of the MCD concept belongs to the Writing Board of DSM 5. Results: The DSM IV focuses on a categorical approach in spite of the difficulty in differentiating “normal” from “pathological” impairment at certain ages. On the other hand, the DSM 5 adopts the Dimensional System with a Mild or Severe Neurocognitive Disorder definition, which is necessarily arbitrary and imposes a statistical criterion. The widespread use of this classification would imply diagnosing a large proportion of the population with huge social and medical implications. This triggered a variety of reactions, such as the APA note which claims that DSM 5 and CIE-10 “virtually contain the same codes”. However a WHO study revealed that 70% of surveyed psychiatrists used CIE 10 criteria. Conclusions: The DSM 5 gives weight to cognitive aspects using as a severity criterion the number of standard deviations in relation to psychometric normality. It might be misleading if applied to some forms of dementia, for instance frontal dementias. The CIE-10 and DSM IV criteria are more operational.

  14. Positive predictive values of the International Classification of Diseases, 10th revision diagnoses of Gram-negative septicemia/sepsis and urosepsis for presence of Gram-negative bacteremia

    Directory of Open Access Journals (Sweden)

    Søgaard KK

    2015-02-01

    Full Text Available Kirstine Kobberøe Søgaard,1 Reimar Wernich Thomsen,1 Henrik Carl Schønheyder,2,3 Mette Søgaard1 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Microbiology, Aalborg University Hospital, 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Background: Health care databases are a valuable resource for infectious disease epidemiology if diagnoses are accurately coded. We examined the ability of diagnostic coding to accurately identify Gram-negative bacteremia. Methods: We randomly selected 100 patients among 1,703 patients recorded in the Danish National Patient Register with a diagnosis of either “septicemia/sepsis due to other Gram-negative organisms” (International Classification of Diseases, 10th revision [ICD-10] code A41.5 or “urosepsis” (ICD-10 code A41.9B who had been admitted at Aalborg University Hospital, Denmark between 1994 and 2012. We estimated the positive predictive value (PPV of these diagnoses for presence of Gram-negative bacteremia, using microbiological results from blood cultures as standard reference. Complementary clinical information was obtained from the medical records. Results: Of the 100 patients registered with Gram-negative septicemia/sepsis or urosepsis, 72 had blood culture confirmed Gram-negative bacteremia, four patients had monomicrobial Gram-positive bacteremia, 21 patients had a negative blood culture, and three had no blood culture taken. The overall PPV of a blood culture confirmed Gram-negative bacteremia diagnosis was 72% (95% confidence interval [CI]: 62%–81%; for ICD-10 code A41.5 it was 86% (95% CI: 74%–94% and for ICD-10 code A41.9B it was 55% (95% CI: 39%–70%. The highest PPV was achieved for diagnoses registered in the most recent calendar period (2009–2012 and for secondary discharge diagnoses. Conclusion: Our findings indicated good agreement between ICD-10 code A41.5

  15. 利用ICD-10分类对深圳市病残儿医学鉴定病种的趋势分析%Analysis of disabled children applied for medical authentication with ICD-10

    Institute of Scientific and Technical Information of China (English)

    谢立春; 陈火星

    2011-01-01

    目的:对深圳市病残儿医学鉴定病种及其构成趋势进行统计分析,为病残儿的防治提供依据.方法:对深圳市近5年病残儿医学鉴定患儿资料用进行疾病分类与编码,用SPSS统计软件进行分析.结果:近5年主要致残病种依次为先天性畸形类、精神行为障碍、神经系统疾病、肿瘤,合计占79.74%,其中先天性畸形类、神经系统疾病相对稳定,而精神行为障碍及肿瘤所占比重呈上升趋势;病残儿出生缺陷累计发生率达62.63%,最高是循环系统先天畸形;主要单病种顺位依次为:童年孤独症、脑瘫、先天性心脏病、精神发育迟滞等.结论:出生缺陷是造成儿童病残的主要原因.应重点加强对先天性心脏病、脑瘫、孤独症和少儿肿瘤的研究和预防.建议在全国范围内建立病残儿鉴定资料信息库,统一按ICD-10进行疾病分类,动态监测分析,为出生缺陷干预和病残儿的防治服务.%Objective: To provide a scientific basis for birth defect prevention by analyzing disease categories of disabled children applied for medical authentication. Methods: Diseases suffered by 691 children applied for medical authentication between 2005 and 2009 were classified and coded according to ICD -10 standard, and analyzed with SPSS software. Results: The top four kinds of diseases were congenital malformation, mental and behavior disorders, nervous system diseases and tumor, accounting for 79.74%. The incidence of the former two remained relatively stable, but the percentage of the latter two had been increasing. The cumulative incidence of birth defects reached 62.63%, and the highest prevalence of congenital malformations of circulatory system was found. The top four single - type diseases were as follows: autism, cerebral palsy, congenital heart disease and mental retardation. Conclusion: Birth defects could be the primary cause of children disability. Researches and interventions on congenital

  16. Clinical characteristics of 297 newly diagnosed Chinese HIV / AIDS patients

    Institute of Scientific and Technical Information of China (English)

    曹玮

    2014-01-01

    Objective To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS.Methods A total of297 newly diagnosed HIV/AIDS patients were enrolled in Peking Union Medical College Hospital(PUMCH)from January 2001 to December 2012,including 19 patients of primary phase,115 of asymptomatic phase and 163 of AIDS phase.Clinical characteristics of these patients were retrospectively analyzed.Results Two hundred and

  17. Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Martić Vesna

    2015-01-01

    Full Text Available Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS. The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ± 14 years and 52 ± 16 years, respectively. All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95. Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is the need for neurophysiological evaluation of patients with complains in the arm.

  18. A new coding system for metabolic disorders demonstrates gaps in the international disease classifications ICD-10 and SNOMED-CT, which can be barriers to genotype-phenotype data sharing.

    Science.gov (United States)

    Sollie, Annet; Sijmons, Rolf H; Lindhout, Dick; van der Ploeg, Ans T; Rubio Gozalbo, M Estela; Smit, G Peter A; Verheijen, Frans; Waterham, Hans R; van Weely, Sonja; Wijburg, Frits A; Wijburg, Rudolph; Visser, Gepke

    2013-07-01

    Data sharing is essential for a better understanding of genetic disorders. Good phenotype coding plays a key role in this process. Unfortunately, the two most widely used coding systems in medicine, ICD-10 and SNOMED-CT, lack information necessary for the detailed classification and annotation of rare and genetic disorders. This prevents the optimal registration of such patients in databases and thus data-sharing efforts. To improve care and to facilitate research for patients with metabolic disorders, we developed a new coding system for metabolic diseases with a dedicated group of clinical specialists. Next, we compared the resulting codes with those in ICD and SNOMED-CT. No matches were found in 76% of cases in ICD-10 and in 54% in SNOMED-CT. We conclude that there are sizable gaps in the SNOMED-CT and ICD coding systems for metabolic disorders. There may be similar gaps for other classes of rare and genetic disorders. We have demonstrated that expert groups can help in addressing such coding issues. Our coding system has been made available to the ICD and SNOMED-CT organizations as well as to the Orphanet and HPO organizations for further public application and updates will be published online (www.ddrmd.nl and www.cineas.org).

  19. Frequency of nursing diagnoses in a surgical clinic

    Directory of Open Access Journals (Sweden)

    Andreza Cavalcanti Vasconcelos

    2015-12-01

    Full Text Available Objective: to identify the frequency of Nursing Diagnoses of patients in a surgical clinic. Methods: cross-sectional study, performed with 99 patients in the postoperative of general surgery. Data were collected through a questionnaire validated according to domains of NANDA International, including physical and laboratory examination. Results: 17 nursing diagnoses were found; eight had a frequency higher than 50.0% (infection risk, impaired tissue integrity, constipation risk, anxiety, bleeding risk, acute pain, delayed surgical recovery, dysfunctional gastrointestinal motility. It was observed in all patients the Nursing Diagnostics: risk of infection, impaired tissue integrity and risk of constipation. Conclusion: the frequency of the most prevalent diagnosis is inserted in the domains safety/protection and nutrition, which determines the need to redirect nursing care, prioritizing the patient's clinic.

  20. The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model

    NARCIS (Netherlands)

    C. de Bruijn; W. van den Brink; R. de Graaf; W.A.M. Vollebergh

    2006-01-01

    To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). T

  1. A técnica de Rorschach e os critérios da CID-10 para o diagnóstico da esquizofrenia The Rorschach technique and the ICD-10 criteria for schizophrenia diagnosis

    Directory of Open Access Journals (Sweden)

    Ana Cristina Resende

    2012-01-01

    Full Text Available Trata de um estudo de correlação entre as variáveis da técnica de Rorschach (Sistema Klopfer e os grupos de sinais e sintomas da CID-10 para a esquizofrenia. Participaram desse estudo 80 pacientes com o diagnóstico de esquizofrenia pela CID-10, com recidiva da doença, internados em hospitais psiquiátricos de Goiânia. Observou-se que, dentre os 8 grupos de sinais e sintomas da CID-10 para esquizofrenia, 7 grupos tiveram correlações com variáveis distintas do Rorschach. Tais dados sugerem que, embora exista uma relação entre as variáveis dos dois instrumentos, estas variáveis não se sobrepõem substancialmente. Entende-se que são importantes as pesquisas que indiquem padrões de inter-relação entre diferentes modelos de avaliação de distúrbios psíquicos, a fim de que se possam apontar pontos de convergência e divergência entre os mesmos, avançando desse modo em questões conceituais.This is a correlational study between the variables of the Rorschach technique (Klopfer System and groups of signals and symptoms of ICD-10 for schizophrenia. Eighty patients diagnosed with schizophrenia by the ICD-10, with disease recidivation, who were hospitalized in a psychiatric service in the city of Goiânia participated in the study. We observed that among the 8 groups of signals and symptoms of ICD10 for schizophrenia, 7 groups had correlations with distinct variable of Rorschach. These data suggest that while there is a relationship between the variables of the two instruments, such variables do not overlap substantially. It is understood that researches are important to indicate patterns of interrelationship between different models for evaluation of mental disorders so that they can point out similarities and differences between them, thereby advancing the conceptual issues.

  2. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure......BACKGROUND: Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac...... amyloidosis. OBJECTIVE: To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses of explanted hearts from patients with progressive cardiac disease. METHODS: The pathological findings...

  3. [The order of coding road traffic injuries in accordance with ICD-10 at government forensic medical expertise institutions of the Russian Federation].

    Science.gov (United States)

    Aleksandrova, G A; Kovalev, A V; Vaĭsman, D Sh

    2013-01-01

    The authors describe the order of coding road traffic injuries in accordance with the 10th edition of the International Classification of the Disease (ICD-10) at government forensic medical expertise institutions of the Russian Federation. In addition, they analyse the application of the coding rules and the identification of the primary causes of death with a view to obtaining reliable road traffic accident mortality statistics compatible with the respective internationally available data. Special attention is given to the consideration and recommendation of the rules for making forensic medical diagnosis in accordance with the requirements of ICD-10 and its inclusion in the road traffic death certificates. The authors emphasize the importance of compliance with the rules for formulation of medical death certificates and identification of the cause of the fatal outcome for the reliable calculation of such demographically significant characteristic as road traffic accident mortality.

  4. [Introduction and transformation of the psychiatric term "anancasm". From Gyula (Julius) Donáth via Kurt Schneider to ICD-10].

    Science.gov (United States)

    Steinberg, H

    2014-09-01

    The conceptual history of "anancasm" in psychiatry remains almost unexplored and this article will help to remove this deficit. It was the Budapest-based neuropsychiatrist Gyula Donáth (1849-1944) who first proposed this Greek-rooted term in 1897 as an international term for compulsive symptoms and as an independent mental illness similar to present-day obsessive compulsive disorders (ICD-10). By suggesting this term Donáth wanted to extend the concept of compulsion as proposed by his teacher Carl Westphal to other compulsive phenomena, psychomotor impulses and restrictions including echolalia, coprolalia, echokinesis, echopraxia, contemporary maladie des tics (present day Tourette's syndrome) and even intermittent dipsomania (craving for alcohol), paraphilias, sexual fetishes and homosexuality. In 1923 Kurt Schneider used this term for a subgroup of psychopathic personalities, the so-called insecure anancastic psychopaths. His concept was much different to that suggested by Donáth, with the only thing in common being the compulsory component. Schneider's anancasts suffered from feelings of insecurity and insufficiency and were forced to try to overcompensate by being excessively careful, meticulous and hyper-correct. Based on Schneider's concept anancasm has survived as a name for a subdivision of compulsive personality disorders in ICD-10; however, these rather complex personality defects were not what Donáth had in mind when he first suggested the term anancasm. The paper discusses further discrepancies between Donáth, Schneider and ICD-10.

  5. Selecting clinical diagnoses: logical strategies informed by experience.

    Science.gov (United States)

    Stanley, Donald Edward; Campos, Daniel G

    2016-08-01

    This article describes reasoning strategies used by clinicians in different diagnostic circumstances and how these modes of inquiry may allow further insight into the evaluation and treatment of patients. Specifically, it aims to make explicit the implicit logical considerations that guide a variety of strategies in the diagnostic process, as exemplified in specific clinical cases. It focuses, in particular, in strategies that clinicians use to move from a large set of possible diagnoses initially suggested by abductive inferences - the process of hypothesis generation that creates a diagnostic space - to a narrower set or even to a single 'best' diagnosis, where the criteria to determine what is 'best' may differ according to different strategies. Experienced clinicians should have a diversified kit of strategies - for example, Bayesian probability or inference to a lovely explanation - to select from among previously generated hypotheses, rather than rely on any one approach every time.

  6. [Autism Spectrum Disorder in DSM-5 - concept, validity, and reliability, impact on clinical care and future research].

    Science.gov (United States)

    Freitag, Christine M

    2014-05-01

    Autism Spectrum Disorder (ASD) in DSM-5 comprises the former DSM-IV-TR diagnoses of Autistic Disorder, Asperger's Disorder and PDD-nos. The criteria for ASD in DSM-5 were considerably revised from those of ICD-10 and DSM-IV-TR. The present article compares the diagnostic criteria, presents studies on the validity and reliability of ASD, and discusses open questions. It ends with a clinical and research perspective.

  7. Diagnosing epilepsy in neurology clinics: a prospective study.

    Science.gov (United States)

    Angus-Leppan, Heather

    2008-07-01

    The certainty of the initial diagnosis of epilepsy was assessed prospectively by one neurologist in outpatients. One hundred and fifty-eight consecutive referrals with loss of consciousness or possible epilepsy were seen. The relative contributions to the initial diagnosis from the referral letter, history taking in clinic, physical examination, and investigation were compared. There was a referring diagnosis in 28.5%. The neurologist reached a diagnosis in 87% of the 158 cases: in 43% epilepsy, 25% syncope, 12% non-epileptic seizures and in 7% other diagnoses. There was a low correlation between referral and specialist diagnosis. Physical examination did not change the diagnosis in any patient. Investigations changed the diagnosis in one patient. Neuro-imaging revealed a relevant abnormality in 12/43 (27.9%) scanned. The yield from EEG was 7/25 (28%), but the EEG changed the diagnosis in only one case. Cardiac testing confirmed the type of syncope in 2/47 (4.3%) of patients. Blood tests did not contribute to the diagnosis in any patient. The neurology consultation significantly increased diagnostic certainty. The diagnosis of epilepsy remains largely clinical. It is important that patients are aware of this prior to investigation.

  8. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan;

    2015-01-01

    arthritis (21.7% versus 15.3%, P study demonstrated a prevalence of clinically diagnosed ankylosing spondylitis of 0.18%. It revealed......INTRODUCTION: Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio......, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. RESULTS: A total of 11,030 cases...

  9. How Medicare Part D, Medicaid, electronic prescribing, and ICD-10 could improve public health (but only if CMS lets them).

    Science.gov (United States)

    Herbst, Jennifer L

    2014-01-01

    A simple change to the Medicare and Medicaid outpatient prescription drug billing systems could improve patient safety and the systems' long-term fiscal stability. Including diagnosis codes on prescription drug claims (codes already in use for other billing purposes) would transform the Medicare Part D and Medicaid prescription drug claims databases into powerful public health research tools--ones that could provide much-needed (and, to date, elusive) information on how prescription drugs work in vulnerable patient populations underrepresented in clinical research. Achieving the full potential of this proposal, though, depends upon the federal agency responsible for Medicare and Medicaid, the Centers for Medicare and Medicaid Services (CMS), maintaining its current reimbursement policy, which is perhaps best characterized as one of benign neglect of the statutory standard for coverage. If, instead of continuing coverage for the vast majority of prescription drugs, CMS decided to deny payment for the millions of prescriptions falling short of the statutory standard (and thus avoid spending billions of federal health care dollars), prescribers would find themselves in an ethical dilemma between truth-telling and effectively treating their patients. Due to the systemic incentives for prescribers and pharmacists to miscode diagnoses in order to get CMS to pay for the prescription drugs needed by patients, the decision to treat patients effectively in the short-term under a strict coverage enforcement policy would undermine the potential to more effectively treat vulnerable patients, reduce prescription errors, and properly allocate federal health care dollars in the future. Even in the midst of a financial crisis, or perhaps especially because of our current financial crisis, we cannot afford to sacrifice improved patient safety and better informed long-term management of federal health care dollars for a short-term reduction in federal spending on prescription drugs.

  10. Clinically Diagnosed Insomnia and Risk of All-Cause and Diagnosis-Specific Disability Pension: A Nationwide Cohort Study

    Directory of Open Access Journals (Sweden)

    Catarina Jansson

    2013-01-01

    Full Text Available Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension. Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17–64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis of disorders of initiating and maintaining sleep (insomnias (ICD-10: G47.0 during 2000/2001–2005 were compared to those with no such inpatient/outpatient care. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2010. Incidence rate ratios (IRRs and 95% confidence intervals (CIs were estimated by Cox regression. Results. In models adjusted for prior sickness absence, sociodemographic factors, and inpatient/specialized outpatient care, associations between insomnia and increased risks of all-cause disability pension (IRR 1.35, 95% CI 1.09–1.67 and disability pension due to mental diagnoses (IRR 1.86, 95% CI 1.38–2.50 were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of disability pension due to cancer, circulatory, or musculoskeletal diagnoses were observed. Conclusion. Insomnia seems to be positively associated with all-cause disability pension and disability pension due to mental diagnoses.

  11. CCMD-2-R精神分裂症诊断标准的临床应用与ICD-10、DSM-IV的比较

    Institute of Scientific and Technical Information of China (English)

    谢光荣; 杜亚松; 胡平安

    1996-01-01

    为了评价CCMD-2-R精神分裂症诊断标准与ICD-10、DSM-IV之间在临床应用中的一致性及其差异,检验CCMD-2-R的效度,市文选取50例临床诊断确定为“精神分裂症”的住院病人,通过SCAN检查与参阅住院病历相结合的方式收集病史,然后分别用CCMD-2-R、ICD-10、DSM-IV精神分裂症诊断标准去诊断,比较它们在框架内容、亚型诊断频度、亚型诊断符合率与症状标准内容方面的一致性。发现CCMD-2-R精神分裂症诊断标准与临床经验诊断,ICD-10之间有很好的一致性(K>0.75),与DSM-IV之间也有一定的一致性(K>0.40),提示CCMD-2-R精神分裂症诊断标准有良好的经验效度和平行效度。说明CCMD-2-R更加完善了我国精神分裂症诊断标准。

  12. Designing a software for systematic registration of oral and maxillofacial diseases based on the latest update of the World Health Organization ICD-10 classification system in 2010

    Directory of Open Access Journals (Sweden)

    Arash Mansorian

    2014-04-01

    Full Text Available   Background and Aims: Classification is a fundamental issue in quantitative studies of any phenomenon and has been known as a necessity for the advancement of science. Using a standard record system for diseases is critical for research purposes and also could improve the quality of medical health services. In this study, after evaluating current codding systems in oral medicine, we designed a software for systematic coding and registration of Oral and Maxillofacial diseases based on the latest update of the World Health Organization ICD-10 classification system in 2010.   Materials and Methods: Based on the latest WHO ICD-10 update in 2010 and by using software s as: vb.net, net framework, SQL Server and Microsoft Visual Studio, standard coding software for recording patient's data at the department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences was designed. Data from all patients were codded by standard ICD-10 codes and registered by the software. Also an online portal for recording patient's data which could be used nationwide was designed. By d esigning this software the process of forming and registering patient's records, and their treatment process is facilitated . An archive of patient data was also stablished .   Conclusion: As a result , this software in addition to maintaining patient data , facilitate studies and research projects greatly. It’s recommended that the Iranian Ministry of Health and Medical Education as the concessioner of this software, improves codding and registration systems of oral diseases at the dental schools by developing this software.

  13. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses;

    2012-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant do...

  14. New proposals for the international classification of diseases-11 revision of pain diagnoses

    DEFF Research Database (Denmark)

    Rief, Winfried; Kaasa, Stein; Jensen, Rigmor

    2012-01-01

    The representation of pain diagnoses in current classification systems like International Classification of Diseases (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV does not adequately reflect the state of the art of pain research, and does not sufficiently support...... the clinical management and research programs for pain conditions. Moreover, there is an urgent need to harmonize classification of pain syndromes of special expert groups (eg, International Classification of Headache Disorders) and general classification systems (eg, ICD-11, DSM-V). Therefore, this paper...... current pain-specific classification proposals to the revision of ICD-11. PERSPECTIVE: Pain research and expertise must be more visible in the ICD-11 revision process. A general category for pain diagnoses as well as specific pain diagnoses under existing categories of organ-specific sections are needed....

  15. Overlapping Diagnostic Analysis between Neurasthenia in China and Related to Emotional Disorders in ICD-10 and DSM-IV%中国的神经衰弱与ICD-10、DSM-IV相关情绪障碍的重叠诊断分析

    Institute of Scientific and Technical Information of China (English)

    耿洪春; 袁瑷琳; 王胜利

    2001-01-01

    目的探讨我国的神经衰弱与ICD-10、DSM-IV相关情绪障碍的重叠诊断情况.方法对符合CCMD-3诊断标准的38例神经衰弱患者进行ICD-10、DSM-IV的再诊断.将有关结果进行统计学处理.结果三种诊断标准的各疾病患者的病程、年龄和男女例数相比差异无显著性.例数的不同主要原因是临床相不同.结论相当数量的神经衰弱患者伴有抑郁情绪;中国的神经衰弱与ICD-10、DSM-IV相关情绪障碍的诊断标准规定的临床相不同.

  16. Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? : Results of a cross sectional observational study

    NARCIS (Netherlands)

    Schneider, A.; Gantner, L.; Maag, I.; Borst, M.M.; Wensing, M.J.P.; Szecsenyi, J.

    2005-01-01

    BACKGROUND: The increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which

  17. Are DSM-IV-TR borderline personality disorder, ICD-10 emotionally unstable personality disorder, and CCMD-III impulsive personality disorder analogous diagnostic categories across psychiatric nomenclatures?

    Science.gov (United States)

    Lai, Ching Man; Leung, Freedom; You, Jianing; Cheung, Fanny

    2012-08-01

    This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.

  18. 78 FR 70558 - Review of Proposed Changes with ICD-10-CM/PCS; Conversion of Quality IndicatorsTM

    Science.gov (United States)

    2013-11-26

    ... in rates that are similar within defined tolerances . . . '' This work will be undertaken over the... Coding Experts: * * *use a team approach that involves experts in the code sets and the appropriate clinical domain. The team should be used to identify specific areas where questions of...

  19. Study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jeong Hwa [Cheju Halla College, Cheju (Korea, Republic of)

    2006-03-15

    The study obtained the following conclusions by making a comparative study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings. I surveyed the value of abdominal ultrasound in 400 patients without clinical symptoms at C Health Clinic Center, Seoul. Compare with blood pressure was high (systolic/diastolic) in 7.5%/4.5% on persons who were diagnosed fatty liver. At the time of the diagnosis, Total cholesterol level was increased in fatty liver patients, HDL-cholesterol level was high in fatty liver patients. And Trigryceride level was increased in fatty liver persons, LDL-cholesterol was high in fatty liver persons. SGOT level was increased in 5.5% on patients who were diagnosed fatty liver, 0% on persons who were normal and SGPT level was high in 29.5% on people who were diagnosed fatty liver, 0% on patients who were diagnosed normal.

  20. CLINICAL AND FAMILY PROFILE OF PATIENTS DIAGNOSED WITH KERATOCONUS

    Directory of Open Access Journals (Sweden)

    Kalpana

    2015-03-01

    Full Text Available PURPOSE: To screen the first degree relatives of patient diagnosed with keratoconus . MATERIALS AND METHODS : All the patients included in the study, patient details were taken which included - name, age, gender, hospital number, address and family history [pedigree tree] . All the patients underwent refraction, best corrected visual acuity, colour vision , keratometry, intraocular pressure measurement and corneal topography [orbscan]. Family screening was done, which included - refraction, best corrected visual acuity, colour vision, keratometry, intraocular pressure and corneal topography [orbscan]. RESULTS: In this study of 40 eyes, 24 eyes [Right eyes - 12 & Left eyes - 12] i.e. 60% have keratoconus, 3 eyes [2 - Right eyes & 1 - Left eye] i.e.15% have advanced keratoconus, 12 eyes [Right eye - 6 & Left eye - 6] i.e. 30% have VKC & Keratoconus, 1 eye have acute hydrops. Total family members screened 55, out of that 17 members are fathers, 20 members are mothers, 12 members are brothers and 6 are sisters

  1. Cardiac autonomic testing and diagnosing heart disease. 'A clinical perspective'

    Directory of Open Access Journals (Sweden)

    Nicholas L. DePace

    2014-12-01

    Full Text Available Background Coronary heart disease (CHD is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE, modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared, including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and sympathetic (P&S activity. Results The Framingham Heart Study, and others, have identified traditional risk factors for the development of CHD. These factors effectively target high-risk patients, but a large number of individuals who will develop CHD and MACE are not identified. Many patients with CHD who appear to be well-managed by traditional therapies still experience MACE. In order to identify these patients, other possible risk factors have been explored. Advanced autonomic dysfunction, and its more severe form, cardiac autonomic neuropathy, have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through P&S testing. Conclusions Independent measures of P&S activity, provides additional information and has the potential to incrementally add to risk assessment. This additional information enables physicians to (1 specifically target more high-risk patients and (2 titrate therapies, with autonomic testing guidance, in order to minimize risk of cardiac mortality and morbidity.

  2. Diagnosing MS

    Science.gov (United States)

    ... a Local Support Group Ask an MS Navigator Edward M. Dowd Personal Advocate Program Connect with Peers ... Symptoms & Diagnosis Diagnosing MS Possible MS Clinically Isolated Syndrome (CIS) Newly Diagnosed Diagnosing Tools Other Conditions to ...

  3. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen;

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  4. 荨麻疹性血管炎ICD-10的编码%Discussion of Disease Classification and Coding about Urticaria Vasculitis

    Institute of Scientific and Technical Information of China (English)

    郭晓玲

    2012-01-01

    目的 确定荨麻疹性血管炎正确的ICD-10编码.方法 通过学习变应性血管炎的相关资料,按照国际疾病分类原则进行编码.结果 根据病案中免疫检验-抗肾小球基底膜抗体的检验结果,变应性血管炎有不同的编码.如果抗肾小球基底膜抗体阳性,变应性血管炎为M31.0;如果抗肾小球基底膜抗体阴性,变应性血管炎的编码为D69.0.结论 国际疾病分类技术性较强,专业要求较高,在实际工作中经常会遇到一些疑难编码,需要认真阅读病案分析情况,查找出准确编码,提高编码准确率.%Objective To discuss the correct ICD-10 coding of urticarialvasculitis. M ethods Coding urticarkl vasculitis according to ICD by studying related m aterial of allergic vasculitis. Results A llergic vasculitis has different codes according to test results of in m une inspectbn-anti gbm erular basem ent m em brane antibody . If gbm erular basem ent m em brane antibody positive, 1he code of allergic vasculitis is M 31.0 ; If gbm erular basem ent m em brane antibody negative, 1he code of allergic vasculitis is D 69 .0 . Conclusbn ICD is a highly technical, high professbnalrequirem ents subject. In 1he actual w ork w e often encounter som e difficulties coding. W e need to carefully read m edical records and find accurate coding to im prove 1he coding accuracy.

  5. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

    Science.gov (United States)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  6. Misdiagnostic analysis of clinically diagnosed severe acute respiratory syndrome after following up 197 convalescent patients

    Institute of Scientific and Technical Information of China (English)

    LIU You-ning; TIAN Qing; HU Hong; XIE Li-xin; FAN Bao-xing; XU Hong-min; CHEN Wei-jun

    2005-01-01

    @@ The severe acute respiratory syndrome (SARS) is an emerging and highly contagious infection caused by a newly discovered strain of coronavirus.1 Since the clinical case definition of SARS is similar to other severe atypical pneumonias, specific laboratory tests that can accurately diagnose SARS-associated coronavirus (SARS-CoV) infection are important. However, published data are insufficient to investigate whether clinically diagnosed SARS patients may include some non-SARS pneumonia. Therefore, we aimed to determine clinical and laboratory features to differentiate SARS patients from non-SARS pneumonias that could reduce misdiagnosis of SARS. A retrospective analysis of clinical and laboratory characteristics after the initial onset of SARS, as well as its convalescent-phase, was examined from clinically diagnosed 197 SARS patients.

  7. Face symmetry assessment abilities: Clinical implications for diagnosing asymmetry

    Science.gov (United States)

    Jackson, Tate H.; Mitroff, Stephen R.; Clark, Kait; Proffit, William R.; Lee, Jessica Y.; Nguyen, Tung T.

    2014-01-01

    Introduction An accurate assessment of face symmetry is necessary for the development of a dentofacial diagnosis in orthodontics, and an understanding of individual differences in perception of face symmetry between patients and providers is needed to facilitate successful treatment. Methods Orthodontists, general dentists, and control participants completed a series of tasks to assess symmetry. Judgments were made on pairs of upright faces (similar to the longitudinal assessment of photographic patient records), inverted faces, and dot patterns. Participants completed questionnaires regarding clinical practice, education level, and self-confidence ratings for symmetry assessment abilities. Results Orthodontists showed expertise compared with controls (P <0.001), whereas dentists showed no advantage over controls. Orthodontists performed better than dentists, however, in only the most difficult face symmetry judgments (P = 0.006). For both orthodontists and dentists, accuracy increased significantly when assessing symmetry in upright vs inverted faces (t = 3.7, P = 0.001; t = 2.7, P = 0.02, respectively). Conclusions Orthodontists showed expertise in assessing face symmetry compared with both laypersons and general dentists, and they were more accurate when judging upright than inverted faces. When using accurate longitudinal photographic records to assess changing face symmetry, orthodontists are likely to be incorrect in less than 15% of cases, suggesting that assistance from some additional technology is infrequently needed for diagnosis. PMID:24182582

  8. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Directory of Open Access Journals (Sweden)

    Sarpong Charity

    2011-05-01

    Full Text Available Abstract Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%, non-sensuality (74.5%, dissatisfaction with sexual acts (71.9%, non-communication (70.8% and impotence (67.9%. Other areas of sexual function, including premature ejaculation (56.6% and avoidance (42.7% were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c, FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high

  9. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Science.gov (United States)

    2011-01-01

    Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high but similar to

  10. New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

    Directory of Open Access Journals (Sweden)

    Pulzi Fernanda BU

    2011-02-01

    Full Text Available Abstract Background Nonalcoholic fatty liver disease (NAFLD is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH, cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery. Methods The medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value Results 83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC≥200 mg/dL, alanine aminotransferase (ALT ≥30, AST/ALT ratio (AAR≤ 1, gammaglutaril-transferase (γGT≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT and US and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%. Conclusion Alterations in TC, ALT, AAR, γGT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the

  11. Reliability of Diagnosing Clinical Hypothyroidism in Adults with Down Syndrome. Brief Report.

    Science.gov (United States)

    Prasher, V. P.

    1995-01-01

    The accuracy of diagnosing hypothyroidism in 160 adults with Down syndrome was examined. A significant association between a clinical diagnosis of hypothyroidism and increasing age was found but no significant association was found between a clinical and a biochemical diagnosis. Regular biochemical screening is recommended. (Author/SW)

  12. Validation of ICD-9-CM/ICD-10 coding algorithms for the identification of patients with acetaminophen overdose and hepatotoxicity using administrative data

    Directory of Open Access Journals (Sweden)

    Shaheen Abdel

    2007-10-01

    Full Text Available Abstract Background Acetaminophen overdose is the most common cause of acute liver failure (ALF. Our objective was to develop coding algorithms using administrative data for identifying patients with acetaminophen overdose and hepatic complications. Methods Patients hospitalized for acetaminophen overdose were identified using population-based administrative data (1995–2004. Coding algorithms for acetaminophen overdose, hepatotoxicity (alanine aminotransferase >1,000 U/L and ALF (encephalopathy and international normalized ratio >1.5 were derived using chart abstraction data as the reference and logistic regression analyses. Results Of 1,776 potential acetaminophen overdose cases, the charts of 181 patients were reviewed; 139 (77% had confirmed acetaminophen overdose. An algorithm including codes 965.4 (ICD-9-CM and T39.1 (ICD-10 was highly accurate (sensitivity 90% [95% confidence interval 84–94%], specificity 83% [69–93%], positive predictive value 95% [89–98%], negative predictive value 71% [57–83%], c-statistic 0.87 [0.80–0.93]. Algorithms for hepatotoxicity (including codes for hepatic necrosis, toxic hepatitis and encephalopathy and ALF (hepatic necrosis and encephalopathy were also highly predictive (c-statistics = 0.88. The accuracy of the algorithms was not affected by age, gender, or ICD coding system, but the acetaminophen overdose algorithm varied between hospitals (c-statistics 0.84–0.98; P = 0.003. Conclusion Administrative databases can be used to identify patients with acetaminophen overdose and hepatic complications. If externally validated, these algorithms will facilitate investigations of the epidemiology and outcomes of acetaminophen overdose.

  13. Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES). METHODS: We conducted a retrospective review of patients diagnosed with PNES in a 5-year period. RESULTS: Fifty patients with PNES were identified, giving an estimated incidence of 0.91\\/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments. CONCLUSIONS: PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

  14. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2009-11-01

    Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.

  15. Annual Research Review: Progress in Using Brain Morphometry as a Clinical Tool for Diagnosing Psychiatric Disorders

    Science.gov (United States)

    Haubold, Alexander; Peterson, Bradley S.; Bansal, Ravi

    2012-01-01

    Brain morphometry in recent decades has increased our understanding of the neural bases of psychiatric disorders by localizing anatomical disturbances to specific nuclei and subnuclei of the brain. At least some of these disturbances precede the overt expression of clinical symptoms and possibly are endophenotypes that could be used to diagnose an…

  16. Differences between men with screening-detected versus clinically diagnosed prostate cancers in the USA

    Directory of Open Access Journals (Sweden)

    Stone S Noell

    2005-03-01

    Full Text Available Abstract Background The advent of prostate specific antigen (PSA testing in the United States of America (USA has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers. Methods We evaluated 3,173 men with prostate cancer in the USA. Surveys and medical records provided information on demographics, socioeconomic status, comorbidities, symptoms, tumor characteristics, and treatment. We classified men presenting with symptoms of advanced cancer – bone pain, weight loss, or hematuria – as "clinically diagnosed"; asymptomatic men and those with only lower urinary tract symptoms were considered "screening-detected." We used multivariate analyses to determine whether screening predicted receiving aggressive treatment for a clinically localized cancer. Results We classified 11% of cancers as being clinically diagnosed. Men with screening-detected cancers were more often non-Hispanic white (77% vs. 65%, P Conclusion Most cancers were detected by screening in this American cohort. Appropriately, younger, healthier men were more likely to be diagnosed by screening. Minority status and lower socio-economic status appeared to be screening barriers. Screening detected earlier-stage cancers and was associated with receiving aggressive treatment.

  17. Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

    Directory of Open Access Journals (Sweden)

    Chanda Pascalina

    2009-04-01

    Full Text Available Abstract Background Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT, a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. Methods A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. Results Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5 than either microscopy (US$ 11.9 or clinical diagnosis (US$ 17.1 for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. Conclusion RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.

  18. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  19. New proposals for the international classification of diseases-11 revision of pain diagnoses.

    NARCIS (Netherlands)

    Rief, W.; Kaasa, S.; Jensen, R.; Perrot, S.; Vlaeyen, J.W.S.; Treede, R.D.; Vissers, K.C.P.

    2012-01-01

    The representation of pain diagnoses in current classification systems like International Classification of Diseases (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV does not adequately reflect the state of the art of pain research, and does not sufficiently support the cl

  20. Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

    Science.gov (United States)

    Alqarni, Abdullah M; Schneiders, Anthony G; Cook, Chad E; Hendrick, Paul A

    2015-08-01

    The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis.

  1. Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire

    DEFF Research Database (Denmark)

    Hederos, C.A.; Hasselgren, M.; Hedlin, G.;

    2007-01-01

    Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ...... with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient...... clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records...

  2. Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients.

    Science.gov (United States)

    Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima

    2016-03-01

    Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

  3. [Clinical diagnosis and standardized evaluation of borderline personality: preliminary report].

    Science.gov (United States)

    Chaine, F; Guelfi, J D; Monier, C; Brun, A; Seunevel, F

    1995-01-01

    A sample of 36 patients considered by French clinicians as suffering from a borderline personality disorder was evaluated using the International Personality Disorder Examination, the Diagnostic Interview for Borderline-Revised, and the Minnesota Multiphasic Personality Inventory. First, global descriptive analysis of the sample elicited the socio-demographic and standard clinical characteristics of the borderline individuals. After diagnostic evaluation, the sample appeared to be quite homogeneous with 25 of the 36 patients evaluated (69.5%) being defined as borderline by two of the three diagnostic systems: ICD 10, DSM III-R and Gunderson (15/36 = 41.5% of patients were defined as borderline by all three systems). It is the types of BL personality co-diagnoses which differentiated the BL subjects in the sample from those classically described in the international literature, since the most frequent personalities were the Dependent and Avoiding ones, not the Antisocial, Histrionic, Narcissistic or Schizotypic personalities of the DSM III-R. ICD 10 elicited the same significant prevalence of Anxious and Dependent personalities. Lastly, the patients diagnosed as borderline both by clinicians and by all diagnostic systems (forming the sample "core") were compared with the rest of the sample with regard to socio-demographic, clinical and diagnostic characteristics. A few hypotheses are proposed on the type of variables that may permit to discriminate between these two types of patients.

  4. Klinefelter syndrome: clinical and auxological features of 14 patients diagnosed in childhood

    Directory of Open Access Journals (Sweden)

    M.F. Messina

    2013-08-01

    Full Text Available Klinefelter syndrome (KS is the most frequent chromosomal aneuploidy with a prevalence of 1: 500 men but it often remains a largely undiagnosed condition and only 10% of cases are identified in childhood and adolescence. We report the anamnestic, clinical and auxological findings of 14 KS patients diagnosed in paediatric age. 3/14 patients (21% with KS were diagnosed in prenatal age by amniocentesis, 1 patient was diagnosed at birth due to genital ambiguity and the remaining 10/14 (71.4% were diagnosed at a chronological age younger than 15 years old for a clinical picture characterized by a peculiar cognitive and behavioral pattern or genital anomalies and abnormalities of pubertal development. The classical karyotype 47 XXY was present in 10/14 subjects (72%, a mosaic form (46 XY/47 XXY was present in 2/14 (14% and a complex aneuploidy (48 XXYY and 48 XXXY was present in the remaining 2/14 (14% patients. All KS patients diagnosed in childhood and adolescence (10/14 =71.4 % showed a stature taller than the respective target height and also the predicted final height (calculated from a chronological age older than 7 years old and the reached final height were significantly taller than target height. Conclusion: according to our retrospective data we can assert that KS in paediatric age is characterized by a stature taller than target height, often associated with a characteristic cognitive and behavioral pattern while the typical clinical signs and symptoms of KS are lacking and manifest only in late adolescence or adulthood.

  5. Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Mikkelsen, Marta K; Hansen, Rikke B;

    2016-01-01

    BACKGROUND: The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level...... December 2013, were reviewed. Clinical characteristics and primary treatment were recorded. The National Comprehensive Cancer Network risk group classification was used. RESULTS: A total of 1934 men with a median age of 69 years (interquartile range 65-75) were diagnosed with PCa in the study period...

  6. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

    OpenAIRE

    2011-01-01

    p.225-230 Context - Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. Objective - To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. Methods - Recorded biopsies archive at “Complexo Hospitalar Professor Edgar Santos”, a general...

  7. Predictive value of combined clinically diagnosed bruxism and occlusal features for TMJ pain.

    Science.gov (United States)

    Manfredini, Daniele; Peretta, Redento; Guarda-Nardini, Luca; Ferronato, Giuseppe

    2010-04-01

    Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

  8. newly diagnosed CP-CML patients | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available treatment. Studio non randomizzato di fase II con Nilotinib 300 mg BID in pazienti con nuova diagnosi di leucemia...wduring treatment. Studio non randomizzato di fase II con Nilotinib 300 mg BID in pazienti con nuova diagnosidi leucemia...pazienti con nuova diagnosi di leucemia mieloide cronica (LMC) in fase cronica E....1.1.1Medical condition in easily understood language newly diagnosed CP-CML patients pazienti con nuova diagnosi di leucemia

  9. Disability and Comorbidity: Diagnoses and Symptoms Associated with Disability in a Clinical Population with Panic Disorder

    Directory of Open Access Journals (Sweden)

    Caroline A. Bonham

    2014-01-01

    Full Text Available Background. Anxiety disorders are associated with considerable disability in the domains of (1 work, (2 social, and (3 family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

  10. A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients

    Institute of Scientific and Technical Information of China (English)

    Jin-You Wang; Yao Zhu; Chao-Fu Wang; Shi-Lin Zhang; Bo Dai; Ding-Wei Ye

    2014-01-01

    Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinical y diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of al included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.

  11. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Zhang Yu; Yu Like; Xie Haiyan; Hu Weihua; Hao Keke; Xia Ning

    2013-01-01

    Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods:The clinical features of2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results:The ratio of male/female was 4.8:1 and the peak onset age was 60~69 years old. The major pathological type was squamous cell carcinoma (44.5%), then adenocarcinoma (25.9%) and small cell lung cancer (18.3%). The incidence of squamous cell carcinoma was the highest in males (50.6%), while that of adenocarcinoma in females (56.2%). The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can signiifcantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  12. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    2013-06-01

    Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  13. How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.

    Directory of Open Access Journals (Sweden)

    Daniel Pilsgaard Henriksen

    Full Text Available BACKGROUND: Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED, overall and related to sites of infection and patient characteristics. METHODS: We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011, to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection. RESULTS: Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8-43.3% compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6-44.1%. Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1-81.3%, specificity 83.9% (95%CI: 82.6-85.1%, positive likelihood ratio 4.95 (95%CI: 4.58-5.36 and negative likelihood ratio 0.24 (95%CI: 0.22-0.26. The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5-9.2 and 11.3 (95%CI: 10.2-12.9 respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity. CONCLUSION: ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general.

  14. Pleuritis clinically diagnosed as aspergillosis during the course of microscopic polyangiitis.

    Science.gov (United States)

    Kimoto, Yasutaka; Oryoji, Kensuke; Uchino, Ayumi; Yoshizawa, Shigeru; Niiro, Hiroaki; Tsukamoto, Hiroshi; Horiuchi, Takahiko

    2014-01-01

    Pleural aspergillosis is a rare fungal infection. We herein report a case of pleuritis clinically diagnosed as aspergillosis without apparent Aspergillus lung lesions. A 75-year-old man receiving immunosuppressive therapy due to microscopic polyangiitis was admitted for treatment of massive pleural effusion. Histology of the parietal pleura revealed septate hyphae. In addition, a hematological marker of Aspergillus indicated Aspergillus pleuritis. The pleural effusion resolved after administration of the voriconazole. The trigger for invasion of Aspergillus into the pleura was thought to be spontaneous pneumothorax, which had occurred five months earlier.

  15. Biosurveillance Using Clinical Diagnoses and Social Media Indicators in Military Populations

    Energy Technology Data Exchange (ETDEWEB)

    Corley, Courtney D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Volkova, Svitlana [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rounds, Jeremiah [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Charles-Smith, Lauren E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Harrison, Joshua J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mendoza, Joshua A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Han, Keith S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-02-23

    U.S. military influenza surveillance uses electronic reporting of clinical diagnoses to monitor health of military personnel and detect naturally occurring and bioterrorism-related epidemics. While accurate, these systems lack in timeliness. More recently, researchers have used novel data sources to detect influenza in real time and capture nontraditional populations. With data-mining techniques, military social media users are identified and influenza-related discourse is integrated along with medical data into a comprehensive disease model. By leveraging heterogeneous data streams and developing dashboard biosurveillance analytics, the researchers hope to increase the speed at which outbreaks are detected and provide accurate disease forecasting among military personnel.

  16. Clinical value of CT three-dimensional imaging in diagnosing gastrointestinal tract diseases

    Institute of Scientific and Technical Information of China (English)

    Shao-Yin Duan; Dan-Tong Zhang; Qing-Chi Lin; Yan-Huan Wu

    2006-01-01

    AIM: To discuss the clinical value of CT three-dimensional (3-D) imaging in diagnosing gastrointestinal tract diseases.METHODS: Three-D imaging findings of 52 patients were retrospectively analyzed. Three-D imaging methods included shaded surface display (SSD), volume rendering (VR), virtual endoscopy (VE) and multiplanar reformatting (MPR). The diagnosis results of CT 3-D were evaluated by comparison with those of endoscopy and/or surgical finding.RESULTS: Fifty-two patients with gastrointestinal tract diseases were diagnosed by CT 3-D imaging, of whom 50 cases were correctly diagnosed and 2 were misdiagnosed. There were 33 cases of gastric diseases (27 with carcinoma, 5 with peptic ulcer and 1 with leiomyoma) and 19 large intestinal diseases (10 with colon carcinoma, 2 with carcinoma of the rectum, 5 with colon polypus and 2 with tuberculosis of the ileocecal junction). Twenty-two cases with prominent lesions (9 with subsequent hollow lesions), 20 with stenosis of cavity (8 with concomitant prominent lesions) and 10 with hollow lesions (5 with concomitant prominent lesions) were shown in 3-D images. The minimal lesion shown was 1.0 cm × 0.8 cm × 0.5 cm.CONCLUSION: CT 3-D imaging, a non-invasive examination without pain, can display clearly and directly the lesions of gastrointestinal tract with accurate location and high diagnosis accuracy. It is an important complementary technique to endoscopy.

  17. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel.

    Science.gov (United States)

    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiñones-Hinojosa, Alfredo; Ye, Xiaobu; Brem, Henry

    2015-12-01

    We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6 months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS.

  18. Identification of Legionella from clinically diagnosed pneumonia patients and environmental samples.

    Science.gov (United States)

    Jahan, R; Tarafder, S; Saleh, A A; Miah, M R A

    2015-04-01

    Legionnaires' disease is a multisystem disease with life-threatening acute and severe form of pneumonia which is responsible for 2-9% pneumonia with high mortality. Eighty six respiratory tract samples and urine were collected from clinically diagnosed pneumonia patients and 12 water samples were collected from different environment. Identification of Legionella was done by culture and Polymerase Chain Reaction (PCR) of respiratory tract samples and environmental samples and Legionella Antigen (Ag) in urine was detected by Immunochromatographic test (ICT). Legionella was identified from 4 (4.65%) clinically diagnosed pneumonia patients of which 1(1.16%) case was culture positive, 1(1.16%) case was urine ICT positive and PCR was positive in all four cases. Of the 12 water samples tested, 4 (33.33%) samples were Legionella positive by PCR but culture results of these samples were negative. Identification of Legionella should be done by PCR in parallel with culture and urine ICT. Detection of Legionella in environmental samples is also needed to explore possible links between the water sources and disease transmission in population.

  19. The Evaluation Clinical and Demographic Characteristics of 115 Patients Diagnosed with Herpes Zoster in Eeastern Turkey

    Directory of Open Access Journals (Sweden)

    Hatice Uce Özkol

    2013-12-01

    Full Text Available Objective: The aim of this study was to investigate the clinical and demographic characteristics of patients diagnosed with herpes zoster and to explore the similarities and differences with other epidemiological studies from Turkey and the world. Methods: We retrospectively reviewed the records of 115 patients diagnosed with herpes zoster in the Yuzuncu Yıl University Medical Faculty Dermatology Department between January 2007 and December 2010. Results: The mean age of the patients was 42.21±23.88 years. 115 patients, -47 female (40.9%, 68 male (59.1%- aged between 2 and 93 years were assessed. Pediatric age group, 20 (17.4%, adult age group, 95 (82.6% patients, respectively. The incidence of HZ was found to be 0.43%. HZ was observed winter rarely (13.04%. Is mostly seen in the months of March (17.39% The affected dermatome were thorasic (49 patient, 42.6%, servical (21 patient, 18.3%, ophtalmic (22 patient, 19.1%, lomber (16 patient, 13.9%, sacral (7 patient, 6.1% respectively. Complications developed in 13% of patients. Conclusion: We observed that our findings were more or less similar to the findings of the literature data. Cases of HZ in our study was very rare during the winter season. Multi-center studies are needed to the emergence of clinical and epidemiological characteristics of HZ in Turkey.

  20. Isolation and Antibiogram of Clostridium tetani from Clinically Diagnosed Tetanus Patients.

    Science.gov (United States)

    Hanif, Hajra; Anjum, Awais; Ali, Naeem; Jamal, Asif; Imran, Muhammad; Ahmad, Bashir; Ali, Muhammad Ishtiaq

    2015-10-01

    Clostridium tetani, the etiologic agent of tetanus, produces a toxin that causes spastic paralysis in humans and other vertebrates. This study was aimed for isolation, identification, and determination of antimicrobial susceptibility of C. tetani from clinically diagnosed tetanus patients. Isolation was done from deep-punctured tissues of the foot and arm injuries of 80 clinically diagnosed tetanus patients from the Pakistan Institute of Medical Sciences hospital. We successfully screened out five C. tetani isolates out of 80 samples based on the strain-specific characteristics confirmed through biochemical testing and toxin production. A disc diffusion method was used for antimicrobial susceptibilities and C. tetani isolates showed susceptibility to cefoperazone, chloramphenicol, metronidazole, penicillin G, and tetracycline, but were found to be resistant to erythromycin and ofloxacin. During animal testing, all the infected mice developed symptoms of tetanus. The results showed that identification of C. tetani is possible using biochemical and molecular tools and that the strains of C. tetani isolated had not developed resistance against the antibiotics most often used for the treatment of tetanus.

  1. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study

    Directory of Open Access Journals (Sweden)

    Juma Kaseem

    2008-04-01

    Full Text Available Abstract Background Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. Methods In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. Results Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. Conclusion Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the

  2. Spreading the clinical window for diagnosing fetal-onset hypogonadism in boys

    Directory of Open Access Journals (Sweden)

    Rodolfo eRey

    2014-05-01

    Full Text Available In early fetal development, the testis secretes –independently of pituitary gonadotropins– androgens and anti-Müllerian hormone (AMH which are essential for male sex differentiation. In the second half of fetal life, the hypothalamic-pituitary axis gains control of testicular hormone secretion. FSH controls Sertoli cell proliferation, responsible for testis volume increase and AMH and inhibin B secretion, whereas LH regulates Leydig cell androgen and INSL3 secretion, involved in the growth and trophism of male external genitalia and in testis descent. This differential regulation of testicular function between early and late fetal periods underlies the distinct clinical presentations of fetal-onset hypogonadism in the newborn male: primary hypogonadism results in ambiguous or female genitalia when early fetal-onset whereas it becomes clinically undistinguishable from central hypogonadism when established later in fetal life. The assessment of the hypothalamic-pituitary-gonadal axis in the male has classically relied on the measurement of gonadotropin and testosterone levels in serum. These hormone levels normally decline 3-6 months after birth, thus constraining the clinical evaluation window for diagnosing male hypogonadism. The advent of new markers of gonadal function has spread this clinical window beyond the first 6 months of life. In this review, we discuss the advantages and limitations of old and new markers used for the functional assessment of the hypothalamic-pituitary-testicular axis in boys suspected of fetal-onset hypogonadism.

  3. How well do discharge diagnoses identify hospitalised patients with community-acquired infections? - a validation study

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Nielsen, Stig Lønberg; Laursen, Christian Borbjerg;

    2014-01-01

    BACKGROUND: Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections...... in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics. METHODS: We manually reviewed 5977 patients...... admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses...

  4. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    Directory of Open Access Journals (Sweden)

    Emmanuel Bäckryd

    2015-03-01

    Full Text Available Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  5. Aromatic L-amino acid decarboxylase deficiency diagnosed by clinical metabolomic profiling of plasma.

    Science.gov (United States)

    Atwal, Paldeep S; Donti, Taraka R; Cardon, Aaron L; Bacino, C A; Sun, Qin; Emrick, L; Reid Sutton, V; Elsea, Sarah H

    2015-01-01

    Aromatic L-amino acid decarboxylase (AADC) deficiency is an inborn error of metabolism affecting the biosynthesis of serotonin, dopamine, and catecholamines. We report a case of AADC deficiency that was detected using the Global MAPS platform. This is a novel platform that allows for parallel clinical testing of hundreds of metabolites in a single plasma specimen. It uses a state-of-the-art mass spectrometry platform, and the resulting spectra are compared against a library of ~2500 metabolites. Our patient is now a 4 year old boy initially seen at 11 months of age for developmental delay and hypotonia. Multiple tests had not yielded a diagnosis until exome sequencing revealed compound heterozygous variants of uncertain significance (VUS), c.286G>A (p.G96R) and c.260C>T (p.P87L) in the DDC gene, causal for AADC deficiency. CSF neurotransmitter analysis confirmed the diagnosis with elevated 3-methoxytyrosine (3-O-methyldopa). Metabolomic profiling was performed on plasma and revealed marked elevation in 3-methoxytyrosine (Z-score +6.1) consistent with the diagnosis of AADC deficiency. These results demonstrate that the Global MAPS platform is able to diagnose AADC deficiency from plasma. In summary, we report a novel and less invasive approach to diagnose AADC deficiency using plasma metabolomic profiling.

  6. 12-STEP FACILITATION FOR THE DUALLY DIAGNOSED: A RANDOMIZED CLINICAL TRIAL

    Science.gov (United States)

    Bogenschutz, Michael P.; Rice, Samara L.; Tonigan, J. Scott; Vogel, Howard S.; Nowinski, Joseph; Hume, Donald; Arenella, Pamela B.

    2014-01-01

    There are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation. PMID:24462479

  7. Clinical or radiological diagnosis of impingement; Klinische oder radiologische Diagnose des Impingements

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    Kloth, J.K.; Weber, M.A. [Universitaetsklinikum Heidelberg, Klinik fuer diagnostische und interventionelle Radiologie, Heidelberg (Germany); Zeifang, F. [Universitaetsklinikum Heidelberg, Zentrum fuer Orthopaedie, Unfallchirurgie und Paraplegiologie, Heidelberg (Germany)

    2015-03-01

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques. (orig.) [German] Das Impingementsyndrom der Schulter ist ein haeufiges Einklemmungsphaenomen von Sehnen oder Bursen mit typischem klinischem Befund. Wichtige radiologische Verfahren sind Sonographie, MRT und MR-Arthrographie. Projektionsradiographie und CT sind ideal, um knoecherne Veraenderungen aufzuzeigen. Die CT-Arthrographie dient zudem als Ersatzverfahren bei Kontraindikationen fuer die MRT. Diese genannten Modalitaeten koennen in der Primaerdiagnostik die Diagnose eines Impingementsyndroms stuetzen und dessen Ursache aufzeigen. Zudem werden bildgebend Folgen der Einklemmung festgestellt und in Zusammenschau von klinischer Symptomatik und radiologischem Befund Therapieentscheidungen getroffen. Die Sensitivitaet und Spezifitaet der zuvor genannten bildgebenden Verfahren in Bezug auf die diagnostische Aufarbeitung einer klinisch evidenten Impingementsymptomatik

  8. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases.

    Science.gov (United States)

    Goodwin, C Rory; Sankey, Eric W; Liu, Ann; Elder, Benjamin D; Kosztowski, Thomas; Lo, Sheng-Fu L; Fisher, Charles G; Clarke, Michelle J; Gokaslan, Ziya L; Sciubba, Daniel M

    2016-05-01

    of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.

  9. Findings, diagnoses and results of a halitosis clinic over a seven year period.

    Science.gov (United States)

    Zürcher, Andrea; Filippi, Andreas

    2012-01-01

    Halitosis or bad breath is a taboo subject that is a widespread problem in the general population. Causes of bad breath can be multifactorial and long time sufferers can be marred from deep psychological stress. Because nine out of ten cases have an oral cause, the initial inquiry should be with a dentist. In a retrospective study from February 2003 to February 2010, the halitosis clinic at the University of Basel analyzed data from 465 patient medical histories. Study objectives evaluated the causes of halitosis, gender distribution and treatment success. All patients reported to have suffered from bad breath. However, 82.7% were actually diagnosed as having halitosis. Within this group, 96.2% showed an oral etiology and 3.8% showed an extra-oral cause. Women suffered significantly more from psychogenic halitosis. Success rates of 92.6% subjectively and 94.5% objectively reflect the treatment success of the diagnostic and therapeutic concepts presented at the University of Basel halitosis clinic over a seven year period.

  10. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

    Directory of Open Access Journals (Sweden)

    Reinaldo Benevides dos Santos

    2011-12-01

    Full Text Available CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%, abdominal pain (78%, diarrhea (78% and weight loss (78% were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

  11. EEG abnormalities in clinically diagnosed brain death organ donors in Iranian tissue bank.

    Science.gov (United States)

    Tavakoli, Seyed Amir Hossein; Khodadadi, Abbas; Azimi Saein, Amir Reza; Bahrami-Nasab, Hasan; Hashemi, Behnam; Tirgar, Niloufar; Nozary Heshmati, Behnaz

    2012-01-01

    Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram (EEG) is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities in brain death diagnosis. In this retrospective study, we used 153 EEGs from medical records of 89 brain death patients in organ procurement unit of the Iranian Tissue Bank admitted during 2002-2008. We extracted and analyzed information including EEGs, which were examined by a neurologist for waves, artifacts and EEG abnormalities. The mean age of the patients was 27.2±12.7 years. The most common cause of brain death was multiple traumas due to accident (65%). The most prevalent artifact was electrical transformer. 125 EEGs (82%) were isoelectric (ECS) and seven EEGs (5%) were depictive of some cerebral activity which upon repeat EEGs, they showed ECS patterns too. There was no relationship between cause of brain death and cerebral activity in EEGs of the patients. In this study, we could confirm ECS patterns in all brain death patients whose status had earlier been diagnosed clinically. Considering the results of this study, it seems sensible to perform EEG as a final confirmatory test as an assurance to the patients' families.

  12. Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation

    Science.gov (United States)

    de Camargo Moraes, Paulo; Thomaz, Luiz Alexandre; Montalli, Victor Angelo Martins; Junqueira, José Luiz Cintra; Ribeiro, Camila Maria Beder

    2016-01-01

    The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patient's vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases. PMID:27980867

  13. Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh.

    Science.gov (United States)

    Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Shahunja, K M; Chisti, Mohammod Jobayer

    2015-01-01

    There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.

  14. Evaluation of an ICD-10 algorithm to detect osteonecrosis of the jaw among cancer patients in the Danish National Registry of Patients

    DEFF Research Database (Denmark)

    Ehrenstein, Vera; Gammelager, Henrik; Schiødt, Morten;

    2015-01-01

    PURPOSE: This study aimed to validate a predefined algorithm for osteonecrosis of the jaw (ONJ) among cancer patients in the Danish National Registry of Patients and to assess the nature of clinical information recorded in medical charts of ONJ patients. METHODS: We identified potential ONJ cases...

  15. A study on clinical findings about vertebral disease diagnosed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham-Gyum [Ansan College, Seoul (Korea, Republic of)

    2006-09-15

    In order to analyze clinical characteristics like sex-and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging (MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE (fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics (such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions: 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra (65.5%), which was followed by cervical vertebrae (27.3%) and thoracic vertebrae (7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows: 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%.

  16. Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis

    DEFF Research Database (Denmark)

    Jørgensen, Terese Sara Høj; Torp-Pedersen, Christian; Gislason, Gunnar H.

    2015-01-01

    BACKGROUND: Centralization of specialized health care in Denmark has caused increased geographical distance to health-care providers, which may be a barrier for Alzheimer patients to seek health care. We examined the incidence of Alzheimer diagnosis in Denmark between 2000 and 2009 and investigated...... the association between patients' distance to Alzheimer clinics and Alzheimer diagnoses. METHODS: Data of all individuals aged 65+ years were collected from Danish national registers. Incidences of Alzheimer diagnoses were analysed with joinpoint regression and hazard ratios (HRs) for Alzheimer diagnoses were...... analysed with Cox regressions. RESULTS: The annual incidence of Alzheimer diagnoses increased with 32.5% [95% confidence interval (CI): 7.1-63.8] among individuals aged 65-74 years from 2000 to 2002 and with 29.1% (95% CI: 11.0-50.2) among individuals aged 75+ years from 2000 to 2003. For both groups...

  17. Clinical value of MRI and acute madopar responsiveness test in diagnosing progressive supranuclear palsy

    Directory of Open Access Journals (Sweden)

    LI Xiao-hong

    2013-07-01

    Full Text Available Objective To investigate the MRI abnormalities and acute madopar responsiveness test in diagnosing progressive supranuclear palsy (PSP and Parkinson's disease (PD. Methods Seventeen patients with PSP and 17 gender and age matched patients with PD were studied with cranial MRI examinations and results of acute madopar responsiveness test, and the clinical manifestations of PSP were summarized. Results The atrophy of the midbrain tegmentum and hummingbird sign was demonstrated in all of the PSP patients in our study, but was not observed in the PD patients. The areas of the midbrain on mid-sagittal MRI in PSP patients [(77.35 ± 15.30 mm2] were significantly smaller than that in those with PD [(142.35 ± 31.49 mm2]. The average ratio of the area of the midbrain to the area of pons in the patients with PSP [(14.31 ± 2.47%] was significantly smaller than that in those with PD [(24.08 ± 4.73%; P = 0.000, for all]. According to the result of acute madopar responsiveness test, the maximum Unified Parkinson's Disease Rating Scale (UPDRS Ⅲ improvement rate of 2 patients with PSP and 16 patients with PD was more than 30% (χ2 = 23.142, P = 0.000. Conclusion The assessment of the mid-sagittal MRI and acute madopar responsiveness test may be a useful method to differentiate PSP from PD.

  18. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

  19. Reporting of clinically diagnosed dementia on death certificates: retrospective cohort study

    Science.gov (United States)

    Perera, Gayan; Stewart, Robert; Higginson, Irene J.; Sleeman, Katherine E.

    2016-01-01

    Background: mortality statistics are a frequently used source of information on deaths in dementia but are limited by concerns over accuracy. Objective: to investigate the frequency with which clinically diagnosed dementia is recorded on death certificates, including predictive factors. Methods: a retrospective cohort study assembled using a large mental healthcare database in South London, linked to Office for National Statistics mortality data. People with a clinical diagnosis of dementia, aged 65 or older, who died between 2006 and 2013 were included. The main outcome was death certificate recording of dementia. Results: in total, 7,115 people were identified. Dementia was recorded on 3,815 (53.6%) death certificates. Frequency of dementia recording increased from 39.9% (2006) to 63.0% (2013) (odds ratio (OR) per year increment 1.11, 95% CI 1.07–1.15). Recording of dementia was more likely if people were older (OR per year increment 1.02, 95% CI 1.01–1.03), and for those who died in care homes (OR 1.89, 95% CI 1.50–2.40) or hospitals (OR 1.14, 95% CI 1.03–1.46) compared with home, and less likely for people with less severe cognitive impairment (OR 0.95, 95% CI 0.94–0.96), and if the diagnosis was Lewy body (OR 0.30, 95% CI 0.15–0.62) or vascular dementia (OR 0.79, 95% CI 0.68–0.93) compared with Alzheimer's disease. Conclusions: changes in certification practices may have contributed to the rise in recorded prevalence of dementia from mortality data. However, mortality data still considerably underestimate the population burden of dementia. Potential biases affecting recording of dementia need to be taken into account when interpreting mortality data. PMID:27146301

  20. Diagnosing Borderline Personality Disorder: Examination of How Clinical Indicators Are Used by Professionals in the Health Setting

    Science.gov (United States)

    Treloar, Amanda Jane Commons; Lewis, Andrew J.

    2009-01-01

    This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…

  1. The clinical application value of glycosylated hemoglobin(HbA1c) plus fasting plasma glucose in diagnosing diabetes

    Institute of Scientific and Technical Information of China (English)

    程多智

    2012-01-01

    Objective To evaluate clinical application value of HbA1c plus fasting plasma glucose(FPG) in diagnosing diabetes mellitus(DM).Methods 681 patients with DM were enrolled in this study. The level of HbA1c by Bio-RAD-10 glycated hemoglobin analyzer,FPG by OLYMPUS

  2. Skin and Environmental Contamination in Patients Diagnosed With Clostridium difficile Infection but Not Meeting Clinical Criteria for Testing.

    Science.gov (United States)

    Kundrapu, Sirisha; Sunkesula, Venkata; Tomas, Myreen; Donskey, Curtis J

    2015-11-01

    Of 134 patients diagnosed with Clostridium difficile infection, 30 (22%) did not meet clinical criteria for testing because they lacked significant diarrhea or had alternative explanations for diarrhea and no recent antibiotic exposure. For these patients, skin and/or environmental contamination was common only in those with prior antibiotic exposure.

  3. Retrospective study of disease incidence and other clinical conditions diagnosed in owned dogs in Delta State, Nigeria

    Directory of Open Access Journals (Sweden)

    Kundu F. Shima

    2015-12-01

    Full Text Available In Nigeria, knowledge on the epidemiology of diseases of dogs is limited. A retrospective study of data from clinical records of six veterinary clinics was undertaken to determine the incidence of disease in owned dogs in Delta State, Nigeria from 2012 to 2014. Association between the diagnosed diseases and the studied variables was explored using Chi-Squared test statistics. This study revealed that most of the conditions presented to the veterinary clinics were preventable. Thirty-one (31 clinical conditions were diagnosed from 571 cases recorded, involving nonspecific (21.6%, infectious (70.9%; P=0.001 and non-infectious (7.5% diseases. The most occurring clinical conditions comprised helminthoses (21.4%, mange (10.5%, parvovirosis (8.4%, babesiosis (7.9%, septicemia (7.2%, gastroenteritis (7.0%, myiasis (7.0%, trauma (6.3%, poisoning (6.0%, ectoparasitism (3.7%, ascites (2.5%, dermatitis (2.3%, aural hematoma (1.2%, and orchitis (1.1%. Disease incidence was highest in Alsatian (40.3%, mixed/cross (33.1%, Rottweiler (7.0% and toy breeds (4.6%. Details on the least occurring diseases and the association between disease and the studied variables are given. The outcomes demonstrate the prevalence of the clinical conditions diagnosed, inadequate husbandry and veterinary care accorded to owned dogs in the State. Education of dog owners on preventive measures is paramount in alleviating some of these health problems.

  4. Influence of the introduction of the ICD-10 on tendencies of mortality by causes (1980-2004 Influencia de la introducción de la CIE-10 en las tendencias de mortalidad por causas (1980-2004

    Directory of Open Access Journals (Sweden)

    Diego Salmerón

    2009-04-01

    Full Text Available Objective: To evaluate the influence of the tenth revision of the International Statistical Classification of Diseases (ICD-10 on tendencies of annual mortality rates, corrected and uncorrected to the ICD-9. Methods: Starting with the causes with a significant comparability ratio, we calculated the annual ageadjusted rates from 1980 to 2004. The comparability ratio was applied to the rates for 1999-2004, obtaining the corrected series for the whole period. This series was then compared with the uncorrected series using joinpoint regression. Results: Mortality decreased between 1999 and 2004. Differences were found in blood diseases, hypertensive diseases, cancer of illdefined sites, respiratory insufficiency, and myelodysplastic syndrome. Conclusions: The tendency of the main causes of mortality has been largely unaffected by the revisions in the ICD-10, except in infrequent or less specific diseases.Objetivo: Evaluar la influencia de la décima revisión de la Clasificación Estadística Internacional de Enfermedades (CIE-10 sobre las tendencias de las tasas anuales de mortalidad, con y sin corrección a la CIE-9. Métodos: Partiendo de las causas con razón de comparabilidad significativas, se calcularon las tasas anuales ajustadas por edad de 1980 a 2004. Se aplicaron a las tasas de 1999-2004 su razón de comparabilidad, y se obtuvo la serie corregida en todo el período, que se comparó con la serie sin corrección utilizando una regresión joinpoint. Resultados: La mortalidad disminuye en el período 1999-2004. Se encontraron diferencias en el grupo de enfermedades de la sangre, enfermedades hipertensivas, cáncer de sitios mal definidos, insuficiencia respiratoria y síndrome mielodisplásico. Conclusiones: La tendencia de las principales causas de mortalidad no se afecta por el cambio de revisión, excepto en enfermedades infrecuentes o poco específicas.

  5. Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Kyun [Dept. of Diagnostic Radiology, Koeralife Daejeon Healthcare Center, Daejeon (Korea, Republic of)

    2008-06-15

    Fatty liver is one of the most commonly found disease by abdominal ultrasonography. The status of fatty liver is classified into mild, moderate and severe degrees. The study was conducted to investigate the clinical significance of fatty liver using ultrasonography. Test set consisted of 2,185 patients who visited D healthcare center in Daejeon to receive an abdominal ultrasonic test from January to December 2007. Out of the 2185 patients, 524 patients was diagnosed as fatty liver (290 male and 234 female patients). They were divided into three groups, group I for mild degree. II for moderate degree, and III for severe degree, depending on the echo of liver parenchyma, the sound attenuation, and the visibility of intrahepatic blood vessels and diaphragm. Then the correlation of obesity indices, liver function tests and metabolic syndrome was analyzed for males and females separately. As for the degree of fatty liver, 350 cases (66.8%) were classified as group I, 153 cases (29.2%) as group II, and 21 cases (4.1%) as group III. In addition, severe degree of fatty liver was more frequently found in males than in females. The mean ages of three groups for males were 46.1, 44.5, and 39.1, and those for females were 48.8, 50.2, 52.4, respectively. Males with lower mean ages have severely of fatty liver for both males and females. The results in this study show that the classification into three degrees of fatty liver in ultrasonography practice is helpful to treat and observe the progress of fatty liver. In addition, careful examination is required to measure the severity of fatty liver as well as detection of it. A standardized method to classify the degree of fatty liver is also needed for more objective measurement.

  6. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy.

    Science.gov (United States)

    Gherman; Goodwin; Leung; Byrne; Montoro

    1998-07-01

    Objective: To determine the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism (VTE).Methods: A retrospective review of VTE cases occurring between 1978 and 1996 was performed. Cases of deep venous thrombosis (DVT) and pulmonary embolism (PE) were identified by ICD-9 discharge diagnosis code and review of antepartum and coagulation laboratory databases. Study inclusion criteria required the objective diagnosis of VTE with either Doppler ultrasound, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or CT/MRI.Results: Among 268,525 deliveries there were 165 (0.06%) episodes of VTE (1/1627 births). There were 127 cases of DVT and 38 cases of PE. Only 14% (23/165) had a prior history of DVT or PE. Most DVTs occurred in the left leg (104/127, 81.9%). Nearly three quarters of the DVTs (95/127, 74.8%) occurred in the antepartum period. Among the antepartum DVT cases, half were detected prior to 15 weeks of gestation (47/95, 49.5%), with only 28 cases occurring after 20 weeks (P cesarean section. Only 1 patient developed PE while on heparin therapy for DVT while 11 others had complications attributable to heparin use.Conclusion: Most pregnancy-related VTE occurs in the antepartum period. The risk of deep venous thrombosis appears to begin early in pregnancy, even before the second trimester. The highest risk period for pulmonary embolism is after cesarean delivery. Maternal complications of heparin anticoagulation during pregnancy are rare.

  7. Contribution of laboratory methods in diagnosing clinically suspected ocular toxoplasmosis in Brazilian patients.

    Science.gov (United States)

    Mattos, Cinara C B; Meira, Cristina S; Ferreira, Ana I C; Frederico, Fábio B; Hiramoto, Roberto M; Almeida, Gildásio C; Mattos, Luiz C; Pereira-Chioccola, Vera L

    2011-07-01

    This prospective study evaluated the value of laboratorial diagnosis in ocular toxoplasmosis analyzing peripheral blood samples from a group of Brazilian patients by immunologic and molecular methods. We analyzed blood samples from 184 immunocompetent patients with ocular disorders divided into 2 groups: Group I, composed of samples from 49 patients with ocular toxoplasmosis diagnosed by clinical features; Group II, samples from 135 patients with other ocular diseases. Samples were assayed by conventional polymerase chain reaction (cnPCR), real-time PCR (qPCR) for Toxoplasma gondii, indirect immunofluorescence reaction (IF), avidity test (crude tachyzoite lysate as antigen), and excreted-secreted tachyzoite proteins as antigen (ESA-ELISA). cnPCR and qPCR profiles were concordant in all samples. Positive PCR was shown in 40.8% of group I patients. The majority of the positive blood samples (75%) were taken from patients with toxoplasmic retinochoroiditis scars, and the others (25%), from patients with retinal exudative lesions. Despite that 86 of the 135 patients from Group II had asymptomatic toxoplasmosis, all DNA blood samples had negative PCR. Concordant results were shown in the data obtained by serologic methods. Around 24% of the patients with ocular toxoplasmosis had high antibody titers determined by ESA-ELISA and IF. Anti-ESA antibodies are shown principally in patients with active infection. Collectively, these data demonstrate the presence of tachyzoites in the blood of patients with chronic infection, supporting the idea of recurrent disease. Circulating parasites in blood of immunocompetent individuals may be associated with the reactivation of the ocular disease.

  8. Typical Versus Atypical Anorexia Nervosa Among Adolescents: Clinical Characteristics and Implications for ICD-11.

    Science.gov (United States)

    Silén, Yasmina; Raevuori, Anu; Jüriloo, Elisabeth; Tainio, Veli-Matti; Marttunen, Mauri; Keski-Rahkonen, Anna

    2015-09-01

    There is scant research on the clinical utility of differentiating International Classification of Diseases (ICD) 10 diagnoses F50.0 anorexia nervosa (typical AN) and F50.1 atypical anorexia. We reviewed systematically records of 47 adolescents who fulfilled criteria for ICD-10 F50.0 (n = 34) or F50.1 (n = 13), assessing the impact of diagnostic subtype, comorbidity, background factors and treatment choices on recovery. Atypical AN patients were significantly older (p = 0.03), heavier (minimum body mass index 16.7 vs 15.1 kg/m(2) , p = 0.003) and less prone to comorbidities (38% vs 71%, p = 0.04) and had shorter, less intensive and less costly treatments than typical AN patients. The diagnosis of typical versus atypical AN was the sole significant predictor of treatment success: recovery from atypical AN was 4.3 times (95% confidence interval [1.1, 17.5]) as likely as recovery from typical AN. Overall, our findings indicate that a broader definition of AN may dilute the prognostic value of the diagnosis, and therefore, ICD-11 should retain its distinction between typical and atypical AN.

  9. Registration of symptoms and diagnoses in patients of a Belarussian-Dutch outpatient clinic in Gomel, October 1991 - September 1993

    Energy Technology Data Exchange (ETDEWEB)

    Van Oostrum, I.E.A.; Svalkoul, T.J.F. [National Poison Control Centre, RIVM, Bilthoven (Netherlands); Joore, J.C.A. [Department of Intensive Care and Clinical Toxicology, AZU, Utrecht (Netherlands); Volkova, G.V.; Savkova, M.I.; Derzhitski, V.E. [Gomel Regional Specialized Dispensary, Gomel (Belarus); Bootsma, P.A. [Bureau for International Cooperation, RIVM, Bilthoven (Netherlands)

    1995-09-01

    The results of a survey of the medical consumption of 4,500 patients at the Belarussian-Dutch Outpatient Clinic in Gomel during 1991-1993 are presented and discussed. Analysis of the patient registration data was focused on complaints related to possible enhanced radiation exposure of the patients since the reactor incident at Chernobyl in 1986. The pattern of complaints and diagnoses was comparable to the situation in a Dutch outpatient clinic, except for a higher number of goitre, gastritis, gastric and duodenal ulcers. Diagnoses that could be attributed to increased radiation exposure were not enhanced compared to the pattern in a Dutch population of similar size, except for a higher number of thyroid disease. 19 refs.

  10. Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register

    Science.gov (United States)

    Rück, Christian; Larsson, K Johan; Lind, Kristina; Perez-Vigil, Ana; Isomura, Kayoko; Sariaslan, Amir; Lichtenstein, Paul; Mataix-Cols, David

    2015-01-01

    Objectives The usefulness of cases diagnosed in administrative registers for research purposes is dependent on diagnostic validity. This study aimed to investigate the validity and inter-rater reliability of recorded diagnoses of tic disorders and obsessive-compulsive disorder (OCD) in the Swedish National Patient Register (NPR). Design Chart review of randomly selected register cases and controls. Method 100 tic disorder cases and 100 OCD cases were randomly selected from the NPR based on codes from the International Classification of Diseases (ICD) 8th, 9th and 10th editions, together with 50 epilepsy and 50 depression control cases. The obtained psychiatric records were blindly assessed by 2 senior psychiatrists according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and ICD-10. Primary outcome measurement Positive predictive value (PPV; cases diagnosed correctly divided by the sum of true positives and false positives). Results Between 1969 and 2009, the NPR included 7286 tic disorder and 24 757 OCD cases. The vast majority (91.3% of tic cases and 80.1% of OCD cases) are coded with the most recent ICD version (ICD-10). For tic disorders, the PPV was high across all ICD versions (PPV=89% in ICD-8, 86% in ICD-9 and 97% in ICD-10). For OCD, only ICD-10 codes had high validity (PPV=91–96%). None of the epilepsy or depression control cases were wrongly diagnosed as having tic disorders or OCD, respectively. Inter-rater reliability was outstanding for both tic disorders (κ=1) and OCD (κ=0.98). Conclusions The validity and reliability of ICD codes for tic disorders and OCD in the Swedish NPR is generally high. We propose simple algorithms to further increase the confidence in the validity of these codes for epidemiological research. PMID:26100027

  11. Comparing ICD9-encoded diagnoses and NLP-processed discharge summaries for clinical trials pre-screening: a case study.

    Science.gov (United States)

    Li, Li; Chase, Herbert S; Patel, Chintan O; Friedman, Carol; Weng, Chunhua

    2008-11-06

    The prevalence of electronic medical record (EMR) systems has made mass-screening for clinical trials viable through secondary uses of clinical data, which often exist in both structured and free text formats. The tradeoffs of using information in either data format for clinical trials screening are understudied. This paper compares the results of clinical trial eligibility queries over ICD9-encoded diagnoses and NLP-processed textual discharge summaries. The strengths and weaknesses of both data sources are summarized along the following dimensions: information completeness, expressiveness, code granularity, and accuracy of temporal information. We conclude that NLP-processed patient reports supplement important information for eligibility screening and should be used in combination with structured data.

  12. Cardiac autonomic testing and diagnosing heart disease. “A clinical perspective”

    OpenAIRE

    Nicholas L. DePace; Joy P. Mears; Michael Yayac; Joseph Colombo

    2014-01-01

    Background Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE), modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods...

  13. Identification of the c.2448-25G>A Polymorphism in Patients Clinically Diagnosed with Wilson's Disease

    Directory of Open Access Journals (Sweden)

    Yulia Clark Feoktistova

    2015-11-01

    Full Text Available Background: Wilson's disease is characterized by copper accumulation in the liver, brain and cornea. It is caused by mutations in the ATP7B gene. Several polymorphisms in the ATP7B gene have been reported in the literature.Objective: to identify conformational changes in the fragment comprising intron 9-exon 10 for detecting the c.2448-25G> A polymorphism in the ATP7B gene of Cuban patients clinically diagnosed with Wilson's disease.Methods: a descriptive study including 100 patients with clinical diagnosis of Wilson's disease was conducted at the National Medical Genetics Center from 2008 to 2012. The polymerase chain reaction was used to amplify the fragment of interest and the single-strand conformation polymorphism was applied in the intron 9-exon 10 region of the ATP7B gene to identify conformational changes. Presence of the c.2448-25G> A polymorphism was detected by sequencing this fragment.Results: the conformational change called b corresponded to the c.2448-25G> A polymorphism in heterozygous state. The allele frequency of the c.2448-25G> A polymorphism in 100 Cuban patients clinically diagnosed with Wilson's disease was 8.5%. The most common manifestations in patients with this polymorphism were related to the liver.Conclusion: the c.2448-25G> A polymorphism was identified in Cuba for the first time, which will enable molecular studies by indirect methods.

  14. Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: An assessment of clinical potential

    Energy Technology Data Exchange (ETDEWEB)

    Hopewell, J.W., E-mail: john.hopewell@gtc.ox.ac.uk [Green Templeton College and Particle Therapy Cancer Research Institute, University of Oxford, Oxford (United Kingdom); Gorlia, T. [Data Center, EORTC, Brussels (Belgium); Pellettieri, L. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Neurosurgery, Goeteborg University, Goeteborg (Sweden); Giusti, V. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Mechanical, Nuclear and Production Engineering, University of Pisa, Pisa (Italy); H-Stenstam, B. [Nykoeping Hospital, County of Sormland (Sweden); Skoeld, K. [Hammercap Medical AB, Stockholm (Sweden)

    2011-12-15

    The purpose of this analysis was to assess the potential of BNCT, with L-boronophenylalanine (L-BPA), as first line radiotherapy for glioblastoma multiforme (GBM). The survival of patients with newly diagnosed GBM from a phase II BNCT study was compared with those from the two arms of a phase III study with conventional radiotherapy (RT) vs. RT plus concomitant and adjuvant medication with temozolomide (TMZ). A small subgroup, for which the methylation status of the O{sup 6}-methylguanine-DNA methyltransferase (MGMT) DNA-repair gene was known, was also considered. The results indicated that the use of BNCT with BPA should be explored in a stratified randomized phase II trial in which patients with the unmethylated MGMT DNA-repair gene are offered BNCT vs. RT plus TMZ.

  15. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state

    Directory of Open Access Journals (Sweden)

    Staii Anca

    2010-12-01

    Full Text Available Abstract Background Our Thyroid-Multidisciplinary Clinic is a large referral site for thyroid diseases. Thyroid biopsies are mainly performed for thyroid cancer screening. Yet, Hashimoto thyroiditis (HT is being too frequently diagnosed. The prevalence of HT is reported as 0.3-1.2% or twice the prevalence of type 1 diabetes. However, the prevalence of HT confirmed by cytology is still uncertain. To evaluate different aspects of thyroid physiopathology including prevalence of Hashimoto's, a database of clinical features, ultrasound images and cytology results of patients referred for FNA of thyroid nodules was prospectively developed. Methods We retrospectively studied 811 consecutive patients for whom ultrasound guided thyroid FNA biopsies were performed at our clinic over 2.5 year period (Mar/2006-Sep/2008. Results The analysis of our database revealed that from 761 patients, 102 (13.4% had HT, from whom 56 (7.4% were euthyroid or had sub-clinical (non-hypothyroid disease, and 46 (6% were clinically hypothyroid. Conclusions This is the first study to show such a high prevalence of HT diagnosed by ultrasound-guided FNA. More strikingly, the prevalence of euthyroid HT, appears to be >5% similar to that of type 2 diabetes. Based on our results, there might be a need to follow up on cytological Hashimoto's to monitor for thyroid failure, especially in high risk states, like pregnancy. The potential risk for thyroid cancer in patients with biopsy-proven inflammation of thyroid epithelium remains to be established prospectively. However, it may explain the increased risk for thyroid cancer observed in patients with elevated but within normal TSH.

  16. The relationship between carers' report of autistic traits and clinical diagnoses of autism spectrum disorders in adults with intellectual disability.

    Science.gov (United States)

    Bhaumik, Sabyasachi; Tyrer, Freya; Barrett, Mary; Tin, Nyunt; McGrother, Catherine W; Kiani, Reza

    2010-01-01

    It is often difficult to determine the triad of impairments and whether autistic features are the consequence of intellectual impairment or autism spectrum disorders in people with intellectual disability (ID). The aim of the current study was to investigate the relationship between carer-reported autistic traits and independent diagnoses of autism spectrum disorders (ASD). Data were collected on carers' subjective report of autistic traits and clinical diagnoses of ASD. Of 1145 adults with ID identified, 220 (19%) individuals had a diagnosis of ASD, and 778 (68%) individuals had at least one autistic trait. Optimal sensitivity and specificity were achieved with two or more autistic traits (sensitivity 63%; specificity 79%) and the positive predictive value increased substantially as the number of autistic traits increased. However, a significant proportion of individuals with ID who did not have a diagnosis of ASD also displayed autistic traits. Our findings suggest that in the absence of other measures, the presence of autistic traits can serve as a useful proxy measure for ASD in research (and/or clinical settings). However, although information on autistic traits may help healthcare practitioners to identify people with possible ASD, it cannot be used alone to make a formal diagnosis.

  17. Generating Evidence for Clinical Benefit of PET/CT in Diagnosing Cancer Patients

    DEFF Research Database (Denmark)

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

    2011-01-01

    of PET/CT in cancer patients: replacement of an invasive procedure, improved accuracy of initial diagnosis, improved accuracy of staging for curative versus palliative treatment, improved accuracy of staging for radiation versus chemotherapy, response evaluation, and acceleration of clinical decisions...

  18. Scoring clinical signs can help diagnose canine visceral leishmaniasis in a highly endemic area in Brazil

    Science.gov (United States)

    da Silva, Kleverton Ribeiro; de Mendonça, Vitor Rosa Ramos; Silva, Kellen Matuzzy; do Nascimento, Leopoldo Fabrício Marçal; Mendes-Sousa, Antonio Ferreira; de Pinho, Flaviane Alves; Barral-Netto, Manoel; Barral, Aldina Maria Prado; Cruz, Maria do Socorro Pires e

    2017-01-01

    Canine visceral leishmaniasis (CVL) diagnosis is still a challenge in endemic areas with limited diagnostic resources. This study proposes a score with the potential to distinguish positive CVL cases from negative ones. We studied 265 dogs that tested positive for CVL on ELISA and parasitological tests. A score ranging between 0 and 19 was recorded on the basis of clinical signs. Dogs with CVL had an overall higher positivity of the majority of clinical signs than did dogs without CVL or with ehrlichiosis. Clinical signs such as enlarged lymph nodes (83.93%), muzzle/ear lesions (55.36%), nutritional status (51.79%), bristle condition (57.14%), pale mucosal colour (48.21%), onychogryphosis (58.93%), skin lesion (39.28%), bleeding (12.50%), muzzle depigmentation (41.07%), alopecia (39.29%), blepharitis (21.43%), and keratoconjunctivitis (42.86%) were more frequent in dogs with CVL than in dogs with ehrlichiosis or without CVL. Moreover, the clinical score increased according to the positivity of all diagnostic tests (ELISA, p < 0.001; parasite culture, p = 0.0021; and smear, p = 0.0003). Onychogryphosis (long nails) [odds ratio (OR): 3.529; 95% confidence interval (CI): 1.832-6.796; p < 0.001], muzzle depigmentation (OR: 4.651; 95% CI: 2.218-9.750; p < 0.001), and keratoconjunctivitis (OR: 5.400; 95% CI: 2.549-11.441; p < 0.001) were highly associated with CVL. Interestingly, a score cut-off value ≥ 6 had an area under the curve of 0.717 (p < 0.0001), sensitivity of 60.71%, and specificity of 73.64% for CVL diagnosis. The clinical sign-based score for CVL diagnosis suggested herein can help veterinarians reliably identify dogs with CVL in endemic areas with limited diagnostic resources. PMID:28076469

  19. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

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    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  20. THE ROLE OF AUTOPSY IN MEDICAL INTENSIVE CARE UNIT: COMPARISON OF CLINICAL AND POSTMORTEM DIAGNOSES

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    Vandana Tukaram

    2016-03-01

    Full Text Available BACKGROUND Autopsy is an essential auditing tool in clinical practice. The autopsy teaches us not only what is killing people right now, but points to what will kill us in the near future. This is the first autopsy study in Medical Intensive Care Unit (MICU in India as per our knowledge. METHODS Retro-prospective study of total of 141 medical autopsies of MICU deaths performed in the Department of Pathology during a period of three years. A meticulous study was performed to compare ante-mortem clinical diagnosis and post-mortem final cause of death. Cases showing a discrepancy between the clinical diagnosis and post-mortem final cause of death were categorized into IV classes according to Goldman classification. RESULTS Maximum autopsies were performed in 21-40 years (58.15%. Female preponderance noted. Non-infectious aetiology was most common cause of death (50%, of which lesions of respiratory system were the most common (33.8%. Amongst the infections, pneumonia was the most common cause of death (29.23%. Discrepancies between ante-mortem and post-mortem were noted in 63 cases (44.68%. Class I and class II discrepancies were 49.21% and 44.45%, respectively. CONCLUSION Our study stresses that routine autopsy is still very useful in MICU and emphasis must be placed on autopsy evaluation for the improvement of quality of patient care.

  1. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

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    Raza Syed A

    2009-12-01

    Full Text Available Abstract Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved

  2. Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Leber’s Hereditary Optic Neuropathy

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    Haluk Esgin

    2012-09-01

    Full Text Available Objective: To investigate possible mitochondrial DNA (mtDNA mutations in patients with Leber’s hereditary optic neuropathy (LHON in order to provide a precise diagnosis and genetic counseling.Material and Methods: Between 1982 and 2007, ten patients were clinically diagnosed with LHON and six of these patients agreed to be involved in this study. Six healthy individuals were also included as a control group. mtDNA was isolated from peripheral blood samples and polymerase chain reaction and mtDNA sequence analysis were performed. Results: In one of the six patients, a homoplasmic mutant m.11778G>A mutation was detected. All of the clinically diagnosed LHON patients and the control groups had the m.14212C>T and m.14580G>A single nucleotide polymorphisms (SNPs. The m.11719A>G SNP was detected in three of six patients and four of the controls. Two of the six patients had the m.3197T>C SNP and, in addition, the m.14258G>A SNP was found in one of these two patients, while neither of these mutations were present in the control group.Conclusion: The clinical diagnosis of LHON could be supported by molecular genetics only in one patient by the detection of one mutation. The m.3197T>C and m.14258G>A SNPs should be considered as potential mtDNA mutations due to the fact that they were detected in the patient group. These mutations should be investigated further in large case groups for suspected gene loci that could lead to optic neuropathy.

  3. [Amyand hernia--a rare anatomic and clinical entity diagnosed intraoperatively].

    Science.gov (United States)

    Grecu, F; Filip, B; Moţoc, I; Andriescu, Nadia; Lăpuşneanu, A; Ursaru, Manuela

    2010-01-01

    The Amyand hernia is an uncommon variant of the inguinal hernia, rarely recognised before the surgical treatment because of the confusion with a strangled hernia. In spite of this, the clinical presentation seems to follow a well determined pathway, so it is possible to state that the uncorrect diagnosis is to be attributed to the ignorance of this variant of hernia. We present two consecutive case reports of acute appendicitis founded in an inguinal hernia sac. The clinical presentation depended on the inflammation extension inside the hernia sac and the presence or not of peritoneal contamination. The patients were admitted for a painful pseudotumor in the inguinal region with irreducibility, mimicking strangled inguinal hernia with acute inflammatory syndrome. Intraoperatively we have found a hernia sac with a phlegmonous/gangrenous appendix inside. Appendectomy was performed, followed by hernioplasty (retrofunicular technique) without prosthetic material). The operation followings were favorable. We conclude that amyand hernia must be considered as differential diagnosis of apparently strangled inguinal hernias. Technical precautions and antibioprophylaxy applied during surgery may prevent septic complications after hernioplasty. The hernia repair must be performed without prosthetic material and using exclusively resorbable sutures.

  4. [THE COMPARATIVE ANALYSIS OF INFORMATION VALUE OF MAIN CLINICAL CRITERIA USED TO DIAGNOSE OF BACTERIAL VAGINOSIS].

    Science.gov (United States)

    Tsvetkova, A V; Murtazina, Z A; Markusheva, T V; Mavzutov, A R

    2015-05-01

    The bacterial vaginosis is one of the most frequent causes of women visiting gynecologist. The diagnostics of bacterial vaginosis is predominantly based on Amsel criteria (1983). Nowadays, the objectivity of these criteria is disputed more often. The analysis of excretion of mucous membranes of posterolateral fornix of vagina was applied to 640 women with clinical diagnosis bacterial vaginosis. The application of light microscopy to mounts of excretion confirmed in laboratory way the diagnosis of bacterial vaginosis in 100 (15.63%) women. The complaints of burning and unpleasant smell and the Amsel criterion of detection of "key cells" against the background of pH > 4.5 were established as statistically significant for bacterial vaginosis. According study data, the occurrence of excretions has no statistical reliable obligation for differentiation of bacterial vaginosis form other inflammatory pathological conditions of female reproductive sphere. At the same time, detection of "key cells" in mount reliably correlated with bacterial vaginosis.

  5. Hepatosplenic T Cell Lymphoma in an Immunocompetent Female Diagnosed using Flow Cytometry: A Rare Clinical Entity.

    Science.gov (United States)

    Dorwal, Pranav; Sachdev, Ritesh; Pande, Amit; Jain, Dharmendra; Jha, Bhawna; Raina, Vimarsh

    2016-08-01

    Hepatosplenic T-cell lymphoma is a rare haematopoietic malignancy that comprises less than 1% of Non-Hodgkin lymphomas. We are reporting a case of a 26-year-old female, who presented with pallor, weight loss, jaundice, pancytopenia and hepatosplenomegaly. The bone marrow examination showed infiltration by lymphoid cells. These cells on flow cytometric evaluation showed the phenotype of hepatosplenic T cell lymphoma. The cells were positive for CD3, CD8, CD56 and TCR γδ and negative for CD5, CD4, CD8, CD16, CD57, TCRαβ along with B cell markers. This case is reported for being a rare clinical entity and its presence in an immunocompetent female making it rarer.

  6. Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules

    Science.gov (United States)

    Harrington, Emma; Clyne, Barbara; Wesseling, Nieneke; Sandhu, Harkiran; Armstrong, Laura; Bennett, Holly; Fahey, Tom

    2017-01-01

    Objectives Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. Design Systematic review. Data sources A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. Study selection and data extraction Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. Results From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. Conclusions At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice. PMID:28264830

  7. Failing to diagnose and failing to treat an addicted client: Two potentially life-threatening clinical errors.

    Science.gov (United States)

    Liese, Bruce S; Reis, Daniel J

    2016-09-01

    Psychotherapists risk making 2 types of errors with clients who struggle with addictive behaviors: failure to addictive behaviors and failure to effectively addictive behaviors. Given the high prevalence of addictive behaviors in clinical populations, therapists are in a unique position to assist individuals with these problems. It is assumed that therapists possess general diagnostic and treatment skills and yet many do not diagnose or do not treat addictive behaviors. Reasons for making these errors include prohibitive beliefs and limited knowledge about addictive behaviors. We offer specific recommendations to reduce these psychotherapy errors. These include: (a) more deliberate screening and diagnosis of addictive behaviors, (b) increased application of empirically supported addiction treatments, (c) required education and training in addictive behaviors, (d) modification of prohibitive attitudes about addressing addictive behaviors, and (e) increased attention paid to the addictive behaviors by professional psychotherapy organizations. (PsycINFO Database Record

  8. Clinical Applications of Successive Spot Radiographs in Esophagography for Diagnosing the Early Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    TANGLi-jun; KONGFan-fu; WANGDe-hang

    2004-01-01

    To introduce primary experience of clinical applications of successive spot radiographs in esophagography for the din mlosis of early esoplmgeal cancer (EEC). Methods: Six patients with EEC were examined and doagnosed dlaarmsed by a digital X-ray machine. According to the routine double contrast study of esophagus, the patient gulped a barimn suspension in the upright position when the successive films were taken by 2 frmnes per second lasting for about 10 seconds. Various phases were obtained including barimn-filled views,mucosal relief views and double contrast views. Results: Functional changes and abnormal mucosal folds of esophagus were present on successive spot radiographs of esophagography in patients with EEC and those patients with EEC were confirmed by endoscopic and pathologic findings. Four patients had mild loss of distensibility, 2 patients had spasmodic contraction and 1 patient had barium retention. Thickened or interrupted folds were found in all cases.Little niches were detected in 5 of 6 patients. Conctusion: Evidence presented in barimn studies of esophagus is more comprehensive and intact for the diagnosis of EEC when successive spot radiographs are employed. Functional changes of esophagus are more evident with this approach.

  9. Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment

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    Petrovic Dejan

    2016-09-01

    Full Text Available Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd and aortic pressure (Pa less than 0.9 (Pd/Pa 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2 and negative captopril scintigraphy (lack of lateralization.

  10. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience

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    Yoshimitsu, Kengo; Mitsufuji, Toshimichi; Shinagawa, Yoshinobu; Fujimitsu, Ritsuko; Morita, Ayako; Urakawa, Hiroshi; Takano, Koichi [Fukuoka University, Department of Radiology, Fukuoka (Japan); Hayashi, Hiroyuki [Fukuoka University, Department of Pathology, Faculty of Medicine, Fukuoka (Japan)

    2016-03-15

    To clarify the usefulness of 3.0-T MR elastography (MRE) in diagnosing the histological grades of liver fibrosis using preliminary clinical data. Between November 2012 and March 2014, MRE was applied to all patients who underwent liver MR study at a 3.0-T clinical unit. Among them, those who had pathological evaluation of liver tissue within 3 months from MR examinations were retrospectively recruited, and the liver stiffness measured by MRE was correlated with histological results. Institutional review board approved this study, waiving informed consent. There were 70 patients who met the inclusion criteria. Liver stiffness showed significant correlation with the pathological grades of liver fibrosis (rho = 0.89, p < 0.0001, Spearman's rank correlation). Areas under the receiver operating characteristic curve were 0.93, 0.95, 0.99 and 0.95 for fibrosis score greater than or equal to F1, F2, F3 and F4, with cut-off values of 3.13, 3.85, 4.28 and 5.38 kPa, respectively. Multivariate analysis suggested that grades of necroinflammation also affected liver stiffness, but to a significantly lesser degree as compared to fibrosis. 3.0-T clinical MRE was suggested to be sufficiently useful in assessing the grades of liver fibrosis. (orig.)

  11. Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population

    Science.gov (United States)

    Tavares, Daniel-Petitet; Rodrigues, Janderson-Teixeira; dos Santos, Teresa-Cristina-Ribeiro-Bartholomeu; Armada, Luciana

    2017-01-01

    Background Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population. Material and Methods The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed. Results Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001). Conclusions PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology. PMID:28149477

  12. Validity of the recorded International Classification of Diseases, 10th edition diagnoses codes of bone metastases and skeletal-related events in breast and prostate cancer patients in the Danish National Registry of Patients

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    Annette Østergaard Jensen

    2009-07-01

    Full Text Available Annette Østergaard Jensen1, Mette Nørgaard1, Mellissa Yong2, Jon P Fryzek2, Henrik Toft Sørensen11Department of Clinical Epidemiology, Aarhus University hospital, Århus, Denmark; 2Global Epidemiology, Amgen inc., Thousands Oaks, CA, USAObjective: The clinical history of bone metastases and skeletal-related events (SREs secondary to cancers is not well understood. In support of studies of the natural history of bone metastases and SREs in Danish prostate and breast cancer patients, we estimated the sensitivity and specificity of hospital diagnoses for bone metastases and SREs (ie, radiation therapy to the bone, pathological or osteoporotic fractures, spinal cord compression and surgery to the bone in a nationwide medical registry in Denmark.Study design and setting: In North Jutland County, Denmark, we randomly sampled 100 patients with primary prostate cancer and 100 patients with primary breast cancer diagnoses from the National Registry of Patients (NRP, during the period January 1st, 2000 to December 31st, 2000 and followed them for up to five years after their cancer diagnosis. We used information from medical chart reviews as the reference for estimating sensitivity, and specificity of the NRP International Classification of Diseases, 10th edition (ICD-10 coding for bone metastases and SRE diagnoses. Results: For prostate cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.54 (95% confidence interval [CI]: 0.39–0.69, and the specificity was 0.96 (95% CI: 0.87–1.00. For breast cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.58 (95% CI: 0.34–0.80, and the specificity was 0.95 (95% CI: 0.88–0.99. Conclusion: We measured the validity of ICD-10 coding in the Danish NRP for bone metastases and SREs in prostate and breast cancer patients and found it has adequate sensitivity and high specificity. The NRP remains a valuable tool for clinical epidemiological studies of bone

  13. Variety of genotypes in males diagnosed as dichromatic on a conventional clinical anomaloscope.

    Science.gov (United States)

    Neitz, Maureen; Carroll, Joseph; Renner, Agnes; Knau, Holger; Werner, John S; Neitz, Jay

    2004-01-01

    The hypothesis that dichromatic behavior on a clinical anomaloscope can be explained by the complement and arrangement of the long- (L) and middle-wavelength (M) pigment genes was tested. It was predicted that dichromacy is associated with an X-chromosome pigment gene array capable of producing only a single functional pigment type. The simplest case of this is when deletion has left only a single X-chromosome pigment gene. The production of a single L or M pigment type can also result from rearrangements in which multiple genes remain. Often, only the two genes at the 5' end of the array are expressed; thus, dichromacy is also predicted to occur if one of these is defective or encodes a defective pigment, or if both of them encode pigments with identical spectral sensitivities. Subjects were 128 males who accepted the full range of admixtures of the two primary lights as matching the comparison light on a Neitz or Nagel anomaloscope. Strikingly, examination of the L and M pigment genes revealed a potential cause for a color-vision defect in all 128 dichromats. This indicates that the major component of color-vision deficiency could be attributed to alterations of the pigment genes or their regulatory regions in all cases, and the variety of gene arrangements associated with dichromacy is cataloged here. However, a fraction of the dichromats (17 out of 128; 13%) had genes predicted to encode pigments that would result in two populations of cones with different spectral sensitivities. Nine of the 17 were predicted to have two pigments with slightly different spectral peaks (usually dichromats, others test as anomalous trichromats. The discrepancy is probably partly attributable to testing method differences and partly to a difference in performance not perception, but it seems there must also be cases in which other factors, for example, cone ratio, contribute to a person's ability to extract a color signal from a small spectral difference.

  14. Sneddon syndrome: rare disease or under diagnosed clinical entity? Review of the literature related to a clinical case.

    Science.gov (United States)

    Orac, Amalia; Artenie, Anca; Toader, Mihaela Paula; Harnagea, Raluca; Dinu-Mitrofan, Diana; Grigorovici, Mirela; Ungureanu, G

    2014-01-01

    Sneddon syndrome is defined by the association of livedo racemosa and recurrent cerebrovascular ischemic lesions. The annual incidence is 4/1,000,000. This syndrome particularly affects young women, some reports suggesting a family predisposition. It is a chronic, progressive, arterio-occlusive disease of unknown etiology that involves small and medium-sized arteries. It is usually associated with antiphospholipid antibodies. We report the case of a female patient with Sneddon syndrome with significant family history, personal history of stroke, epilepsy, migraine, cardiovascular involvement, three miscarriages, cognitive decline, noncompliant to therapy, in the absence of antiphospholipid antibodies. This paper aims to analyze the main characteristic features and management of Sneddon syndrome by conducting a literature review related to a clinical case.

  15. Patients newly diagnosed with clinical type 2 diabetes mellitus but presenting with HbA1c within normal range: 19-year mortality and clinical outcomes

    DEFF Research Database (Denmark)

    Veloso, A.G.; Siersma, V.; Heldgaard, P.E.;

    2013-01-01

    AIMS: To investigate whether long-term mortality or clinical outcomes differed between patients diagnosed with type 2 diabetes mellitus and presenting with HbA1c within or above normal range at time of diagnosis. METHODS: Data were from a population-based sample of 1136 individuals with newly...... diagnosed type 2 diabetes mellitus. The diagnosis was confirmed with a single fasting whole blood/plasma glucose ≥7.0/8.0mmol/l. The median time from day of diagnosis until end of follow up was 18.8years. Patients were grouped according to normal HbA1c and elevated HbA1c at diagnosis. The effect of elevated...... HbA1c on a number of clinical outcomes and all-cause mortality was assessed in Cox regression models. RESULTS: At diagnosis, 97 patients (8.5%) had an HbA1c level within normal range. Age (mean (SD)) at diagnosis was 64.5 (11.5) years. Both unadjusted and adjusted hazard ratios for the effect of HbA1...

  16. Variants Within TSC2 Exons 25 and 31 Are Very Unlikely to Cause Clinically Diagnosable Tuberous Sclerosis.

    Science.gov (United States)

    Ekong, Rosemary; Nellist, Mark; Hoogeveen-Westerveld, Marianne; Wentink, Marjolein; Panzer, Jessica; Sparagana, Steven; Emmett, Warren; Dawson, Natalie L; Malinge, Marie Claire; Nabbout, Rima; Carbonara, Caterina; Barberis, Marco; Padovan, Sergio; Futema, Marta; Plagnol, Vincent; Humphries, Steve E; Migone, Nicola; Povey, Sue

    2016-04-01

    Inactivating mutations in TSC1 and TSC2 cause tuberous sclerosis complex (TSC). The 2012 international consensus meeting on TSC diagnosis and management agreed that the identification of a pathogenic TSC1 or TSC2 variant establishes a diagnosis of TSC, even in the absence of clinical signs. However, exons 25 and 31 of TSC2 are subject to alternative splicing. No variants causing clinically diagnosed TSC have been reported in these exons, raising the possibility that such variants would not cause TSC. We present truncating and in-frame variants in exons 25 and 31 in three individuals unlikely to fulfil TSC diagnostic criteria and examine the importance of these exons in TSC using different approaches. Amino acid conservation analysis suggests significantly less conservation in these exons compared with the majority of TSC2 exons, and TSC2 expression data demonstrates that the majority of TSC2 transcripts lack exons 25 and/or 31 in many human adult tissues. In vitro assay of both exons shows that neither exon is essential for TSC complex function. Our evidence suggests that variants in TSC2 exons 25 or 31 are very unlikely to cause classical TSC, although a role for these exons in tissue/stage specific development cannot be excluded.

  17. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database.

    Directory of Open Access Journals (Sweden)

    Katy B Kozhimannil

    2014-10-01

    Full Text Available BACKGROUND: Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS: Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals. The outcome was cesarean (versus vaginal delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1% among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15. The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]. A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS: Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These

  18. Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses

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    Ferrari Pierre

    2008-07-01

    Full Text Available Abstract Background Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (Kiddie-SADS-PL into an in-patient adolescent clinical setting. Methods Participants were all adolescents admitted through the years 2001–2004 (N = 333 admissions, age 12–17 years. The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. Results The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. Conclusion The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings.

  19. Sociodemographic Characteristics and Diagnoses of Individuals Referred to a Child and Adolescent Psychiatry Outpatient Clinic of a University Hospital

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    Sevcan Karakoç Demirkaya

    2015-04-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the sociodemographic characteristics, complaints, and diagnoses of individuals who were admitted to a child and adolescent psychiatry outpatient clinic. MATERIALS AND METHODS: Medical charts of the patients who were admitted to the child and adolescent psychiatry unit of Adnan Menderes University between February 1st and July 31st, 2014 were retrospectively studied. RESULTS: The rate of girls and boys from a total of 832 cases who were referred to the child and adolescent psychiatry outpatient clinic in the six month period was 41.8% and 58.2%, respectively. The mean age of the girls and boys was 10.8±4.9 and 8.5±4.7 years, respectively. The most common age range was between 12 and 18 years. The proportion of patients who lived with both parents was 81.1%; however, the proportion of individuals brought in by institutional caregivers was 0.8%. The proportion of consanguineous marriages was 13.7%. The education level of mothers and fathers was mostly a primary school degree (47% and 45.6%, respectively. A positive psychiatric history was present in 13.7% of the mothers and 7.6% of the fathers. Reasons for child psychiatric assessments were as follows: 21.9% for disability report, 13.8% for forensic evaluation, 11.2% for consultation, and 52.9% for general psychiatric evaluation. Referral complaints were irritability/anger (15.7%, attention deficit/hyperactivity (14.8%, delay in speech (10.5%, fear/anxiety (5.9%, and poor school performance (5.7%. The diagnoses were as follows: attention deficit hyperactivity disorder (ADHD (20.6%, other disruptive behaviors (12.4%, and anxiety disorder (10.2%. CONCLUSION: We revealed that the most common referring complaint was irritability/anger and that the most common diagnosis was ADHD in our patient group, which was similar to previous studies. Our results showed that a low parental educational level and a positive history for parental psychopathology were

  20. Schizoaffective disorder-- the reliability of its clinical diagnostic use

    DEFF Research Database (Denmark)

    Vollmer-Larsen, Anne; Jacobsen, TB; 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...

  1. Does naftifine have anti-inflammatory properties? A double-blind comparative study with 1% clotrimazole/1% hydrocortisone in clinically diagnosed fungal infection of the skin.

    Science.gov (United States)

    Evans, E G; James, I G; Seaman, R A; Richardson, M D

    1993-10-01

    In a multicentre, double-blind, randomized, parallel group study in general practice, 269 patients with clinically diagnosed fungal infection of the skin were treated with either naftifine (Exoderil) or 1% clotrimazole plus 1% hydrocortisone (CHC; Canesten HC) applied twice daily for 4 weeks. Only 115 patients were shown subsequently to have a fungal infection by laboratory tests; the others had inflammatory disease of unknown aetiology. In those with fungal disease, both treatments were equally effective in terms of mycological cure (negative microscopy and culture). Clinical results for all 265 patients showed no clinically identifiable difference between the two preparations in terms of resolution of the disease, indicating that naftifine does have anti-inflammatory activity at least equal to CHC. This study suggests that there is no clinical advantage in treating patients with clinically diagnosed fungal infection of the skin with an antimycotic/corticosteroid combination as opposed to naftifine alone.

  2. A 30-year Evaluation of the Agreement between Clinical and Histopathological Diagnoses of Peripheral Epithelial and Mesenchymal Lesions in Mashhad Dental School: 1976-2006

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    Salehinejad J.

    2011-10-01

    Full Text Available Statement of Problems: Sufficient knowledge, experience and careful examination usually lead to appropriate clinical diagnosis. However, lesions with similar clinical features present a diagnostic challenge. Therefore, a confirmatory histopathological examination can be helpful to reach the final diagnosis. Purpose: The present study was conducted to evaluate the agreement between clinical and histopathological diagnoses of oral epithelial and mesenchymal lesions in a period of 30-years (1976-2006 at Mashhad Dental School.Materials and Methods: The percentage of concurrence and discrepancy between clinical and histopathological diagnoses of 625 epithelial and 2480 mesenchymal lesions was compared. Clinical data including the patient’s gender and age and the lesion’s location were also evaluated in cases with discrepancy. Data were analyzed using Mann-Whitney, T-Test, Chi-Square, Likehood Ratio, Fisher’s Exact and Kappa tests.Results: An overall agreement between clinical and histopathological diagnoses was seen in 71/4% of epithelial lesion cases, with maximum parity in squamous cell carcinoma and papilloma. In 57/1% of the mesenchymal cases, the diagnosis was in total agreement. Denture hyperplasia, epulis fissuratum, and pregnancy tumor showed the highest concurrence, respectively.Conclusion: Although histopathological examination leads to final diagnosis, in some cases proper strategies and more attention to clinical features of the lesion are necessary to minimize the discrepancy, especially for those with non-specific clinical presentation.

  3. Clinical-epidemiological features of HIV-infected patients diagnosed at age of 50 years or older

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    V Fink

    2012-11-01

    Full Text Available HIV/AIDS prevention and care efforts are directed to individuals of reproductive age (15–49 yrs. With the extension of sexual life of older people, they became a growing population at risk of HIV infection, usually not included in prevention strategies. In order to evaluate clinical profile of HIV/AIDS pts diagnosed at 50 yrs or older assisted in an HIV outpatient center in Buenos Aires, we retrospectively assessed clinical records of pts initiating care between Jan 1986 and Dec 2011. Age, CD4 cells and viral load (pVL at HIV diagnosis and most recent value, opportunistic infections (OIs, co-morbidities and antiretroviral therapy (ARV were recorded. Of 10,998 pts assisted in the 26-yr period, 495 (4.5% were≥50 yrs old at HIV diagnosis; median annual diagnoses: 18.5 (IQR 3.3–30.3 without significant changes in the last 20 yrs. Demographics: median age 54.7 yrs (IQR 51.8–59.2, rank 50–80, 76.6% male. Risk behavior: HTX 61.4%, MSM 34.1%, others 4.4%. 55.4% of HIV diagnoses occurred during hospitalization or simultaneously with acute OIs. One third (n=176 had AIDS at diagnosis, 24% had history of STDs. HCV co-infection 5.7%, past HBV infection 28.1% and chronic HBV infection 5.1%. Median CD4 cells at HIV diagnosis: 223.5 (13.7% (IQR 98.8–420.3, initial pVL 60,000 cp/mL (IQR 9,995.5–208,391. 69.3% of pts started ARV therapy during follow-up (FU, and the median time between diagnosis and treatment initiation was 3.4 mo (IQR 0.7–14; 56.9% of them started a non-nucleoside-based regimen (ZDV/3TC/EFV, 28.3% a PI-based regimen (ZDV/3TC/IDV and 14.6% a nucleoside-based regimen (ZDV/ddI pre-HAART era. After a year (±6 mo, 63.8% pts achieved undetectable pVL and gained 136 CD4 cells from BSL (IQR 83–204. After 40.6 mo of FU (IQR 6.7-89.8, 66.3% are alive, 7.1% died (68.6% of HIV-related diseases and 26.7% are lost to FU. Co-morbidities were present in 125 (25.3%, mainly hypertension, increased lipids, CVD and DBT. Among treated pts, 70

  4. Geographic variation of clinically diagnosed mood and anxiety disorders in Christchurch after the 2010/11 earthquakes.

    Science.gov (United States)

    Hogg, Daniel; Kingham, Simon; Wilson, Thomas M; Griffin, Edward; Ardagh, Michael

    2014-11-01

    The 22nd February 2011 Christchurch earthquake killed 185 people, injured over 8000, damaged over 100,000 buildings and on-going aftershocks maintained high anxiety levels. This paper examines the dose of exposure effect of earthquake damage assessments, earthquake intensity measures, liquefaction and lateral spreading on mood and anxiety disorders in Christchurch after this event. We hypothesise that such disorders are more likely to develop in people who have experienced greater exposure to these impacts within their neighborhood than others who have been less exposed, but also live in the city. For this purpose, almost all clinically diagnosed incident and relapsed cases in Christchurch in a 12 months period after the 2011 earthquake were analysed. Spatio-temporal cluster analysis shows that people living in the widely affected central and eastern parts after the 2010/11 earthquakes have a 23% higher risk of developing a mood or anxiety disorder than people living in other parts of the city. Generally, mood and anxiety-related disorders increase with closer proximity to damage from liquefaction and moderate to major lateral spreading, as well as areas that are more likely to suffer from damage in future earthquakes.

  5. Birth Order and Sibling Gender Ratio of a Clinical Sample of Children and Adolescents Diagnosed with Attention Deficit Hyperactivity Disorder

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    Ahmad Ghanizadeh

    2012-09-01

    Full Text Available Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD. This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-IV-TR, diagnostic criteria according to face-to-face interview with the children and their parents. ADHD DSM-IV checklist was used to measure inattentiveness and hyperactivity/impulsivity scores.Results: The association of birth order and diagnosis of ADHD was not statistically significant after adjusting for covariate factors. The gender ratio of siblings is not associated with ADHD.Conclusion: Birth order and siblings gender ratio are independent of ADHD diagnosis. The results of this study support the fact that genetic factors rather than environmental factor of birth order is associated with ADHD. Moreover, contrary to autism, the current results do not suggest the androgen theory for ADHD.

  6. Towards optimal clinical and epidemiological registration of haematological malignancies: Guidelines for recording progressions, transformations and multiple diagnoses.

    Science.gov (United States)

    Gavin, Anna; Rous, Brian; Marcos-Gragera, Rafael; Middleton, Richard; Steliarova-Foucher, Eva; Maynadie, Marc; Zanetti, Roberto; Visser, Otto

    2015-06-01

    Haematological malignancies (HM) represent over 6% of the total cancer incidence in Europe and affect all ages, ranging between 45% of all cancers in children and 7% in the elderly. Thirty per cent of childhood cancer deaths are due to HM, 8% in the elderly. Their registration presents specific challenges, mainly because HM may transform or progress in the course of the disease into other types of HM. In the context of cancer registration decisions have to be made about classifying subsequent notifications on the same patient as the same tumour (progression), a transformation or a new tumour registration. Allocation of incidence date and method of diagnosis must also be standardised. We developed European Network of Cancer Registries (ENCR) recommendations providing specific advice for cancer registries to use haematology and molecular laboratories as data sources, conserve the original date of incidence in case of change of diagnosis, make provision for recording both the original as well as transformed tumour and to apply precise rules for recording and counting multiple diagnoses. A reference table advising on codes which reflect a potential transformation or a new tumour is included. This work will help to improve comparability of data produced by population-based cancer registries, which are indispensable for aetiological research, health care planning and clinical research, an increasing important area with the application of targeted therapies.

  7. Validity of a Farsi translation of the composite International Diagnostic Interview (CIDI to diagnose schizophrenia and bipolar disorder

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    H. Amini

    2006-08-01

    Full Text Available Background: The Composite International Diagnostic Interview (CIDI is a comprehensive, standardized diagnostic interview for the assessment of psychiatric disorders. There have been few studies on the validity of the CIDI. The objective of present study was to assess the validity of a Farsi translation of the complete CIDI and its psychosis/mania module in five referral clinical psychiatric settings. Methods: Two hundred and three as well as 104 consecutive admissions were interviewed using the complete and the psychosis/mania module, respectively. Within two days of the CIDI interview, two last year residents of psychiatry or psychiatrist who were blind to the CIDI diagnosis completed the Clinical diagnostic checklists (based on DSM-IV and ICD-10 criteria simultaneously and reached the consensus diagnosis. Data analysis was performed using SPSS 11 to determine the validity of CIDI. Results: The sensitivity and specificity for the diagnosis of schizophrenia was 0.12 and 0.96 using DSM-IV criteria. According to ICD-10 criteria, the results were the same with 0.19% sensitivity and 0.96% specificity. The sensitivity for the diagnosis of bipolar I disorder was low (0.21 using DSM-IV criteria and 0.17% using ICD-10 and specificity, high (0.90 compared to DSM-IV and 0.89 compared to ICD-10 criteria. The results were rather similar for the psychosis/mania module of CIDI. Conclusion: This study suggests that the Farsi translation of both the complete CIDI and the psychosis/mania module of CIDI have good specificity, but poor sensitivity for the diagnosis of schizophrenia and of bipolar I disorder.

  8. Validity of dementia diagnoses in the danish hospital registers

    DEFF Research Database (Denmark)

    Andersen, B.B.; Phung, T.K.T.; Høgh, P.;

    2007-01-01

    Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety......-seven journals were available for review and 51 patients were interviewed. A registered diagnosis of dementia was found to be correct in 169 (85.8%) cases. Regarding dementia subtypes, the degree of agreement between the registers and the results of the validating process was low with a kappa of 0.36 (95% CI 0...

  9. Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009

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    Sara Sblano

    2014-03-01

    Full Text Available INTRODUCTION: In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences. MATERIAL AND METHODS: A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at "Policlinico of Bari" from 1990 to 2009. RESULTS: All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms; 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on; 116 uncertain discrepant diagnoses; 82 unclear diagnoses. CONCLUSIONS: The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.

  10. 医学生辅助诊断能力的培养%Medical ethics education in clinic practice: Training medicos to envisage the effects of high- tech instruments in diagnoses of diseases

    Institute of Scientific and Technical Information of China (English)

    韦怀新; 蔡绍曦

    2005-01-01

    It belongs to the ethics that depending to much on high - tech instruments in diagnoses of diseases and overlooking medical examination and clinical history. In clinic educations, we should train medicos to envisage the effects of high - tech instruments in diagnoses of diseases, and strengthen their feeling of responsibihty and training of clinic basic shills.

  11. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

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    Elif Peker

    2016-01-01

    Full Text Available Introduction: The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations. Aims and Objectives: This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions. Material and Methods: Biopsy of 1938 lesions (2008-2013 was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions. Statistical Analysis: The variables were recorded and analysed using descriptive statistics. Results and Observations: Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination. Conclusion: Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.

  12. Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma.

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    Ng, Alvin C; Kumar, Shaji K; Rajkumar, S Vincent; Drake, Matthew T

    2009-07-01

    Vitamin D is a fundamental mediator of skeletal metabolism. It also has important nonskeletal actions. We hypothesized that vitamin D deficiency may play an important role in skeletal morbidity and clinical outcomes in MM. We studied 148 newly diagnosed MM patients from January 1, 2004 through December 31, 2008 who had a serum 25-hydroxyvitamin D [25(OH)D] obtained within 14 days of diagnosis. Subjects with vitamin D deficiency [25(OH)D level less than 50 nmol/L (20 ng/mL)] had higher mean values of serum C-reactive protein (CRP) (2.40 mg/L vs. 0.84 mg/L, P = 0.02) and creatinine (1.75 mg/dL vs. 1.24 mg/dL, P = 0.03) and lower serum albumin values (3.12 g/dL vs. 3.39 g/dL, P = 0.003) compared to subjects without vitamin D deficiency. The prevalence of vitamin D deficiency increased in parallel with International Staging System (ISS): 16% of subjects in Stage I, 20% in Stage II, and 37% in Stage III (P = 0.03) were vitamin D deficient. No differences were detected between the two groups in terms of skeletal morbidity. Association of vitamin D deficiency with higher serum CRP, serum creatinine and ISS stage at time of diagnosis suggests that vitamin D deficiency may portend poorer outcomes in subjects with MM. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.

  13. The Clinical Course of Late Diagnosed Fatal Cases of A (H1N1 Influenza in Poland 

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    Marta Rorat

    2013-06-01

    Full Text Available Introduction: The most frequent complication of A (H1N1 influenza and the leading cause of death was pneumonia with a primary viral or mixed viral and bacterial etiology. 182 patients had died because of a pandemic influenza in Poland by 31st July 2010.Material and Methods: A retrospective study of 6 fatal cases of pandemic influenza, aged 23-41, including 3 women, hospitalised between November 2009 and February 2011 in different Polish medical centres.Results: We present the clinical course of 6 late diagnosed cases of A (H1N1 influenza. All patients presented typical flu-like symptoms in the beginning. 4/6 patients had severe disease risk factors: pregnancy, arthritis, Wegener granulomatosis and obesity. All patients were seen by doctors, no one had received antiviral therapy, 4/5 were treated with antibiotics before they were hospitalized. One patient had nosocomial infection. Patients were admitted to the hospital on the 3rd to 8th day of the disease. They received oseltamivir treatment on the 4th to 9th day. All patients developed pneumonia complicated by acute respiratory distress syndrome. Death appeared between the 4th and 27th day after the onset of symptoms. Autopsies were performed in 5 cases and revealed haemorrhagic pneumonia in 2 patients.Conclusion: Delayed diagnosis and antiviral treatment initiation has a significant impact on mortality in A (H1N1 influenza. During the influenza epidemic, patients presenting typical symptoms should always be suspected of having influenza. Antiviral treatment has to be initiated immediately, especially ifthere are risk factors of severe disease.

  14. How Is Lactose Intolerance Diagnosed?

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    ... Information Clinical Trials Resources and Publications How is lactose intolerance diagnosed? Skip sharing on social media links ... people think that they or their children are lactose intolerant without being tested or diagnosed. 1 As ...

  15. How Is Pelvic Pain Diagnosed?

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    ... Information Clinical Trials Resources and Publications How is pelvic pain diagnosed? Skip sharing on social media links Share ... needed to help diagnose the cause of the pelvic pain. These tests or procedures may include 1 , 2 : ...

  16. Validation of spontaneous abortion diagnoses in the Danish National Registry of Patients

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    Sarah Rytter Lohse

    2010-10-01

    Full Text Available Sarah Rytter Lohse1, Dóra Körmendiné Farkas1, Nicolai Lohse1, Sven Olaf Skouby2, Finn Erland Nielsen3, Timothy L Lash1, Vera Ehrenstein11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Obstetrics and Gynecology, 3Department of Cardiology, Herlev University Hospital, Herlev, DenmarkPurpose: The purpose of this study is to validate the diagnosis of spontaneous abortion (SA recorded in the Danish National Registry of Patients (DNRP.Methods: We randomly selected patients registered in the DNRP with a diagnosis of SA between 1980 and 2008 from hospitals in the county of North Jutland and searched for their discharge records in hospital files. We estimated positive predictive value (PPV of the DNRP diagnosis and stratified the analysis by period (1980–1994 versus 1995–2008, hospital type (regional versus local, and International Classification of Diseases revisions (ICD-8 versus ICD-10.Results: We could identify hospital files of 117/174 (67% sampled registration records. Of those, the diagnosis was confirmed in 114 patients, yielding a PPV of 97.4% (95% confidence interval = 92.7%–99.5%. The PPV did not markedly vary by period, hospital type, or ICD revision. Among the three patients with available data who did not fulfill the criteria for SA, one had an induced abortion and two had threatened abortion but did not miscarry.Conclusion: Registration of SA in the DNRP accurately reflects the diagnoses recorded in medical charts. The DNRP is a suitable source of data on SAs for epidemiologic research.Keywords: spontaneous abortion, validation, diagnosis, Danish National Registry of Patients, positive predictive value

  17. In newly diagnosed breast cancer, screening MRI of the contralateral breast detects mammographically occult cancer, even in elderly women: the mayo clinic in Florida experience.

    Science.gov (United States)

    Bernard, Johnny Ray; Vallow, Laura A; DePeri, Elizabeth R; McNeil, Rebecca B; Feigel, Deborah G; Amar, Surabhi; Buskirk, Steven J; Perez, Edith A

    2010-01-01

    The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis.

  18. Comparando a Classificação Internacional de Doenças em Odontologia e Estomatologia (CID-OE com a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10 Comparing the International Classification of Disease to Dentistry and Stomatology (ICD-DA and the International Statistical Classification of Diseases and Related Health Problems (ICD-10

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    Olga M. P. Silva

    2001-08-01

    Full Text Available INTRODUÇÃO: Nos estudos epidemiológicos de morbidade é necessário se adotar um sistema de classificação de doenças. Na odontologia e nos traumatismos buco-maxilo-faciais pode-se usar a Classificação Internacional de Doenças em Estomatologia e Odontologia (CID-OE mas, em alguns casos, esta classificação não é adequada. O objetivo deste estudo é comparar a aplicação da CID-OE com a aplicação da CID-10 na classificação de diagnósticos da área. MATERIAL E MÉTODOS: Foram analisados 2.372 casos atendidos em serviços de traumatismos buco-maxilo-faciais e emergências dentais no Município de São Paulo, Brasil, onde os diagnósticos encontrados foram codificados por ambas as classificações. RESULTADOS: A CID-OE especificou melhor 1.117 casos mas, em 267, não ofereceu possibilidade de codificação. Em 978 casos, o detalhamento dado pela codificação foi o mesmo em ambas as classificações.INTRODUCTION: Adopting a classification system of diseases is necessary to perform epidemiological studies of morbidity. In oral and maxillo-facial injuries and in dentistry we may use the International Classification of Diseases for Dentistry and Stomatology (ICD-DA, but the classification is not always appropriate. The objective of the study is to compare the accuracy of the ICD-DA to the International Classification of Diseases-10th Revision (ICD-10 in the classification of diagnoses. MATERIAL AND METHODS: 2,372 encounters were analyzed in oral and maxillo-facial care and in dental emergency services, in the city of São Paulo, Brazil. The encounters were codified by both classifications. RESULTS: 1,117 cases were better classified by the dental classification, but in 267 cases the ICD-DA does not offer a code. In 978 cases the details were the same in both classifications.

  19. High IFIT1 expression predicts improved clinical outcome, and IFIT1 along with MGMT more accurately predicts prognosis in newly diagnosed glioblastoma.

    Science.gov (United States)

    Zhang, Jin-Feng; Chen, Yao; Lin, Guo-Shi; Zhang, Jian-Dong; Tang, Wen-Long; Huang, Jian-Huang; Chen, Jin-Shou; Wang, Xing-Fu; Lin, Zhi-Xiong

    2016-06-01

    Interferon-induced protein with tetratricopeptide repeat 1 (IFIT1) plays a key role in growth suppression and apoptosis promotion in cancer cells. Interferon was reported to induce the expression of IFIT1 and inhibit the expression of O-6-methylguanine-DNA methyltransferase (MGMT).This study aimed to investigate the expression of IFIT1, the correlation between IFIT1 and MGMT, and their impact on the clinical outcome in newly diagnosed glioblastoma. The expression of IFIT1 and MGMT and their correlation were investigated in the tumor tissues from 70 patients with newly diagnosed glioblastoma. The effects on progression-free survival and overall survival were evaluated. Of 70 cases, 57 (81.4%) tissue samples showed high expression of IFIT1 by immunostaining. The χ(2) test indicated that the expression of IFIT1 and MGMT was negatively correlated (r = -0.288, P = .016). Univariate and multivariate analyses confirmed high IFIT1 expression as a favorable prognostic indicator for progression-free survival (P = .005 and .017) and overall survival (P = .001 and .001), respectively. Patients with 2 favorable factors (high IFIT1 and low MGMT) had an improved prognosis as compared with others. The results demonstrated significantly increased expression of IFIT1 in newly diagnosed glioblastoma tissue. The negative correlation between IFIT1 and MGMT expression may be triggered by interferon. High IFIT1 can be a predictive biomarker of favorable clinical outcome, and IFIT1 along with MGMT more accurately predicts prognosis in newly diagnosed glioblastoma.

  20. Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: clinical case report, literature review, and diagnostic challenges.

    Science.gov (United States)

    Ioannidis, Konstantinos; Serfontein, Jaco; Müller, Ulrich

    2014-05-01

    There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account.

  1. Newly Diagnosed

    Science.gov (United States)

    ... Sites Podcasts QR Codes RSS Feeds Social Bookmarking Social Network Sites Text Messaging Twitter Video Games Video Sharing ... in care is similar to that of HIV-negative individuals. Additional Resources AIDSinfo – Just Diagnosed: Next ...

  2. Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection

    DEFF Research Database (Denmark)

    Fuursted, K.; Arpi, M.; Lindblad, B.E.

    2008-01-01

    We aimed to evaluate broad-range PCR and subsequent sequencing compared to conventional culture in the diagnosis of spinal infection. The method was a prospective study of all patients admitted to Aarhus University Hospital for surgery during a 12-months period with a clinically diagnosed infection...... allowed for a microbiological diagnosis in 72% of patients (13/18). A positive culture was found only in patients treated compared to PCR. However, PCR and culture result were equally negatively affected by duration of treatment. The combination of culture and broad-range PCR...... (clinically diagnosed spinal infections=18; non-infectious diseases=20). The specificity was excellent for both culture and PCR (95% and 100%, respectively). A true culture positive result was obtained in 50% of patients (9/18) and 61% was positive (11/18) by broad-range PCR. When combined, culture and PCR...

  3. National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses with Clinical Reassessments

    Science.gov (United States)

    Kessler, Ronald C.; Avenevoli, Shelli; Green, Jennifer; Gruber, Michael J.; Guyer, Margaret; He, Yulei; Jin, Robert; Kaufman, Joan; Sampson, Nancy A.; Zaslavsky, Alan M.; Merikangas, Kathleen R.

    2009-01-01

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnoses that was based on the World Health Organization's Composite International Diagnostic Interview (CIDI) and implemented in the National comorbidity survey replication adolescent supplement is found to have good individual-level concordance with diagnosis based on blinded…

  4. Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients

    DEFF Research Database (Denmark)

    Svensson, Elisabeth; Mor, Anil; Rungby, Jørgen

    2014-01-01

    BACKGROUND: We aimed to examine the prevalence of and modifiable factors associated with elevated C-reactive Protein (CRP), a marker of inflammation, in men and women with newly diagnosed Type 2 Diabetes mellitus (DM) in a population-based setting. METHODS: CRP was measured in 1,037 patients (57%...

  5. Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed with Depression at a Community Clinic

    Science.gov (United States)

    Kanter, Jonathan W.; Santiago-Rivera, Azara L.; Rusch, Laura C.; Busch, Andrew M.; West, Paul

    2010-01-01

    Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets…

  6. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  7. Amphetamine and methamphetamine induced psychosis: toxicological findings, comparison with acute symptoms of schizophrenia and transition of diagnoses. A clinical investigation

    OpenAIRE

    Medhus, Sigrid

    2014-01-01

    Background: There is a long-standing debate about the relationship between amphetamines and psychoses. While some have found psychoses induced by amphetamines to be indistinguishable from schizophrenia, others have found that psychoses induced by amphetamines, in contrast to schizophrenia, were characterized by visual hallucinations and lack of thought disorder. It has also been discusses whether there really are sharp boundaries between the two diagnoses, and whether there is a transition be...

  8. Etiology and Clinical Characteristics of Single and Multiple Respiratory Virus Infections Diagnosed in Croatian Children in Two Respiratory Seasons

    Directory of Open Access Journals (Sweden)

    Sunčanica Ljubin-Sternak

    2016-01-01

    Full Text Available The aim of this study was to determine the causative agent of acute respiratory infection (ARI in hospitalized children, as well as investigate the characteristics of ARIs with single and multiple virus detection in two respiratory seasons. In 2010 and 2015, nasopharyngeal and pharyngeal swabs from a total of 134 children, admitted to the hospital due to ARI, were tested using multiplex PCR. Viral etiology was established in 81.3% of the patients. Coinfection with two viruses was diagnosed in 27.6% of the patients, and concurrent detection of three or more viruses was diagnosed in 12.8% of the patients. The most commonly diagnosed virus in both seasons combined was respiratory syncytial virus (RSV (28.6%, followed by parainfluenza viruses (PIVs types 1–3 (18.4%, rhinovirus (HRV (14.3%, human metapneumovirus (10.1%, adenovirus (AdV (7.1%, influenza viruses types A and B (4.8%, and coronaviruses (4.2%. In 2015, additional pathogens were investigated with the following detection rate: enterovirus (13.2%, bocavirus (HBoV (10.5%, PIV-4 (2.6%, and parechovirus (1.3%. There were no statistical differences between single and multiple virus infection regarding patients age, localization of infection, and severity of disease (P>0.05. AdV, HRV, HBoV, and PIVs were significantly more often detected in multiple virus infections compared to the other respiratory viruses (P<0.001.

  9. Retrospective Analysis of Discrepancies between Clinical and Histopathological Diagnoses in Head and Neck Lesions: An Institutional Study with 10 Years Database

    Directory of Open Access Journals (Sweden)

    Ketki P Kalele

    2016-01-01

    Full Text Available Introduction: Oral and maxillofacial lesions present a wide spectrum of clinical manifestations ranging from an asympto - matic small lesion to a large destructive one. Several lesions mimic each other in their clinical presentation posing a diag - nostic dilemma. Due to interoperator subjectivity and lack of defined objective diagnostic criteria, histopathological investi - gation, most of the times, plays a vital role in final diagnosis. Many studies have reported the concordance rates among the clinical and histopathological diagnoses of oral lesions, however, there are very few studies which have highlighted the discrepancies in them that have led to drastic changes in the lines of diagnoses and treatment. This institutional retro - spective descriptive study intended to highlight this lacuna by going through histopathological registry to study such cases with discrepancies in clinical and histopathological diagnoses in last 10 years. The aim of this study was to systematically analyze the discrepancies in clinical and histopathological diagnoses of various oral lesions with an emphasis on malig - nant and nonmalignant groups so as to stress the importance of histopathological examination to ultimately minimize the risk of inadvertent inappropriate treatment. Materials and methods: A total of 1570 cases that were reported to our institute over a period of 10 years were evaluated from the histopathology registry. Out of these, 1300 cases met our inclusion criteria. Discrepancies were charted as major and minor discrepancies and discrepancy indices were calculated. Lesions were divided into malignan t and nonmalignant groups and were subjected to d i agnostic-screening test evaluation to assess the discrepancies. Results: Total discrepancy value (discrepancy index obtained was 12.9%, out of which 9.23% showed major discrepancies and 3.69% showed minor discrepancies. Ninety-five percent confidence interval (CI was calculated, and was found in

  10. Are Bone Turnover Markers Related with Fracture Risk in Initial Diagnose Postmenopausal Osteoporosis? A Cross-Sectional Clinical Study

    Directory of Open Access Journals (Sweden)

    Şeniz Akçay Yalbuzdağ

    2015-08-01

    Full Text Available Objective: In this study, we investigated the relationships between 10 year fracture risk calculated with FRAX assessment tool and bone turnover markers (BTM in women with diagnosed as postmenopausal osteoporosis for the first time. Materials and Methods: After exclusion of the causes of secondary osteoporosis 61 postmenopausal women diagnosed with osteoporosis for the first time were enrolled. Height and weight measurements, comorbid diseases, menopause age, and laboratory investigations were recorded. Lumbar and femur neck and femur total T scores were measured by dual-energy x-ray absorptiometry (DXA. As BTM, serum osteocalcin (OC and urine deoxypridinoline levels were measured. 10-year fracture risk of hip and major osteoporotic fracture was calculated with FRAX assessment tool. Results: The mean age of patients was 61±39 years. Median value of menopause year was 15.13 years (min: 2, max: 40. The median 10-year hip fracture and major osteoporotic fracture risks were calculated as 1.10% (min: 0, max: 23, 6.9% (min: 3, max: 34 respectively. There was no significant relationship between BTM and fracture risk. Positive significant correlation was found between menopause year and hip fracture risk, and between menopause year and major osteoporotic fracture risks (p=0.031, 0.276; p=0.025, r=0.287. Negative significant correlation was detected between body mass index and hip fracture risk (p=0.002, r=-0.392. Conclusion: In our study, we couldn’t find relationship between BTM and fracture risks assessed by using FRAX tool in patients with initially diagnosed of postmenopausal osteoporosis. Further studies are needed to investigate the relationship between BTM and fracture risk in different patient groups. (Turkish Journal of Osteoporosis 2015;21: 58-62

  11. Clinical and radiographic factors do not accurately diagnose smear-negative tuberculosis in HIV-infected inpatients in Uganda: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    J Lucian Davis

    Full Text Available BACKGROUND: Although World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with a high incidence of tuberculosis. METHODOLOGY: We performed a cross-sectional study enrolling consecutive HIV-infected inpatients with unexplained cough and negative sputum smears for acid-fast bacilli at Mulago Hospital in Kampala, Uganda. Trained medical officers prospectively collected data on standard symptoms and signs of systemic respiratory illness, and two radiologists interpreted chest radiographs in a standardized fashion. We calculated positive- and negative-likelihood ratios of these factors for diagnosing pulmonary tuberculosis (defined when mycobacterial cultures of sputum or bronchoalveolar lavage fluid were positive. We used both conventional and novel regression techniques to develop multivariable prediction models for pulmonary tuberculosis. PRINCIPAL FINDINGS: Among 202 enrolled HIV-infected adults with negative sputum smears for acid-fast bacilli, 72 (36% had culture-positive pulmonary tuberculosis. No single factor, including respiratory symptoms, physical findings, CD4+ T-cell count, or chest radiographic abnormalities, substantially increased or decreased the likelihood of pulmonary tuberculosis. After exhaustive testing, we were also unable to identify any combination of factors which reliably predicted bacteriologically confirmed tuberculosis. CONCLUSIONS AND SIGNIFICANCE: Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting. Enhanced diagnostic

  12. Early weaning and hospitalization with alcohol-related diagnoses in adult life

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik L; Reinisch, June M;

    2006-01-01

    OBJECTIVE: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. METHOD: The study was a prospective longitudinal birth cohort design...... conducted in a sample of 6,562 men and women, all of whom were born in Copenhagen, Denmark, between October 1959 and December 1961. The sample was divided into two categories based on duration of breast-feeding, as assessed by a physician interview with mothers at a 1-year examination. Psychiatric...... hospitalizations with alcohol-related diagnoses according to ICD-8 or ICD-10 were identified in the Danish Psychiatric Central Register in 1999. Nine potential confounders were included as covariates: gender of the cohort member, maternal age, parental social status, maternal prenatal smoking, unwanted pregnancy...

  13. Early weaning and hospitalization with alcohol-related diagnoses in adult life

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik Lykke; Reinisch, June M

    2006-01-01

    hospitalizations with alcohol-related diagnoses according to ICD-8 or ICD-10 were identified in the Danish Psychiatric Central Register in 1999. Nine potential confounders were included as covariates: gender of the cohort member, maternal age, parental social status, maternal prenatal smoking, unwanted pregnancy...... of early weaning was 1.47. Elevated relative risks were also associated with maternal smoking during pregnancy (1.52) and unwanted pregnancy status (1.59). Other independent predictors were male gender, maternal psychiatric hospitalization with alcohol-related diagnosis, and low parental social status......OBJECTIVE: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. METHOD: The study was a prospective longitudinal birth cohort design...

  14. A clinical comparative study on treatment of severe newly diagnosed immune thrombocytopenia by recombinant human thrombopoietin combined with glucocorticoid

    Institute of Scientific and Technical Information of China (English)

    顾史洋

    2013-01-01

    Objective To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) combined with glucocorticoid in treatment of severe newly diagnosed primary immune thrombocytopenia (ITP) .Methods From June 2009 to December 2012,24 male patients and 38female patients with the diagnosis of severe primary ITP in our hospital were randomized into trial group (31cases) or control group (31 cases) ,the median age was 50 years (range:21-84 years) .Trial group was treated with rhTPO combined with glucocorticoid,and control group was

  15. Evaluation of NANDA nursing diagnoses of healthcare college final year students during the clinical application of the mental health and disease nursing course

    Directory of Open Access Journals (Sweden)

    Gülay Taşdemir

    2013-01-01

    Full Text Available The aim of this descriptive study was to evaluate the NANDA nursing diagnoses of Pamukkale University Denizli Healthcare College final year students for the patients they undertook the care of and to determine the aims and interventions relevant to these diagnoses.The study universe consisted of all Pamukkale University Denizli Healthcare College final year students who were continuing their education during the 2009-2010 educational year and took the Mental Health and Disease Nursing course (84. The universe was studied before selecting a sample. The internal medicine, surgery, cardiovascular surgery, chest disease, orthopedics-urology, and physical treatment and rehabilitation clinics were chosen for the consultation liaison psychiatry (CLP while the AMATEM Center of the Denizli State Hospital and the Pamukkale University Psychiatry clinics were chosen as the student clinical application areas. The data were collected by evaluating the 136 nursing care plans prepared by the students and the data collection forms the students had used for nursing care during the 2009-2010 autumn semester. The nursing care was evaluated according to the symptom, etiology and problem (SEP format, using the diagnostic list containing the NANDA diagnoses that had previously been provided to the students, and the number and percentage distributions were determined.The patients cared for at the CLP clinics by the students included in the study had been admitted for surgical interventions at a rate of 29.8% and cancer at 28.6% while those in the psychiatry clinics had been admitted for psychosis or alcohol-substance abuse at a rate of 16.7%. The students included in the study had determined 36 nursing diagnoses in 136 cases. The 6 most common diagnoses were infection risk at 34.5%, disturbance of sleep pattern at 33.3%, anxiety at 25.0%, activity intolerance at 20.2%, inadequate personal coping at 16.7% and trauma risk at 13.1% at the CLP clinics, and disturbed sleep

  16. Resolving clinical diagnoses for syndromic cleft lip and/or palate phenotypes using whole-exome sequencing.

    Science.gov (United States)

    Pengelly, R J; Upstill-Goddard, R; Arias, L; Martinez, J; Gibson, J; Knut, M; Collins, A L; Ennis, S; Collins, A; Briceno, I

    2015-11-01

    Individuals from three families ascertained in Bogota, Colombia, showing syndromic phenotypes, including cleft lip and/or palate, were exome-sequenced. In each case, sequencing revealed the underlying causal variation confirming or establishing diagnoses. The findings include very rare and novel variants providing insights into genotype and phenotype relationships. These include the molecular diagnosis of an individual with Nager syndrome and a family exhibiting an atypical incontinentia pigmenti phenotype with a missense mutation in IKBKG. IKBKG mutations are typically associated with preterm male death, but this variant is associated with survival for 8-15 days. The third family exhibits unusual phenotypic features and the proband received a provisional diagnosis of Pierre Robin sequence (PRS). Affected individuals share a novel deleterious mutation in IRF6. Mutations in IRF6 cause Van der Woude and popliteal pterygium syndrome and contribute to nonsyndromic cleft lip phenotypes but have not previously been associated with a PRS phenotype. Exome sequencing followed by in silico screening to identify candidate causal variant(s), and functional assay in some cases offers a powerful route to establishing molecular diagnoses. This approach is invaluable for conditions showing phenotypic and/or genetic heterogeneity including cleft lip and/or palate phenotypes where many underlying causal genes have not been identified.

  17. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline.

    Science.gov (United States)

    Hillegass, Ellen; Puthoff, Michael; Frese, Ethel M; Thigpen, Mary; Sobush, Dennis C; Auten, Beth

    2016-02-01

    The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

  18. Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States.

    Science.gov (United States)

    Philbin, Morgan M; Tanner, Amanda E; DuVal, Anna; Ellen, Jonathan M; Xu, Jiahong; Kapogiannis, Bill; Bethel, Jim; Fortenberry, J Dennis

    2014-08-01

    Early linkage to care and engagement in care are critical for initiation of medical interventions. However, over 50 % of newly diagnosed persons do not receive HIV-related care within 6 months of diagnosis. We evaluated a linkage to care and engagement in care initiative for HIV-positive adolescents in 15 U.S.-based clinics. Structural and client-level factors (e.g. demographic and behavioral characteristics, clinic staff and location) were evaluated as predictors of successful linkage and engagement. Within 32 months, 1,172/1,679 (69.8 %) of adolescents were linked to care of which 1,043/1,172 (89 %) were engaged in care. Only 62.1 % (1,043/1,679) of adolescents were linked and engaged in care. Linkage to care failure was attributed to adolescent, provider, and clinic-specific factors. Many adolescents provided incomplete data during the linkage process or failed to attend appointments, both associated with failure to linkage to care. Additional improvements in HIV care will require creative approaches to coordinated data sharing, as well as continued outreach services to support newly diagnosed adolescents.

  19. Personality Trait Differences in Boys and Girls with Clinical or Sub-Clinical Diagnoses of Conduct Disorder versus Antisocial Personality Disorder

    Science.gov (United States)

    Taylor, Jeanette; Iacono, William G.

    2007-01-01

    This study tested differences in personality traits measured by the Multidimensional Personality Questionnaire (MPQ) in a community sample of adolescents with definite or probable conduct disorder (CD) diagnoses that did not progress to a diagnosis of antisocial personality disorder (ASPD) by early adulthood (n=43), those with definite or probable…

  20. Comparing the prevalence rates of social phobia in a community according to ICD-10 and DSM-III-R Comparando estimativas de prevalência da fobia social na comunidade empregando-se a CID-10 e a DSM-III-R

    Directory of Open Access Journals (Sweden)

    Fábio Lopes Rocha

    2005-09-01

    Full Text Available OBJECTIVE: This population-based study aimed to compare the prevalence rates of social phobia using DSM-III-R and CID-10, based on the Composite International Diagnostic Interview (CIDI, in a Brazilian community. METHODS: This survey was carried out in a representative sample of 1,041 residents from Bambuí, Minas Gerais, Brazil (attrition rate = 14.7%. The Brazilian version of the CIDI was used. One-month, one-year and lifetime social phobia prevalence rates were estimated, employing the DSM-III-R and ICD-10 classifications, using the CIDI computer program. RESULTS: One-month, one-year, and life prevalence rates of social phobia, based on the DSM-III-R (7.9, 9.0 and 11.7% respectively were higher than those based on the ICD-10 (4.7, 5.2 and 6.7% respectively; p OBJETIVO: Este estudo populacional visa comparar estimativas de prevalência de fobia social empregando-se a CID-10 e a DSM-III-R em uma comunidade brasileira. MÉTODOS: O levantamento foi realizado em uma amostra representativa de 1.041 residentes de Bambuí, Minas Gerais, Brasil (perda = 14,7%. Foi utilizada a versão brasileira da Composite International Diagnostic Interview (CIDI. As prevalências de 1 mês, 1 ano e vida foram estimadas empregando-se as classificações CID-10 e DSM-III-R, utilizando-se o programa de computador da CIDI. RESULTADOS: As prevalências de 1 mês, 1 ano e vida da fobia social, baseadas na DSM-III-R (7,9, 9,0 e 11,7% respectivamente foram mais elevadas que aquelas baseadas na CID-10 (4,7, 5,2 e 6,7%, respectivamente; p < 0,01 para todos. CONCLUSÃO: Nossos resultados reforçam a hipótese de que as taxas de prevalência de fobia social são mais elevadas quando baseadas na DSM-III-R em comparação com a CID-10.

  1. Lymphography and computed tomography of abdominal nodes in newly diagnosed patients with Hodgkin's disease in clinical stage I-III

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, C.H.

    1986-10-01

    Between 1978 and 1983, 80 patients with Hodgkin's disease (HD) in clinical Stage I-III had computed tomography (CT) of the abdomen and pelvis and lymphography (LAG) prior to staging laparatomy with multiple lymph node biopsies at Stanford University Medical Center. There were 224 biopsied nodal sites. The sensitivity and specificity for CT to determine the status of biopsied paraortic and iliac nodes was .61 and .91 vs. .94 and .90 for LAG. CT appeared of even lower sensitivity (.13) in evaluating splenic hilar, celiac axis and portal nodes. Including all biopsy proven subdiaphragmatic nodal sites, CT's sensitivity to diagnose the presence of subdiaphragmatic adenopathy was .38 vs. .52 in LAG. Assessment of the final pathological stage was more successful by LAG (.61) than by CT (.49). Positive and negative predictive values of both tests indicate higher reliability of LAG results as regards individual intraabdominal nodes (LAG .71, .98 vs. CT .58, .86), the entire subdiaphragmatic nodal area (LAG .79, .77 vs. CT .61, .71) and prediction of final pathological stage. LAG appeared to be the more useful test during initial staging of newly diagnosed and untreated patients with HD. None of the test for itself or in combination can replace laparatomy when exact information is necessary for further clinical decisions.

  2. Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study

    Directory of Open Access Journals (Sweden)

    Almind Gitte

    2011-02-01

    Full Text Available Abstract Background Many diabetic patients fear visual loss as the worst consequence of diabetes. In most studies the main eye pathology is assigned as the cause of visual impairment. This study analysed a broad range of possible ocular and non-ocular predictors of visual impairment prospectively in patients newly diagnosed with clinical type 2 diabetes. Methods Data were from a population-based cohort of 1,241 persons newly diagnosed with clinical, often symptomatic type 2 diabetes aged ≥ 40 years. After 6 years, 807 patients were followed up. Standard eye examinations were done by practising ophthalmologists. Results At diabetes diagnosis median age was 65.5 years. Over 6 years, the prevalence of blindness (visual acuity of best seeing eye ≤ 0.1 rose from 0.9% (11/1,241 to 2.4% (19/807 and the prevalence of moderate visual impairment (> 0.1; Conclusions In a comprehensive assessment of predictors of visual impairment, even in a health care system allowing self-referral to free eye examinations, treatable eye pathologies such as DR and cataract emerge together with age as the most notable predictors of continued visual loss after diabetes diagnosis. Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

  3. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting.

    Science.gov (United States)

    Middleton, Lavinia P; Sneige, Nour; Coyne, Robin; Shen, Yu; Dong, Wenli; Dempsey, Peter; Bevers, Therese B

    2014-06-01

    We evaluated the efficacy of using standard radiologic and histologic criteria to guide the follow-up of patients with lobular carcinoma in situ (LCIS), lobular neoplasia (LN), or atypical lobular hyperplasia (ALH). Patients with high-risk benign lesions diagnosed on biopsy were presented and reviewed in a multidisciplinary clinical management conference from 1 November 2003 through September 2011. Associations between patient characteristics and rates of upgrade were determined by univariate and multivariate logistic models, and times to diagnosis carcinoma were calculated. Of 853 cases reviewed, 124 (14.5%) were lobular neoplasms. In all, 104 patients were clinically and/or radiographically monitored. In 20 patients, who were found to have LN on core biopsy and were recommended to have immediate surgical excision, a more significant lesion was identified in 8 (40%) of the excised specimens. Factors associated with a more significant lesion on excisional biopsy included whether the lobular lesion had been targeted for biopsy and whether the extent of disease involved three or more terminal duct lobular units. Of the 104 patients radiographically and clinically monitored, the median follow-up time was 3.4 years with a range of 0.44-8.6 years. Five patients under surveillance were subsequently diagnosed with breast malignancy (three of the five at a site unrelated to the initial biopsy). Patients with incidental lobular lesions identified on percutaneous core needle biopsy have a small risk of upgrade and may not require an excisional biopsy. Clinical management of low-volume lobular lesions in a multidisciplinary setting is an efficacious alternative to surgical excision when radiologic and histologic characteristics are well-defined.

  4. Use of ICD-10 codes to monitor uterine rupture

    DEFF Research Database (Denmark)

    Thisted, Dorthe L A; Mortensen, Laust Hvas; Hvidman, Lone;

    2014-01-01

    OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine...... the validity of registration of uterine rupture in the MBR within the population of pregnant women with prior cesarean section by conducting a review of the medical records. STUDY DESIGN: We reviewed 1709 medical records within the population of singleton pregnant woman delivering at term between 1997 and 2007....... We retrieved the medical records of all women in the MBR with a code for uterine rupture during labor regardless of whether or not a prior cesarean section had been reported to the registry. In addition medical records of all women with a code for previous cesarean section and delivery of a child...

  5. Utilization of Gene Mapping and Candidate Gene Mutation Screening for Diagnosing Clinically Equivocal Conditions:A Norrie Disease Case Study

    Institute of Scientific and Technical Information of China (English)

    Vasiliki Chini; Danai Stambouli; Florina Mihaela Nedelea; George Alexandru Filipescu; Diana Mina; Marios Kambouris; Hatem El-Shanti

    2014-01-01

    Prenatal diagnosis was requested for an undiagnosed eye disease showing X-linked inheritance in a family. No medical records existed for the affected family members..Mapping of the X chromosome and candidate gene mutation screening i-dentified a c.C267A[p.F89L] mutation in NPD previously de-scribed as possibly causing Norrie disease..The detection of the c.C267A[p.F89L] variant in another unrelated family con-firms the pathogenic nature of the mutation for the Norrie dis-ease phenotype. Gene mapping, haplotype analysis, and can-didate gene screening have been previously utilized in research applications but were applied here in a diagnostic setting due to the scarcity of available clinical information..The clinical diagnosis and mutation identification were critical for provid-ing proper genetic counseling and prenatal diagnosis for this family.

  6. The Affects of a Single Bout of Exercise on Mood and Self-Esteem in Clinically Diagnosed Mental Health Patients

    OpenAIRE

    Ellis, Naomi; RANDALL, Jason; Punnett, Grant

    2013-01-01

    Research has highlighted the importance of regular exercise within the general population and mental health groups in regard to mood and self-esteem, as well as single bout exercise within the general population. However, research into single bout exercise in mental health population is lacking. This study investigated the impact of a single bout of exercise, on mood and self-esteem, in patients with a wider clinical mental health diagnosis. Design: A quantitative questionnaire was completed ...

  7. Diagnosing malnutrition.

    OpenAIRE

    Dionigi, R; Dominioni, L; Jemos, V; Cremaschi, R; Monico, R

    1986-01-01

    The measurement of selected anthropometric, biochemical and immunological variables, and clinical judgment can be used to assess nutritional state. Nutritional assessment has three main aims: to define the type and severity of malnutrition; to identify high risk patients; to monitor the efficacy of nutritional support. The problems associated with the various methods to assess the nutritional state and the applications of nutritional assessment in clinical practice are presented and discussed.

  8. Typology of adults diagnosed with mental disorders based on socio-demographics and clinical and service use characteristics

    Directory of Open Access Journals (Sweden)

    Perreault Michel

    2011-04-01

    Full Text Available Abstract Background Mental disorder is a leading cause of morbidity worldwide. Its cost and negative impact on productivity are substantial. Consequently, improving mental health-care system efficiency - especially service utilisation - is a priority. Few studies have explored the use of services by specific subgroups of persons with mental disorder; a better understanding of these individuals is key to improving service planning. This study develops a typology of individuals, diagnosed with mental disorder in a 12-month period, based on their individual characteristics and use of services within a Canadian urban catchment area of 258,000 persons served by a psychiatric hospital. Methods From among the 2,443 people who took part in the survey, 406 (17% experienced at least one episode of mental disorder (as per the Composite International Diagnostic Interview (CIDI in the 12 months pre-interview. These individuals were selected for cluster analysis. Results Analysis yielded four user clusters: people who experienced mainly anxiety disorder; depressive disorder; alcohol and/or drug disorder; and multiple mental and dependence disorder. Two clusters were more closely associated with females and anxiety or depressive disorders. In the two other clusters, males were over-represented compared with the sample as a whole, namely, substance abuses with or without concomitant mental disorder. Clusters with the greatest number of mental disorders per subject used a greater number of mental health-care services. Conversely, clusters associated exclusively with dependence disorders used few services. Conclusion The study found considerable heterogeneity among socio-demographic characteristics, number of disorders, and number of health-care services used by individuals with mental or dependence disorders. Cluster analysis revealed important differences in service use with regard to gender and age. It reinforces the relevance of developing targeted programs

  9. Isolated new onset 'atypical' optic neuritis in the NMO clinic: serum antibodies, prognoses and diagnoses at follow-up.

    Science.gov (United States)

    Piccolo, L; Woodhall, M; Tackley, G; Juryńczyk, M; Kong, Y; Domingos, J; Gore, R; Vincent, A; Waters, P; Leite, M I; Palace, J

    2016-02-01

    Severe, recurrent or bilateral optic neuritis (ON) often falls within the neuromyelitis optica spectrum disorders (NMOSD), but the diagnosis can be particularly challenging and has important treatment implications. We report the features, course and outcomes of patients presenting with atypical ON when isolated at onset. We retrospectively analyzed 69 sequential patients referred to a single UK NMO center with isolated ON at onset. Aquaporin-4 antibody (AQP4-Ab) assessment was performed in all patients and IgG1 myelin-oligodenrocyte glycoprotein (MOG-Ab) in AQP4-Ab(neg) patients. 37 AQP4-Ab positive (AQP4-Ab(pos)) and 32 AQP4-Ab negative (AQP4-Ab(neg)) patients (8 with MOG-Ab) were identified. The AQP4-Ab(neg) group included heterogeneous diagnoses: multiple sclerosis (MS), NMO, relapsing isolated ON (RION), monophasic isolated ON and relapsing acute disseminated encephalomyelitis (ADEM)-like syndromes. Compared to AQP4-Ab(neg) patients, AQP4-Ab(pos) patients had a worse residual visual outcome from first attack (median VFSS 4 vs. 0, p = 0.010) and at last assessment (median VFSS 5 versus 2, p = 0.005). However, AQP4-Ab(neg) patients with RION also had poor visual outcome. Up to 35% of AQP4-Ab(neg) patients developed a LETM and two developed low positivity for AQP4-Ab over time. Eight AQP4-Ab(neg) patients (25%) were MOG-Ab positive, covering a range of phenotypes excluding MS; the first ON attack was often bilateral and most had relapsing disease with a poor final visual outcome [VFSS 4, range (0-6)]. In conlcusion, AQP4-Ab positivity is confirmed as a predictor of poor visual outcome but AQP4-Ab(neg) RION also had a poor visual outcome. Of those without AQP4-Ab, 25% had MOG-Ab and another 25% developed MS; thus, MOG-Ab is associated with AQP4-Ab(neg) non-MS ON.

  10. Self – perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys

    Directory of Open Access Journals (Sweden)

    Sgan-Cohen Harold D

    2003-07-01

    Full Text Available Abstract Background Clinical (normative and subjective (self-assessment evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self–perceived assessment as compared to clinical examinations (normative assessment and to evaluate the implications of the results in understanding the public's perception of oral health. Methods The investigation was performed on 4920, 21 year-old Israeli adults upon release from compulsory military service between 1996 and 1998. Participants were asked to fill in a questionnaire inquiring how they would rate their personal dental and periodontal health levels. Clinical examinations, employing the DMFT and CPITN indices, were performed to determine normative oral health status. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values and overall proportions using the clinical examinations as a gold standard. Results The sensitivity (disease perception for dental status was found to be 0.34, while the specificity (health perception was found to be 0.83. The positive predictive value for perceived dental status was found to be 0.68, whereas the negative predictive value was found to be 0.54. The sensitivity for perceived periodontal status was found to be 0.28, while the specificity was found to be 0.83. The positive predictive value for perceived periodontal status was found to be 0.05, whereas the negative predictive value was found to be 0.97. Regarding the overall proportions, a large discrepancy was found between self–assessment and professional assessment for both dental and periodontal health status. Conclusions Self-assessment questionnaires were of low value in evaluating oral health status both in the individual and public

  11. The Structured Clinical Interview for DSM-5 Internet Gaming Disorder: Development and Validation for Diagnosing IGD in Adolescents

    Science.gov (United States)

    Koo, Hoon Jung; Han, Doug Hyun; Park, Sung-Yong

    2017-01-01

    Objective This study aimed to develop and validate a Structured Clinical Interview for Internet Gaming Disorder (SCI-IGD) in adolescents. Methods First, we generated preliminary items of the SCI-IGD based on the information from the DSM-5 literature reviews and expert consultations. Next, a total of 236 adolescents, from both community and clinical settings, were recruited to evaluate the psychometric properties of the SCI-IGD. Results First, the SCI-IGD was found to be consistent over the time period of about one month. Second, diagnostic concordances between the SCI-IGD and clinician's diagnostic impression were good to excellent. The Likelihood Ratio Positive and the Likelihood Ratio Negative estimates for the diagnosis of SCI-IGD were 10.93 and 0.35, respectively, indicating that SCI-IGD was ‘very useful test’ for identifying the presence of IGD and ‘useful test’ for identifying the absence of IGD. Third, SCI-IGD could identify disordered gamers from non-disordered gamers. Conclusion The implications and limitations of the study are also discussed. PMID:28096871

  12. Estimation of the true incidence of lactic acidosis within the Lighthouse Clinic cohort, and the likely magnitude of missed diagnoses in the region

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    Colin Speight

    2014-11-01

    Full Text Available Introduction: Lactic acidosis is one of the most serious side effects associated with ART, most commonly associated with stavudine. Clinical features are non-specific and specialist laboratory capabilities are essential to confirm the diagnosis, making under-diagnosis likely in resource-constrained settings. Lighthouse Trust is a tertiary referral ART centre with over 23,500 patients on ART. The adjacent University of North Carolina Project laboratory, also serving Kamuzu Central Hospital, has been the only site processing lactate tests in Central Zone for many years. Our objective was to quantify the true incidence within our cohort, and estimate the likely degree of historical missed diagnoses from less central ART clinics. Methods: All high lactate results between June 2010 and June 2013 were treated as cases, and cross referenced with the Lighthouse database. Patients transferring in to Lighthouse within one month prior to diagnosis were assumed to have been referred due to their lactic acidosis, and moved to the Central Zone cohort to avoid referral bias. Routinely collected quarterly ART cohort data for both Lighthouse and the entire Central Zone were analyzed. Results: Over the three-year period, from within the Lighthouse cohort, there were 138 cases: 74% were female, median duration on ART was 14 months (IQR 10–26, and 98.5% were attributable to stavudine (only two cases to zidovudine. Over this period, the average number of patients taking stavudine at Lighthouse was 10,960 (3,600 on zidovudine. For the whole Central Zone (minus Lighthouse patients there were 61,000 on stavudine (4,830 on zidovudine, yet only 124 cases of lactic acidosis were apparently diagnosed from within this cohort. Conclusions: Although cases may, of course, also have been missed at Lighthouse, as a tertiary referral centre the rate observed is likely to be closer to the true incidence. Over the three years, with 138 cases from the 10,960 patients taking

  13. Cost differentials of dental outpatient care across clinical dentistry branches

    OpenAIRE

    Jovana Rančić; Nemanja Rančić; Nemanja Majstorović; Vladimir Biočanin; Marko Milosavljević; Mihajlo Jakovljević

    2015-01-01

    Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was...

  14. Modifiable clinical and lifestyle factors are associated with elevated alanine aminotransferase levels in newly diagnosed type 2 diabetes patients

    DEFF Research Database (Denmark)

    Mor, Anil; Svensson, Elisabeth; Rungby, Jørgen;

    2014-01-01

    />21 drinks per week for women/men) (aPR: 1.60, 95% CI: 1.03-2.50), and in those with no regular physical activity (aPR: 1.42, 95% CI: 1.04-1.93). Obesity and metabolic syndrome per se showed no association with elevated ALT when adjusted for other markers, whereas we found positive associations of ALT...... aminotransferase (ALT) levels as a marker of NAFLD in new T2DM patients. METHODS: Alanine aminotransferase levels were measured in 1026 incident T2DM patients enrolled in the nationwide Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. We examined prevalence of elevated ALT (>38 IU/L for women...... and >50 IU/L for men) and calculated prevalence ratios associated with clinical and lifestyle factors using Poisson regression. We examined the association with other biomarkers by linear regression. RESULTS: The median value of ALT was 24 IU/L (interquartile range: 18-32 IU/L) in women and 30 IU...

  15. Clinical Outcome of Children With Newly Diagnosed Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia Treated Between 1995 and 2005

    Science.gov (United States)

    Aricò, Maurizio; Schrappe, Martin; Hunger, Stephen P.; Carroll, William L.; Conter, Valentino; Galimberti, Stefania; Manabe, Atsushi; Saha, Vaskar; Baruchel, André; Vettenranta, Kim; Horibe, Keizo; Benoit, Yves; Pieters, Rob; Escherich, Gabriele; Silverman, Lewis B.; Pui, Ching-Hon; Valsecchi, Maria Grazia

    2010-01-01

    Purpose In a previous analysis of 326 children with Philadelphia chromosome (Ph) –positive acute lymphoblastic leukemia (ALL) treated between 1986 and 1996, hematopoietic stem-cell transplantation from HLA-matched related donors, but not from unrelated donors, offered a superior outcome than chemotherapy alone. To evaluate the impact of recent improvements in chemotherapy and transplantation, we performed a similar analysis on patients treated in the following decade. Patients and Methods We analyzed 610 patients with Ph-positive ALL treated between 1995 and 2005 without tyrosine kinase inhibitor therapy. The median follow-up duration was 6.3 years. Results Complete remission was achieved in 89% of patients. The 7-year event-free survival and overall survival rates were superior in the present cohort compared with the previous cohort (32.0% ± 2.0% v 25.0% ± 3.0, respectively, P = .007; and 44.9% ± 2.2% v 36.0% ± 3.0%, respectively, P = .017). Compared with chemotherapy alone, transplantation with matched related donors or unrelated donors in first remission (325 patients) showed an advantage with increasing follow-up, suggesting greater protection against late relapses (hazard ratio at 5 years, 0.37; P < .001). In the multivariate Cox regression analysis accounting for treatment (transplantation v no transplantation), age, leukocyte count, and early response had independent impact on treatment outcome. Conclusion Clinical outcome of children and adolescents with Ph-positive ALL has improved with advances in transplantation and chemotherapy. Transplantations with matched related donors and unrelated donors were equivalent and offered better disease control compared with chemotherapy alone. Age, leukocyte count, and early treatment response were independent prognostic indicators. The results of this study will serve as a historical reference to evaluate the therapeutic impact of tyrosine kinase inhibitors on the outcome of Ph-positive ALL. PMID:20876426

  16. Evidence-based interventional pain medicine according to clinical diagnoses. 17. Herpes zoster and post-herpetic neuralgia.

    Science.gov (United States)

    van Wijck, Albert J M; Wallace, Mark; Mekhail, Nagy; van Kleef, Maarten

    2011-01-01

    Herpes zoster infection is caused by a reactivation of the latent varicella zoster virus that causes chicken pox. It appears predominantly in older adults whose immunity for the virus has waned. The natural course of the disease is usually favorable, and the symptoms disappear spontaneously within a few weeks. Some patients, however, have prolonged pain: post-herpetic neuralgia. The diagnosis of acute zoster infection is made on the clinical signs including the appearance of rash. Post-herpetic neuralgia is described as sharp, burning, aching, or shooting constantly present in the dermatome that corresponds with the earlier rash. The objectives of treating herpes zoster are: (1) acute pain reduction; (2) promotion of recovery of epidermal defects and prevention of secondary infections; and (3) reduction or prevention of post-herpetic neuralgia. The objective of the treatment of post-herpetic neuralgia is primarily pain alleviation and improvement of the quality of life. Early treatment of the infection and the pain is believed to reduce the risk for post-herpetic neuralgia. This persistent pain syndrome is difficult to treat. Antiepileptic drugs and tricyclic antidepressants are the first choice. Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered (2 C+); if this treatment provides unsatisfactory results, spinal cord stimulation may be considered, in a study context (2 C+).

  17. Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006–2010: differences by sex and transmission route

    Science.gov (United States)

    2013-01-01

    Background Gonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006–2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection. Methods All gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model. Results 2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups. Most MSM cases were Spaniards (72%), aged 25–34 years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%. HIV co-infection was highest in MSM (20.9%). Co-infection was associated with age > 35 years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with

  18. Diagnosticando o TDAH em adultos na prática clínica Diagnosing adult ADHD in clinical practice

    Directory of Open Access Journals (Sweden)

    Gabriela Dias

    2007-01-01

    Full Text Available Embora a forma adulta do transtorno de déficit de atenção e hiperatividade (TDAH seja oficialmente reconhecida e respaldada cientificamente, esse diagnóstico ainda é motivo de embates entre especialistas. A maior parte do conhecimento existente ainda se deve à extrapolação dos achados de estudos com populações de crianças e adolescentes, havendo necessidade de novos estudos para validar os critérios com populações adultas. O critério de idade de início dos sintomas, o ponto de corte de seis sintomas e a necessidade de atestar comprometimento funcional em ao menos dois ambientes distintos são algumas das principais dificuldades encontradas na prática clínica para o estabelecimento do diagnóstico em adultos que freqüentemente apresentam dificuldades para resgatar informações remontando à infância. Muitos sintomas descritos são também alvos de críticas, uma vez que são claramente inapropriados para adultos. A utilização de instrumentos adaptados para adultos (como o ASRS-18, a coleta de informações com outros informantes (cônjuge e pais, por exemplo, a flexibilização da idade de início dos sintomas e uma investigação abrangente dos ambientes comprometidos pelos sintomas podem minimizar essas dificuldades.Although attention deficit hyperactivity disorder (ADHD has been officially recognized as a valid disorder into adulthood, this diagnosis is still an issue of debates between specialists. Most of the existing knowledge regarding this condition is due to the excess of findings of studies with children. As the field studies that determined DSM-IV diagnostic criteria comprised only children and adolescents, more studies with adult populations are required to validate the criteria for this population. The age of onset criteria, the cut-off of six symptoms and the requirement of impairment in at least two different settings are some of the difficulties faced by clinicians to make the diagnosis in clinical practice

  19. Multicountry prospective clinical evaluation of two enzyme-linked immunosorbent assays and two rapid diagnostic tests for diagnosing dengue fever.

    Science.gov (United States)

    Pal, Subhamoy; Dauner, Allison L; Valks, Andrea; Forshey, Brett M; Long, Kanya C; Thaisomboonsuk, Butsaya; Sierra, Gloria; Picos, Victor; Talmage, Sara; Morrison, Amy C; Halsey, Eric S; Comach, Guillermo; Yasuda, Chadwick; Loeffelholz, Michael; Jarman, Richard G; Fernandez, Stefan; An, Ung Sam; Kochel, Tadeusz J; Jasper, Louis E; Wu, Shuenn-Jue L

    2015-04-01

    We evaluated four dengue diagnostic devices from Alere, including the SD Bioline Dengue Duo (nonstructural [NS] 1 Ag and IgG/IgM), the Panbio Dengue Duo Cassette (IgM/IgG) rapid diagnostic tests (RDTs), and the Panbio dengue IgM and IgG capture enzyme-linked immunosorbent assays (ELISAs) in a prospective, controlled, multicenter study in Peru, Venezuela, Cambodia, and the United States, using samples from 1,021 febrile individuals. Archived, well-characterized samples from an additional 135 febrile individuals from Thailand were also used. Reference testing was performed on all samples using an algorithm involving virus isolation, in-house IgM and IgG capture ELISAs, and plaque reduction neutralization tests (PRNT) to determine the infection status of the individual. The primary endpoints were the clinical sensitivities and specificities of these devices. The SD Bioline Dengue Duo had an overall sensitivity of 87.3% (95% confidence interval [CI], 84.1 to 90.2%) and specificity of 86.8% (95% CI, 83.9 to 89.3%) during the first 14 days post-symptom onset (p.s.o.). The Panbio Dengue Duo Cassette demonstrated a sensitivity of 92.1% (87.8 to 95.2%) and specificity of 62.2% (54.5 to 69.5%) during days 4 to 14 p.s.o. The Panbio IgM capture ELISA had a sensitivity of 87.6% (82.7 to 91.4%) and specificity of 88.1% (82.2 to 92.6%) during days 4 to 14 p.s.o. Finally, the Panbio IgG capture ELISA had a sensitivity of 69.6% (62.1 to 76.4%) and a specificity of 88.4% (82.6 to 92.8%) during days 4 to 14 p.s.o. for identification of secondary dengue infections. This multicountry prospective study resulted in reliable real-world performance data that will facilitate data-driven laboratory test choices for managing patient care during dengue outbreaks.

  20. Genotypic and phenotypic applications for the differentiation and species-level identification of achromobacter for clinical diagnoses.

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    Margarita Gomila

    Full Text Available The Achromobacter is a genus in the family Alcaligenaceae, comprising fifteen species isolated from different sources, including clinical samples. The ability to detect and correctly identify Achromobacter species, particularly A. xylosoxidans, and differentiate them from other phenotypically similar and genotypically related Gram-negative, aerobic, non-fermenting species is important for patients with cystic fibrosis (CF, as well as for nosocomial and other opportunistic infections. Traditional phenotypic profile-based analyses have been demonstrated to be inadequate for reliable identifications of isolates of Achromobacter species and genotypic-based assays, relying upon comparative 16S rRNA gene sequence analyses are not able to insure definitive identifications of Achromobacter species, due to the inherently conserved nature of the gene. The uses of alternative methodologies to enable high-resolution differentiation between the species in the genus are needed. A comparative multi-locus sequence analysis (MLSA of four selected 'house-keeping' genes (atpD, gyrB, recA, and rpoB assessed the individual gene sequences for their potential in developing a reliable, rapid and cost-effective diagnostic protocol for Achromobacter species identifications. The analysis of the type strains of the species of the genus and 46 strains of Achromobacter species showed congruence between the cluster analyses derived from the individual genes. The MLSA gene sequences exhibited different levels of resolution in delineating the validly published Achromobacter species and elucidated strains that represent new genotypes and probable new species of the genus. Our results also suggested that the recently described A. spritinus is a later heterotypic synonym of A. marplatensis. Strains were analyzed, using whole-cell Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry (MALDI-TOF MS, as an alternative phenotypic profile-based method with the

  1. Clinical presentation, diagnostic evaluation, treatment and diagnoses of febrile children presenting to the emergency department at Muhimbili national hospital in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    F.H. Ringo*

    2013-12-01

    Conclusion: A wide range of presentations and management were documented. There was a high rate of positive diagnostic test results. Malaria and pneumonia were top diagnoses, but a wide range of infections were diagnosed.

  2. The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths

    NARCIS (Netherlands)

    Roelofs, J.; Muris, P.; Braet, C.; Arntz, A.; Beelen, I.

    2015-01-01

    The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children

  3. The clinical impact of thalidomide maintenance after autologous stem cell transplantation in patients with newly diagnosed multiple myeloma in real clinical practice of Korea.

    Science.gov (United States)

    Lee, Ho Sup; Min, Chang-Ki; Lee, Je-Jung; Kim, Kihyun; Kim, Seok Jin; Yoon, Dok Hyun; Eom, Hyeon-Seok; Lee, Hyewon; Lee, Won Sik; Shin, Ho-Jin; Lee, Ji Hyun; Park, Yong; Jo, Jae-Cheol; Do, Young Rok; Mun, Yeung-Chul; Lee, Mark Hong

    2016-05-01

    In real clinical settings (not clinical trials), thalidomide has been accepted as maintenance therapy to patients with multiple myeloma (MM) because of the cost of drugs, the limitations of medical insurance, etc., in our country (South Korea). The purpose of this study was to evaluate the utility of thalidomide maintenance for improving survival in transplantation-eligible patients with MM in the real clinical field. Differences in survival rates were estimated in patients treated with or without thalidomide maintenance. The 3-year progression-free survival rates (PFS) of patients with and without maintenance, respectively, were 55.4 and 37.2 % (p = 0.005). The 3-year overall survival rates (OS) were 88.0 and 84.0 % (p = 0.105). No difference in 3-year OS after relapse or progression (OS2) was observed between the two groups (50.4 and 55.3 %, p = 0.661). The 3-year PFS of patients with and without maintenance therapy who had shown less than CR after ASCT were 68.4 and 23.3 % (p maintenance therapy showed longer PFS in real clinical practice, and long-term use of thalidomide did not interfere with the efficacy of salvage chemotherapy in patients who experienced progression or relapse after ASCT. In addition, thalidomide maintenance might be also useful for patients who have shown less than CR after ASCT.

  4. Borderline Personality Disorder and Narcissistic Personality Disorder Diagnoses From the Perspective of the DSM-5 Personality Traits: A Study on Italian Clinical Participants.

    Science.gov (United States)

    Fossati, Andrea; Somma, Antonella; Borroni, Serena; Maffei, Cesare; Markon, Kristian E; Krueger, Robert F

    2016-12-01

    To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.

  5. The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis

    Directory of Open Access Journals (Sweden)

    Kadriye Yasar

    2012-01-01

    Full Text Available Objective: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD was aimed. Materials and Methods: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. Results: Of 55 cases aged ranging between 25 to 79, 33 (59% were female. The cases with tuberculous SD (TBSD, brucellar SD (BSD and pyogenic SD (PSD were found in 24 (43%, 12 (21% and in 19 (34% patients.Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%, 22 (39% and 8 (14% cases. The number of the cases with history of previous surgery or trauma was 14 (25%. Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25% had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively. Conclusion: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation.

  6. Associated Clinical Disorders Diagnosed by Medical Specialists in 188 FMR1 Premutation Carriers Found in the Last 25 Years in the Spanish Basque Country: A Retrospective Study

    Science.gov (United States)

    Merino, Sonia; Ibarluzea, Nekane; Maortua, Hiart; Prieto, Begoña; Rouco, Idoia; López-Aríztegui, Maria-Asunción; Tejada, Maria-Isabel

    2016-01-01

    Fragile X-associated tremor/ataxia syndrome (FXTAS) and fragile X-associated primary ovarian insufficiency (FXPOI) are definitely related to the fragile X mental retardation 1 (FMR1) premutation (PM). Additional medical problems have also been associated with the PM, such as fibromyalgia, endocrine, and psychiatric disorders. To improve our understanding in the field, we reviewed all PM carriers and their reasons for any medical referrals from 104 fragile X families molecularly diagnosed in our laboratory and living in the Spanish Basque Country. After signing the written informed consent, we studied their electronic medical records in order to identify the disorders associated with the PM and their frequencies. We obtained clinical data in 188 PM carriers (147 women and 41 men). In women, the frequency of FXPOI (22.61%) was similar to that previously reported in PM carriers. In men, the frequency of definite FXTAS (28.57%) was lower than reported elsewhere. Furthermore, thyroid pathology was associated with the PM, the frequency of hypothyroidism being much higher in the studied region than in the general population (8.84% vs. 0.93%). Finally, we found no association with fibromyalgia or psychiatric problems. These findings represent another population contribution in this field and may be useful for the clinical management of PM carriers. PMID:27775646

  7. Low incidence of limb-girdle muscular dystrophy type 2C revealed by a mutation study in Japanese patients clinically diagnosed with DMD

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    Maruyama Koichi

    2010-03-01

    Full Text Available Abstract Background Limb-girdle muscular dystrophy type 2C (LGMD2C is an autosomal recessive muscle dystrophy that resembles Duchenne muscular dystrophy (DMD. Although DMD is known to affect one in every 3500 males regardless of race, a widespread founder mutation causing LGMD2C has been described in North Africa. However, the incidence of LGMD2C in Japanese has been unknown because the genetic background remains uncharacterized in many patients clinically diagnosed with DMD. Methods We enrolled 324 patients referred to the Kobe University Hospital with suspected DMD. Mutations in the dystrophin or the SGCG genes were analyzed using not only genomic DNA but also cDNA. Results In 322 of the 324 patients, responsible mutations in the dystrophin were successfully revealed, confirming DMD diagnosis. The remaining two patients had normal dystrophin expression but absence of γ-sarcoglycan in skeletal muscle. Mutation analysis of the SGCG gene revealed homozygous deletion of exon 6 in one patient, while the other had a novel single nucleotide insertion in exon 7 in one allele and deletion of exon 6 in the other allele. These mutations created a stop codon that led to a γ-sarcoglycan deficiency, and we therefore diagnosed these two patients as having LGMD2C. Thus, the relative incidence of LGMD2C among Japanese DMD-like patients can be calculated as 1 in 161 patients suspected to have DMD (2 of 324 patients = 0.6%. Taking into consideration the DMD incidence for the overall population (1/3,500 males, the incidence of LGMD2C can be estimated as 1 per 560,000 or 1.8 per million. Conclusions To the best of our knowledge, this is the first study to demonstrate a low incidence of LGMD2C in the Japanese population.

  8. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999–2008

    Directory of Open Access Journals (Sweden)

    Schnell Kerry

    2012-07-01

    Full Text Available Abstract Background Treatment of chronic diseases such as chronic obstructive pulmonary disease (COPD is complicated by the presence of comorbidities. The objective of this analysis was to estimate the prevalence of comorbidity in COPD using nationally-representative data. Methods This study draws from a multi-year analytic sample of 14,828 subjects aged 45+, including 995 with COPD, from the National Health and Nutrition Examination Survey (NHANES, 1999–2008. COPD was defined by self-reported physician diagnosis of chronic bronchitis or emphysema; patients who reported a diagnosis of asthma were excluded. Using population weights, we estimated the age-and-gender-stratified prevalence of 22 comorbid conditions that may influence COPD and its treatment. Results Subjects 45+ with physician-diagnosed COPD were more likely than subjects without physician-diagnosed COPD to have coexisting arthritis (54.6% vs. 36.9%, depression (20.6% vs. 12.5%, osteoporosis (16.9% vs. 8.5%, cancer (16.5% vs. 9.9%, coronary heart disease (12.7% vs. 6.1%, congestive heart failure (12.1% vs. 3.9%, and stroke (8.9% vs. 4.6%. Subjects with COPD were also more likely to report mobility difficulty (55.6% vs. 32.5%, use of >4 prescription medications (51.8% vs. 32.1, dizziness/balance problems (41.1% vs. 23.8%, urinary incontinence (34.9% vs. 27.3%, memory problems (18.5% vs. 8.8%, low glomerular filtration rate (16.2% vs. 10.5%, and visual impairment (14.0% vs. 9.6%. All reported comparisons have p  Conclusions Our study indicates that COPD management may need to take into account a complex spectrum of comorbidities. This work identifies which conditions are most common in a nationally-representative set of COPD patients (physician-diagnosed, a necessary step for setting research priorities and developing clinical practice guidelines that address COPD within the context of comorbidity.

  9. Prevalence of delirium among patients at a cancer ward: Clinical risk factors and prediction by bedside cognitive tests.

    Science.gov (United States)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie

    2016-08-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium.

  10. Phase II clinical study of boron neutron capture therapy combined with X-ray radiotherapy/temozolomide in patients with newly diagnosed glioblastoma multiforme-Study design and current status report

    Energy Technology Data Exchange (ETDEWEB)

    Kawabata, Shinji, E-mail: neu046@poh.osaka-med.ac.jp [Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka 569-8686 (Japan); Miyatake, Shin-Ichi; Hiramatsu, Ryo; Hirota, Yuki; Miyata, Shiro; Takekita, Yoko; Kuroiwa, Toshihiko [Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka 569-8686 (Japan); Kirihata, Mitsunori [Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8931 (Japan); Sakurai, Yoshinori; Maruhashi, Akira; Ono, Koji [Kyoto University Research Reactor Institute, 2 Asashiro-Nishi, Kumatori-cho, Sennan-gun, Osaka 590-0494 (Japan)

    2011-12-15

    Recently, we reported our clinical experiences of boron neutron capture therapy (BNCT) for the newly diagnosed glioblastoma. The major differences of our protocol from the other past studies were simultaneous use of both sodium borocapate and boronophenylalanine, and combination with fractionated X-ray irradiation. These results showed the efficacy of combination therapy with external beam X-ray irradiation and BNCT. For our future study, we planned the multi-centric phase II clinical study for newly diagnosed glioblastoma patients in Japan (OSAKA-TRIBRAIN0902, NCT00974987).

  11. Analysis of diagnoses extracted from electronic health records in a large mental health case register

    Science.gov (United States)

    Kovalchuk, Yevgeniya; Stewart, Robert; Broadbent, Matthew; Hubbard, Tim J. P.; Dobson, Richard J. B.

    2017-01-01

    The UK government has recently recognised the need to improve mental health services in the country. Electronic health records provide a rich source of patient data which could help policymakers to better understand needs of the service users. The main objective of this study is to unveil statistics of diagnoses recorded in the Case Register of the South London and Maudsley NHS Foundation Trust, one of the largest mental health providers in the UK and Europe serving a source population of over 1.2 million people residing in south London. Based on over 500,000 diagnoses recorded in ICD10 codes for a cohort of approximately 200,000 mental health patients, we established frequency rate of each diagnosis (the ratio of the number of patients for whom a diagnosis has ever been recorded to the number of patients in the entire population who have made contact with mental disorders). We also investigated differences in diagnoses prevalence between subgroups of patients stratified by gender and ethnicity. The most common diagnoses in the considered population were (recurrent) depression (ICD10 codes F32-33; 16.4% of patients), reaction to severe stress and adjustment disorders (F43; 7.1%), mental/behavioural disorders due to use of alcohol (F10; 6.9%), and schizophrenia (F20; 5.6%). We also found many diagnoses which were more likely to be recorded in patients of a certain gender or ethnicity. For example, mood (affective) disorders (F31-F39); neurotic, stress-related and somatoform disorders (F40-F48, except F42); and eating disorders (F50) were more likely to be found in records of female patients, while males were more likely to be diagnosed with mental/behavioural disorders due to psychoactive substance use (F10-F19). Furthermore, mental/behavioural disorders due to use of alcohol and opioids were more likely to be recorded in patients of white ethnicity, and disorders due to use of cannabinoids in those of black ethnicity. PMID:28207753

  12. Multi-institutional phase 2 clinical and pharmacogenomic trial of tipifarnib plus etoposide for elderly adults with newly diagnosed acute myelogenous leukemia.

    Science.gov (United States)

    Karp, Judith E; Vener, Tatiana I; Raponi, Mitch; Ritchie, Ellen K; Smith, B Douglas; Gore, Steven D; Morris, Lawrence E; Feldman, Eric J; Greer, Jacqueline M; Malek, Sami; Carraway, Hetty E; Ironside, Valerie; Galkin, Steven; Levis, Mark J; McDevitt, Michael A; Roboz, Gail R; Gocke, Christopher D; Derecho, Carlo; Palma, John; Wang, Yixin; Kaufmann, Scott H; Wright, John J; Garret-Mayer, Elizabeth

    2012-01-05

    Tipifarnib (T) exhibits modest activity in elderly adults with newly diagnosed acute myelogenous leukemia (AML). Based on preclinical synergy, a phase 1 trial of T plus etoposide (E) yielded 25% complete remission (CR). We selected 2 comparable dose levels for a randomized phase 2 trial in 84 adults (age range, 70-90 years; median, 76 years) who were not candidates for conventional chemotherapy. Arm A (T 600 mg twice a day × 14 days, E 100 mg days 1-3 and 8-10) and arm B (T 400 mg twice a day × 14 days, E 200 mg days 1-3 and 8-10) yielded similar CR, but arm B had greater toxicity. Total CR was 25%, day 30 death rate 7%. A 2-gene signature of high RASGRP1 and low aprataxin (APTX) expression previously predicted for T response. Assays using blasts from a subset of 40 patients treated with T plus E on this study showed that AMLs with a RASGRP1/APTX ratio of more than 5.2 had a 78% CR rate and negative predictive value 87%. This ratio did not correlate with outcome in 41 patients treated with conventional chemotherapies. The next T-based clinical trials will test the ability of the 2-gene signature to enrich for T responders prospectively. This study is registered at www.clinicaltrials.gov as #NCT00602771.

  13. Sexual arousal and lubrication problems in women with clinically diagnosed hypoactive sexual desire disorder: preliminary findings from the hypoactive sexual desire disorder registry for women.

    Science.gov (United States)

    Maserejian, Nancy N; Shifren, Jan; Parish, Sharon J; Segraves, R Taylor; Huang, Liyuan; Rosen, Raymond C

    2012-01-01

    Sexual desire and arousal difficulties are often correlated in women. However, no studies have examined characteristics of women with clinically diagnosed hypoactive sexual desire disorder (HSDD) that increase the likelihood of co-occurring arousal difficulties. The authors examined combined HSDD and arousal/ lubrication problems using baseline cross-sectional data from the HSDD Registry for Women. Their analyses were restricted to women who could be classified with certainty as having arousal or lubrication difficulties by the Female Sexual Function Index (requiring sexually activity in the past 4 weeks). Results showed that among 426 premenopausal women with HSDD, 50.2% had arousal problems, 42.5% lubrication problems, 39.0% combination, and 46.2% neither. Among 174 postmenopausal women, prevalence percentages were 58.0% arousal, 56.9% lubrication, 49.4% combined, and 34.5% neither. The strongest predictor of combined arousal/lubrication problems was self-reported severity of HSDD. Among premenopausal women, race/ethnicity, depression, and lower relationship happiness were also associated with combined arousal/lubrication problems. Among postmenopausal women, surgical menopause and use of selective serotonin reuptake inhibitors were positively associated with arousal problems. Arousal and lubrication problems were present in approximately half of this subsample of HSDD Registry participants, with distinctions in prevalence and predictors by menopausal status and type of arousal difficulty (arousal vs. lubrication).

  14. Clinical and radiographic predictors in diagnosing sputum smear-negative pulmonary tuberculosis in HIV-negative patients: a cross-sectional study in China

    Institute of Scientific and Technical Information of China (English)

    LI Xin-xu; JIANG Shi-wen; ZHANG Hui; JING Kuan-he; WANG Li; LI Wei-bin; LIU Xiao-qiu

    2013-01-01

    Background In county-level tuberculosis (TB) dispensaries in China,the accurate diagnosis of sputum smear-negative pulmonary tuberculosis (SNPT) needs to be improved by developing and validating clinical and radiographic predictors.Methods The study was conducted simultaneously in three counties per province in Chongqing Municipality and Liaoning Province in China between May 2005 and May 2006.A total of 432 new SNPT patients who are HIV-negative and more than 15 years old diagnosed by expert panels in county-level TB dispensaries were recruited.Their sputum samples were collected for culture before anti-TB treatment,and the treatment outcomes (changes of X-rays) were followed up at the end of the 6th month.Results Of the 432 SNPT patients,sputum culture positive (9.7%) or culture negative with good changes of X-rays at the end of the 6th month (73.6%) was validated as SNPT.Four predictive variables were associated with validated SNPT in the multivariate logistic regression model:age ≤55 years old (odds ratio (OR) 5.66; 95% CI 2.69-11.91),>60 days of cough (OR 3.73; 95% CI 1.10-12.65),≥10% of pulmonary consolidation in the lungs (OR 5.40; 95% CI 2.90-10.06),and pulmonary consolidation in the upper lobe anterior segment (OR 3.00; 95% CI 1.57-5.72).The area under the receiver operating characteristic curve of the model was 0.77 (95% CI 0.71-0.83).Conclusion Four predictors of clinical and radiological characteristics that had a good diagnostic performance of SNPT deserve to be recommended as index indicators of SNPT diagnosis in county-level TB dispensaries in China.

  15. Causes and time-course of vertigo in an ear, nose, and throat clinic.

    Science.gov (United States)

    Isaradisaikul, Suwicha; Navacharoen, Niramon; Hanprasertpong, Charuk; Kangsanarak, Jaran; Panyathong, Rapeepun

    2010-12-01

    The purpose of this study is to review etiologies and identify the time-course of vertigo presenting in an ear, nose, and throat clinic, and serve as a reference guide for other clinics. The study includes retrospective chart review in a tertiary care, university hospital. The patient data with reported ICD-10 codes as causes of vertigo between April 2005 and December 2007 were extracted from the database. At each visit, the main diagnosis as to etiology, characteristics of the vertigo, its time-course, and patient demographic data were recorded. Of 547 cases, 17 diagnoses were made in 73.9%. Diagnostic categories included peripheral vertigo 72.9%, central vertigo 0.8%, psychogenic cause 0.2%, and unknown 26.1%. Common causes of vertigo were benign paroxysmal positional vertigo (BPPV) 52.5%, Meniere's disease 14.6%, and sudden idiopathic hearing loss 2.9%. Less common diagnoses were benign paroxysmal vertigo of childhood 0.7%, labyrinthitis 0.7%, and vestibular schwannoma 0.3%. Rare conditions were delayed endolymphatic hydrops, Ramsey Hunt syndrome, otosyphilis, vestibular neuritis, temporal bone fracture, post-concussion syndrome, cerebellar infarction, epilepsy, cervical vertigo, Streptococcus suis meningitis, and psychogenic vertigo. Ninety-nine cases who reported remission of vertigo during the study period had median onset of the remission at 4 weeks. In the ear, nose, and throat clinic at Chiang Mai University, a tertiary university hospital, peripheral vestibular disorders were the main etiology of vertigo. The three most common causes were BPPV, Meniere's disease, and sudden idiopathic hearing loss. Half of the cases who returned for follow up had remitted symptoms within 4 weeks.

  16. The use of rituximab in newly diagnosed patients with systemic lupus erythematosus: long-term steroid saving capacity and clinical effectiveness

    Science.gov (United States)

    Gracia-Tello, Borja; Ezeonyeji, Amara; Isenberg, David

    2017-01-01

    Background Previous reports indicate that treating patients with lupus (SLE) at or close to the time of diagnosis successfully without using any, or minimal, corticosteroids by using B-cell depletion (BCD) is possible in the short-term. It is not however known whether using BCD is as effective or reduces corticosteroid use in the long-term. We report the long-term (up to 7 years) use of BCD with respect to its steroid-saving capacity and clinical effectiveness in newly diagnosed SLE. Methods Sixteen female patients with SLE were treated at, or shortly after diagnosis, with BCD therapy (BCDT) minimising the routine use of oral steroids. Post-treatment, most patients were given hydroxychloroquine (n=14) and azathioprine (n=10). The British Isles Lupus Assessment Group (BILAG) disease activity index was used for clinical assessment. Serum antidouble-stranded DNA (dsDNA) antibodies, complement (C3), erythrocyte sedimentation rate (ESR), circulating B lymphocytes (CD19+) and total inmmunoglobulins were tested every 2–6 months (average of 4.5 years) (SD 2) post-treatment. Disease activity and steroid requirement were compared with three patients with SLE treated conventionally, each matched for ethnicity, sex, age, clinical features, disease duration at diagnosis and follow-up period. Results All patients given rituximab achieved BCD. The mean number of flares during follow-up (new BILAG A or B) was 2.63 (SD 3) in the BCDT group and 4 (SD 3.6) in the controls (NS, p=0.14). Post-BCDT, mean anti-dsDNA antibody level fell from 1114 U/mL (SD 1699.3) to 194 (SD 346.7) at 18 months (p=0.043), mean serum ESR fell by >70% at 6 months maintained during follow-up and serum C3 level normalised in 8 patients. The mean cumulative prednisolone dose at 60 months for the patients who underwent BCDT (n=11) was 4745.67 mg (SD 6090 mg) vs 12 553.92 mg (SD 12 672 mg) for the controls (p=0.01). Conclusions Early treatment of patients with SLE with BCDT is safe

  17. How Are Arrhythmias Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Are Arrhythmias Diagnosed? Arrhythmias can be hard to diagnose, especially the types ... symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical ...

  18. 女性"前列腺增生症"的临床诊治分析%Female Benign Prostatic Hyperplasia:Analysis of Clinical Diagnoses and Treatments

    Institute of Scientific and Technical Information of China (English)

    林峰; 陈军; 王鸿康

    2013-01-01

    Objective To analyze the clinical diagnosis and treatments of female benign prostatic heperplasia to strengthen physicians'awareness to improve their diagnoses and treatments. Methods The clinical data of 46 cases of female benign prostatic hyperplasia admitted between June 2009 and August 2012 were analyzed retrospectively, to summarize its clinical manifestations, misdiagnoses, laboratory tests, therapeutic methods and effects, prognosis. Results Twenty - one patients were misdiagnosed ( 6 as urinary tract infection, 15 as urethral syndrome ). The main symptom was urinary tract infection in 28 patients and urinary obstruction in 18. By routine urine examination, 40 had negative results, 41 had negative mid - stream u-rine culture. Ultrasound and cystoscopy showed varying - degree proliferation and hypertrophy at neck of bladder. Urodynamics showed decreased maximum urinary flow rate ( average 9. 8 ml/s ). Four patients had conservative treatment. The symptoms of 42 patients disappeared after bladder neck transuretinal resection without surgical complications. Conclusion Female benign prostatic hyperplasia is easy to be misdiagnosed. Its diagnosis should depend on cystoscopy and urodynamic tests besides case histories, clinical manifestations, physical check -ups, uronoscopy and B ultrasonography. Transurethral resection of bladder neck can obtain better clinical efficacy without surgical complications.%目的 通过对女性"前列腺增生症"患者的临床诊治资料进行分析,加强对本病的认识,提高临床诊治水平.方法 对我院2009年6月-2012年8月收治的46例女性前列腺增生症患者的临床资料进行回顾性分析,总结该病的误诊情况、临床表现、实验室检查、治疗方法、疗效及预后情况.结果 46例患者中有21例被误诊(6例被误诊为尿路感染,15例被误诊为尿道综合征).28例患者临床表现以尿路刺激症状为主,18例患者以排尿梗阻症状为主.尿常规检查40例

  19. Clinical significance of the mixing test in laboratory diagnoses of lupus anticoagulant: the fate of the mixing test in integrated lupus anticoagulant test systems.

    Science.gov (United States)

    Hong, Sung Kuk; Hwang, Sang Mee; Kim, Ji-Eun; Kim, Hyun Kyung

    2012-12-01

    The mixing test is used to determine the presence of inhibitors in laboratory diagnoses of lupus anticoagulant. Updated international guidelines state that an integrated lupus anticoagulant test system does not require the mixing test; an appraisal of the mixing tests in integrated lupus anticoagulant test systems is, therefore, required. We investigated the clinical relevance of mixing tests by using the best cutoff value of the mixing test through thrombotic risk analysis. A retrospective analysis was performed on 525 specimens with positive screening tests by using two integrated lupus anticoagulant tests: diluted Russell's Viper venom (dRVVT) and silica clotting time. The diagnostic performance of two interpretation formulas (percentage correction, Rosner index) was assessed, and the thrombotic risk of a subgroup based on the mixing results was investigated. Finally, the thrombotic risk of lupus anticoagulant positivity based on the integrated lupus anticoagulant test system procedures was assessed for the appraisal of mixing test exclusion in integrated lupus anticoagulant test systems. The best cutoff values of mixing test interpretation methods based on dRVVT were as follows: 60.1% for percentage correction and 15.7 for Rosner index. There was no substantial difference in the thrombotic risk between percentage correction and the Rosner index. The mixing-positive group showed a higher lupus anticoagulant titer and higher thrombotic risk than the mixing-negative group. However, even the mixing-negative group carried a significant risk of thrombosis. Finally, lupus anticoagulant positivity determined by the updated two-step procedure (screening and confirmation tests) showed higher thrombotic risk than that determined by the traditional three-step procedure (screening, mixing, and confirmation tests). Although a positive mixing result can predict a high risk of thrombosis, negative mixing results are also associated with a substantial thrombotic risk. The

  20. Bayesian evaluation of clinical diagnostic test characteristics of visual observations and remote monitoring to diagnose bovine respiratory disease in beef calves.

    Science.gov (United States)

    White, Brad J; Goehl, Dan R; Amrine, David E; Booker, Calvin; Wildman, Brian; Perrett, Tye

    2016-04-01

    Accurate diagnosis of bovine respiratory disease (BRD) in beef cattle is a critical facet of therapeutic programs through promotion of prompt treatment of diseased calves in concert with judicious use of antimicrobials. Despite the known inaccuracies, visual observation (VO) of clinical signs is the conventional diagnostic modality for BRD diagnosis. Objective methods of remotely monitoring cattle wellness could improve diagnostic accuracy; however, little information exists describing the accuracy of this method compared to traditional techniques. The objective of this research is to employ Bayesian methodology to elicit diagnostic characteristics of conventional VO compared to remote early disease identification (REDI) to diagnose BRD. Data from previous literature on the accuracy of VO were combined with trial data consisting of direct comparison between VO and REDI for BRD in two populations. No true gold standard diagnostic test exists for BRD; therefore, estimates of diagnostic characteristics of each test were generated using Bayesian latent class analysis. Results indicate a 90.0% probability that the sensitivity of REDI (median 81.3%; 95% probability interval [PI]: 55.5, 95.8) was higher than VO sensitivity (64.5%; PI: 57.9, 70.8). The specificity of REDI (median 92.9%; PI: 88.2, 96.9) was also higher compared to VO (median 69.1%; PI: 66.3, 71.8). The differences in sensitivity and specificity resulted in REDI exhibiting higher positive and negative predictive values in both high (41.3%) and low (2.6%) prevalence situations. This research illustrates the potential of remote cattle monitoring to augment conventional methods of BRD diagnosis resulting in more accurate identification of diseased cattle.

  1. Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and psoriatic arthritis in southern Sweden--a population-based register study.

    Directory of Open Access Journals (Sweden)

    Sofia Löfvendahl

    Full Text Available OBJECTIVE: To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden. METHODS: In the Skåne Healthcare Register (SHR, all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million. During 2005-2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10. Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010. RESULTS: We identified 16 171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986. The proportion of ICD-10 codes that could be confirmed by review of medical records was 81% for psoriasis and 63% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed ≥2 occasions in specialized care. For 19% and 29% of the cases respectively it was not possible to determine diagnosis due to insufficient information. Thus, the positive predicted value (PPV of one ICD-10 code for psoriasis and psoriasis with PsA ranged between 81-100% and 63-92%, respectively. Assuming the most conservative PPV, the post-validation prevalence was 1.23% (95% CI: 1.21-1.25 for psoriasis (with or without PsA, 1.02% (95% CI: 1.00-1.03 for psoriasis alone and 0.21% (95% CI: 0.20-0.22 for psoriasis with PsA. The post-validation prevalence of PsA in the psoriasis cohort was 17.3% (95% CI: 16.65-17.96. CONCLUSIONS: The proportion of diagnostic codes in SHR that could be verified varied with frequency of diagnostic codes and level of care highlighting the importance of sensitivity analyses using different case ascertainment criteria. The prevalence of physician-diagnosed psoriasis and Ps

  2. Clinical analysis of intracranial diseases initial diagnosed in otology%首诊于耳科的颅内疾患临床分析

    Institute of Scientific and Technical Information of China (English)

    肖恒; 叶胜难

    2016-01-01

    目的:探讨首诊于耳科的颅内疾患的临床特点、诊断及相关治疗经验。方法对2002-2015年我院门诊及病房收治的以听力下降、眩晕或耳鸣为首发症状的患者的临床特征进行分析,共发现27例颅内病变的患者。结果27例患者中,其中21例听神经瘤,2例颅内肿瘤,3例脑血管意外,1例脱髓鞘病变,这些患者当中,早期均无偏瘫、抽搐、意识障碍等神经系统的阳性症状体征,且主要症状均为耳部常见症状,经磁共振或高分辨率CT扫描后诊断明确,转诊相关专科处理。结论对于耳科门诊常见的听力下降、眩晕或耳鸣症状,除了要进行相关的听力、前庭学检查外,神经系统的体检也应注意涉及,必要时需行颅脑、内耳的磁共振或高分辨率CT检查,以免漏诊相关的颅内疾患,产生严重后果。%Objective To explore the clinical features, diagnosis and treatment of the initial diagnosis intracranial dis-eases related in the ear outpatient. Method Analyze the clinical characteristics of patients with hearing loss, vertigo or tinni-tus as the first symptoms of the patients with intracranial diseases in our hospital during the 2002-2015. Result In 27 pa-tients, there were 21 cases of acoustic neuroma, 2 cases of intracranial tumor, 3 cases of cerebral vascular accident and 1 case demyelinating disease. These patients, without nervous system positive location signs as paralysis, convulsions, con-sciousness disorder and with common symptoms of ear during early stage, after magnetic resonance imaging examination or high resolution CT scan, they were definite diagnosed and transferred to specialist department. Conclusion For patients with common hearing loss, vertigo or tinnitus symptoms in the otology clinic, not only taking correlative hearing and vestib-ular examination, but also physical examination of the nervous system. If necessary, brain and inner ear magnetic resonance or

  3. Study on the Clinical Characteristics of Newly Diagnosed Consumptive Thirst Disease%初诊消渴病临床特点研究

    Institute of Scientific and Technical Information of China (English)

    周羽; 祝萃

    2016-01-01

    Objective To Analyze both of the clinical characteristics and the syndrome types of the newly diagnosed patients with type 2 diabetes, to discuss the life diet, family history, some other factors and the correlation between these factors and the syndrome types of the traditional Chinese medicine of type 2 diabetes patients.Methods To register for the information of the patients with type 2 diabetes that were initial diagnosed, hospitalized from July 19, 2014 to September 20, 2015 in Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, their clinical characteristics, diet, exercise habits, family history, disease found way, related complications and some physical and chemical test results were recorded, and the data were statistically analyzed.Results Collateral syndrome types in the order were type of qi and yin deficiency or whether with blood stasis was 53 patients (43.4%), damp and hot trapped spleen syndrome or whether with blood stasis was 25 patients (20.5%), and the number of asymptomatic patients were 25 cases (20.5%), 8 (6.5%) patients were yin scorching syndrome, 6(4. 9%) patients were deficiency of both yin and yang or whether with blood stasis .In the object of study, 87 (71.4%) people found diabetes by accident, there were 35 (28.7%) people found diabetes on suspicion.68 (55.7%) people had family history of diabetes, 85 (69.7%) people being overweight or obese, 88 (72.1%) people usually like to eat greasy food, 79 (64.8%) people who don't like to take part in exercise.And these factors are closely associated with damp and hot trapped spleen syndrome or whether with blood stasis (P <0.05).Conclusion Diabetes incidence is closely related to the factors such as age, family history, mind greasy food, less dynamic or being overweight or obese.So regular screening for diabetes, it is particularly important to early diagnosis and treatment .%目的:对初诊2型消渴病病人发病特点及中医临床

  4. Comparison of the clinical characteristics of diabetes mellitus diagnosed using fasting plasma glucose and haemoglobin A1c: The 2011 Korea National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Hong, Sangmo; Kang, Jun Goo; Kim, Chul Sik; Lee, Seong Jin; Lee, Chang Beom; Ihm, Sung-Hee

    2016-03-01

    We compared the characteristics of a Korean adult population diagnosed with diabetes using only a fasting plasma glucose criterion or an HbA1c criterion. The single difference between these two groups was age. Further studies should be undertaken to clarify whether age-specific diagnostic criteria would be appropriate in Korean populations.

  5. [Schizoaffective disorder: clinical symptoms and present-day approach to treatment].

    Science.gov (United States)

    Danileviciūte, Vita

    2002-01-01

    During 20th century serious mental disorders were divided into two groups according symptomatology and course of disorder. Individuals with dominating disturbance of perception, thinking and cognition were basically diagnosed having schizophrenic. Individuals with mood disturbance were basically diagnosed having affective disorders. However, there were patients who did not fit neatly into either category. In 1933 Jocob Kasanin introduced the term "schizoaffective psychosis". Scientific discussions involved the possibility that schizoaffective disorder was conceptualized most accurately as following: a type of schizophrenia, a type of affective disorder, a unique disorder that was separate from both schizophrenia and bipolar disorder, an arbitrary categorization of clinical symptoms that marked a continuum between schizophrenia and affective illness, a heterogeneous collection of "interforms" between schizophrenia and affective disorders. However, diagnosis of schizoaffective disorder is included both in DSM-IV-TR and ICD-10. Schizoaffective disorder is listed in the category "schizophrenia and other psychotic disorders". The differential diagnosis includes basically either schizophrenia or affective disorder. The epidemiological status of schizoaffective disorder is somewhat uncertain compared with schizophrenia because of dilemmas related to diagnosis and classification of the disorder. Treatment of schizoaffective disorder comprises psychotropic medication, supportive psychotherapy, social care, rehabilitation. The most important groups of psychotropic medications are: antipsychotics, antidepressants and mood stabilizers. Atypical antipsychotics are the first-line medication for schizoaffective disorder due to their pharmacological properties. In the case of schizoaffective disorders combination of atypical antipsychotics with antidepressants seems to be useful. Novel antidepressants have priority for the combination mentioned above. Peculiarities of mechanism of

  6. Cases with manifestation of chemodectoma diagnosed in dogs in Department of Internal Diseases with Horses, Dogs and Cats Clinic, Veterinary Medicine Faculty, University of Environmental and Life Sciences, Wroclaw, Poland

    Directory of Open Access Journals (Sweden)

    Atamaniuk Wojciech

    2010-05-01

    Full Text Available Abstract In the period of 3 years, 9 tumours of chemodectoma were supravitally diagnosed and histopathologically verified in dogs. In this period 15 351 dogs were admitted to the Clinic of Dogs and Cats and 2 145 dogs were examined in the cardiological outpatient clinic for dogs. This tumour is located in a typical place - at the base of the heart. Most frequently the tumour manifested in older boxers. Only in one case such a tumour was diagnosed in another breed of dogs. The tumours ranged in size between 3 and 16 cm in diameter. The principal sign accompanying tumours of cardiac base involved dyspnoea but in 3 cases the tumours yielded no clinical signs. All the diagnoses were additionally verified using immunohistochemical examination. We used antibodies to chromogranin A (clone DAK-A3 1:100, synaptophysin (clone SY38 1:20 and neuron-specific enolase (clone BBS/NC/VI-H14 1:150. An immunohistochemical examination is vital for the diagnosis since it allows to differentiate histologically distinct types of neoplasia which may locate in the same site and may manifest a similar histological pattern.

  7. How Is COPD Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is COPD Diagnosed? Your doctor will diagnose COPD based on ... Rate This Content: NEXT >> Featured Video What is COPD? 05/22/2014 Describes how COPD, or chronic ...

  8. Diagnosing Tic Disorders

    Science.gov (United States)

    ... Other Websites Information For... Media Policy Makers Diagnosing Tic Disorders Language: English Español (Spanish) Recommend on Facebook ... or postviral encephalitis). Persistent (Chronic) Motor or Vocal Tic Disorder For a person to be diagnosed with ...

  9. How Is Atherosclerosis Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Atherosclerosis Diagnosed? Your doctor will diagnose atherosclerosis based on ... Rate This Content: NEXT >> Featured Video What is atherosclerosis? 05/22/2014 Describes how the build-up ...

  10. Stable feature selection for clinical prediction: exploiting ICD tree structure using Tree-Lasso.

    Science.gov (United States)

    Kamkar, Iman; Gupta, Sunil Kumar; Phung, Dinh; Venkatesh, Svetha

    2015-02-01

    Modern healthcare is getting reshaped by growing Electronic Medical Records (EMR). Recently, these records have been shown of great value towards building clinical prediction models. In EMR data, patients' diseases and hospital interventions are captured through a set of diagnoses and procedures codes. These codes are usually represented in a tree form (e.g. ICD-10 tree) and the codes within a tree branch may be highly correlated. These codes can be used as features to build a prediction model and an appropriate feature selection can inform a clinician about important risk factors for a disease. Traditional feature selection methods (e.g. Information Gain, T-test, etc.) consider each variable independently and usually end up having a long feature list. Recently, Lasso and related l1-penalty based feature selection methods have become popular due to their joint feature selection property. However, Lasso is known to have problems of selecting one feature of many correlated features randomly. This hinders the clinicians to arrive at a stable feature set, which is crucial for clinical decision making process. In this paper, we solve this problem by using a recently proposed Tree-Lasso model. Since, the stability behavior of Tree-Lasso is not well understood, we study the stability behavior of Tree-Lasso and compare it with other feature selection methods. Using a synthetic and two real-world datasets (Cancer and Acute Myocardial Infarction), we show that Tree-Lasso based feature selection is significantly more stable than Lasso and comparable to other methods e.g. Information Gain, ReliefF and T-test. We further show that, using different types of classifiers such as logistic regression, naive Bayes, support vector machines, decision trees and Random Forest, the classification performance of Tree-Lasso is comparable to Lasso and better than other methods. Our result has implications in identifying stable risk factors for many healthcare problems and therefore can

  11. Diagnosing mucopolysaccharidosis IVA.

    Science.gov (United States)

    Wood, Timothy C; Harvey, Katie; Beck, Michael; Burin, Maira Graeff; Chien, Yin-Hsiu; Church, Heather J; D'Almeida, Vânia; van Diggelen, Otto P; Fietz, Michael; Giugliani, Roberto; Harmatz, Paul; Hawley, Sara M; Hwu, Wuh-Liang; Ketteridge, David; Lukacs, Zoltan; Miller, Nicole; Pasquali, Marzia; Schenone, Andrea; Thompson, Jerry N; Tylee, Karen; Yu, Chunli; Hendriksz, Christian J

    2013-03-01

    Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is an autosomal recessive lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) activity. Diagnosis can be challenging and requires agreement of clinical, radiographic, and laboratory findings. A group of biochemical genetics laboratory directors and clinicians involved in the diagnosis of MPS IVA, convened by BioMarin Pharmaceutical Inc., met to develop recommendations for diagnosis. The following conclusions were reached. Due to the wide variation and subtleties of radiographic findings, imaging of multiple body regions is recommended. Urinary glycosaminoglycan analysis is particularly problematic for MPS IVA and it is strongly recommended to proceed to enzyme activity testing even if urine appears normal when there is clinical suspicion of MPS IVA. Enzyme activity testing of GALNS is essential in diagnosing MPS IVA. Additional analyses to confirm sample integrity and rule out MPS IVB, multiple sulfatase deficiency, and mucolipidoses types II/III are critical as part of enzyme activity testing. Leukocytes or cultured dermal fibroblasts are strongly recommended for enzyme activity testing to confirm screening results. Molecular testing may also be used to confirm the diagnosis in many patients. However, two known or probable causative mutations may not be identified in all cases of MPS IVA. A diagnostic testing algorithm is presented which attempts to streamline this complex testing process.

  12. The predictive value of SS-16 in clinically diagnosed Parkinson’s disease patients: comparison with 99mTc-TRODAT-1 SPECT scans

    OpenAIRE

    Kang, Wenyan; Dong, Fangyi; Li, Dunhui; Quinn, Thomas J.; Chen, Shengdi; Liu, Jun

    2016-01-01

    Background Dopamine transporter based imaging has high diagnostic performance in distinguishing patients with Parkinson’s disease (PD) from patients with non-Parkinsonian syndromes. Our previous study indicated that the “Sniffin’ Sticks” odor identification test (SS-16) acts as a valid instrument for olfactory assessment in Chinese PD patients. The aim of the study was to compare the efficacy of the two methods in diagnosing PD. Methods Fifty-two PD patients were involved in this study and un...

  13. Challenges in diagnosing hepatic encephalopathy.

    Science.gov (United States)

    Weissenborn, K

    2015-02-01

    The term "hepatic encephalopathy" (HE) covers the neuropsychiatric syndrome associated with acute, chronic and acute-on-chronic liver disease (CLD). This paper deals with clinical features and diagnosis of HE in patients with liver cirrhosis and portal hypertension or porto-systemic shunts. The possible impact of concomitant disorders and the cirrhosis underlying liver disease upon brain function is described emphasizing the need of a detailed diagnostic work up of every individual case before diagnosing HE. Currently used methods for diagnosing minimal or covert hepatic encephalopathy are compared with regard to their sensitivity and specificity for diagnosing HE against the background of a multitude of concomitant disorders and diseases that could contribute to brain dysfunction.

  14. 临床督导专题述评%Editorial on the column of clinical supervision

    Institute of Scientific and Technical Information of China (English)

    张道龙; 张小梅; 黄国平; 杨昆

    2016-01-01

    Clinical supervision is a valuable and essential part of any healthcare professional’s development. By receiving feedback and clinical training,psychiatrists and clinical psychologists can accelerate their professional growth and clinical competency.Supervision is especially important in developing familiarity with diagnostic criteria,such as the DSM - 5 or ICD - 10,distinguishing differential diagnoses,improving psychotherapy,and learning psychopharmacology. It also serves a critical function in teaching junior psychiatrists and clinical psychologists to analyae their patient’s symptoms and condition. For instance,a supervisor’s guidance and experience can assist a clinician to differentiate primary depression and anxiety from a personality disorder,with secondary presentation of depression and anxiety. Supervision can additionally direct young clinicians and help them to course - correct when running into obstacles. Through the use of videotaping,recordings,and clinical interview transcripts,a supervisor can walk them step - by - step through what can be improved in future patient interactions. Finally,a supervisor’s chief role is to support new clinicians through the complexities of the clinical setting and help them to overcome inevitable frustrations while developing achievements and a sense of accomplishment. Without the opportunity to receive feedback on their performance in the clinic,junior psychiatrists and psychologists are missing a crucial opportunity for personal and professional growth.%临床督导是精神科医生和心理咨询师职业发展的必备环节,通过不断操练和接收反馈可以加速专业化进程并有效地提升临床胜任力。在督导中,要着重训练以下几个方面:熟练掌握 DSM-5或 ICD-10诊断标准,厘清鉴别诊断的思路,提高心理治疗技能,并将精神药理学理论灵活应用于实践。例如,一位督导师的指导和经验可以帮助临床工作者区分继发抑郁

  15. Does Training and Support of General Practitioners in Intensive Treatment of People with Screen-Detected Diabetes Improve Medication, Morbidity and Mortality in People with Clinically-Diagnosed Diabetes? Investigation of a Spill-Over Effect in a Cluster RCT

    Science.gov (United States)

    Skriver, Mette V.; Griffin, Simon J.; Simmons, Rebecca K.; Witte, Daniel R.; Dalsgaard, Else-Marie; Lauritzen, Torsten; Sandbæk, Annelli

    2017-01-01

    Introduction Very few studies have examined the potential spill-over effect of a trial intervention in general practice. We investigated whether training and support of general practitioners in the intensive treatment of people with screen-detected diabetes improved rates of redeemed medication, morbidity and mortality in people with clinically-diagnosed diabetes. Methods This is a secondary, post-hoc, register-based analysis linked to a cluster randomised trial. In the ADDITION-Denmark trial, 175 general practices were cluster randomised (i) to routine care, or (ii) to receive training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (2001 to 2009). Using national registers we identified all individuals who were diagnosed with clinically incident diabetes in the same practices over the same time period. (Patients participating in the ADDITION trial were excluded). We compared rates of redeemed medication, a cardiovascular composite endpoint, and all-cause mortality between the routine care and intensive treatment groups. Results In total, 4,107 individuals were diagnosed with clinically incident diabetes in ADDITION-Denmark practices between 2001 and 2009 (2,051 in the routine care group and 2,056 in the intensive treatment group). There were large and significant increases in the proportion of patients redeeming cardio-protective medication in both treatment groups during follow-up. After a median of seven years of follow-up, there was no difference in the incidence of a composite cardiovascular endpoint (HR 1.15, 95% CI 0.95 to 1.38) or all-cause mortality between the two groups (HR 1.08, 95% CI 0.94 to 1.23). Discussion There was no evidence of a spill-over effect from an intervention promoting intensive treatment of people with screen-detected diabetes to those with clinically-diagnosed diabetes. Overall, the proportion of patients redeeming cardio-protective medication during follow-up was similar in both groups

  16. How Are Pelvic Floor Disorders Diagnosed?

    Science.gov (United States)

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders diagnosed? Skip sharing on social media links ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  17. How Are Obesity and Overweight Diagnosed?

    Science.gov (United States)

    ... Clinical Trials Resources and Publications How are obesity & overweight diagnosed? Skip sharing on social media links Share ... common way to determine if a person is overweight or obese is to calculate body mass index ( ...

  18. A Clinical Pilot Study Comparing Sweet Bee Venom parallel treatment with only Acupuncture Treatment in patient diagnosed with lumbar spine sprain

    Directory of Open Access Journals (Sweden)

    Shin Yong-jeen

    2011-06-01

    Full Text Available Objectives: This study was carried out to compare the Sweet Bee Venom (referred to as Sweet BV hereafter acupuncture parallel treatment to treatment with acupuncture only for the patient diagnosed with lumbar spine sprain and find a better treatment. Methods: The subjects were patients diagnosed with lumbar spine sprain and hospitalized at Suncheon oriental medical hospital, which was randomly divided into sweet BV parallel treatment group and acupuncture-only group, and other treatment conditions were maintained the same. Then,VAS (Visual Analogue Scale was used to compare the difference in the treatment period between the two groups from VAS 10 to VAS 0, from VAS 10 to VAS 5, and from VAS 5 to VAS 0. Result & Conclusion: Sweet BV parallel treatment group and acupuncture-only treatment group were compared regarding the respective treatment period, and as the result, the treatment period from VAS 10 to VAS 5 was significantly reduced in sweet BV parallel treatment group compared to the acupuncture-only treatment group, but the treatment period from VAS 5 to VAS 0 did not show a significant difference. Therefore, it can be said that sweet BV parallel treatment is effective in shortening the treatment period and controlling early pain compared to acupuncture-only treatment.

  19. Diagnosing GORD in respiratory medicine

    Directory of Open Access Journals (Sweden)

    Chris James Timms

    2011-07-01

    Full Text Available Gastroesophageal reflux disease is increasing in prevalence and is associated with several lung diseases such as asthma and COPD. Current diagnostic methods are imperfect, being insensitive, nonspecific, expensive or invasive. An accurate diagnosis of GORD can aid effective treatment with a significant clinical impact. Novel methods such as exhaled breath condensate analysis and electronic nose technology have the potential to improve the accuracy of diagnosing GORD.

  20. Challenges in diagnosing tuberculosis in children

    DEFF Research Database (Denmark)

    Rahman, Nadia; Pedersen, Karin Kæreby; Nielsen, Vibeke Rosenfeldt

    2012-01-01

    Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country.......Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country....

  1. Clinical normative data for eating disorder examination questionnaire and eating disorder inventory for DSM-5 feeding and eating disorder classifications: a retrospective study of patients formerly diagnosed via DSM-IV.

    Science.gov (United States)

    Brewin, Nicola; Baggott, Jonathan; Dugard, Pat; Arcelus, Jon

    2014-07-01

    Normative data for measures of eating disorder (ED) psychopathology provide a fundamental description of a presentation and a means to establish clinically significant change following an intervention. Clinical norms for the ED population are lacking and out of date following the publication of Diagnostic and Statistical Manual of Mental Health Disorders (DSM) 5. This study aimed to show that scores from the Eating Disorder Examination Questionnaire (EDE-q) and the Eating Disorder Inventory (EDI) differ across ED diagnosis groups and provide norm data for DSM-5 ED diagnoses. Patients (n = 932) presenting to an out-patient service over 5 years were retrospectively re-diagnosed based on DSM-5 criteria. Statistical analysis showed a significant difference on most subscale scores of the EDE-q and the EDI across diagnosis. Means, standard deviations and percentile ranks are presented by diagnosis. The norms detailed contribute to improving the accuracy with which scores are interpreted when using DSM-5 and aid with the assessment of clinically significant change following treatment.

  2. How to diagnose acute appendicitis

    DEFF Research Database (Denmark)

    Mostbeck, Gerhard; Adam, E Jane; Nielsen, Michael Bachmann;

    2016-01-01

    Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order...... appendicitis (AA). • Primary US for AA diagnosis will decrease ionizing radiation and cost. • Sensitivity of US to diagnose AA is lower than of CT/MRI. • Non-visualization of the appendix should lead to clinical reassessment. • Complementary MRI or CT may be performed if diagnosis remains unclear....

  3. Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria. Comparison between sepsis and trauma.

    Science.gov (United States)

    Kushimoto, Shigeki; Gando, Satoshi; Saitoh, Daizoh; Ogura, Hiroshi; Mayumi, Toshihiko; Koseki, Kazuhide; Ikeda, Toshiaki; Ishikura, Hiroyasu; Iba, Toshiaki; Ueyama, Masashi; Eguchi, Yutaka; Otomo, Yasuhiro; Okamoto, Kohji; Endo, Shigeatsu; Shimazaki, Shuji

    2008-12-01

    The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH). Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n = 98) or trauma (n = 95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.

  4. Diagnosing Sleep Disorders

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Sleep Disorders Diagnosing Sleep Disorders Past Issues / Summer 2015 Table of Contents Depending ... several possible tests when trying to diagnose a sleep disorder: Sleep history and sleep log If you believe ...

  5. How Is Raynaud's Diagnosed?

    Science.gov (United States)

    ... diagnose primary Raynaud's (Raynaud's disease) or secondary Raynaud's (Raynaud's phenomenon) based on your medical history, a physical exam, and test results. Specialists Involved Primary care doctors and internists often diagnose and treat Raynaud's. If you have the disorder, you also may ...

  6. Differential diagnoses to MS

    DEFF Research Database (Denmark)

    Horwitz, Henrik; Friis, Tina; Modvig, Signe;

    2014-01-01

    of 643 patients were included in the study. Apart from ON, the most frequent diagnoses were tumors (n = 15), ischemic or hypertensive neuropathies (n = 13), and retinal or choroid disorders (n = 9). Six patients were diagnosed with neuromyelitis optica. Rarer causes of visual loss were infections (n = 5...

  7. Acromegaly according to the Danish National Registry of Patients: how valid are ICD diagnoses and how do patterns of registration affect the accuracy of registry data?

    Directory of Open Access Journals (Sweden)

    Dal J

    2014-09-01

    Full Text Available Jakob Dal,1 Nikolaj Skou,1 Eigil Husted Nielsen,2 Jens Otto Lunde Jørgensen,1 Lars Pedersen3 1Department of Endocrinology, Aarhus University Hospital, Aarhus, 2Department of Endocrinology, Aalborg University Hospital, Aalborg, 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Background: The incidence of acromegaly is uncertain, since population-based studies are few. In the absence of a specific acromegaly registry, the Danish National Registry of Patients (DNRP becomes a potential source of data for studying the epidemiology of acromegaly, by linking all hospital discharge diagnoses to the personal identification numbers of individual Danish inhabitants. The validity of the DNRP with respect to acromegaly, however, remains to be tested. The aim of this study was to validate the International Classification of Diseases (ICD codes for acromegaly (ICD-8: 25300, 25301. ICD-10: E22.0 as used in the DNRP, and to assess the influence of various registration patterns on the accuracy of registry data. Methods: We identified patients registered with ICD codes for the diagnosis of acromegaly or other pituitary disorders during the period 1991–2009. Data on the institutional origin of each registration and the number of relevant DNRP registrations were recorded, and systematic patient chart reviews were performed to confirm the diagnosis. Results: In total, 110 cases of acromegaly were confirmed, compared with 275 registered cases, yielding a positive predictive value (PPV of 40%. When restricting the search to the regional highly specialized department of endocrinology, the PPV increased to 53% with no loss of cases with confirmed acromegaly. With a requirement of at least one, two, or three DNRP registrations, the PPV increased, but with a concurrent loss of confirmed cases. Conclusion: The DNRP seems to be a useful source for identifying new cases of acromegaly, especially when restricting the search to a relevant

  8. Association of Diffusion and Anatomic Imaging Parameters with Survival for Patients with Newly Diagnosed Glioblastoma Participating in Two Different Clinical Trials

    Directory of Open Access Journals (Sweden)

    Qiuting Wen

    2015-12-01

    Full Text Available PURPOSE: To evaluate the time course and association with survival of anatomic lesion volumes and diffusion imaging parameters for patients with newly diagnosed glioblastoma who were treated with radiation and concurrently with either temozolomide and enzastaurin (TMZ+enza cohort or temozolomide, erlotonib, and bevaciumab (TMZ+erl+bev cohort. MATERIALS AND METHODS: Regions of interest corresponding to the contrast-enhancing and hyperintense lesions on T2-weighted images were generated. Diffusion-weighted images were processed to provide maps of apparent diffusion coefficient, fractional anisotropy, and longitudinal and radial eigenvalues. Histograms of diffusion values were generated and summary statistics calculated. Cox proportional hazards models were employed to assess the association of representative imaging parameters with survival with adjustments for age, Karnofsky performance status, and extent of resection. RESULTS: Although progression-free survival was significantly longer for the TMZ+erl+bev cohort (12.8 vs 7.3 months, there was no significant difference in overall survival between the two populations (17.0 vs 17.8 months. The median contrast-enhancing lesion volumes decreased from 6.3 to 1.9 cm3 from baseline to the postradiotherapy scan for patients in the TMZ+enza cohort and from 2.8 to 0.9cm3 for the TMZ+erl+bev cohort. Changes in the T2 lesion volumes were only significant for the latter cohort (26.5 to 11.9 cm3. The median apparent diffusion coefficient and related diffusion parameters were significantly increased for the TMZ+enza cohort (1054 to 1225 μm2/s. More of the anatomic parameters were associated with survival for the TMZ+enza cohort, whereas more diffusion parameters were associated with survival for the TMZ+erl+bev cohort. CONCLUSION: The early changes in anatomic and diffusion imaging parameters and their association with survival reflected differences in the mechanisms of action of the treatments that were being

  9. International, open-label, noncomparative, clinical trial of micafungin alone and in combination for treatment of newly diagnosed and refractory candidemia.

    Science.gov (United States)

    Ostrosky-Zeichner, L; Kontoyiannis, D; Raffalli, J; Mullane, K M; Vazquez, J; Anaissie, E J; Lipton, J; Jacobs, P; van Rensburg, J H Jansen; Rex, J H; Lau, W; Facklam, D; Buell, D N

    2005-10-01

    Candida spp. are the fourth leading cause of bloodstream infections, and non-albicans species are increasing in importance. Micafungin is a new echinocandin antifungal agent with excellent in vitro activity against Candida spp. Pediatric, neonatal, and adult patients with new or refractory candidemia were enrolled into this open-label, noncomparative, international study. The initial dose of micafungin was 50 mg/d (1 mg/kg for patients <40 kg) for infections due to C. albicans and 100 mg/d (2 mg/kg for patients <40 kg) for infections due to other species. Dose escalation was allowed. Maximum length of therapy was 42 days. A total of 126 patients were evaluable (received at least five doses of micafungin). Success (complete or partial response) was seen in 83.3% patients overall. Success rates for treatment of infections caused by the most common Candida spp. were as follows: C. albicans 85.1%, C. glabrata 93.8%, C. parapsilosis 86.4%, and C. tropicalis 83.3%. Serious adverse events related to micafungin were uncommon. Micafungin shows promise as a safe and effective agent for the treatment of newly diagnosed and refractory cases of candidemia. Large-scale, randomized, controlled trials are warranted.

  10. Study on the clinical treatment of low - grade squamous intraepithelial lesion diagnosed by cytological test%宫颈细胞学诊断低度上皮内瘤变的临床处理探讨

    Institute of Scientific and Technical Information of China (English)

    张娟; 蔡林儿; 严杏

    2012-01-01

    目的:探讨宫颈细胞学诊断低度上皮内瘤变的意义及临床处理方法.方法:对2010年5月~2011年11月在广东省中医院就诊并经TCT检查为LSIL的195例女性病例进一步行HPV-DNA-PCR检测及阴道镜检查,观察其最终病理结果的构成及在不同年龄阶段的分布差异.结果:在195例LSIL患者中,高危HPV阳性144例(73.8%),病理诊断为癌前病变及癌者共87例(60.4%);高危HPV阴性51例(26.2%),病理诊断为癌前病变及癌者共8例(15.7%).在35岁以下的93例中,病理诊断为癌前病变及癌者共43例(46.2%);在35~45岁的69例中,病理诊断为癌前病变及癌者共41例(69.9%);45岁以上33例中,病理诊断为癌前病变及癌者共11例(33.3%).结论:在TCT诊断为LSIL的患者中,高危HPV阳性与高危HPV阴性患者的宫颈病变检出率差异有统计学意义,不同年龄段之间宫颈病变检出率差异有统计学意义,临床处理方法及随访计划的制定与年龄及HPV感染情况有关.%Objective: To explore the significance of cervical cytological test for diagnosis of low - grade squamous intraepithelial lesion (LSIL) and the clinical treatment. Methods: A total of 195 female cases who were diagnosed as low grade squamous intraepithelial lesion (LSIL) by TCT in the hospital from May 2010 to November 2011 further underwent HPV - DNA PCR and colposcopy, the proportion of finally pathological results and the difference of different age distributions were observed. Results: Among 195 patients with LSIL, 144 patients (73. 8% ) were found with positive high risk HPV, 87 patients (60. 4% ) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis; 51 patients (26. 2% ) were found with negative high risk HPV, 8 patients (15. 7% ) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis. Among 93 patients under 35 years old, 43 patients (46.2% ) were diagnosed as cervical precancerous

  11. How Is Hemophilia Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Hemophilia Diagnosed? If you or your child appears to ... have bleeding problems. However, some people who have hemophilia have no recent family history of the disease. ...

  12. Department of Defense Sexually Transmitted Infections: Estimation of Burden among Active Duty Service Members using Clinical Diagnoses, Laboratory Results, and Medical Event Reports

    Science.gov (United States)

    2016-03-01

    not assess whether those individuals had a comparably better or worse matching to related encounter records or if the infections were reported to...Approved for public release. Distribution is unlimited. The views expressed in this document are those of the authors and do not necessarily reflect...non-shore based facilities whose records are not included in common clinical data sources. The EDC Department of the Navy and Marine Corps Public

  13. Clinical features, outcome and prognostic factors in dogs diagnosed with non-cortisol-secreting adrenal tumours without adrenalectomy: 20 cases (1994-2009).

    Science.gov (United States)

    Arenas, C; Pérez-Alenza, D; Melián, C

    2013-11-23

    The aims of this study were to describe the clinical features, the outcome and the prognostic factors of dogs with non-cortisol-secreting adrenal masses without adrenalectomy, and also to provide clinical data that can be useful for making decisions when managing dogs with these types of neoplasms. Medical records from 1994 to 2009 were reviewed and 20 dogs were included in the study. The results showed that mean age at diagnosis for dogs with non-cortisol-secreting adrenal masses was 12 years with no sex predisposition. Most dogs were asymptomatic. The most frequent clinical signs, when present, were lethargy, weakness and hypertension. Radiological evidence of metastases at diagnosis was not frequent. The maximal dorso-ventral thickness of the adrenal mass ranged from 10.0 to 45.0 mm. Right adrenal gland masses were more frequent than left-sided. Hypertension was found to be related to tumour growth during follow-up. The median survival time of dogs with non-cortisol-secreting tumours was 17.8 months. Body weight at diagnosis, tumour size and the presence of metastases at diagnosis were inversely related to survival. In conclusion, survival of dogs with non-cortisol-secreting adrenal tumours without adrenalectomy is relatively high and comparable with that of dogs treated with adrenalectomy. Dogs with metastasis and large adrenal tumours have a poorer prognosis. Hypertension is related to tumour growth, and might be used as an additional tool to assess the potential growing capacity of the tumour.

  14. 临床诊断湿疹患者400例的病理诊断分析%Pathological diagnosis of 400 cases of clinically diagnosed eczema: a retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    关欣; 张倩; 李邻峰

    2014-01-01

    Objective To analyze the pathological diagnosis of patients with clinically diagnosed eczema,to describe the spectrum of skin diseases tending to be misdiagnosed as eczema,and to investigate factors associated with their misdiagnosis.Methods A retrospective study was performed on 400 patients who were clinically diagnosed as eczema and received pathological examination at the dermatology clinic of Peking University Third Hospital from August 2006 to April 2013.Skin biopsy specimens were re-reviewed for these patients,and pathological diagnosis was made in combination with clinical presentations.Results Of the 400 outpatients with clinically diagnosed eczema,110 (27.5%) were finally diagnosed as non-eczema skin diseases pathologically,including 16 cases of psoriasis,13 bullous pemphigoid (BP),11 lichen planus (LP),9 cutaneous amyloidosis,8 mycosis fungoides (MF),14 skin malignancies,and 39 other skin diseases.The highest misdiagnosis rate was observed in people aged 60 to 79 years (33.9%) and lesions at the genital sites (46.2%).Conclusions Many conditions tend to be misdiagnosed as eczema in clinic,including psoriasis,BP,LP,cutaneous amyloidosis,MF and skin malignancies.Misdiagnosis is rather frequent in elderly people and eczematous lesions in genital areas,and pathological examination should be taken actively for uncertain cases.%目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况.探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素.方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析.结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5%.误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例.60 ~ 79岁

  15. Comparação entre os diagnósticos clínicos e os achados de necropsia: análise retrospectiva de 680 pacientes Correlation between clinical and autopsy diagnoses: a retrospective analysis of 680 patients

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    Marcos Emanuel de Alcântara Segura

    2006-12-01

    Full Text Available OBJETIVO: Analisar a concordância entre os diagnósticos clínicos e os achados anatomopatológicos obtidos por meio do exame necroscópico, a fim de determinar a freqüência com que a necropsia revela diagnósticos principais inesperados, que são relevantes para a causa do óbito. MÉTODOS: Foram analisadas retrospectivamente 680 necropsias realizadas no Hospital de Base do Distrito Federal (HBDF, de janeiro de 1997 a dezembro de 2002. Para a comparação entre os achados clínicos e anatomopatológicos utilizou-se a classificação de Goldman, e fez-se a correlação segundo o sexo, a idade do paciente, a unidade de internação e o tempo de permanência hospitalar. Foram utilizados, como fonte de dados, os pedidos de necropsia, preenchidos pelos médicos-assistentes, e os laudos finais de necropsia. RESULTADOS: A necropsia confirmou os diagnósticos principais formulados pela clínica em 69% das amostras. Em relação aos casos discordantes, 18% foram classificados como classe I (com potencial impacto na sobrevida do paciente e 13% como classe II (sem o questionável impacto na sobrevida do paciente. Os principais diagnósticos discordantes mais freqüentes foram doenças do aparelho circulatório (acidente vascular cerebral, insuficiência cardíaca congestiva e miocardiopatia hipertrófica, moléstias infecciosas (meningite bacteriana, tuberculose miliar e neurotoxoplasmose e neoplasias (linfomas. CONCLUSÕES: Evidenciou-se significativa discordância entre os diagnósticos clínicos e anatomopatológicos post mortem, mostrando que a necropsia ainda é um procedimento importante para o esclarecimento diagnóstico, bem como para a melhoria dos serviços de saúde.OBJECTIVE: To analyze the discrepancies between clinical and postmortem diagnoses in order to determine the frequency of relevant missed diagnoses detected at autopsy. METHOD: Six hundred and eighty patients autopsied at the Hospital de Base do Distrito Federal, Brazil, between

  16. Health anxiety symptoms in children and adolescents diagnosed with OCD.

    Science.gov (United States)

    Villadsen, Anna; Thorgaard, Mette V; Hybel, Katja A; Jensen, Jens Søndergaard; Thomsen, Per H; Rask, Charlotte U

    2017-02-01

    Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30 % presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.

  17. The assessment of serum-mediated phagocytosis of necrotic material by polymorphonuclear leukocytes to diagnose and predict the clinical features of systemic lupus erythematosus

    DEFF Research Database (Denmark)

    Compagno, Michele; Gullstrand, Birgitta; Jacobsen, Søren;

    2016-01-01

    relationships between PNC positivity and specific clinical manifestations. RESULTS: In 35 of 529 MRG patients, 13 of whom had SLE, the PNC assay result was positive. Combined positivity of the PNC assay and anti-double-stranded DNA antibodies increased specificity and positive predictive value for SLE diagnosis...... to 0.99 and 0.67, respectively. In the longitudinal study, 42 of 69 SLE cohort patients had positive results in the PNC assay at least once. PNC assay positivity was associated with current hematological manifestations and could predict mucocutaneous manifestations. When combined...

  18. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India

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    Nagarajan Sripriya

    2008-01-01

    Full Text Available Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth, which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

  19. Screening of PRKAR1A and PDE4D in a Large Italian Series of Patients Clinically Diagnosed With Albright Hereditary Osteodystrophy and/or Pseudohypoparathyroidism.

    Science.gov (United States)

    Elli, Francesca Marta; Bordogna, Paolo; de Sanctis, Luisa; Giachero, Federica; Verrua, Elisa; Segni, Maria; Mazzanti, Laura; Boldrin, Valentina; Toromanovic, Alma; Spada, Anna; Mantovani, Giovanna

    2016-06-01

    The cyclic adenosine monophosphate (cAMP) intracellular signaling pathway mediates the physiological effects of several hormones and neurotransmitters, acting by the activation of G-protein coupled receptors (GPCRs) and several downstream intracellular effectors, including the heterotrimeric stimulatory G-protein (Gs), the cAMP-dependent protein kinase A (PKA), and cAMP-specific phosphodiesterases (PDEs). Defective G-protein-mediated signaling has been associated with an increasing number of disorders, including Albright hereditary osteodistrophy (AHO) and pseudohypoparathyroidism (PHP), a heterogeneous group of rare genetic metabolic disorders resulting from molecular defects at the GNAS locus. Moreover, mutations in PRKAR1A and PDE4D genes have been recently detected in patients with acrodysostosis (ACRDYS), showing a skeletal and endocrinological phenotype partially overlapping with AHO/PHP. Despite the high detection rate of molecular defects by currently available molecular approaches, about 30% of AHO/PHP patients still lack a molecular diagnosis, hence the need to screen patients negative for GNAS epi/genetic defects also for chromosomal regions and genes associated with diseases that undergo differential diagnosis with PHP. According to the growing knowledge on Gsα-cAMP signaling-linked disorders, we investigated our series of patients (n = 81) with a clinical diagnosis of PHP/AHO but negative for GNAS anomalies for the presence of novel genetic variants at PRKAR1A and PDE4D genes. Our work allowed the detection of 8 novel missense variants affecting genes so far associated with ACRDYS in 9 patients. Our data further confirm the molecular and clinical overlap among these disorders. We present the data collected from a large series of patients and a brief review of the literature in order to compare our findings with already published data; to look for PRKAR1A/PDE4D mutation spectrum, recurrent mutations, and mutation hot spots; and to identify specific

  20. Discussion on the ICD-10 Coding of External Causes of Medical Complications%医疗并发症外因的ICD-10编码探讨

    Institute of Scientific and Technical Information of China (English)

    段沁江; 陈艳

    2016-01-01

    Objectives To conduct retrospective study on the coding quality of medical complications in discharged medical records encoding with Y84-Y40 of a hospital. Methods 276 copies of hospital records for Y40-Y84 were retrieved in 2014 with the application of comprehensive inquiry function of the medical records statistic system. Results There were 25 error encoding, the error rate was 9.2%, Y60-Y69 misuse for Y83-Y84 and Y83-Y84 misuse of Y60-Y69 were most common, and the composition ratios were 28% and 24%. The constitute ratio of mechanical failure in medical devices was 19.2%, and the management should be strengthened. A major cause of coding errors was unclear concept of external causes of medical complications among the coders, which accounted for 52%. Conclusions Medical complications all had their own appropriate external coding,which used for a complete description and qualitative elaboration of the complications.%目的:回顾性调查某医院编码为Y40-Y84的出院病案医疗并发症编码质量。方法运用病案统计系统综合查询功能,检索得到2014年编码为Y40-Y84的出院病案276份,逐份核查。结果错误编码25份,错码率9.2%,错码率较高的是Y60-Y69误用为Y83-Y84和Y83-Y84误用为Y60-Y69,构成比分别是28%和24%。医疗装置机械性故障构成比是19.2%,建议加强对医疗装置的管理。编码员对医疗并发症外因概念不清是编码错误的主要原因,构成比为52%。结论各种医疗并发症具有相应的外因编码,用于对并发症完整描述和定性说明。

  1. El cuerpo como excusa: El diagnostico de la fibromialgia en una consulta de reumatología The body likes excuse: Diagnosing fibromyalgia in a rheumatologic clinic

    Directory of Open Access Journals (Sweden)

    Beatriz Tosal Herrero

    2008-03-01

    Full Text Available Introducción: El proceso de medicalización de la sociedad ha generado una dependencia de la biomedicina para entender, gestionar y legitimar la enfermedad. Como consecuencia surge una nueva forma de considerar los procesos corporales que transforma las identidades y subjetividades de los individuos y los grupos sociales. La enfermedad se concibe y se experimenta en el cuerpo en forma de signos y síntomas. Esta representación de la enfermedad compartida por expertos y enfermos durante el encuentro clínico se convierte en el lenguaje propio de la interacción. Esto ocurre incluso en casos, como el de la fibromialgia, en los que el diagnóstico se produce en ausencia de alteraciones ‘objetivas’ del cuerpo. Metodología: Observación participante, sobre la elaboración y comunicación del diagnóstico de fibromialgia en una consulta de reumatología. Resultados: Se analizan las representaciones sobre el cuerpo y la enfermedad que manejan tanto médicos como enfermos, y la utilización de los síntomas corporales como estrategia de legitimación e interacción durante el encuentro clínico. Conclusión: En la fibromialgia, a pesar de la ausencia de alteraciones biológicas ‘objetivas’, la relación sanitario-paciente se ve mediada por el cuerpo. Este es el lugar en el que se producen las intervenciones terapéuticas y el vehículo de la comunicación entre ambos.Introduction: The process of medicalization of the society has generated a dependence of the biomedicine to understand, to negotiate and to legitimate the illness. As consequence arises, a new form of considering the bodily processes that transforms the identities and the individuals' subjectivities. Persons conceive and experience the illness in the body as signs and symptoms. This representation of the illness shared by experts and patients during the clinical encounter it becomes the characteristic language of the interaction. This even happens in cases, as that of the

  2. [Value of (99)Tc(m)-MDP SPECT/CT in clinical decision-making for nasopharyngeal carcinoma and a comparison of the values of different imaging techniques for diagnosing skull-base bone invasion].

    Science.gov (United States)

    Li, W; Zhang, R S; Zhang, L Q; Lu, B G; Fu, W H

    2017-02-23

    Objective: To analyze the clinical value of SPECT/CT in diagnosis of skull base bone invasion and clinical decision-making for nasopharyngeal carcinoma (NPC), and to compare their diagnostic value with SPECT/CT, CT, MRI, and MRI combined with SPECT (MRI-SPECT) for skull base bone invasion. Methods: Before treatment, among 348 newly diagnosed NPC patients, CT scan was performed in 186 patients (group A) and the remaining 162 patients received MRI scan (group B). Clinical doctors then made clinical management decisions according to the CT or MRI results. After that, all patients underwent (99)Tc(m)-MDP SPECT/CT examination for nasopharyngeal local tomography, and the results were provided to the clinical doctors to make clinical management decisions again. The changes between the two clinical management decisions were scored according to diagnosis, range of lesion, staging, treatment regimens, and auxiliary examination. The diagnostic value of CT scan, MRI scan, SPECT/CT and MRI-SPECT for skull base bone invasion was then evaluated and compared. Results: In terms of changes in scores of clinical management decisions, the score of group A was 1.387 and group B was 0.951, showing a significant difference between the two groups by Wilcoxon test (Z=6.570, P<0.001). By χ(2) test, there were correlations between CT and SPECT/CT (χ(2) =98.495, P<0.001), and between MRI and SPECT/CT (χ(2) =32.662, P<0.001). The consistency of CT and SPECT/CT (Kappa=0.713) was greater than MRI and SPECT (Kappa=0.449). The sensitivity of CT, MRI, SPECT/CT and MRI-SPECT was 67.1%, 84.5%, 90.8% and 100%, the specificity was 73.3%, 92.3%, 85.6% and 84.6%, and the area under the ROC curve was 0.702, 0.884, 0.882 and 0.923, respectively. Conclusions: SPECT/CT has important impact on clinical management decision for NPC. In the judgement of skull base invasion, the diagnostic value of SPECT/CT is significantly higher than CT and approximately equal to MRI. SPECT/CT should be one of the routine

  3. The long-term clinical implications of clonal chromosomal abnormalities in newly diagnosed chronic phase chronic myeloid leukemia patients treated with imatinib mesylate.

    Science.gov (United States)

    Lee, Sung-Eun; Choi, Soo Young; Bang, Ju-Hee; Kim, Soo-Hyun; Jang, Eun-Jung; Byeun, Ji-Young; Park, Jin Eok; Jeon, Hye-Rim; Oh, Yun Jeong; Kim, Myungshin; Kim, Dong-Wook

    2012-11-01

    The aim of this study was to evaluate the long-term clinical significance of an additional chromosomal abnormality (ACA), variant Philadelphia chromosome (vPh) at diagnosis, and newly developed other chromosomal abnormalities (OCA) in patients with chronic myeloid leukemia (CML) on imatinib (IM) therapy. Sequential cytogenetic data from 281 consecutive new chronic phase CML patients were analyzed. With a median follow-up of 78.6 months, the 22 patients with vPh (P = 0.034) or ACA (P = 0.034) at diagnosis had more events of IM failure than did the patients with a standard Ph. The 5-year overall survival (OS), event-free survival (EFS), and failure-free survival (FFS) rates for patients with vPh at diagnosis were 77.8%, 75.0%, and 53.3%, respectively; for patients with ACA at diagnosis, 100%, 66.3%, and 52.1%, respectively; and for patients with a standard Ph, 96.0%, 91.3%, and 83.7%, respectively. During IM therapy, eight patients developed an OCA, which had no impact on outcomes as a time-dependent covariate in our Cox proportional hazards regression models. This study showed that vPh was associated with poor OS and FFS and that ACA had adverse effects on EFS and FFS. In addition, no OCA, except monosomy 7, had any prognostic impact, suggesting that the development of OCA may not require a change in treatment strategy.

  4. How Is Testicular Cancer Diagnosed?

    Science.gov (United States)

    ... Cancer Early Detection, Diagnosis, and Staging How Is Testicular Cancer Diagnosed? Testicular cancer is usually found as a ... the tumor might have returned. Surgery to diagnose testicular cancer Most types of cancer are diagnosed by removing ...

  5. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  6. 经直肠腔内超声诊断后尿道结石的临床价值%The Clinical Value of Transrectal Ultrasonography in Diagnosing Hind Urethra Calculus

    Institute of Scientific and Technical Information of China (English)

    李庆; 谢江凌

    2013-01-01

    目的 探讨经直肠腔内超声对后尿道结石的诊断价值.方法 对36例后尿道结石患者采用经直肠腔内超声检查,并将超声诊断结果与临床结果进行对比分析.结果 经直肠腔内超声检查诊断后尿道结石35例,误诊1例.后尿道结石中,位于后尿道前列腺部22例,后尿道膜部14例,经直肠腔内超声检查诊断后尿道结石符合率为97.22%.结论 经直肠腔内超声检查对后尿道结石的诊断率高,可为临床治疗提供可靠的依据,值得临床推广应用.%Objective To study the value of transrectal ultrasonography in diagnosing hind urethra calculus. Methods Using intracavity probe, combined with high frequency rectum transducer and line transducer necessary, to check the hind urethra calculus by transrectal ultrasonography. Results By transrectal ultrasonography, 35 cases have been diagnosed as hind urethra calculus, misdiagnosis 1 case, 22 as prostate calculus of hind urethra and 14 as membrane calculus of hind urethra,the coincidence rate is 97. 22%. Conclusion Transrectal ultrasonography can improve the diagnostic rate of hind urethra calculus, provide reliable basis for the clinical diagnosis and treatment, worthy of clinical application.

  7. An algorithm to diagnose influenza infection: evaluating the clinical importance and impact on hospital costs of screening with rapid antigen detection tests.

    Science.gov (United States)

    González-Del Vecchio, M; Catalán, P; de Egea, V; Rodríguez-Borlado, A; Martos, C; Padilla, B; Rodríguez-Sanchez, B; Bouza, E

    2015-06-01

    Rapid antigen detection tests (RADTs) are immunoassays that produce results in 15 min or less, have low sensitivity (50 %), but high specificity (95 %). We studied the clinical impact and laboratory savings of a diagnostic algorithm for influenza infection using RADTs as a first-step technique during the influenza season. From January 15th to March 31st 2014, we performed a diagnostic algorithm for influenza infection consisting of an RADT for all respiratory samples received in the laboratory. We studied all the patients with positive results for influenza infection, dividing them into two groups: Group A with a negative RADT but positive reference tests [reverse transcription polymerase chain reaction (RT-PCR) and/or culture] and Group B with an initial positive RADT. During the study period, we had a total of 1,156 patients with suspicion of influenza infection. Of them, 217 (19 %) had a positive result for influenza: 132 (11 %) had an initial negative RADT (Group A) and 85 (7 %) had a positive RADT (Group B). When comparing patients in Group A and Group B, we found significant differences, as follows: prescribed oseltamivir (67 % vs. 82 %; p = 0.02), initiation of oseltamivir before 24 h (89 % vs. 97 %; p = 0.03), antibiotics prescribed (89 % vs. 67 %; p = <0.01), intensive care unit (ICU) admissions after diagnosis (23 % vs. 14 %; p = 0.05), and need for supplementary oxygen (61 % vs. 47 %; p = 0.01). An influenza algorithm including RADTs as the first step improves the time of administration of proper antiviral therapy, reduces the use of antibiotics and ICU admissions, and decreases hospital costs.

  8. Being publicly diagnosed

    DEFF Research Database (Denmark)

    Konradsen, Hanne; Lillebaek, Troels; Wilcke, Torgny;

    2014-01-01

    . METHOD: A grounded theory design with field studies and qualitative interviews, following the recommendations from Glaser and Strauss. RESULT: A process of being publicly diagnosed was identified, which developed during the patient's trajectory from being on the way to becoming a patient, becoming...

  9. Diagnosing ADHD in Adolescence

    Science.gov (United States)

    Sibley, Margaret H.; Pelham, William E., Jr.; Molina, Brooke S. G.; Gnagy, Elizabeth M.; Waschbusch, Daniel A.; Garefino, Allison C.; Kuriyan, Aparajita B.; Babinski, Dara E.; Karch, Kathryn M.

    2012-01-01

    Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and…

  10. Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort.

    Science.gov (United States)

    Harman, Halil; Tekeoğlu, İbrahim; Takçı, Sibel; Kamanlı, Ayhan; Nas, Kemal; Harman, Sibel

    2015-08-01

    We analyzed the longitudinal changes in gray-scale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS) parameters and correlated them with clinical, functional, and radiologic outcomes in patients with newly diagnosed rheumatoid arthritis (RA). GSUS and PDUS examinations, 44-joint disease activity score (DAS44) calculations, measurements of erythrocyte sedimentation rate, and C-reactive protein levels were performed in 68 RA patients at baseline and after 1, 3, 6, 9, and 12 months. Metacarpophalangeal joints, wrist, elbow, knee, ankle, metatarsophalangeal joints, and wrist and ankle tendons were examined by GSUS and PDUS. The laboratory and clinical findings began to decrease significantly at 1 month (P US) variables began at 3 months. After 6 months, all of the joint synovitis scores, except those of the knee, elbow, and ankle joints, showed a statistically significant reduction compared to baseline scores (P US synovitis at large joints such as the knee, elbow, and ankle tended to be delayed compared to that at small joints. PD synovitis that is persistent despite disease-modifying anti-rheumatic drug therapy may cause radiographic bone erosions.

  11. 以诊断未明疾病入院的巨幼细胞贫血患者临床特点分析%Clinical features of patients with megaloblastic anemia diagnosed as diseases of unknown origin at admission

    Institute of Scientific and Technical Information of China (English)

    孟婵; 陈嘉林; 曾学军

    2016-01-01

    Objective To analyze the clinical features of patients with megaloblastic anemia diagnosed as diseases of unknown origin at admission.Methods Seventeen patients admitted during the period of January 2001 to September 2015,who were diagnosed as disease of unknown origin at admission and finally diagnosed as megaloblastic cell anemia,were included in the analysis.The clinical data of patients including age,gender,disease duration,clinical manifestations,laboratory testing,misdiagnosis and treatments were retrospectively analyzed.Results Of the 17 patients,14 were males and 3 were females,the median age is 63 years.The interval from disease onset to consultation was 22 days-60 months with a median time of 7 months.Nine cases had the history of repeated consultations without confirmed diagnoses,13 cases were misdiagnosed in the first visit or at the admission.Symptoms of neurological (12 cases),digestive (10 cases)and cardiovascular (8 cases) systems were predominant clinical manifestations.The average hemoglobin concentration at admission was (64.9 ± 18.7) g/L,the mean corpuscular volume (MCV) was (112.2 ± 10.5) fl,and 12 cases had pancytopenia.Two cases were diagnosed based on the elevated MCV and hyper-segmented nucleus of neutrophils,respectively.Fifteen patients underwent serum vitamin B12 and folate examination;vitamin B12 levels decreased in all cases,while only 1 had folate under normal range.All 17 patients recovered successfully by vitamin B12 and folate supplement and were doing well during follow-ups.Conclusions Megaloblastic anemia is likely to be misdiagnosed,because the clinical manifestations are usually not specific.It is necessary to raise the awareness of the disease for early diagnosis and treatment.%目的 总结巨幼细胞贫血的临床特点,提高对该病的认识,减少误诊.方法 回顾性分析2001年1月至2015年9月北京协和医院普通内科以诊断未明疾病收治而最终确诊为巨幼细胞贫血患者17例的病历资

  12. FISH技术在诊断膀胱移行上皮细胞癌中的应用%Clinical practice of fluorescence in situ hybridization in diagnosing bladder transitional cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    杨渝伟; 唐洁; 陈小红; 薛冰蓉; 刘运双; 俸家富

    2011-01-01

    目的 探讨荧光原位杂交(FISH)技术在膀胱移行上皮细胞癌诊断中的价值和意义.方法用随机引物法标记 3、7、17号染色体着丝粒及p16基因探针,对该院103例膀胱移行上皮细胞癌患者尿液或膀胱冲洗液中脱落细胞FISH进行检测,分析染色体畸变或数目异常情况及与临床分期、病理分级的关系.结果 3、7、17号染色体和p16基因的畸变率分别为41.7%(43/103)、45.6%(47/103)、31.1%(32/103)和55.3%(57/103),畸变与临床分期无相关性,除p16基因外其余染色体畸变与病理分级相关,其中17号染色体畸变与病理分级显著相关(P<0.01).4个探针组合诊断膀胱移行上皮细胞癌的总阳性率为46.6%,与临床分期无相关性(P>0.05),但与病理分级显著相关(P<0.01).结论 FISH 技术检测有助于膀胱移行上皮细胞癌的诊断,并可用于探索染色体畸变与病理分级的关系.%Objective To investigate the value and significance of fluorescence in situ hybridization(FISH)in diagnosing bladder transitional cell carcinoma. Methods The probes of chromosome 3,7,17 centromeres and p16 gene were labeled by random primer method. FISH was performed on interphase nuclei of exfoliated cells collected in urine and bladder washings in 103 samples of bladder transitional cell carcinoma,and analyzed the correlations between chromosome aberration or numerical abnormality with clinical stages and pathologic grades. Results The rate of aneuploidy was 41. 7% for chromosome 3,4 5. 6% for chromosome 7,31. 1% for chromosome 17,and 55. 3% for pl6 gene in bladder transitional cell carcinoma. All the aberrations had no correlation to clinical stages. The aberrations of chromosomes 3,7,17 were significantly correlated to pathologic grades(P<0. 01) , especially, chromosome 17. As using the 4 chromosome probes in combination,the sensitivity for diagnosing bladder transitional cell carcinoma was 46. 6% , and had no correlation to clinical stages,but were

  13. Diagnosing patients with longstanding shoulder joint pain

    DEFF Research Database (Denmark)

    Nørregaard, J; Krogsgaard, M R; Lorenzen, T

    2002-01-01

    OBJECTIVE: To examine the interobserver agreement of commonly used clinical tests and diagnoses in patients with shoulder pain, and the accuracy of these tests and ultrasonographic findings in comparison with arthroscopic findings. METHODS: Eighty six patients with longstanding shoulder joint pain...

  14. Eating Disorder Diagnoses: Empirical Approaches to Classification

    Science.gov (United States)

    Wonderlich, Stephen A.; Joiner, Thomas E., Jr.; Keel, Pamela K.; Williamson, Donald A.; Crosby, Ross D.

    2007-01-01

    Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in…

  15. Fighting to be heard: contested diagnoses

    NARCIS (Netherlands)

    C. Trundle; I. Singh; C. Bröer

    2014-01-01

    This chapter explores how diagnoses can become sites of contest, rather than of agreement. Conflict can arise when illness refuses to yield the level of proof that epidemiology, clinical medicine, and toxicology require, or its existence is doubted within mainstream medicine. Other forms of contest

  16. How Do Health Care Providers Diagnose Vaginitis?

    Science.gov (United States)

    ... the treatments? Are there complications? Does it affect pregnancy? How is it prevented? NICHD Research Information Clinical Trials Resources and Publications How do health care providers diagnose vaginitis? Skip sharing on social media links Share this: Page Content To find out ...

  17. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

    Directory of Open Access Journals (Sweden)

    Garbe Edeltraut

    2011-08-01

    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  18. Automatic mapping of clinical documentation to SNOMED CT.

    Science.gov (United States)

    Stenzhorn, Holger; Pacheco, Edson José; Nohama, Percy; Schulz, Stefan

    2009-01-01

    Clinical documentation needs to be fine-grained to truthfully represent the history, development, and treatment of a patient. But natural language, as the main information carrier, is characterized by many issues, like idiosyncratic terminology, spelling and grammar errors, and a lack of grammatical structure. Therefore coding systems, like ICD-10, have been introduced, but their use varies highly among physicians, and they are often used incompletely or incorrectly. The almost exponential growth of clinical data is yet another problem. We present a new methodology to process this data: Through combining several natural language processing methods we extract morphemes from clinical texts and map them onto concepts from SNOMED CT. We first performed a manual analysis of clinical texts received from a university hospital and evaluated the issues found in them. Based on this we implemented a prototypical system which incorporates both the OpenNLP and the MorphoSaurus natural language processing systems.

  19. The Clinical Value of Different Methods on Branchofiberoscope Specimens to Diagnose Small Cell Lung Cancer%不同方法在纤维支气管镜刷检肺小细胞癌中的诊断价值

    Institute of Scientific and Technical Information of China (English)

    江涛; 朱立强; 朱玉秋; 叶涛; 方先勇

    2011-01-01

    Objective To evaluate the clinical value of different methods including conventional smear,liquid-based cytology and biology to diagnose small cell lung cancer on the specimens obtained by branchofiberoscope. Methods The 208 cases of specimens obtained by branchofiberoscope were diagnosed by method of conventional smear, liquid-based cytology and biology at the same time, the positive rates were compared between them. Results The positive rates of conventional smear, liquid-based cytology and biology to diagnose 208 cases of primary small cell lung cancer were 56.7% ( 118/208 ),75.5% ( 157/208 ), 72.1% ( 150/208 ), respectively. The positive rates of liquid-based cytology and biology were higher than the conventional smear ( P < 0.01 ). The positive rate of combination of liquid-based cytology and biology was 89.4% , higher than any single methods( P < 0.01 ). Conclusion Liquid-based cytology is superior to the conventional smear and biology. Combination of the liquid-based cytology and biology can increase the positive detection rate and provide more significant informations for clinical diagnosis.%目的 探讨纤维支气管镜刷检中传统涂片法、液基细胞法及钳取活检法对原发性肺小细胞癌的诊断价值.方法 对208例患者纤维支气管镜刷取和钳取的标本同时用传统涂片法、液基细胞法、钳取活检法进行诊断,将3种方法的结果进行比较分析.结果 208例原发性肺小细胞癌经纤维支气管镜刷检传统涂片法、液基细胞法、钳取活检法及液基细胞法+钳取活检法的阳性率分别为56.7%(118/208)、75.5%(157/208)、72.1%(150/208)、89.4%(186/208).液基细胞法、钳取活检法的阳性检出率较传统涂片法高(P<0.01),联合液基细胞法和钳取活检法阳性检出率明显高于单一方法(P<0.01).结论 纤支镜刷检液基细胞法在诊断肺小细胞癌中具有一定的优势,联合钳取活检法可提高肺小细胞癌的阳性检出

  20. Positive predictive values of the International Classification of Disease, 10th edition diagnoses codes for diverticular disease in the Danish National Registry of Patients

    Directory of Open Access Journals (Sweden)

    Rune Erichsen

    2010-10-01

    Full Text Available Rune Erichsen1, Lisa Strate2, Henrik Toft Sørensen1, John A Baron31Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Division of Gastroenterology, University of Washington, Seattle, WA, USA; 3Departments of Medicine and of Community and Family Medicine, Dartmouth Medical School, NH, USAObjective: To investigate the accuracy of diagnostic coding for diverticular disease in the Danish National Registry of Patients (NRP.Study design and setting: At Aalborg Hospital, Denmark, with a catchment area of 640,000 inhabitants, we identified 100 patients recorded in the NRP with a diagnosis of diverticular disease (International Classification of Disease codes, 10th revision [ICD-10] K572–K579 during the 1999–2008 period. We assessed the positive predictive value (PPV as a measure of the accuracy of discharge codes for diverticular disease using information from discharge abstracts and outpatient notes as the reference standard.Results: Of the 100 patients coded with diverticular disease, 49 had complicated diverticular disease, whereas 51 had uncomplicated diverticulosis. For the overall diagnosis of diverticular disease (K57, the PPV was 0.98 (95% confidence intervals [CIs]: 0.93, 0.99. For the more detailed subgroups of diagnosis indicating the presence or absence of complications (K573–K579 the PPVs ranged from 0.67 (95% CI: 0.09, 0.99 to 0.92 (95% CI: 0.52, 1.00. The diagnosis codes did not allow accurate identification of uncomplicated disease or any specific complication. However, the combined ICD-10 codes K572, K574, and K578 had a PPV of 0.91 (95% CI: 0.71, 0.99 for any complication.Conclusion: The diagnosis codes in the NRP can be used to identify patients with diverticular disease in general; however, they do not accurately discern patients with uncomplicated diverticulosis or with specific diverticular complications.Keywords: diverticulum, colon, diverticulitis, validation studies

  1. How Is Pulmonary Hypertension Diagnosed?

    Science.gov (United States)

    ... from the NHLBI on Twitter. How Is Pulmonary Hypertension Diagnosed? Your doctor will diagnose pulmonary hypertension (PH) ... To Look for the Underlying Cause of Pulmonary Hypertension PH has many causes, so many tests may ...

  2. How Is Kawasaki Disease Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Kawasaki Disease Diagnosed? Kawasaki disease is diagnosed based on your child's signs and ... are the first to suspect a child has Kawasaki disease. Pediatricians are doctors who specialize in treating children. ...

  3. Diagnosing Dementia--Positive Signs

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Diagnosing Dementia—Positive Signs Past Issues / Fall 2007 Table of ... easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? Researchers ...

  4. Clinical application of electronic gastroscope in diagnosing gastric ulcer patients%电子胃镜在诊断胃溃疡患者中的临床应用

    Institute of Scientific and Technical Information of China (English)

    李宗奎

    2016-01-01

    Objective:To analyze and evaluate the electronic gastroscope clinical application in diagnosing gastric ulcer patients, providing theoretical basis to clinical treatment.Methods: The research objects were our hospital digestive internal medicine treating and diagnosed 148 cases gastric ulcer patients, all patients were doing electronic gastroscopy. Retrospectively analyzed electronic gastroscope biopsy results and compared the results with the pathological diagnosis results, evaluating electronic gastroscopy accuracy in the diagnosis of gastric ulcer patients.Results: One hundred and forty-eight cases gastric ulcer patients, pathological diagnosis results were benign, diagnostic accuracy was 100%. Electronic gastroscope showed that 140 benign gastric ulcer patients, diagnosis accuracy rate was 94.6%. Among them, the gastric perforation 58 cases, accounting for 39.2%, hemorrhage 62 cases, accounting for 41.9%; pyloric obstruction 49 cases, accounting for 33.1%, combined two kinds of lesions and more than 37 cases, accounting for 25.0%.Conclusion: Electronic gastroscopy can observe the fine structure of the gastric mucosa, accurately identify gastric ulcer patients, having high accuracy in diagnosis of gastric ulcer patients and widely clinical application worth.%目的:分析与评价电子胃镜在诊断胃溃疡患者中的临床应用,为临床治疗提供依据。方法:选取经病例活检确诊的148例胃溃疡患者,所有患者均进行电子胃镜检查,回顾性分析其电子胃镜显示结果,并与病理确诊结果进行对比,评价电子胃镜在诊断胃溃疡患者中的准确性。结果:148例胃溃疡患者,经病理确诊均为良性,诊断准确率为100%。电子胃镜显示140例良性胃溃疡患者,诊断准确率为94.6%。其中,穿孔58例(占39.2%)、出血62例(占41.9%);幽门梗阻49例(占33.1%)、合并两种及以上37例(占25.0%)。结论:电子胃镜可以观察到胃黏膜的微细结构,准

  5. Diagnosing and Managing IBD

    Science.gov (United States)

    ... a clinical trial of experimental treatments. Interactive Disease Tracker Use GI Buddy to keep a daily log ... with an accurate diagnosis and assessment of disease activity, including its precise location in the gastrointestinal tract. ...

  6. The clinical , neurophysiological and neuropathological characteristics of Kennedy disease——attaching two patients diagnosed by genetic analysis%Kennedy病的临床、电生理及病理特征分析(附2例报道)

    Institute of Scientific and Technical Information of China (English)

    汪仁斌; 刘尊敬; 董明睿; 郝莹; 汪伟; 毛坤; 孙少杰; 严莉

    2012-01-01

    Objective To discuss the clinical, neurophysiological and neuropathological characteristics of patients with Kennedy disease (KD). Methods Two patients with KD diagnosed by gene detection were reported, and their clinical features, the results of electromyography and nerve conduction study and the biopsy of sural nerve were analyzed. Results The symptoms of KD patients initiated in middle age, presented with a slow progression of lower motor neuron weakness and atrophy, involving bulbar and proximal limb muscles. Gynecomastia due to androgen insensitivity was probably the most common non-neurological manifestation, even though their sexual hormone levels were in normal range. There might be mild to severe hyper-CK-emia. Needle electromyography (EMG) showed extensive chronic denervation and reinnervation, nerve conduction studies revealed reduced sensory nerve action potential (SNAP) amplitudes, and abnormal H reflexes. There was a loss of large myelinated fiber in nerve biopsy. The number of CAG repeats for the coding region of androgen receptor gene exceeds 40. Conclusions There are relatively unique clinical, neurophysiological and neuropathological characteristics of KD. and its definite diagnosis should be made by genetic analysis.%目的 探讨Kennedy病的临床、神经电生理及病理特征.方法 报道2例经基因确诊的Kennedy病患者,分析其临床症状、体征、肌电图和神经传导检查和神经病理等特点.结果 两例患者均中年发病,进展缓慢.神经系统表现为以肢体近端无力和延髓受累为主的下运动神经元瘫痪.血清性激素水平正常,但有男性乳腺发育等雄激素功能低下表现.血清肌酸激酶轻度升高.肌电图呈广泛神经源性损害,神经传导检查提示感觉神经动作电位波幅减低,H反射异常,神经活检提示大的有髓纤维减少.雄激素受体基因编码区CAG重复数大于40.结论 Kennedy病有相对独特的临床、电生理及病理特征,确诊

  7. 一次性宫腔组织吸引管在异常子宫出血诊断中的临床价值%Clinical value of disposable uterine cavity tissue suction tube in diagnosing abnormal uterine bleeding

    Institute of Scientific and Technical Information of China (English)

    郑妮; 孙奇; 韦静

    2015-01-01

    Objective To explore the clinical value of the disposable uterine cavity tissue suction tube in diagnosing abnormal u‐terine bleeding .Methods Seventy‐five patients ,who needed an endometrial biopsy because of abnormal uterine bleeding ,were se‐lected for this study .An endometrial biopsy was performed by a disposable uterine cavity tissue suction tube before the conventional suction dilatation and curettage (D&C) .The sample satisfactory rate and the diagnose accordance rate of the two methods were compared .Results The sample satisfactory rate of the disposable uterine cavity tissue suction tube and of the D&C was 85 .3%(64/75) and 94 .7% (71/75) respectively .The difference was not statistically significant(P>0 .05) .The diagnose accordance rate of the disposable uterine cavity tissue suction tube and the D&C was 90 .3% (56/62) and 93 .5% (58/62) respectively .The differ‐ence was not statistically significant(P>0 .05) .Conclusion To a certain extent ,endometrial biopsy performed by disposable uter‐ine cavity tissue suction tube can be a substitute for D&C as the initial inspection to assess abnormal uterine bleeding ,for its econo‐my ,efficiency and safety .%目的:探讨一次性宫腔组织吸引管在异常子宫出血诊断中的临床价值。方法选取因异常子宫出血需进行子宫内膜活检的患者75例,在接受常规分段诊刮术前利用一次性宫腔组织吸引管先获取子宫内膜组织。比较两种方法的取材标本满意率和诊断符合率。结果一次性宫腔组织吸引管取材标本满意率为85.3%(64/75),常规分段诊刮术取材标本满意率为94.7%(71/75),差异无统计学意义(P>0.05);一次性宫腔组织吸引管取材诊断符合率为90.3%(56/62),常规分段诊刮术取材诊断符合率为93.5%(58/62),差异无统计学意义(P>0.05)。结论一次性宫腔组织吸引管经济、有效、安全,可在一定程度上

  8. 77 FR 32975 - AHRQ Workgroups on ICD-10-CM/PCS Conversion of Quality Indicators (QIs)

    Science.gov (United States)

    2012-06-04

    ..., diabetes and endocrine disease, infectious disease, neonatology and pediatric disease, miscellaneous) and..., critical care and pulmonary disease, diabetes and endocrine disease, infectious disease, neonatology and..., neonatology and pediatric disease, miscellaneous), along with background documents justifying or...

  9. Gastrointestinal Endoscopic Terminology Coding (GET-C): A WHO-approved extension of the ICD-10

    NARCIS (Netherlands)

    M.J.M. Groenen (Marcel); W. Hirs (Willem); H. Becker (Henk); E.J. Kuipers (Ernst); G.P. van Berge Henegouwen (Gerard); P. Fockens (Paul); R.J.T. Ouwendijk (Rob)

    2007-01-01

    textabstractTechnological developments have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy and creating databases. The aim of this study was to develop a comprehensive WHO-approved code system for gastrointestinal endoscopic terminology. The I

  10. The Clinical Observation of Several Urine Tests to Diagnose the Renal Damage in Systemic Lupus Erythematosus%浅析对系统性红斑狼疮患者进行尿检的临床意义

    Institute of Scientific and Technical Information of China (English)

    华继平

    2016-01-01

    Objective:To investigate the clinical value of several urine tests of the urine protein, the urinary albumin/ creatinine, the urinary N-acetyl-β-D-glucosaminidase/creatinine and the urineα1-microglobulin to diagnose the renal damage in systemic lupus erythematosus. Methods:52 patients with systemic lupus erythematosus were observed as the observation group, 30 healthy persons were observed as the control group. The urine protein, the urinary albumin/creatinine, the urinary N-acetyl-β-D-glucosaminidase/creatinine and the urineα1-macroglobulin were compared between the two groups. Results:There were significant differences between the observation group and the control group in the positive rate of urinary protein, the urinary albumin/creatinine, the urinary N-acetyl-β-D-glucosaminidase/creatinine and the urineα1-macroglobulin (P<0.05). There were remarkable differences between the urine protein positive patients and the urine protein negative patients of the observation group in the urinary albumin/creatinine, the urinary N-acetyl-β-D-glucosaminidase/creatinine and the urineα1-macroglobulin (P<0.05). Conclusion:Several urine tests is helpful to diagnose the renal damage disease of patients with systemic lupus erythematosus. It is worthy of clinical promotion.%目的:探讨对系统性红斑狼疮患者进行尿检(尿液常规检查)的临床意义。方法:对2014年9月~2015年9月期间我院收治的52例系统性红斑狼疮患者的临床资料进行回顾性研究。我们将这52例患者作为观察组,同时选取同一时期在我院进行体检的30例健康人作为参照组。我院对这两组研究对象均进行了尿检,然后比较两组研究对象的尿蛋白定性及尿mALB/Cr(尿微量白蛋白/肌酐)、尿NAG/Cr(尿N-乙酰β-D氨基葡萄糖苷酶/肌肝)和尿α1-MG(尿α1-微球蛋白)的水平。结果:观察组患者尿蛋白的阳性检出率为57.69%,其尿mALB/Cr、尿NAG/Cr和尿α1-MG的水平

  11. 初诊原发性干燥综合征86例临床研究%Clinical features of newly-diagnosed primary Sj(o)gren's syndrome: analysis of 86 cases

    Institute of Scientific and Technical Information of China (English)

    冯学兵; 张华勇; 周康兴; 刘布骏; 孙凌云

    2009-01-01

    Objective To assess the clinical features of newly diagnosed primary Sjogren's syndrome (pSS). Methods Patients were diagnosed according to the international consensus criteria for Sjogren's Syndrome published in 2002. Clinical manifestations and laboratory tests of 86 pSS cases hospitalized in Nanjing Drum Tower Hospital in the past two years were reviewed. Results Among the 86 patients, 95.3% were female and the average disease onset age was 38.6 years. The median time from disease onset to diagnosis was 6 months. Dry mouth, dry eyes and arthralgia were the most common symptoms. Hematologic involvement was found to be prominent in these patients (69.8%). The incidence of abnormal liver function, interstitial lung disease and pulmonary arterial hypertension was 19.8%, 8.2% and 5.8% simultaneously. Younger patients (less than 18 years old) had lower frequency of dry mouth and dry eyes but higher ffrequency of fever and lymph nodes enlargement than the elderly patients (P<0.05). Patients with positive anti-SSA or anti-SSB antibodies had higher incidence of hematological changes as well as ESR than those with negative auto-antibodia. Elevated globulin/IgG and positive antinuclear antibody or rheumatoid factor (P< 0.05). Conclusion pSS is not always a benign disease. Some patients will develop vital organ damages very early and thus need to be identified and treated in time. It should not be overemphasize the importance of dry mouth and dry eyes for the diagnosis of pSS, especially in young patients. Those patients who have fever, high globulin level and positive rheumatoid factor of unknown origin should be screened for pSS.%目的 探讨初诊原发性干燥综合征(pSS)的临床特点,旨在提高对pSS的早期诊断水平.方法 对2006~2007本院86例旨次诊断为pSS的住院患者临床表现及实验室指标进行回顾总结.结果 除口干、眼干、关节痛外,患者血液系统受累较为多见.18岁以下青少年患者口干、眼干发生率

  12. 全身骨显像诊断肺癌骨转移的临床价值%Clinical value of the whole body bone imaging in diagnosing bone metastasis from lung cancer

    Institute of Scientific and Technical Information of China (English)

    贾莉; 夏正武; 马世兴

    2011-01-01

    Objective: To explore clinical value of the whole body bone imaging in diagnosing bone metastasis from lung cancer, in order to guide staging and treatment of patients with lung cancer. Methods: 126 patients with pathological diagnosis of lung cancer were performed whole body bone imaging, CT and ALP, blood calcium inspection. Probability of bone metastasis from lung cancer of the different pathological type and different clinical stage were counted. The whole body bone imaging and clinical factors of suspicious bone metastasis (including bone pain, alkaline phosphatase, high calcium lev -els, arbitrary or a few) for diagnosis accuracy of bone metastases were statistical compared. Results: The incidence of bone metastasis from lung cancer was 27.8%, and the bone metastases occurrence probability of peripheral lung cancer was higher than central lung cancer (P<0.01), bone metastases occurrence probability of lung adenocarcinoma was higher than lung squamous cell carcinoma (P<0.01), bone metastases occurrence probability of period Ⅲ, IV patients was obviously higher than that of period I , II (P<0.01). The sensitivity (94.3%), specific degrees (84.6%), accuracy (87.3%) of the whole body bone imaging diagnosis of bone metastases from lung cancer were higher than the clinical factors of suspicious bone metas -tasis diagnosis of bone metastases. Conclusion: Whole body bone imaging should be a routine examination in patients with lung cancer. The clinical significance is important to determine stage and treatment of lung cancer.%目的:探讨全身骨显像在诊断肺癌骨转移的临床价值,以便更好地指导肺癌患者的分期及治疗.方法:126例病理确诊为肺癌的患者均行全身骨显像、CT及碱性磷酸酶、血钙检查.统计肺癌患者不同病理类型、不同临床分期发生骨转移的几率,将全身骨显像与可疑骨转移临床因素(包括骨痛、碱性磷酸酶升高、高钙血症中任意一项或几项)诊断骨转移

  13. Diagnosing oceanic nutrient deficiency

    Science.gov (United States)

    Moore, C. Mark

    2016-11-01

    The supply of a range of nutrient elements to surface waters is an important driver of oceanic production and the subsequent linked cycling of the nutrients and carbon. Relative deficiencies of different nutrients with respect to biological requirements, within both surface and internal water masses, can be both a key indicator and driver of the potential for these nutrients to become limiting for the production of new organic material in the upper ocean. The availability of high-quality, full-depth and global-scale datasets on the concentrations of a wide range of both macro- and micro-nutrients produced through the international GEOTRACES programme provides the potential for estimation of multi-element deficiencies at unprecedented scales. Resultant coherent large-scale patterns in diagnosed deficiency can be linked to the interacting physical-chemical-biological processes which drive upper ocean nutrient biogeochemistry. Calculations of ranked deficiencies across multiple elements further highlight important remaining uncertainties in the stoichiometric plasticity of nutrient ratios within oceanic microbial systems and caveats with regards to linkages to upper ocean nutrient limitation. This article is part of the themed issue 'Biological and climatic impacts of ocean trace element chemistry'.

  14. Diagnosing mucopolysaccharidosis IVA

    NARCIS (Netherlands)

    T.C. Wood (Timothy); K. Harvey (Kirsten); M. Beck (Markus); M.G. Burin (Maira Graeff); Y.H. Chien; H.J. Church (Heather); V. D'Almeida (Vânia); O.P. van Diggelen (Otto); M. Fietz (Michael); R. Giugliani (Roberto); P. Harmatz (Paul); S.M. Hawley (Sara); W.L. Hwu; D. Ketteridge (David); Z. Lukacs; N. Miller (Nicola); M. Pasquali (Marzia); A. Schenone (Andrea); J.N. Thompson; K. Tylee (Karen); C. Yu (Cong); C. Hendriksz (Chris)

    2013-01-01

    textabstractMucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is an autosomal recessive lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) activity. Diagnosis can be challenging and requires agreement of clinical, radiographic, and labor

  15. Diagnosing chronic rhinosinusitis

    DEFF Research Database (Denmark)

    Lange, B; Thilsing, T; Baelum, J;

    2013-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the...

  16. The Clinical Value Discussion of Using CT to Diagnose Coronary Disease Which Caused Brain Tissue Lesions%应用CT诊断冠心病引起脑组织病变的临床价值探讨

    Institute of Scientific and Technical Information of China (English)

    王立莎

    2013-01-01

      目的:探讨CT诊断冠心病引起脑组织病变的临床应用价值。方法:将选取的100例冠心病引起脑组织病变患者按年龄分为老年组和非老年组,其中老年组54例,非老年组46例,采用CT对所有患者进行检查,观察其检查结果、两组的CT特点和所出现的临床表现。结果:CT检查显示局限性低密度区改变、豆状核边界不清、大脑中动脉区改变和双侧额极低密度改变等病灶非常明确,具有较高的阳性诊断率;非老年组患者CT检查显示的单侧脑组织病灶明显多于老年组,显示的多脑组织病灶则明显较老年组少,两组比较差异具有统计学意义(P<0.05);老年组中患者的构音障碍、偏瘫和意识障碍等明显较非老年组多见,而出现偏身感觉障碍、头晕和头痛等症状明显少于非老年组,差异均具有统计学意义(P均<0.05)。结论:常规CT扫描检查对于冠心病引起脑组织病变的患者的诊断具有比较重要的临床价值,与临床表现结合可对患者做出明确诊断。%Objectives:To discuss clinical application value of using CT to diagnose coronary disease which caused brain tissue lesions.Methods:Divided those 100 cases of coronary disease which caused brain tissue lesions patients into senile group and non-senile group according to their ages,senile group has 54 cases,while non-senile group has 46 cases,adopted CT to check up all of the patients,observed their inspection results,these two groups’ CT characteristics and their clinical features.Results:CT examination showed that change of limitations low density area,unclear boundary of lenticular nucleus, change of the brain artery area and change of bilateral forehead extremely low density these nidus were very clear,it has fairly high positive diagnosisi rate;Unilateral brain tissue focus which showed in non-senile group through the CT examination is obviously more than senile group

  17. Clinical Trials

    Science.gov (United States)

    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers ... prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  18. PET-CT在乳腺癌术前诊断与分期中的临床应用%The clinical application of PET-CT in preoperative diagnosing and staging for breast cancer

    Institute of Scientific and Technical Information of China (English)

    汪世存; 方雷; 潘博; 展凤麟; 谢强; 谢吉奎

    2011-01-01

    Aim To evaluate the clinical application of PET-CT in preoperative diagnosing and staging for breast cancer. Methods The 56 patients who were presumed by clinical manifestation and physical examination as breast cancer in our hospital underwent PET-CT examination which included primary breast lesion , area lymphaden and other organs of the whole body. After complete routine scanning , we should rescan breast by particular scanning mode and carry out PET projection collection and CT thin slice scanning. Then, both the results of PET-CT examination should be analyzed and contrasted with pathology results of after operation or paracentesis. Results There were 4 cases of Phase Ⅰ ,31 cases of phase Ⅱ .6 cases of phase Ⅲ were and 15 cases of phase Ⅳ in 56 patients. In the 35 cases of.there were 34 cases of Axillary lymph nodes metastasis .4 cases of homonymy internal mammary lymph nodes metastasis and 1 case of supraclavicular lymph nodes metastasis. Meanwhile.in the 21 cases of phase JII ancl lV .there were 8 cases of pulmonary metastasis.8 cases of hepatic metastasis , bony 11 cases of metastasis( including 5 cases of osteogenesis and 6 cases of mixed type) and 1 case of brain metastases.The pathology results of afteroperation or paracentesis can prompt that there were 2 cases of carcinoma in situ.21 cases of ductal carcinoma in situ with local micro invasion.33 cases of invasive ductal carcinoma and 31 cases of axillary lymph nodes metastasis( 31/34) . The diagnostic accuracy was 91. 2% . Conclusion PET-CT imaging has higher sensitivity and specificity in diagnosing breast cancer, especially in diagnosing area lymphaden and metastasis ,which can guide us to choose therapy way%目的 探讨PET-CT在乳腺癌术前诊断与分期中的临床价值.方法 对该院临床表现和体格检查提示为乳腺癌的56例患者行PET-CT检查,检查范围包括乳腺癌原发病灶、区域淋巴结及全身脏器;完成常规扫描后,再应用特殊的乳腺扫

  19. Clinical characteristics of 297 newly diagnosed Chinese HIV/AIDS patients%297例首次确诊的中国HIV/AIDS患者临床特征分析

    Institute of Scientific and Technical Information of China (English)

    曹玮; 宋晓璟; 李雁凌; 邱志峰; 谢静; 韩扬; 吕玮; 王焕玲; 范洪伟

    2014-01-01

    Objective To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS.Methods A total of 297 newly diagnosed HIV/ AIDS patients were enrolled in Peking Union Medical College Hospital (PUMCH) from January 2001 to December 2012,including 19 patients of primary phase,115 of asymptomatic phase and 163 of AIDS phase.Clinical characteristics of these patients were retrospectively analyzed.Results Two hundred and nineteen out of 297 patients reported clinical symptoms with variety.The main systemic symptoms included fever (100 cases,33.7%),weight loss (50 cases,16.8%) and fatigue (38 cases,12.8%).Organ involvement included mucocutaneous (67 cases,22.6%),respiratory (62 cases,20.9%),gastrointestinal (40 cases,13.5%) systems.Patients in AIDS phase were more symptomatic.Seventy-three out of 173 (42.2%) patients have been referred by 2 healthcare providers at least before the diagnosis of HIV infection was confirmed.Initial diagnoses were made in Departments of Infectious Diseases (36.9%),Gastroenterology (16.4%),and Emergency (13.7%).Opportunistic infections accounted for most AIDS defining conditions (ADC),including pneumocystis jiroveci pneumonia (PCP) (36 cases,22.1%),cytomegalovirus infection (25 cases,15.3%) and tuberculosis (22 cases,13.5%).Median peripheral CD4+ T lymphocyte count in patients with ADC were 36 cells/μl.Conclusions Common clinical presentations of HIV/AIDS included fever,weight loss,diarrhea,short of breath and mucocutaneous lesions.Opportunistic infections mainly affected respiratory and gastrointestinal system,with PCP the most common one.The diagnosis of HIV infection was delayed in most cases,suggesting that more efforts are required especially in universal education of clinicians and accurate viral detection.%目的 总结综合医院首次确诊HIV/AIDS患者的临床特征,以提高临床医生对HIV/AIDS患者的早

  20. Clinical application of three diamensions computed tomography angiography in diagnosing intracranial aneurysms%颅内动脉瘤三维计算机断层扫描血管造影的临床应用

    Institute of Scientific and Technical Information of China (English)

    董福仁; 张祥林; 王志铭; 雷振

    2013-01-01

    目的 探讨三维计算机断层扫描血管造影(3D-CTA)对颅内动脉瘤的临床诊断价值.方法 经普通CT诊断为蛛网膜下腔出血而高度怀疑颅内动脉瘤的患者38例,均行3D-CTA和DSA检查并同时获得CT三维图像;对颅内动脉显示情况、动脉瘤检出情况、动脉瘤与载瘤动脉及颅骨解剖关系进行回顾性分析.结果 与DSA一样,CTA图像可清晰显示颅内动脉主干及其分支.动脉瘤确诊患者35例,检出动脉瘤42个;其中,DSA检出动脉瘤40个,CTA检出动脉瘤41个.CTA对25个瘤颈形态及与载瘤血管三维立体结构清晰显示,DSA仅对8个动脉瘤颈清晰显示(P<0.05).结论 3D-CTA可以作为临床筛选诊断颅内动脉瘤的常规影像学检查方法,能够为临床治疗方案的选择提供参考依据.%Objective To investigate the diagnostic value of three-dimensional computed tomographic angiography (3D-CTA) in intracranial aneurysms. Methods 3D-CTA and digital subtraction angiography (DSA) examinations were performed in 38 patients with subarachnoid hemorrhage or highly suspected to be intracranial aneurysm diagnosed by CT. The 3DCT images from 3D-CTA and DSA were obtained. The manifestations of intracranial arteries, detection of intracranial aneurysm and relationship between aneurysm and parent artery or crinial bone were analyzed. Results CTA images showed the intracranial arterial trunk and branchs as clear as DSA A total of 42 intracranial aneurysms in 35 cases was diagnosed definitely, of which 40 aneurysms were detected by DSA and 41 aneurysms were detected by CTA. The appearance of aneurysm neck and stereochemical structure of 25 parent arteries were clearly showed by CTA, but the appearance of aneurysm neck was clearly showed only in 8 aneurysms by DSA(P<0. 05). Conclusion 3D-CTA can be used as a conventiobal radiological method to find aneurysms and reexamine them after surgery and may provide a reference for selecting the regime of clinical treatment.

  1. The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility

    DEFF Research Database (Denmark)

    Junge, Tina; Runge, Lisbeth; Juul-Kristensen, Birgit;

    2015-01-01

    /9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine...

  2. Clinical Analysis of 174 Infertility Patients Diagnosed and Treated Using a Combination of Laparoscopy and Hysteroscopy%腹、宫腔镜联合诊治不孕症174例临床分析

    Institute of Scientific and Technical Information of China (English)

    黄琼; 成伟大

    2012-01-01

    rate of 72. 94%. Conclusions The operation that combines laparoscopy and hysteroscopy enables obstetricians to visually and accurately understand the causes of infertility associated with pelvic cavity and uterus, fully assess the factors that lead to infertility, and diagnose and treat the disease. To summarize, hysteroscopy helps significantly increase the reliability and effect of treatment in complex hysteroscopy operations and hysteroscopy - guided interventional therapies. This approach can be widely used in clinical applications.

  3. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England

    Directory of Open Access Journals (Sweden)

    Wright F

    2012-10-01

    Full Text Available Abstract Background Electronic linkage to routine administrative datasets, such as the Hospital Episode Statistics (HES in England, is increasingly used in medical research. Relatively little is known about the reliability of HES diagnostic information for epidemiological studies. In the United Kingdom (UK, general practitioners hold comprehensive records for individuals relating to their primary, secondary and tertiary care. For a random sample of participants in a large UK cohort, we compared vascular disease diagnoses in HES and general practice records to assess agreement between the two sources. Methods Million Women Study participants with a HES record of hospital admission with vascular disease (ischaemic heart disease [ICD-10 codes I20-I25], cerebrovascular disease [G45, I60-I69] or venous thromboembolism [I26, I80-I82] between April 1st 1997 and March 31st 2005 were identified. In each broad diagnostic group and in women with no such HES diagnoses, a random sample of about a thousand women was selected for study. We asked each woman’s general practitioner to provide information on her history of vascular disease and this information was compared with the HES diagnosis record. Results Over 90% of study forms sent to general practitioners were returned and 88% of these contained analysable data. For the vast majority of study participants for whom information was available, diagnostic information from general practice and HES records was consistent. Overall, for 93% of women with a HES diagnosis of vascular disease, general practice records agreed with the HES diagnosis; and for 97% of women with no HES diagnosis of vascular disease, the general practitioner had no record of a diagnosis of vascular disease. For severe vascular disease, including myocardial infarction (I21-22, stroke, both overall (I60-64 and by subtype, and pulmonary embolism (I26, HES records appeared to be both reliable and complete. Conclusion Hospital admission data

  4. 四项免疫组化标志物在诊断甲状腺乳头状癌中的临床探讨%The Clinical Application of Diagnosing Papillary Thyroid Carcinoma by Four Items Immunohistochemical Markers

    Institute of Scientific and Technical Information of China (English)

    陈桂军; 董征

    2015-01-01

    Objective To approach expression of diagnosing papillary thyroid carcinoma by four items immunohistochemical markers.Method The 50 cases clinical data of papillary thyroid carcinoma patients in the center hospita of jinzhoul from February 2010 to March 2014, which was detection group. the benign thyroid nodules 200 cases were selected, which was to be control group.Result The Ki67, TTF-1, HBME-1 and HER-2/neu positive rate dection group were higher than control group,P<0.05, the difference statistical signiifcance. The sensitivity of the diagnosis of thyroid papillary carcinoma of HER-2/neu was 92%, speciifcity of TTF-1 was 96%.Conclusion Thyroid papillary carcinoma accuracy of HER-2/neu and TTF-1 are improved, which is to be used.%目的:探讨四项免疫组化标志物在诊断甲状腺乳头状癌中的表达情况。方法分析锦州市中心医院2010年2月至2014年3月收治的甲状腺乳头状癌患者50例临床资料,作为观察组,选取同期良性甲状腺结节患者200例作为对照组。结果观察组Ki67、TTF-1、HBME-1和HER-2/neu阳性率明显高于对照组,P<0.05,差异均有统计学意义。HER-2/neu诊断甲状腺乳头状癌的敏感性最高92%, TTF-1特异性最高96%。结论 HER-2/neu联合TTF-1可能明显的提高诊断甲状腺乳头状癌准确率,值得临床推广应用。

  5. Clinical value of high-frequency color Doppler ultrasound in diagnosing perianal abscess and anal fistula%高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

    Institute of Scientific and Technical Information of China (English)

    董愉

    2012-01-01

    目的 探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值.方法 使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照.结果 肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%.结论 高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受.%Objective To study the clinical value of high-frequency coloc Doppler ultrasound in diagnosing perianal abscess and a-nal fistula. Methods Ninety cases of perianal abscess or anal fistula were inspected by high-frequency color Doppler ultrasound. The inspection results were compared with surgical findings. Results There were significantly differences in the sonogram between the tissue with perianal abscess or anal fistula and surrounding normal tissues. The diagnostic specificity of perianal abscess and the positive predictive value were 100% , the sensitivity was 94. 3% ; the diagnostic specificity of anal fistula the positive predictive value were 95.1% and 95.5% , the sensitivity was 85.7%. Conclusion High-frequency color Doppler ultrasound can ascertain the location, size, number and extent of perianal abscess and clearly estimate the trend and number of anal fistula, and it is simple, direct, painless, with high diagnostic accuracy, easily be accepted by patients.

  6. Clinical Study of Whole Body Diffusion-Weighted Imaging in Diagnosing Bone Metastasis of Malignant Tumors%全身弥散加权成像对恶性肿瘤骨转移的临床应用

    Institute of Scientific and Technical Information of China (English)

    牛磊; 朱斌; 崔文; 朱蒙蒙; 王明浩; 刘圆圆; 尤传文

    2011-01-01

    Objective To investigate the clinical value of whole body MR diffusion weighted imaging(WB-DWI) in diagnosis of bone metastases in patients with malignant tumors. Methods Totally 62 patients with malignant tumors and suspected bone metastases were enrolled. All patients underwent WB-DWI and bone scintigraphy within 2 weeks. The skeletal system included 10 regions:skull , cervical spine , thoracic spine , lumbar spine , sacrum, rib , scapula , pelvic bone and femur. Hot spots or cold spots on bone scintigraphic images and hyperintensity on WB-DWI were considered as metastatic foci. The numbers of foci detected by borh scintigraphy and MR imaging were compared. Results In 62 cases,362 and 281 pathological lesions were detected by bone scintigraphy and WB-DWI, respectively. More metastases of lymph nodes and extraskeletal organs were found with WB-DWI compared with that of scintigraphy. Conclusion WB-DWI is of significant value in diagnosing bone metastasis,it combined with skeletal scintigraphy can gain more informations in dewecting bone metastases.%目的 研究全身弥散加权成像(WBDWI)对恶性肿瘤远处骨转移的临床应用.方法 62例经病理证实的恶性肿瘤患者,均在2周内分别行WBDWI及核素骨显像.将骨骼分为10个部位分析,分别为颅骨、胸骨、颈椎、胸椎、腰椎、骶椎、肋骨、肩胛骨、骨盆、股骨.以核素骨显像见异常浓聚灶或稀疏灶,WBDWI见高信号为阳性,分析比较两者所显示的病灶数.结果 62例患者中,WBDWI显示362处病灶,核素骨显像显示281处病灶.WBDWI可以发现更多的骨外器官及淋巴结的病变.结论 WBDWI对骨转移具有很好的诊断价值,可以与核素骨显像互相补充,为临床提供更加全面的信息.

  7. How to diagnose autism.

    Science.gov (United States)

    Dover, Clare J; Le Couteur, Ann

    2007-06-01

    Over the past two decades, there has been an explosion of interest in autism and autism spectrum disorders. Knowledge and awareness of the condition has grown exponentially at all levels among the general public, parents, health professionals, the research community and, more recently, at parliamentary level. Alongside the increased understanding of these complex and disabling conditions is the acknowledgment of a broadening of the diagnostic criteria away from a narrow definition of autism to the autism spectrum with less clear diagnostic boundaries. Growing evidence of the importance of early diagnosis and intervention demands knowledge and skills from all professionals working with young children and in particular those involved in recognising early concerns about a child's development. This article outlines current clinical and research findings in relation to early diagnosis and considers the role of the paediatrician in this process. Reference is also made to the National Autism Plan for Children.

  8. How Is Aplastic Anemia Diagnosed?

    Science.gov (United States)

    ... from the NHLBI on Twitter. How Is Aplastic Anemia Diagnosed? Your doctor will diagnose aplastic anemia based on your medical and family histories, a ... your primary care doctor thinks you have aplastic anemia, he or she may refer you to a ...

  9. Analysis on clinical characteristics and nutriture in children with digestive diseases diagnosed by gastroscope inspection%胃镜检查诊断消化道疾病儿童临床特征与营养状况分析

    Institute of Scientific and Technical Information of China (English)

    陈光华; 黎海芪

    2011-01-01

    目的 分析胃镜检查诊断为消化道疾病的6~18岁儿童的临床表现、胃镜结果与营养状况关系.方法 以2010年8月至2011年1月在重庆医科大学附属儿童医院内镜中心行胃镜检查的儿童为研究对象,进行问卷调查,测量体格生长指标(身高和体重),分析临床表现和胃镜检查结果,参照WHO 2007年制定的"儿童生长标准"评价胃镜检查诊断为消化道疾病儿童的营养状况.结果 研究期间431例儿童行胃镜检查,排除资料不完整者25例,406例(94.2%)进入分析,其中6~12岁313例,~18岁93例.①244例以慢性反复性腹痛为主诉,病程多在1年以上;急性腹痛就诊59例,以进食后早饱、食欲不振就诊40例;以进食后恶心、呕吐就诊15例.②389/406例(95.8%)胃镜检查结果异常,其中73.3%(285例)为慢性胃炎,十二指肠、食管和急性胃黏膜病变检出率分别为78例(20.1%)、11例(2.8%)和8例(2.1%).③389例胃镜检查结果异常儿童BMI呈偏态分布;胃部病变、十二指肠病变、食管病变儿童BMI<P5分别占23.7%(71/300例)、16.7%(13/78例)和9.1%(1/11例);在BMI<P5的67例慢性胃炎患儿中,HP相关性慢性胃炎占38.8%(26/67例).④胃镜检查结果异常的243/389例慢性腹痛儿童中,40例(16.5%)BMI<P5;58/389例急性腹痛儿童中,1例(1.7%)BMI<P5;39/389例以"消瘦"为主诉就诊的儿童中,38例(97.4%)BMI<P5.结论 上消化道疾病儿童体型消瘦的比例较高.慢性腹痛、无明原因的体重减轻或消瘦等症状的学龄儿童和青少年需除外慢性上消化道疾病.%Objective To analyze the clinical characteristics and nutriture in gastroscope inspection in 406 children and adolescents diagnosed as digestive diseases. Methods Medical histories and the results of gastroscope inspection were collected in the endoscopy center, Children's Hospital of Chongqing Medical University from August 2010 to January 2011. The questionnaire investigation was performed. The

  10. Diagnosing Autism Spectrum Disorder: Who Will Get a DSM-5 Diagnosis?

    Science.gov (United States)

    Kent, Rachel G.; Carrington, Sarah J.; Le Couteur, Ann; Gould, Judith; Wing, Lorna; Maljaars, Jarymke; Noens, Ilse; Berckelaer-Onnes, Ina; Leekam, Susan R.

    2013-01-01

    Background: Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD- 10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new…

  11. Are Pediatricians Diagnosing Obese Children?

    Science.gov (United States)

    Thomas, Katharine; Urrego, Fernando

    2017-01-01

    Background: Pediatric obesity is the most prevalent nutritional disorder in American children. The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting. The primary purpose of this study was to determine if pediatricians at one pediatrics clinic in the Ochsner Health System are documenting the presence of an overweight or obese body mass index (BMI) as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System to be used for program development. Methods: A retrospective medical record review was conducted. Records from April 1, 2012 to April 1, 2016, were reviewed for the presence of the diagnosis of BMI classified as obese or overweight. Results: We analyzed a total of 175,066 records in this study. Of these records, 1.32% documented a diagnosis of obesity, and 0.5% documented a BMI score indicating overweight. The percentages of patient visits that met the Centers for Disease Control and Prevention criteria to be classified as obese or overweight were 28.66% and 30.41%, respectively. The majority of our pediatric patients were male (51.76%), white (43.31%), and 5-12 years old (43.80%). Conclusion: This study demonstrates that pediatricians at Ochsner Health Center for Children are not diagnosing patients who have unhealthy BMI scores as overweight or obese. Interventions are needed to increase the identification of children who may benefit from receiving resources that encourage a healthy lifestyle and optimal weight maintenance. PMID:28331453

  12. [Dysthymia and cyclothymia--serious consequences of rarely diagnosed disorders].

    Science.gov (United States)

    Brieger, P; Marneros, A

    1998-12-01

    Dysthymia and cyclothymia are chronic affective disorders with a minimum duration of 2 years. Both ICD-10 and DSM-IV define cyclothymia as a bipolar disorder with low intensity. This disorder is rare and little research has been done on it. Its economic and social consequences vary from case to case. In contrast dysthymias, chronic depressive disorders, are frequent (prevalence 3-6%) and cause considerable distress. They have serious economic and social consequences, which are comparable to those caused by other chronic conditions such as arthritis or diabetes mellitus. Despite widely held conviction a majority of dysthymias improves under consequent pharmaco- and psychotherapy.

  13. Psychiatric diagnoses in legal systems: an issue of validity.

    Science.gov (United States)

    Mellsop, Graham W; Diesfel, Kate

    2011-12-01

    When considering psychiatric evidence, justice systems from many countries are frequently presented with diagnostic labels from official psychiatric classificatory systems. A lack of validity in much of these classificatory systems is receiving increasing attention. Illustrative examples include post-traumatic stress disorder, various personality disorders and dissociative identity disorder. The courts and review bodies from many jurisdictions place tremendous faith in the present categorical classifications (e.g., DSMIV and ICD10). This paper questions whether the reliance on these classifications systems is appropriate in legal proceedings.

  14. Comparison of clinical diagnoses of BK virus-associated nephropathy in renal transplant recipients%肾移植后BK病毒相关性肾病的临床诊断方法的比较

    Institute of Scientific and Technical Information of China (English)

    黄刚; 董愉; 梁先维; 王长希; 费继光; 邓素雄; 邱江; 李军; 陈国栋

    2013-01-01

    目的 探讨肾移植后BK病毒相关性肾病(BKVAN)的临床诊断特点及无创检测对于预测不同病理分期BKVAN的临床意义.方法 选择2006年1月至2013年8月接受移植肾穿刺活检的479例肾移植受者,进行尿沉渣Decoy细胞计数;同时检测尿、血标本中BK病毒DNA含量.并且运用常规病理染色、免疫组织化学染色的方法检查移植肾组织,确定BKVAN的诊断,并进行BKVAN病理分期.比较不同的诊断方法预测不同病理分期BKVAN的临床意义.结果 479例受者中共诊断BKVAN 39例,发生率为8.1%(39/479),其中BKVAN A期9例,B期25例,C期5例.免疫抑制方案均为他克莫司+吗替麦考酚酯+皮质激素.确诊时血肌酐水平出现不同程度上升(平均为194.9 μmol/L),尿比重降低(平均为1.007),34例受者尿蛋白阴性.BKVAN组的尿沉渣Decoy细胞阳性率、BK病毒尿症、BK病毒血症及BK病毒DNA阳性率均高于非BKVAN组(P<0.05).尿Decoy细胞预测BKVAN的阴性预测值为0.949,敏感度为0.995,均最高;BK病毒血症预测BKVAN的阳性预测值为0.770,特异性为0.977,均最高.三项筛查指标预测BKVAN B期的敏感性、特异性、阳性预测值、阴性预测值最高.结论 尿沉渣细胞学结合BK病毒DNA的血、尿检测,并注意观察肾移植受者常规随访检查的细节,可以及时发现移植肾BKVAN.%Objective To investigate the clinical diagnoses of BK virus-associated nephropathy (BKVAN) and estimate the utility of screening methods for BKVAN in different patterns.Method We used three screening methods for BKVAN including quantitative PCR assay for BKV DNA load in urine and plasma,and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 479 patients.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry,and classified into three categories of BKVAN.These three screening methods were compared for prediction of

  15. How Is Thyroid Cancer Diagnosed?

    Science.gov (United States)

    ... Cancer Early Detection, Diagnosis, and Staging Tests for Thyroid Cancer Thyroid cancer may be diagnosed after a person ... Health Care Team About Thyroid Cancer? More In Thyroid Cancer About Thyroid Cancer Causes, Risk Factors, and Prevention ...

  16. How Is Marfan Syndrome Diagnosed?

    Science.gov (United States)

    ... common in many people. Doctors use a scoring system based on the number and type of Ghent criteria present to diagnose Marfan syndrome. Talk ... National Institutes of Health Department of Health and Human Services USA.gov

  17. How to diagnose cardiac tamponade

    NARCIS (Netherlands)

    van Steijn, JHM; Sleijfer, DT; van der Graaf, WTA; van der Sluis, A; Nieboer, P

    2002-01-01

    Malignant pericardial effusion is a potentially fatal complication of malignancy unless recognised and treated promptly. Patients with this condition are often difficult to diagnose. Physical examination, chest radiography and electrocardiography have poor diagnostic values in identification of pati

  18. How Is Stomach Cancer Diagnosed?

    Science.gov (United States)

    ... Cancer Early Detection, Diagnosis, and Staging How Is Stomach Cancer Diagnosed? Stomach cancers are usually found when a ... Ask Your Doctor About Stomach Cancer? More In Stomach Cancer About Stomach Cancer Causes, Risk Factors, and Prevention ...

  19. How Is Ovarian Cancer Diagnosed?

    Science.gov (United States)

    ... Cancer Early Detection, Diagnosis, and Staging How Is Ovarian Cancer Diagnosed? If you have symptoms of ovarian cancer ... Ask Your Doctor About Ovarian Cancer? More In Ovarian Cancer About Ovarian Cancer Causes, Risk Factors, and Prevention ...

  20. 64排螺旋CT对先天性主动脉缩窄诊断的临床应用价值%Clinical Application of 64-slice Spiral CT Angiography in Diagnosing the Congenital Coarctation of Aorta

    Institute of Scientific and Technical Information of China (English)

    王小红; 亓波

    2011-01-01

    Objective To evaluate the clinical diagnostic valie of 64-slice spiral CT angiography (CTA )in coarctation of aorta (CoA).M ethods 154 caseswith coarciation of the aorta(47 women and 107 men;mean age3 .3 years;age range 20 days-60 years) were diagnosed by by 64-slfce spiral CT angiDgraphy (CTA ) and translhoracic echocardiography (TTE ) ,and 77 of than were treated by operation .Results In the operative 77 cases ,17 m issed by TTE and no case missed by CTA .The definite diagnosis rate of TTE was 77 .9% ,and the definite diagnosis rate of CTA was 100% .Among 154 cases,44 cases (28 .6% ) were staple aortic coarctation , 95 cases(61.7% )were pediatric pcmpfex portic coarctation and 15 cases(9 .7% ) were atypicalpomplex portic coarctation .therewere significant differences bete een year of three types CoA ( P<0 .001) .The m ean stenotic ratio (the diam eterof the ooarctatbn to thatofthe proxinalnomalsegnentof the aortic ooarctation )R = 0 .29+0 .13 .Conclusion MDCT examhation is able to clearly display type,scope,extent and can plicated m alform ations ,can provide in portent infem ation for the diagnosis and teatn ent of aortic ooaictetian.%目的 评价64排螺旋CT(MDCT)在主动脉缩窄临床诊断中的价值.方法 154例主动脉缩窄患者,男性107例,女性47例,年龄20天-60岁,平均3.3岁,均采用64排螺旋CT血管成像扫描和经胸心脏超声检查.结果 77例经手术证实CoA病例中,超声心动图检查55例明确诊断,5例诊断可疑,17例漏诊,准确率为77.9%(60/77),MDCT均明确诊断,准确率为100%(77/77).154例主动脉缩窄患者中,单纯型44例(28.6%),复杂婴儿型95例(61.7%),复杂不典型型15例(9.7%);其中局限性缩窄91例(59.1%),管性缩窄63例(40.9%),3种类型的CoA在年龄分布上存在着显著性差异(K-W统计值为22.9,P<0.001).MDCT测量最窄处内径与主肺动脉水平升主动脉内径比值R为0.29±0.13.结论 CTA能够全面显示主动脉缩窄的类型、范围程度及伴随畸形,能

  1. The Investigation of First Diagnosed Case and Analysis of Clinical Characteristics of Adolescent Depression%青少年抑郁症的首诊状况调查与临床特征分析

    Institute of Scientific and Technical Information of China (English)

    程道猛; 刘靖雯; 黄鹏; 徐世超; 王春江

    2013-01-01

    Objective :To investigate first diagnosed Case and clinical characteristics of adolescent Depression ,and to provide a reference for the early diagnosis .Methods :Make a retrospective analysis of 115 adolescent depression data ,all patients were judged by Depression Rating Scale (HAMD) and Homemade somatic symptoms questionnaire .Results:(1) 33 adolescents depression went to psychiatric when initial outbreak ,accounting for 28 .70% in 115 adolescents de-pression ;the other 82 adolescents depression went to non-psychiatric treatment when initial outbreak ,accounting for 71 .30% in 115 adolescents depression ;(2)82 adolescents depression which went to non-psychiatric treatment were misdiagnosed as autonomic dysfunction ,nervous headache;(3) all adolescents depression had physical discomfort ,11 patients (9 .57% ) had ≤ 11 somatic symptoms ,104 patients (90 .43% ) had > 11 somatic symptoms .Conclusion:The main symptoms of adolescent depression are somatic symptoms ,most adolescent depression go to non-psychiatric treat-ment when initial outbreak ,have high misdiagnosis rate and missed rate ,doctor should strengthen and enhance under-standing of somatic symptoms of adolescents depression ,take timely and reasonable scientific treatment ,improve clini-cian recognition rate ,diagnosis rate ,treatment rates .%  目的:调查分析青少年抑郁症的首诊状况与临床特征,为早期诊断提供借鉴。方法:回顾分析我院就诊的115例青少年抑郁症患者的临床资料,所有患者均采用密尔顿抑郁量表(HAMD)和自制躯体症状调查表进行评定。结果:(1)115例青少年抑郁患者中初次发病就到精神专科就诊者33例(28.70%),其他82例(71.30%)均为到非精神科就诊;(2)82例在非精神专科就诊患者主要被误诊为植物神经功能紊乱、神经性头痛;(3)所有患者就诊时均有躯体不适的突出主诉,11例(9.57%)患者伴有≤11

  2. [Attention deficit syndrome in adults: clinical, psychophysiological features and treatment].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Iu; Iakovenko, E A; Nikishena, I S; Anisimova, T I

    2013-01-01

    The authors present the results of examination of 34 patients, aged from 18 to 30 years, with attention deficit hyperactivity disorder (ADHD) (ICD-10 item F90.0). The study has shown that inattentive type of ADHD is noted in 50%, combined type in 38.3% and hyperactivity/impulsivity type in 11.7% of patients. Adult patients with ADHD also have a high level of anxiety and asthenic disorders. This study evaluated the efficacy and safety of adaptol in dosage 1500 mg daily during 8 weeks in the treatment of this group of patients. The high efficacy (improvement in 64,7% of cases) and safety of adaptol confirmed by the data of clinical, psychological and neurophysiological studies.

  3. Occurrence of ADHD in parents of ADHD children in a clinical sample

    Directory of Open Access Journals (Sweden)

    Starck M

    2016-03-01

    Full Text Available Martina Starck,1 Julia Grünwald,1 Angelika A Schlarb1,21Faculty of Science, Department of Psychology, University of Tuebingen, Tuebingen, 2Department of Psychology, Faculty for Psychology and Sport Science, University of Bielefeld, Bielefeld, GermanyBackground: Despite the fact that there is a large amount of research on childhood attention deficit hyperactivity disorder (ADHD treatment and an increasing amount of research on adult ADHD, little is known about the prevalence and influence of parental ADHD. Therefore, this study examined the frequency of parental ADHD in a clinical sample of German children suffering from ADHD. We also tried to find different levels of symptom severity for prognostic relevance. Furthermore, the association between subtypes of ADHD in children and their parents was investigated.Method: In this study, parents of 79 ADHD children were screened for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition and International Classification of Diseases, 10th edition. The Wender Utah Rating Scale and the ADHS-Self-Report were given to 75 mothers and 49 fathers for retrospective and current symptoms. Frequency of ADHD symptoms and severity groups was calculated and relationship between parental and children’s ADHD was tested.Results: ADHD occurrence for mothers of children with ADHD was 41.3%, for fathers 51.0%. About 16.0% of the mothers had a mixed type, 9.3% had a hyperactive-impulsive subtype, and 16.0% had an inattentive subtype. Of the fathers, 18.4% had a mixed type, 10.2% had a hyperactive-impulsive subtype, and 22.4% had an inattentive subtype; 61% of the mothers and 46.9% of the fathers had low symptom severity. Medium symptom severity was reported by 37.7% mothers and 46.9% fathers, while 1.3% of the mothers and 6.2% of the fathers showed severe symptoms. No significant correlation between parental and child diagnoses was observed.Conclusion: As nearly half of the parents

  4. Nursing diagnoses in patients with chronic venous ulcer: observational study

    Directory of Open Access Journals (Sweden)

    Glycia de Almeida Nogueira

    2015-06-01

    Full Text Available This study aimed to analyze nursing diagnoses in people with chronic venous ulcer. An observational, descriptive, quantitative research conducted in an ambulatory specialized in wound treatment, with a non-probabilistic sample of 20 patients.  Data collection was performed in an institutional form denominated Assessment Protocol for Clients with Tissue Lesions. Diagnoses were established by consensus among four researchers with experience in nursing diagnoses and wound treatments. From data analysis, 16 diagnoses were identified, with 100% of participants presenting: Impaired tissue integrity, Ineffective peripheral tissue perfusion, Risk of infection, Impaired physical mobility and Ineffective health self-control. These diagnoses are found in Safety/Protection, Activity/Rest and Health promotion domains, which from the clinical practice stand point should be priority focuses in nursing intervention and assessment.

  5. 循证医学在治疗多囊卵巢综合征中的应用%Evidence-based Clinical Treatment for a Infertile Patient Diagnosed with Polycystic Ovary Syndrome

    Institute of Scientific and Technical Information of China (English)

    蔡召忠; 徐华; 连玉红; 魏娟; 瞿萍; 邓守恒

    2011-01-01

    采用循证治疗的方法为1例已婚未育PCOS患者制定合理的治疗方案,有效提高了治疗疗效和妊娠率.%We take an individualized evidence-based treatment for infertile patients diagnosed with polycystic ovary syndrome. The results showed that treatment efficacy and pregnancy rate had been significantly improved.

  6. 基于人工神经网络与人工智能的计算机系统在儿童心理障碍诊断领域的应用%Application of computer system based on artificial neural network and artificial intelligence in diagnosing child mental health disorders

    Institute of Scientific and Technical Information of China (English)

    陈冰梅; 樊晓平; 周志明; 李雪荣

    2011-01-01

    BACKGROUND: It is not a report concerning utilization of artificial intelligence combined with artificial neural network in mental health domain, rather than that combining artificial intelligence, artificial neural network and simulating human brain thinking mode for diagnosing child mental health disorders. OBJECTIVE: Using computer to simulate thinking modes of human brain, to establish an artificial intelligence expert system for diagnosis and treatment of child mental health disorders based on artificial neural network and expert system.METHODS: The expert system involves in child psychiatry, child psychology, psychological measurement, psychological therapy, and computer science, and so on. The diagnosis system combines the diagnosis standard of ICD 10, DSM IV, CCMD-2, the epidemiological data, and the clinical data with senior psychiatrist knowledge. The clinical data were obtained from 14 epidemiological and outpatient department, and 1 125 valid data were harvested for the system compilation.RESULTS AND CONCLUSION: The system can diagnose 61 kinds of child mental health disorders. It includes more than 95% child mental health disorders. After diagnosis, the computer will give a treatment suggestion. Comparing the diagnosis by computer with diagnosis by the senior child psychiatrists, the consistent rate is 99%. The research can help the younger doctors to learn abundant clinical experiences of senior child psychiatrists and can help children of mental health disorders throughout the country.%背景:将人工智能和人工神经网络二者相结合应用于精神卫生领域的文献在国内外还未见报道,更未见将人工神经网络与人工智能相结合用于模拟人类医学专家大脑诊断思维模式诊断儿童心理障碍的相关报道.目的:用计算机模拟人脑诊断思维模式,建立一套基于人工神经网络与专家系统的儿童心理障碍标准化诊断与防治的人工智能专家系统.方法:儿童心理障碍

  7. 新诊断酮症起病糖尿病临床特征及初步分型探讨%Clinical characteristics and primary classification for newly diagnosed ketosis-onset diabetes

    Institute of Scientific and Technical Information of China (English)

    范元硕; 时立新; 罗建华; 于瑞萍; 刘波; 龙本丹

    2011-01-01

    Objective To investigate the clinical characteristics and primary classification of newly diagnosed ketosis-onset diabetes.Methods Based on the presence or absence of islet autoantibodies (A + or A - ) and of β - cell functional reserve ( β + or β - ),86 patients with newly diagnosed ketosis-onset diabetes from July 2008 to August 2009 were divided into 4 groups:A + β -,A + β +,A - β - and A - β + group.Clinical characteristics,including gender,age,presence of metabolic syndrome,body mass index,random blood glucose,glycosylated hemoglobin,β hydroxybutyric acid and C-peptide levels,et al,were compared among the 4 groups.Analysis of variance was used for statistic analysis.Results Therewere 15 cases in A + β - group( 17.4%,male 9,female 6),5 cases in group A + β + (5.8%,male 3,female 2),27 cases in group A - β - (31.4%,male 20,female 7 ) and 39 cases in group A - β + (45.4%,male 26,female 13),respectively.Group A + β - had obviously lower age,body mass index,waist circumference and carbon dioxide combining power than those in group A + β +,A - β - and A - β +( age:( 24 ± 12 ) vs ( 44 ± 13 ),( 43 ± 13 ) and ( 54 t 17 ) years,respectively,all P < 0.05 ; body massindex:( 18 ± 3 ) vs ( 22 ± 3 ),( 22 ± 3 ) and ( 24 ± 4 ) kg/m2,respectively,all P < 0.05 ; waist circumference:(69 ± 12) vs (82 ±5),(81 ±9) and (86 ± 10) cm,respectively,all P<0.05; carbon dioxide combining power:(12±7) vs (20±4),(19 ±7) and (21±4) mmol/L,respectively,all P< 0.05 ).Random blood glucose and β hydroxybutyric acid levels in group A + β - were obviously higher than those in group A + β +,A - β - and A - β + ( random blood glucose:( 32 ± 9) vs ( 19 ± 3 ),( 25 ± 9 ) and ( 23 ± 6) mmol/L,respectively,all P < 0.05 ; 3 hydroxybutyric acid:4.80 ( 1.74 - 14.03 ) vs 0.79 ( 0.41-3.37 ),1.34 ( 0.33-15.75 ) and 0.80 ( 0.31-8.27 ) mmol/L,respectively,all P < 0.05 ).Group A - β - had obviously lower age and body mass index than those in group A -

  8. Nursing diagnoses in overweight adolescents

    Directory of Open Access Journals (Sweden)

    Raphaela Santos do Nascimento Rodrigues

    2013-05-01

    Full Text Available This study aimed to identify nursing diagnoses in overweight adolescents from public schools, according to the International Classification for Nursing Practice. A population-based cross-sectional study that investigated the socio-demographic, behavioural and psychological characteristics of adolescents aged from 10 to 14 years. 11 nursing diagnoses were identified: "Risk of overweight", "Risk of impaired adolescent development", "Risk of insecurity in parental role performance", "Risk of the family impaired ability to manage diet regime", "Risk of impaired ability to manage diet regime", "Risk of lack of knowledge of dietary regime", "Risk of excess food intake", "Risk of negative self-image", "Risk of low self-esteem", "Risk of impaired social well-being" and "Impaired exercise pattern". These diagnoses reflect the multifactorial nature of obesity, highlighting the need for interdisciplinary and intersectoral articulation of nursing interventions for prevention and control of overweight.

  9. 神经性厌食症27例临床分析%ANOREXIA NERVOSA: CLINICAL ANALYSIS OF 27 CASES

    Institute of Scientific and Technical Information of China (English)

    席巧真; 刘小翠; 刘珊; 田博

    2011-01-01

    目的 探讨神经性厌食症(AN)病人的临床特点.方法 将符合国际疾病分类第10版(ICD-10)AN诊断标准的27例病人的临床资料进行分析.结果 AN以女性较多,惧怕肥胖是AN病人病态心理的核心;AN病人的躯体损害明显,社会功能损害严重.结论 AN不仅有躯体损害,而且伴有精神症状,应引起重视.%Objective To study the clinical features of patients with anorexia nervosa (AN).Methods The clinical data of 27 AN patients who met the criteria of the 10th Revision of International Classification of Diseases (ICD-10) were analyzed.Results More AN patients were female, fear of obesity being the core of their patienthood.The damage of their body and social activities were obvious.Conclusion AN presents have not only physical damage but also psychotic symptoms, a attention should be paid to this condition.

  10. Immunological methods for diagnosing neurocysticercosis

    Energy Technology Data Exchange (ETDEWEB)

    Kuhn, R.E.; Estrada, J.J.; Grogl, M.

    1989-01-31

    A method is described for diagnosing active human neurocysticercosis by detecting the presence of at least one Taenia solium larval antigen in cerebrospinal fluid, which comprises: contacting cerebrospinal fluid from a human to be diagnosed with a solid support, wherein the support binds with a Taenia solium larval antigen if present, contacting the support with a first antibody, wherein the first antibody binds with a larval Taenia solium antigen if present in the cerebrospinal fluid, contacting the solid support with a detectable second antibody which will bind with the first antibody, and detecting the second antibody bound to the support.

  11. 国际医师会诊网络系统在眼病诊断及治疗中的应用%Application and clinical significance of International Physician Referral Network in diagnosing and treating ocular diseases

    Institute of Scientific and Technical Information of China (English)

    赵宏; 王瑞峰; 李彩红; 周芳; 赵晓金; 田思佳

    2016-01-01

    Objective To discuss clinical application and significance of International Physician Referral Network(IPRN) in diagnosing and treating ocular diseases.Methods A total of 318 cases from March 2014 to September 2015 were enrolled in this study.All detailed data were transmitted to the center for Fundus Diseases Control and Prevention in Kansas for discussion about the diagnosis and the opinion of treatment and surgery.Results Among the 318 cases,there were 48 cases of proliferative diabetic retinopathy,42 cases of age related macular degeneration,39 cases of refractory glaucoma,35 cases of familial exudative vitreoretionpathy,22 cases of panuveitis,20 cases of optic neuroretinopathy,19 cases of external exudative retinopathy,15 cases of retinal vein occlusion,15 cases of retinopathy in high myopic eyes,14 cases of cytomegalovirus retinitis,13 cases of congenital coloboma of choroid,11 cases of retinoschisis,8 cases of central retinal arteral occlusion,5 cases of retinal cysticercosis,3 cases of acute evanescent white dots syndrome,3 cases of melanoma of choroid,2 cases of retinal racemose angioma,2 cases of retinal maeroaneurysm,1 ease of diffuse choroid atrophy,and 1 ease of melanocytoma of the optic disc.The feedback diagnosis was identical with that of us in 292 cases,the corresponding rate of diagnosis was 91.82% (292/318).The 25 G vitrectomy was performed in 42 patients with diabetic retinopathy,5 patients with retinal cysticercosis,and 4 patients with retinal detachment caused by cytomegalovirus retinitis.12 patients with age related macular degeneration received intravitreal ranibizumab,patients with refractory glaucoma had glaucoma filtration device implantation.All the proposed treatment methods,except some very special drugs therapy,were adopted by our hospital.Conclusion A new work mode of medical diagnosis is started by telemedicine consultation and cooperation over international medical resources in China,which deserves further exploration and

  12. Postnatal Treatment in Antenatally Diagnosed Meconium Peritonitis.

    Science.gov (United States)

    Ionescu, S; Andrei, B; Oancea, M; Licsandru, E; Ivanov, M; Marcu, V; Popa-Stanila, R; Mocanu, M

    2015-01-01

    Meconium peritonitis is a rare prenatal disease with an increased rate of morbidity and mortality in the neonatal period. Distinctive features revealed by prenatal and postnatal ultrasoundmay be present: abdominal calcifications, ascites, polyhydramnios, meconium pseudocyst, echogenic mass and dilated bowel or intestinal obstruction. Establishing clear postnatal treatment and prognosis is difficult because of the heterogeneity of the results obtained by ultrasound. The aim of the study is to determine how prenatal diagnosis of meconium peritonitis is associated with perinatal management and further evolution. Clinical results are different depending on the presence of antenatal diagnosis of meconium peritonitis and its form, which can be mild or severe. Surgical treatment and management of meconium peritonitis depend on the clinical presentation of the newborn. Meconium peritonitis diagnosed prenatally differs from that of the newborn, not only concerning the mortality rates but also through reduced morbidity and overall better prognosis.

  13. Knowledge and Lifestyle-Associated Prevalence of Obesity among Newly Diagnosed Type II Diabetes Mellitus Patients Attending Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Hospital-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Yaa Obirikorang

    2016-01-01

    Full Text Available This study aimed to determine the knowledge and prevalence of obesity among Ghanaian newly diagnosed type 2 diabetics. This cross-sectional study was conducted among diagnosed type 2 diabetics. Structured questionnaire was used to obtain data. Anthropometric measurements and fasting blood sugar levels were also assessed. Participants had adequate knowledge about the general concept of obesity (72.0% and method of weight measurement (98.6% but were less knowledgeable of ideal body weight (4.2%. The commonly known cause, complication, and management of obesity were poor diet (76.9%, hypertension (81.8%, and diet modification (86.7%, respectively. The anthropometric measures were higher among females compared to males. Prevalence of obesity was 61.3% according to WHR classification, 40.8% according to WHtR classification, 26.1% according to WC, and 14.8% according to BMI classification. Being female was significantly associated with high prevalence of obesity irrespective of the anthropometric measure used (p<0.05. Taking of snacks in meals, eating meals late at night, physical inactivity, excessive fast food intake, and alcoholic beverage intake were associated with increased prevalence of obesity (p<0.05. Prevalence of obesity is high among diabetic patient and thus increasing effort towards developing and making education programs by focusing on adjusting to lifestyle modifications is required.

  14. How Is Fanconi Anemia Diagnosed?

    Science.gov (United States)

    ... from the NHLBI on Twitter. How Is Fanconi Anemia Diagnosed? People who have Fanconi anemia (FA) are born with the disorder. They may ... questions about: Any personal or family history of anemia Any surgeries you’ve had related to the ...

  15. Correlation and characteristics of self-rating and clinical rating of depression among alcoholics in the course of early abstinence

    Directory of Open Access Journals (Sweden)

    Mandić-Gajić Gordana

    2015-01-01

    Full Text Available Background/Aim. Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. Methods. A total of 100 inpatient, primary male alcoholics (20-60 years diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV were recruited consecutively. The Hamilton Depression Rating Scale (HDRS and Beck Depression Inventory (BDI were scored on admission (T1, after 4 weeks (T2 and after 8 weeks (T3. Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p < 0.05. Factor analyses of symptoms were performed. Results: On HDRS T1, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ± 6.34, 7.35 ± 4.18, 4.23 ± 2.93 vs 14.20 ± 9.56, 8.14 ± 7.35, 5.30 ± 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA. The HRDS and BDI correlations on T1, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively. Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on T1, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. Conclusions. The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS sub-scale, and self-blame, anhedonia and guilt BDI symptoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored

  16. Human immunodeficiency virus-associated malignant lymphoma in eastern Denmark diagnosed from 1990-1996: clinical features, histopathology, and association with Epstein-Barr virus and human herpesvirus-8

    DEFF Research Database (Denmark)

    Hansen, P B; Penkowa, M; Kirk, O;

    2000-01-01

    The clinicopathological features of human immunodeficiency virus (HIV)-associated lymphoma were investigated in a retrospective study of 85 adult patients in eastern Denmark diagnosed during the period 1990-1996. The possible pathogenetic role of Epstein-Barr virus (EBV) and human herpesvirus 8......%) and including 20 of 23 evaluable patients with CNS lymphoma (87%). EBV RNA was demonstrated by in situ hybridization in 51 of 65 evaluable tumours (79%) and in 14 of 16 cases (88%) with CNS-lymphoma. Three cases showed a T-cell phenotype. The presence of HHV-8 DNA was analysed by PCR in 32 cases. A strong band...... results provide further evidence that EBV plays a major role in the pathogenesis of large cell AIDS-related lymphoma, whereas HHV-8 does not appear to contribute significantly to the development of solid lymphomas in this group of patients....

  17. Physicians' diagnoses compared with algorithmic differentiation of causes of jaundice.

    Science.gov (United States)

    Boom, R; Chavez-Oest, J; Gonzalez, C; Cantu, M A; Rivero, F; Reyes, A; Aguilar, E; Santamaria, J

    1988-01-01

    Clinical data were collected in 194 cases of jaundiced patients treated at the "Adolfo Lopez Mateos" ISSSTE Hospital in Mexico City from July 1985 to July 1986. A copy of the clinical history of each patient was given to each of four physicians--one recently graduated from medical school, another in his first year of gastroenterology, and two others who were experienced gastroenterologists. The same clinical data were processed by a computer set up to use a modified Danish COMIC algorithm. All physicians and the computer technician were blinded to the "gold standard" pathologic diagnoses, with which their diagnoses were compared. Accuracy rates of the physicians in distinguishing intrahepatic (medical) from extrahepatic (surgical) jaundice were 78%, 86%, 86%, and 91%, and the accuracy of computer-assisted diagnoses was 96%. Chi-squared analysis of the diagnoses of three of the physicians and those of the computer showed significant differences (p between 0.1 and 0.01). For the diagnoses of the remaining physician, however, no significant difference was found after chi-squared continuity correction.

  18. Phenome-wide association studies on a quantitative trait: application to TPMT enzyme activity and thiopurine therapy in pharmacogenomics.

    Directory of Open Access Journals (Sweden)

    Antoine Neuraz

    Full Text Available Phenome-Wide Association Studies (PheWAS investigate whether genetic polymorphisms associated with a phenotype are also associated with other diagnoses. In this study, we have developed new methods to perform a PheWAS based on ICD-10 codes and biological test results, and to use a quantitative trait as the selection criterion. We tested our approach on thiopurine S-methyltransferase (TPMT activity in patients treated by thiopurine drugs. We developed 2 aggregation methods for the ICD-10 codes: an ICD-10 hierarchy and a mapping to existing ICD-9-CM based PheWAS codes. Eleven biological test results were also analyzed using discretization algorithms. We applied these methods in patients having a TPMT activity assessment from the clinical data warehouse of a French academic hospital between January 2000 and July 2013. Data after initiation of thiopurine treatment were analyzed and patient groups were compared according to their TPMT activity level. A total of 442 patient records were analyzed representing 10,252 ICD-10 codes and 72,711 biological test results. The results from the ICD-9-CM based PheWAS codes and ICD-10 hierarchy codes were concordant. Cross-validation with the biological test results allowed us to validate the ICD phenotypes. Iron-deficiency anemia and diabetes mellitus were associated with a very high TPMT activity (p = 0.0004 and p = 0.0015, respectively. We describe here an original method to perform PheWAS on a quantitative trait using both ICD-10 diagnosis codes and biological test results to identify associated phenotypes. In the field of pharmacogenomics, PheWAS allow for the identification of new subgroups of patients who require personalized clinical and therapeutic management.

  19. Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism

    DEFF Research Database (Denmark)

    Simonsen, Rikke; Hald, Gert Martin; Giraldi, Annamaria

    2015-01-01

    on individuals diagnosed with transsexualism difficult. AIMS: (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any......INTRODUCTION: Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment......, for clinical treatment initiatives for individuals diagnosed with transsexualism. METHODS: Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit...

  20. Outcome with lenalidomide plus dexamethasone followed by early autologous stem cell transplantation in patients with newly diagnosed multiple myeloma on the ECOG-ACRIN E4A03 randomized clinical trial: long-term follow-up

    Science.gov (United States)

    Biran, N; Jacobus, S; Vesole, D H; Callander, N S; Fonseca, R; Williams, M E; Abonour, R; Katz, M S; Rajkumar, S V; Greipp, P R; Siegel, D S

    2016-01-01

    In Eastern Cooperative Oncology Group-ACRIN E4A03, on completion of four cycles of therapy, newly diagnosed multiple myeloma patients had the option of proceeding to autologous peripheral blood stem cell transplant (ASCT) or continuing on their assigned therapy lenalidomide plus low-dose dexamethasone (Ld) or lenalidomide plus high-dose dexamethasone (LD). This landmark analysis compared the outcome of 431 patients surviving their first four cycles of therapy pursuing early ASCT to those continuing on their assigned therapy. Survival distributions were estimated using the Kaplan–Meier method and compared with log-rank test. Ninety patients (21%) opted for early ASCT. The 1-, 2-, 3-, 4- and 5-year survival probability estimates were higher for early ASCT versus no early ASCT at 99, 93, 91, 85 and 80% versus 94, 84, 75, 65 and 57%, respectively. The median overall survival (OS) in the early versus no early ASCT group was not reached (NR) versus 5.78 years. In patients confidence interval: (0.50, 0.25). In patients ⩾65 years of age, median OS in the early versus no early ASCT was NR versus 5.11 years. ASCT dropped out of statistical significance (P=0.080). Patients opting for ASCT after induction Ld/LD had a higher survival probability and improvement in OS regardless of dexamethasone dose density. PMID:27588519

  1. Impaired Sertoli cell function in males diagnosed with Noonan syndrome.

    NARCIS (Netherlands)

    Marcus, K.A.; Sweep, C.G.J.; Burgt, I van der; Noordam, C.

    2008-01-01

    In order to study male gonadal function in Noonan syndrome, clinical and laboratory data, including inhibin B, were gathered in nine pubertal males diagnosed with Noonan syndrome. Bilateral testicular maldescent was observed in four, and unilateral cryptorchidism occurred in two. Puberty was delayed

  2. Challenges in Diagnosing Narcolepsy without Cataplexy: A Consensus Statement

    NARCIS (Netherlands)

    Baumann, C.R.; Mignot, E.; Lammers, G.J.; Overeem, S.; Arnulf, I.; Rye, D.; Dauvilliers, Y.; Honda, M.; Owens, J.A.; Plazzi, G.; Scammell, T.E.

    2014-01-01

    BACKGROUND: Diagnosing narcolepsy without cataplexy is often a challenge as the symptoms are nonspecific, current diagnostic tests are limited, and there are no useful biomarkers. In this report, we review the clinical and physiological aspects of narcolepsy without cataplexy, the limitations of ava

  3. Gastroesophageal reflux diagnosed by occlusal splint tintion.

    Science.gov (United States)

    Cebrián-Carretero, José Luis; López-Arcas-Calleja, José María

    2006-01-01

    The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

  4. Diagnosability issues in multiprocessor systems

    Energy Technology Data Exchange (ETDEWEB)

    Raghavan, V.

    1989-01-01

    In a seminal paper on fault diagnosis, Preparata, Metze, and Chien introduced a graph-theoretical model. Barsi, Grandoni, and Maestrini relaxed some constraints in this model to create a different model for fault diagnosis. Both these models have become the subject of intense research in the past two decades. A major open problem for these models is the question of sequential t-diagnosability-Given an arbitrary system of units and that there are no more than t faulty units in it, can we always identify at least one faulty unit The author shows that this problem is co-NP complete in both models. Recent research has shown that there are polynomial time algorithms to find the maximum number of faulty units a system can withstand and still identify all of them from a single collection of test results. He presents improved algorithms to solve this problem in both models. Using the letters n,m, and {tau} to denote the number of units, the number of tests, and the maximum number of faulty units respectively, our results can be summarized as follows: in the model of Barsi, Grandoni, and Maestrini, the algorithm has a time complexity of O(n{tau}{sup 2}/log{tau}) improving on the currently known O(n{tau}{sup 2}); in the model of Preparata, Metze, and Chien, the algorithm has a complexity of O(n{tau}{sup 2.5}) improving on the currently known O(mn{sup 1.5}). He also presents related results in the latter model, which suggest the possibility of reducing the complexity even further. Finally, he develops a general scheme for characterizing diagnosable systems. Using this scheme, he solves the open problem of characterizing t/s and sequentially t-diagnosable systems. The characterizations are then used to rederive some known results.

  5. Research and Analysis of Western Medicine Clinical Diagnosis Standard of Clinical Research Data of Traditional Chinese Medicine%中医临床科研数据西医疾病诊断规范的研究分析

    Institute of Scientific and Technical Information of China (English)

    宋红梅; 刘保延; 张润顺; 何丽云; 宋观礼; 周雪忠

    2013-01-01

    目的:通过西医疾病诊断与标准诊断的吻合程度比较,分析目前中医临床住院病历诊断的现状.方法:选取行业专项参研单位所在的全国23家医院的34个临床科室电子病历采集数据中具有完整西医疾病诊断的数据,以国际疾病分类第十次修订(ICD-10)为标准,在数据库中初步对原始诊断进行规范,通过语句建立比较,得出结论.结果:西医疾病诊断和ICD-10的符合程度是36.57%.结论:针对符合率较低的情况,进一步加强临床医务人员对ICD-10的学习和熟悉是正确书写病历西医诊断的前提.%Objective: Through comparison of fitting of western medicine disease diagnosis and standard diagnosis, the current situation of clinical inpatient medical record diagnosis of traditional Chinese medicine is analyzed. Methods: Data with complete western medicine disease diagnosis in data collected from electronic medical records of 34 clinical divisions of 23 hospitals in China which are special research units in the industry is selected. The tenth revision of international classification of diseases (ICD—10) is used as the standard. In the database original diagnosis is preliminarily standardized. Through the statements the comparison is established and the conclusion is drawn. Results: the western medicine disease diagnosis and ICD—10 conform to the degree is 36.57%. Conclusion: In view of the low coincidence rate, further strengthening clinical medical staffs learning and understanding of ICD—10 is the premise of correct writing of medical records of western medicine diagnosis.

  6. 儿童食物过敏的消化道临床表现及诊治%Clinical Manifestations,Diagnose and Treatment of Children′s Food Allergy

    Institute of Scientific and Technical Information of China (English)

    司徒爱明

    2011-01-01

    Food Allergy is an adverse reaction to food and caused by immune mechanisms. Infants and children are at a high risk of food allergy. Gastrointestinal tract is a main responflent organ of food allergy.Food allergy in children has a variety of symptoms and is difficult to be diagnosed. The diagnosis requires a detailed history and physical examination combined with specific IgE measurements, skin prick test, or even food challenge test. Food restriction is the most effective treatment and other treatments include management of complications , control of risk factors , supplement of probiotics , and immunotherapy.%食物过敏是人们对某些食物产生的一种不良反应,是由免疫机制介导的.食物过敏的高危人群为婴幼儿及儿童.消化道是食物过敏的主要效应器官,临床表现多样,诊断困难,需要依靠详细的病史、查体,并结合食物特异性血清IgE测定、皮肤点刺试验,甚至食物激发试验等综合分析才能作出诊断.严格的饮食回避是最有效的治疗,包括治疗并发症、控制危险因素、添加肠道益生菌及免疫疗法等.

  7. Distal DVT: worth diagnosing? Yes.

    Science.gov (United States)

    Schellong, S M

    2007-07-01

    Much of the argument for or against diagnosis of distal deep vain thrombosis (DVT) depends on the extra effort that has to be spent on it. This review presents the data on ultrasound of paired calf veins and calf muscle veins (distal ultrasound) in terms of protocols, feasibility, reliability and expected findings. In summary, provided there is adequate and anatomically sound training of sonographers, distal ultrasound is a valid, 4-minute procedure, which can easily be added to the examination of proximal veins. The second part of the review refers to the pathophysiology of ascending DVT, which is the most common type. Adequate patient care in terms of benefit, harm and cost includes a single non-invasive examination followed by risk adopted treatment allocation. This concept ideally should be valid for any type of DVT. The data extending this concept to distal DVT can only be derived from studies that look closely at this entity (i.e. in fact diagnose distal DVT). Even before these data are available, diagnosing distal DVT at least doubles the number of symptomatic patients in which signs and symptoms can be ascribed to a definitive diagnosis, which in itself is a benefit for patient care.

  8. Does Early Postsurgical Temozolomide Plus Concomitant Radiochemotherapy Regimen Have Any Benefit in Newly-diagnosed Glioblastoma Patients? A Multi-center,Randomized, Parallel, Open-label, Phase Ⅱ Clinical Trial

    Institute of Scientific and Technical Information of China (English)

    Ying Mao; Yu Yao; Li-Wei Zhang; Yi-Cheng Lu; Zhong-Ping Chen; Jian-Min Zhang; Song-Tao Qi

    2015-01-01

    Background:The radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery,followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM).However,its median overall survival (OS) is only 14.6 months.This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen.Methods:A randomized,parallel group,open-label study of 99 newly diagnosed GBM patients was conducted at 1 0 independent Chinese neurosurgical departments from June 2008 to June 2012.Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group).Overall response was assessed based on objective tumor assessments,administration ofcorticosteroid and neurological status test.Hematological,biochemical,laboratory,adverse event (AE),and neurological condition were measured for 24 months of follow-up.The primary efficacy endpoint of this study was overall survival (OS).The secondary endpoint was progression free survival (PFS).Results:The median OS time in the early TMZ group was 17.6 months,compared with 13.2 months in the control group (log-rank test P =0.021).In addition,the OS rate in the early TMZ group was higher at 6,12,and 18 months than in the control group,respectively (P <0.05).The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P =0.695).AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups,including nausea (15.4% vs.33.3%),vomiting (7.7% vs.28.6%),fever (7.7% vs.11.9%),and headache (3.8% vs.23.8%).Only 30.8% and 33.3% were drug-related,respectively.Conclusions:Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated

  9. Clinical importance of reproductive hormone detection and transvaginal ultrasonography in diagnosing polycystic ovary syndrome with infertility%生殖激素及超声检测PCOS合并不孕症临床意义

    Institute of Scientific and Technical Information of China (English)

    徐潭妹; 魏静芬

    2015-01-01

    目的:探讨阴道超声以及生殖激素检查对诊断多囊卵巢综合征( PCOS)合并不孕症的临床价值。方法选择2011年4月至2014年4月在松阳县妇幼保健所就诊的82例PCOS合并不孕症患者,对所有患者检测血清睾酮、促黄体激素( LH)、卵泡刺激素( FSH)等指标,行阴道超声诊断为卵巢多囊样改变,并分析生殖激素检测结果及超声检测结果。结果对82例患者的检测结果分析显示,阴道超声(59.76%)与高雄激素血症(13.41%)和LH/FSH>3(39.02%)的发生率相比差异均有统计学意义(χ2=21.975,P=0.000;χ2=8.336,P=0.009)。 PCOS合并不孕患者相比正常女性,卵巢间质动脉舒张末期流速和卵巢间质动脉收缩期峰值流速更高,阻力指数和搏动指数更低,各指标对比差异均有统计学意义(t值分别为5.669、6.762、5.983、4.982,均P3 was 39. 02%. There were statistical differences among them (χ2 =21. 975,P=0. 000;χ2 =8. 336, P=0. 009). Compared with normal women, PCOS infertility patients had higher EDV and PSV but lower RI and PI. The differences among these indicators were significant (t value was 5. 669, 6. 762, 5. 983 and 4. 982, respectively, all P <0. 05). Conclusion Transvaginal ultrasonography is a better method to diagnose PCOS complicated with infertility than reproductive hormones detection.

  10. How Is Diabetic Heart Disease Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Diabetic Heart Disease Diagnosed? Your doctor will diagnose diabetic ... have diabetes, protein in the urine is a risk factor for DHD. Other Tests and Procedures Your doctor ...

  11. Comparação entre métodos clínicos e laboratoriais no diagnóstico das faringotonsilites estreptocócicas Comparative analysis of clinical and laboratory methods for diagnosing streptococcal sore throat

    Directory of Open Access Journals (Sweden)

    Ana Gabriela P. dos Santos

    2005-02-01

    Full Text Available OBJETIVOS: O diagnóstico e tratamento correto das faringotonsilites causadas pelo estreptococo beta-hemolítico do grupo A é importante, particularmente na prevenção das seqüelas não-supurativas. Achados clínicos continuam sendo utilizados para diferenciar infecção estreptocócica de faringotonsilite viral. A Academia Americana de Pediatria recomenda que o diagnóstico da faringotonsilite estreptocócica seja sempre confirmado por métodos de identificação microbiológica. O objetivo deste estudo foi avaliar a acurácia do diagnóstico clínico comparado com resultados de cultura e teste rápido no diagnóstico das faringotonsilites estreptocócicas. MÉTODOS: Crianças entre 2 e 13 anos com diagnóstico clínico de faringotonsilite avaliadas na unidade de emergência pediátrica da Santa Casa de São Paulo eram selecionadas, e aquelas com sintomas de infecção viral eram excluídas. Foram registrados achados clínicos e colhidos suabes para a realização de cultura e teste rápido para estreptococo do grupo A. RESULTADOS: Das 376 crianças avaliadas, a cultura foi positiva em 96 (24,4%. A presença de petéquias, exsudato e gânglios dolorosos foi mais comum nas crianças com culturas positivas, mas com baixa acurácia diagnóstica. A avaliação subjetiva do médico que assistia o paciente não identificou 21% dos casos positivos e recomendou antibióticos para 47% das crianças com cultura negativa, contra 3 e 6% identificados pelo teste rápido, respectivamente. CONCLUSÕES: Um método de diagnóstico microbiológico é necessário para a adequada prescrição de antibióticos em crianças com faringotonsilites estreptocócicas.OBJECTIVES: Diagnosis and correct treatment of group A streptococcal sore throat is important particularly to prevent non-suppurative sequelae. Clinical findings continue to be used to differentiate streptococcal infection from viral sore throat. The American Academy of Pediatrics recommends that

  12. Psychiatric diagnoses in a group of astronaut applicants

    Science.gov (United States)

    Santy, Patricia A.; Faulk, Dean M.; Holland, Al W.

    1991-01-01

    Between 1959 and 1987, the psychiatric evaluation of astronaut candidates evolved from a 30-h intensive examination evaluating applicants for psychopathology, and studying their performance under stress, to a 2-h clinical interview whose structure and contents were determined by the individual examiner. Evaluations done during these years applied both psychiatric (or, 'select-out') criteria and psychological (or, 'select-in') criteria. In an attempt to more rigorously define the psychiatric, 'select-out' component, a standardized, semistructured clinical interview was developed to identify the presence or history of psychiatric disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed. ('DSM-III'). A total of 117 astronaut applicants underwent this clinical interview as part of a comprehensive medical evaluation during a recent astronaut selection. Of the 117 applicants, 9 (7.7 percent) met DSM-III criteria for a variety of Axis I and Axis II diagnoses, including V-code diagnoses.

  13. 宫腹腔镜联合诊治女性不孕症500例临床分析%Clinical analysis on 500 infertile women diagnosed and treated with hysteroscopy combined with laparoscopy

    Institute of Scientific and Technical Information of China (English)

    郭政; 王丽英; 李华

    2011-01-01

    Objective: To explore the value of laparoscopy combined with hysteroscopy in diagnosis and treatment of women with infertility. Methods: The results of 500 infertile women receiving hysteroscopy combined with laparoscopy from January 2008 to December 2009 were analyzed retrospectively. Results; 445 women were found with pelvic abnormality by hysteroscopy combined with laparoscopy, accounting for 89. 0%. The main causes of female infertility were chronic pelvic inflammatory disease (58. 6% ) , polycystic ovary syndrome (18. 0% ) and endometriosis ( 14. 0% ) . The proportion of chronic pelvic inflammatory disease in women with secondary infertility was significantly higher than that in women with primary infertility (x = 8. 60, P < 0. 01 ) , while the proportion of polycystic ovary syndrome in women with secondary infertility was significantly lower than that in women with primary infertility (x2 = 17. 02, P <0. 01) . The major surgical methods were pelvic adhesiolysis, fimbrioplasty and salpingostomy, ovarian drilling and cauiery of endometriosis. Conclusion:Laparoscopy combined with hysteroscopy can confirm the causes of female infertility, corresponding minimal invasive surgery can be conducted targeting to the causes of female infertility, the advantages of laparoscopy and hysteroscopy are complementary, which are the optimal methods to diagnose and treat women with infertility induced by pelvic factor.%目的:探讨宫、腹腔镜联合检查在女性不孕症中的诊治价值.方法:对2008年1月~2009年12月500例女性不孕症的宫、腹腔镜联合检查结果进行回顾性分析.结果:宫、腹腔镜检查发现盆腔异常445例,占89.0%.女性不孕症的主要原因依次为慢性盆腔炎(58.6%)、多囊卵巢综合征(18.0%)、子宫内膜异位征(14.0%).继发性不孕症中,慢性盆腔炎的构成比高于原发不孕(x2=8.60,P<0.01),多囊卵巢综合征的构成比低于原发不孕(x2=17.02,P<0.01).盆腔粘连松解术、输卵管伞

  14. Clinical value of echocardiography in diagnosing of congenital cardiovascular malformation fetus%超声心动图诊断胎儿先天性心血管畸形的临床价值

    Institute of Scientific and Technical Information of China (English)

    关海天

    2014-01-01

    目的:研究使用超声心动图对于诊断胎儿先天性心血管畸形的重要意义,总结概括出现误诊以及漏诊的原因,提高诊断准确率。方法本院通过对10981例进行产前胎儿超声心动图检查的孕妇研究总结,通过对产前超声诊断结果与孕妇产后的超声心动图诊断以及被认为是畸形胎儿的尸体解剖结果进行比对,确定超声心动图诊断的价值。结果2981例孕妇中有107例(3.60%)胎儿检出先天性心血管异常。在这107例胎儿中,单纯性三尖瓣反流胎儿有77例(72.57%),心腔内强回声光斑胎儿9例(8.73%),左室假腱索胎儿6例(5.60%),结构性心血管异常胎儿11例(10.28%),单纯性肺动脉瓣反流胎儿2例(1.87%),其中有11例孕妇选择引产。结论胎儿超声心动图是一种有效的胎儿先天性心脏病产前检查方法,有利于降低先天性心脏病患儿的出生率。%Objective To study significance of echocardiography in diagnosing congenital cardiovascular malformation fetus and sum up the reasons of misdiagnosis and missed diagnosis to improve the diagnostic accuracy. Methods There were 2981 cases of pregnant women for prenatal fetal echocardiography in our hospital for research summary, through to the prenatal ultrasound diagnosis of pregnant women with postpartum echocardiography diagnosis and is considered to be one of the malformation fetus compare the autopsy results, determine the value of echocardiography in the diagnosis. Results Out of 2981 cases of pregnant women, 107 patients (3.60%) of fetal congenital cardiovascular anomaly detection. In the 398 cases of fetus, simple tricuspid regurgitation in 77 patients (72.57%), fetal heart cavity the strong echo light fetal 9cases (8.73%), left ventricular false chordae tendineae6 cases (5.60%), fetal structural cardiovascular abnormalities fetus 11 cases (10.28%), idiopathic pulmonary valve regurgitation in fetal 2 cases (1.87%), including 11 cases of

  15. Diagnosing and treating lateral epicondylitis.

    OpenAIRE

    1994-01-01

    Lateral epicondylitis is often encountered in primary care. Although its diagnosis can be fairly straightforward, its treatment is often difficult. This review examines the epidemiology, pathophysiology, and clinical presentation of tennis elbow. Management options are discussed.

  16. The clinical significance of electrocardiogram changes to diagnose the left pneumothorax%心电图改变对左侧气胸的临床诊断意义

    Institute of Scientific and Technical Information of China (English)

    黄丽嫦; 谢再汉; 舒予静; 李飞; 贺晓

    2014-01-01

    目的:探讨左侧气胸患者心电图改变特点及临床意义。方法:回顾性分析43例经X线胸片证实为左侧气胸患者的心电图改变。结果:窦性心动过速15例(34.9%),V5、V6导联QRS波群低电压35例(81.4%),顺时针转位34例(79.1%)。结论:左侧气胸心电图有特征性改变,对气胸患者进行心电图检查,有助于临床医师进行诊断与鉴别诊断。%Objective:To study the electrocardiogram characteristics and clinical significance of the patients with left pneu-mothorax. Methods:The electrocardiogram changes of 43 cases with left pneumothorax confirmed by chest X-ray were ret-rospectively analyzed. Results:The electrocardiogram characteristic changes of patients with left pneumothorax included sinus tachycardia for 15 cases(34. 9%),the lower voltage of QRS in V5 and V6 for 35 cases(81. 4%),and revoled clockwise for 34 cases(79. 1%). Conclusions:The electrocardiogram of patients with left pneumothorax had characteris-tic changes. The examination of the electrocardiogram in patients with pneumothorax will help clinical doctors in diagnosis and differential diagnosis.

  17. Clinical research on dual-energy X-ray absorptiometry in diagnose of osteoporosis in the elderly%双能X线骨密度测量仪在老年人骨质疏松的临床研究

    Institute of Scientific and Technical Information of China (English)

    曹学胜; 李秀芬; 黄欣

    2015-01-01

    目的:探讨双能X线骨密度测量仪在治疗老年人骨质疏松的临床应用价值.方法:收集200例老年住院患者在双能X线骨密度测量仪下测量,并对其数据进行分析.结果:老年人多数患有骨质疏松,女性明显高于男性,在骨质疏松的患者中,90%的患者有骨折病史,有统计学意义(P<0.01).结论:双能X线骨密度测量仪对诊断、治疗老年人骨质疏松有重要的临床意义.%Objective: To investigate the clinical value of the dual-energy X-ray absorptiometry in gauging osteoporosis in the elderly. Methods: 200 cases of elderly patients hospitalized were measured by the dual energy X-ray absorptiometry measurement instrument, and the data were analyzed. Results: Most of the elderly were suffering from osteoporosis and the incurrence of osteoporsis in females was much significantly higher than in males. 90 percent of patients with osteoporosis have a history of fracture and it is of statistical significance (P<0.01). Conclusion: dual-energy X-ray absorptiometry meter in diagnosis and treatment of osteoporosis in the elderly has shown important clinical significance.

  18. 溴隐亭治疗利培酮致女性中度高催乳素血症的临床研究%Clinical study of Bromocriptine in treatment of moderate hyperprolactinemia caused by Risperidone

    Institute of Scientific and Technical Information of China (English)

    秦卫红; 魏时懿; 张军勐

    2014-01-01

    Objective:To discuss the efficacy of Bromocriptine in treatment of hyperprolactinemia cause by Risperidone and an-alyze the possibility of psychiatric symptom fluctuation for female patients with schizophrenia. Methods:According to the ICD-10, 59 female inpatients diagnosed as schizophrenia and got the mild hyperprolactinemia (100ug/ Lt0. 001(59), Pt0.001(59),P<0.001〕,BPRS 量表前后3次评定结果进行比较无显著差异。结论:本研究证实溴隐亭治疗利培酮所致女性中度高催乳素血症有实际临床应用价值,其有效性和安全性均非常可靠。

  19. Peptidomic Identification of Serum Peptides Diagnosing Preeclampsia.

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    Qiaojun Wen

    Full Text Available We sought to identify serological markers capable of diagnosing preeclampsia (PE. We performed serum peptide analysis (liquid chromatography mass spectrometry of 62 unique samples from 31 PE patients and 31 healthy pregnant controls, with two-thirds used as a training set and the other third as a testing set. Differential serum peptide profiling identified 52 significant serum peptides, and a 19-peptide panel collectively discriminating PE in training sets (n = 21 PE, n = 21 control; specificity = 85.7% and sensitivity = 100% and testing sets (n = 10 PE, n = 10 control; specificity = 80% and sensitivity = 100%. The panel peptides were derived from 6 different protein precursors: 13 from fibrinogen alpha (FGA, 1 from alpha-1-antitrypsin (A1AT, 1 from apolipoprotein L1 (APO-L1, 1 from inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4, 2 from kininogen-1 (KNG1, and 1 from thymosin beta-4 (TMSB4. We concluded that serum peptides can accurately discriminate active PE. Measurement of a 19-peptide panel could be performed quickly and in a quantitative mass spectrometric platform available in clinical laboratories. This serum peptide panel quantification could provide clinical utility in predicting PE or differential diagnosis of PE from confounding chronic hypertension.

  20. 儿童颅内动脉瘤的诊断与治疗(附16例报道)%Diagnoses and treatments of pediatric intracranial aneurysms:a clinical analysis of 16 cases

    Institute of Scientific and Technical Information of China (English)

    周杰; 黄昌仁; 刘洛同; 董劲虎; 周牮; 董程远; 江涌; 明杨; 陈礼刚

    2016-01-01

    Objective To investigate the clinical features, treatments and prognoses of pediatric intracranial aneurysms. Methods The clinical and follow-up data of 16 consecutive patients with pediatric intracranial aneurysms (≤16 years), admitted to our hospital from January 2003 to December 2014, were analyzed retrospectively. Results Pediatric intracranial aneurysms in this study accounted for 0.78%of all intracranial aneurysms. Of the 16 children, 14 were male, 2 were female. There were 12 anterior circulation aneurysms and 5 posterior circulation aneurysms; there were 4 large aneurysms (diameter 11-25 mm) and 2 giant aneurysms (diameter≥25 mm);there were 14 complex aneurysms. At a mean follow-up duration of 16.8 months, no death was noted. Of the 12 patients received microsurgical therapy, 10 patients had favorable outcomes (modified Rankin scale [mRS] 0-1) and 2 patients had some sequelae: different degrees of disability (mRS 2-4). Of the 4 patients received endovascular therapy, 3 patients had favorable outcomes (mRS 0-1) and one patient had hemiparesis (mRS 2). Conclusions Pediatric intracranial aneurysms are different from adult intracranial aneurysms. The treatment effects and prognosis are relatively well when we select individualized treatment mode according to the clinical features of pediatric intracranial aneurysms.%目的:探讨儿童颅内动脉瘤的临床特点﹑治疗及预后。方法回顾性分析西南医科大学附属医院神经外科自2003年1月至2014年12月收治的16例颅内动脉瘤患儿(≤16岁)的临床资料和随访结果。结果本组儿童颅内动脉瘤占总颅内动脉瘤发病率的0.78%,其中男14例,女2例﹔前循环动脉瘤12个,后循环动脉瘤5个﹔大动脉瘤(直径11~25 mm)4个,巨大动脉瘤(直径>25 mm)2个﹔复杂动脉瘤14例。本组患儿无死亡病例,平均随访16.8月。12例患儿行开颅手术,10例患儿预后良好[改良Rankin量表(mRS)评分0~1分],2例患儿出现不同程

  1. Clinical application of epididymis diseases diagnosed by color Doppler ultrasound.%经彩色多普勒超声诊断附睾疾病的临床应用

    Institute of Scientific and Technical Information of China (English)

    周成礼; 汤瑞强; 张菊梅

    2011-01-01

    目的 探讨彩色多普勒超声在附睾疾病诊断中的应用价值.方法 采用常规的横向、纵向、斜向多切面扫描方法进行检查;同时对附睾、睾丸、精索、阴囊壁、腹股沟及鞘膜腔进行扫描,并将患侧及健侧的检测结果进行比较.结果 62例患者彩超均检出病变部位,与病理检查检出例数差异无统计学意义(X=1.28,P>0.05),检出率为100%;彩超病症检出率98.39%(61/62),与病理结果比较差异无统计学意义(X=2.88,P<0.05).结论 彩色多普勒超声具有较高的定位、定性诊断的敏感性,具有极高的临床应用价值.%Objective To discuss the clinical value of color Doppler ultrasound in the diagnosis of epididymis diseases. Methods The lesions were checked with horizontal, vertical, diagonal multi-slice scan, and the epididymis, testis, spermatic cord, scrotal wall, groin and sheath cavity were scaned. Then the ipsilateral and contralateral resuits of patients were compared. Results The lesion detection rate of 62 cases was 100~,4, including 15 cases (24.19%) of simple epididymitis, 3 cases (4.84%) of epididymal cyst, 2 cases (3.23%) of combined orchitis, 30 cases (48.39%) of combined hydrocele, 5 cases (8.06%) of combined varicose veins, 3 cases (4.84%) of spermatic cord and testicular hydrocele, and 4 cases (6.45%) of traumatic testis and epididymis. Conclusion Color Doppler ultrasound had a high sensitivity in position and qualitative analysis, with the high clinical value.

  2. Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing.

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    Koleka Mlisana

    Full Text Available BACKGROUND: Prompt diagnosis of acute HIV infection (AHI benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. METHODS: 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. RESULTS: Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5-9.8. Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4-7.1, rash (OR = 6.1; 2.4-15.4, sore throat (OR = 2.7; 1.0-7.6, weight loss (OR = 4.4; 1.5-13.4, genital ulcers (OR = 8.0; 1.6-39.5 and vaginal discharge (OR = 5.4; 1.6-18.4. A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001. CONCLUSIONS: Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission.

  3. Clinical analysis of 29 cases of fetal digestive tract malformation diagnosed prenatally by ultrasound%产前超声诊断胎儿消化道畸形29例临床分析

    Institute of Scientific and Technical Information of China (English)

    卓娜; 段清; 张晖; 田晶; 孙彤

    2015-01-01

    目的:探讨产前超声检查诊断胎儿消化道发育畸形的临床意义。方法对孕期30~32周于本院检查出存在先天性消化道发育畸形的29例胎儿根据超声图像的不同特点进行分类分析,探讨其不同超声表现。结果29例中无胃泡或小胃泡11例(37.93%),合并多发畸形4例,合并羊水过多9例。管扩张、肠管多囊泡有7例(24.14%),其中合并多发畸形3例,羊水过多3例。双泡征有8例(27.58%),其中合并多发畸形1例,羊水过多7例。另3例无明显超声影像特征。结论30~32周胎儿进行产前超声检查对发现胎儿消化道发育畸形有很高的诊断价值,值得在临床推广应用。%Objective To investigate the clinical significance of prenatal ultrasound examination in the diagnosis of fe⁃tal digestive tract development. Methods Twenty-nine cases of congenital digestive tract malformation were examined in according to the different characteristics of their different fetal ultrasound images. Results There were 11 cases with non-magenblase or less magenblase (37.93%), 4 cases with combination of multiple malformations, and 9 cases with combination of amniotic fluid in the 29 cases. There were 7 cases (24.14%) with dilatation of intestine and intestinal vesicles, in which 3 with multiple malformations and 3 with polyhydramnios. There were 8 cases (27.58%) with double bubbles, in which 1 case with multiple malformations and 7 cases with amniotic fluid. Conclusion The prenatal ultrasound examination in 30 to 32 weeks of pregnancy is very valuable in diagnosis of fetal digestive tract development, which is worthy of clinical application.

  4. Urinary incontinence nursing diagnoses in patients with stroke

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    Telma Alteniza Leandro

    2015-12-01

    Full Text Available Abstract OBJECTIVE Identifying the prevalence of Stress urinary incontinence (SUI, Urge urinary incontinence (UUI, Functional urinary incontinence (FUI, Overflow urinary incontinence (OUI and Reflex urinary incontinence (RUI nursing diagnoses and their defining characteristics in stroke patients. METHOD A cross-sectional study with 156 patients treated in a neurological clinic. Data were collected through interviews and forwarded to nurses for diagnostic inference. RESULTS 92.3% of the patients had at least one of the studied diagnoses; OUI showed the highest prevalence (72.4%, followed by FUI (53.2%, RUI (50.0%, UUI (41.0% and SUI (37.8%. Overdistended bladder and reports of inability to reach the toilet in time to avoid urine loss were the most prevalent defining characteristics. A statistically significant association of the defining characteristics with the studied diagnosis was verified. CONCLUSION The five incontinence diagnoses were identified in the evaluated patients, with different prevalence.

  5. Clinical value of the placental abruption diagnosed by color Doppler ultrasonic combining with enhancement Doppler E-flow imaging%彩色多普勒超声结合增强型能量多普勒成像诊断胎盘早剥的临床价值探讨

    Institute of Scientific and Technical Information of China (English)

    魏达友; 梁玉婷; 蔡永秋; 巫朝君; 刘思怡; 吴绍锋

    2008-01-01

    目的 探讨彩色多普勒超声结合增强型能量多普勒(E-Flow)成像诊断胎盘早剥,尤其是轻型胎盘早剥的声像图特点,为临床提供有效的诊断依据.方法 应用彩色多普勒超声结合E-Flow对50例重型胎盘早剥、23例轻型胎盘早剥的声像图及临床结局进行分析研究.结果 50例重型胎盘早剥的彩色多普勒超声结合E-Flow的诊断与临床及产后病理诊断相符,诊断符合率100%;23例轻型胎盘早剥的彩色多普勒超声结合E-Flow的诊断与临床及产后病理诊断符合19例,诊断符合率83%,漏诊、误诊4例(17%).73例胎盘早剥患者中剖宫产60例,阴道分娩13例.结论 增强型能量多普勒超声结合彩色多普勒超声成像技术对重型胎盘早剥的诊断准确率高,为轻型胎盘早剥的诊断提供了新手段,并能动态监测轻型胎盘早剥的转归.%Objective To explore the ultrasonographical characteristics of placental abruption, especially the light placental abruption that was diagnosed by color Doppler ultrasonic combining with enhancement Doppler E-flow imaging, providing diagnosis data for clinical treatment. Methods With color Doppler ultrasonic and enhancement Doppler E-flow imaging, an analysis was made on the ultrasonography and clinical result of 50 patients with heavy placental abruption and 23 patients with light placental abruption. Results The diagnosis and clinical treatment of 50 patients with heavy placental abruption who had been diagnosed by color Doppler ultrasonic combining with enhancement Doppler E-flow imaging were in conformity with the postnatal pathological diagnosis. The coincidence rate in diagnosis was 100%. Of 23 patients with light placental abruption who had been diagnosed by color Doppler ultrasonic combining with enhancement E-flow Doppler imaging, 19 cases' diagnosis and clinical treatment were in accordance with their postnatal pathological diagnosis and the coincidence rate was 83%, 4 cases were

  6. Diagnosing chronic thromboembolic pulmonary hypertension: current perspectives

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    Hadinnapola C

    2014-09-01

    Full Text Available Charaka Hadinnapola, Deepa Gopalan, David P Jenkins Papworth Hospital National Health Service Foundation Trust, Papworth Everard, Cambridge, United Kingdom Abstract: Chronic thromboembolic pulmonary hypertension is a rare and relatively poorly understood disease. It remains underdiagnosed and is often not recognized in primary and secondary care, as its symptoms are nonspecific and there are few clinical signs until late in the disease process. However, pulmonary endarterectomy (PEA offers a potential cure for patients with this type of pulmonary hypertension; therefore, it is important that they are identified and diagnosed in a timely manner. PEA is associated with a 2.2%–5% risk of significant morbidity and mortality, even in experienced PEA centers. Therefore, once chronic thromboembolic pulmonary hypertension is diagnosed, further assessment of operability and patient selection is crucial. Assessment of operability involves determining the distribution and burden of chronic thromboembolic disease, assessing pulmonary hemodynamics, and assessing the functional impairment of the patient. Ventilation perfusion scintigraphy is of value in screening for the presence of chronic thromboembolic disease. However, computer tomography pulmonary angiography and magnetic resonance pulmonary angiography are now increasingly used to image the vascular occlusions directly. This allows assessment of the surgically accessible disease burden. Some centers still advocate conventional selective pulmonary angiography for the latter. Right-heart catheterization remains the gold standard for assessing pulmonary hemodynamics. Higher pulmonary vascular resistances are associated with poorer outcomes as well as increased risks at the time of surgery. This is in part because of the presence of more distal chronic thromboembolic material and distal pulmonary artery remodeling. However, in experienced centers, these patients are being operated on safely and with good

  7. Advantages and Limitations of Direct PCR Amplification of Bacterial 16S-rDNA from Resected Heart Tissue or Swabs Followed by Direct Sequencing for Diagnosing Infective Endocarditis: A Retrospective Analysis in the Routine Clinical Setting

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    Daniela Maneg

    2016-01-01

    Full Text Available Infective endocarditis (IE is a life-threatening disease that is associated with high morbidity and mortality. Its long-term prognosis strongly depends on a timely and optimized antibiotic treatment. Therefore, identification of the causative pathogen is crucial and currently based on blood cultures followed by characterization and susceptibility testing of the isolate. However, antibiotic treatment starting prior to blood sampling or IE caused by fastidious or intracellular microorganisms may cause negative culture results. Here we investigate the additional diagnostic value of broad-range PCR in combination with direct sequencing on resected heart tissue or swabs in patients with tissue or swab culture-negative IE in a routine clinical setting. Sensitivity, specificity, and positive and negative predictive values of broad-range PCR from diagnostic material in our patients were 33.3%, 76.9%, 90.9%, and 14.3%, respectively. We identified a total of 20 patients (21.5% with tissue or culture-negative IE who profited by the additional application of broad-range PCR. We conclude that broad-range PCR on resected heart tissue or swabs is an important complementary diagnostic approach. It should be seen as an indispensable new tool for both the therapeutic and diagnostic management of culture-negative IE and we thus propose its possible inclusion in Duke’s diagnostic classification scheme.

  8. Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the “priceless” value of the clinical examination in the technological era

    Science.gov (United States)

    COLASANTI, R.; IACOANGELI, M.; DI RIENZO, A.; DOBRAN, M.; DI SOMMA, L.; NOCCHI, N.; SCERRATI, M.

    2016-01-01

    Background Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis. Case report We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5–C6 and C6–C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm. Results Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery. Conclusions A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences. PMID:27142825

  9. ICD-10进食障碍分类和诊断标准在中国应用的几点修改建议%Amendment of ICD-10 Diagnostic Criteria for Eating Disorder

    Institute of Scientific and Technical Information of China (English)

    张大荣; 徐玉玉; 张卫华

    2009-01-01

    @@ 进食障碍(eating disorders,ED)是以进食行为异常为显著特征的一组综合征,主要包括神经性厌食和神经性贪食两大类,是主要发生于青少年和成年早期女性的心身疾病,患病率为 1%~4.2%,在美国、日本、西班牙、中国香港等地开展的研究显示,随着社会经济的发展,进食障碍的患病率呈增加的趋势[1].因此进食障碍的标准化诊断,就显得尤为重要.

  10. Association among nursing diagnoses, demographic variables, and clinical characteristics of patients with high blood pressure Asociación entre diagnósticos de enfermería y variables sociales/clinicas en pacientes hipertensos Associação entre diagnósticos de enfermagem e variáveis sociais/clínicas em pacientes hipertensos

    Directory of Open Access Journals (Sweden)

    Francisca de Fátima Vasconcelos

    2007-09-01

    Full Text Available OBJECTIVES: To analyze the association among diagnoses, demographic variables, and clinical characteristics of patients with high blood pressure. METHODS: The data were collected in 67 patients from a primary care unit in Fortaleza, Brazil. The NANDA Taxonomy was used to determine the nursing diagnoses. Data analysis consisted of Fisher's exact test, Chi-square test, and likelihood ratio test. RESULTS: Fifty four nursing diagnoses were identified; fifteen were above the 75th percentile. Ineffective individual therapeutic regimen management and number of medication, sleep pattern disturbance and marital status, activity intolerance and education, activity intolerance and time of diagnoses, sexual dysfunction and gender, sexual dysfunction and education, risk for falls and age, marital status and time of diagnoses, chronic pain and marital status all had significant association coefficients. CONCLUSION: Some demographic characteristics were associated with nursing diagnoses.OBJETIVO: Analizar la asociación estadística entre diagnósticos y características sociales / clínicas de pacientes hipertensos. MÉTODOS: Los datos fueron recolectados en una unidad básica de salud de Fortaleza-Ceará con 67 pacientes. La identificación de los diagnósticos se llevó a cabo según la taxonomía de la NANDA. Para el análisis de los datos se utilizó test de Fisher, Chi-Cuadrado de Pearson y Razón de Verosemejanza. RESULTADOS: Se encontró 54 diagnósticos de enfermería y 15 sobre el percentil 75. Se verificó asociación estadística entre: Control eficaz del régimen terapéutico y número de medicamentos; Patrón de sueño perturbado y estado civil; Intolerancia a la actividad y escolaridad y años de diagnóstico; Disfunción sexual y sexo y escolaridad; Riesgo para caídas y edad, estado civil y tiempo de diagnóstico de la enfermedad; Dolor crónico y estado civil. CONCLUSIÓN: Algunas características demográficas están asociadas a la

  11. A comparison of three methods to measure asthma in epidemiologic studies

    DEFF Research Database (Denmark)

    Hansen, Susanne; Strøm, Marin; Maslova, Ekaterina;

    2012-01-01

    Asthma is a heterogeneous outcome and how the condition should be measured to best capture clinically relevant disease in epidemiologic studies remains unclear. We compared three methods of measuring asthma in the Danish National Birth Cohort (n>50.000). When the children were 7 years old...... the asthma prevalence was 3.6%. In conclusion, self-reported asthma, ICD-10 diagnoses from a hospitalization registry and data on anti-asthmatic medication use from a prescription registry lead to different prevalences of asthma in the same cohort of children. The non-overlap between the methods may be due......, the prevalence of asthma was estimated from a self-administered questionnaire using parental report of doctor diagnoses, ICD-10 diagnoses from a population-based hospitalization registry, and data on anti-asthmatic medication from a population-based prescription registry. We assessed the agreement between...

  12. Anatomical Findings in Patients with Infective Endocarditis Diagnosed at Autopsy

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    Miguel Angel Serra Valdés

    2013-12-01

    Full Text Available Background: Infective endocarditis continues to challenge modern medicine despite its rare occurrence in the general population. Its incidence depends on risk groups. Correlation of anatomical and pathological findings with clinical and epidemiological elements may explain the current features of this condition. Objective: to describe the anatomical features of patients with infective endocarditis diagnosed at autopsy. Methods: A descriptive study including cases of infective endocarditis diagnosed at autopsy between 1986 and 2008 was conducted in the Provincial Clinical-Surgical Hospital Celia Sanchez, Granma. The variables analyzed were: age, sex, previous anatomical lesions, location of vegetations, multi-organ embolic infarcts and embolic abscesses, complications, culture of lesions and direct causes of death. Results: frequency of infective endocarditis diagnosed at necropsy ranged annually from 0.4 to 1.5%. Native valve endocarditis without previous damage was the most frequent. The anatomical findings were more common in the left side of the heart. Right-sided nosocomial endocarditis accounted for almost a third of the deceased patients and risk factors were identified. Embolic lesions affecting various organs, systemic complications and direct causes of death showed acute infectious endocarditis. The most common pathogen was Staphylococcus aureus. Conclusion: knowing the anatomical findings may contribute to the understanding of the clinical and epidemiological aspects of this condition. Correlation between anatomical and clinical findings was low; therefore difficulties in establishing the diagnosis during life are inferred.

  13. [Left pulmonary agenesis diagnosed late].

    Science.gov (United States)

    Deleanu, Oana; Pătraşcu, Natalia; Nebunoiu, Ana-Maria; Vintilă, V; Ulmeanu, Ruxandra; Mihălţan, F D

    2010-01-01

    We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.

  14. A Trial to Maximize the Accuracy of Military Womens Genitourinary Self-Diagnoses

    Science.gov (United States)

    2013-04-08

    diagnoses and providers’ (N=5) clinical diagnoses to DNA-probe analysis for evidence of Gardnerella species, Trichomonas vaginalis , and Candida species in...vaginal itching, to differentiate between bacterial/ Trichomonas , and yeast vaginitis.7 The research plan was to compare women’s (N=715) self

  15. Clinical Implications of Biochemical Tests for Diagnose and Treat Advanced Malignancy%生化检测对晚期恶性肿瘤诊治的临床意义

    Institute of Scientific and Technical Information of China (English)

    胡少娟; 李婷婷; 孙渌; 张哲

    2016-01-01

    目的:为了尽可能延长晚期恶性肿瘤患者生存时间,分析生化结果以探讨患者出现意识改变病因。方法现摘取我院临床收治的典型的13例伴有意识改变的晚期恶性肿瘤患者临床资料,通过对其生化指标变化、疾病诊治经过以及患者的预后转归进行分析。结果13例患者中7例因低血糖出现昏迷,约占52%(7/13)。其中2例因未能及时发现低血糖在住院后1 d内死亡,其原发病分别为1例胃癌、1例胆管癌;3例通过及时补充高张糖,病情缓解后进一步CT或磁共振检查明确了原发性肝癌诊断;2例为胰腺肿瘤复发及恶化。4例因高钙血症出现意识改变,约占30%(4/13),其中2例为肺癌、1例为前列腺癌,1例误诊为恶性肿瘤骨转移后发生急性肾功能衰竭,但骨髓穿刺诊断为多发性骨髓瘤,确诊后2天内死亡。10例出现低钠、低氯血症,约占77%(10/13),其中2例因严重低钠、低氯血症出现意识模糊,经过补充高渗盐水等治疗后病情缓解。3例伴有低钾血症。13例患者入院后2 d内死亡人数为3人,死亡率约占23%(3/13),抢救成功率约为77%(10/13)。结论急检生化能够对明确恶性肿瘤患者意识改变病因、临床诊治及预后有帮助,能够减少此类患者短期内的死亡风险。%ObjectiveTo prolong the survival time of advanced malignancy patients as soon as possibile,we aimed to investigate the etiology of patients with altered states of consciousness by analyzing biochemistry results.Methods 13-cases patients were admitted to our hospital with altered states of consciousness. Clinical data were colected from advanced malignancy. Analyses were by biochemical parameters changes,diagnosis and treatment of disease,prognosis and outcome.Results 7 cases of patients with hypoglycemic coma accounts for 52%(7/13). 2 cases failed to find hypoglycemia were dead after hospitalization within one

  16. [Sexual addiction: chimera or clinical syndrom? A plea for a clinical conceptualization].

    Science.gov (United States)

    Wölfle, Roland

    2010-01-01

    The phenomenon of sexual addiction as a clinical syndrom is discussed controversially. The article first deals with some mythological, historical and literary sources, which have been an inspiration for the nomenclature, e.g. nymphomania. Scientific research started in the 19th century, but also a classification in terms of a morally contaminated pathology, which led to barbaric forms of "therapies" and procedures, especially for women. The ICD-10 and the DSM-IV do not contain categories that correspond with the clinical experience of many experts. The application of the WHO criteria should be possible, but this might fail due to big intercultural and individual differences in defining normal sexuality as the point of origin for pathological aberrances. Later some nosological concepts and therapeutic approaches are presented. The criticism of the term of "sexual addiction" is followed by the criticism of the criticism. The article ends with the conviction, that it should be a useful and reasonable challenge for psychiatrists to come to a reliable classification of this disorder to provide easier access to serious and professional help to those who often suffer enormous pain and shame.

  17. Predictive factors of postoperative pathologic extra-capsular extension in clinically diagnosed localized prostate cancer after radical prostatectomy%临床局限性前列腺癌根治性切除术后病理包膜侵犯的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    张帆; 黄毅; 陆敏; 马潞林

    2012-01-01

    目的:探讨临床局限性前列腺癌根治性切除术后病理发现包膜侵犯的危险因素.方法:回顾性分析191例经前列腺穿刺活检确诊并临床评估为局限性前列腺癌患者对临床资料,收集患者确诊时年龄、体重指数(BMI)、前列腺特异抗原(PSA)、前列腺体积(PV)、穿刺针数、穿刺阳性百分数、临床分期、穿刺Gleason评分等,根据前列腺根治性切除术后病理标本评估包膜侵犯情况,使用单因素和多因素Logistic回归分析临床局限性前列腺癌根治性切除术后病理包膜侵犯的危险因素.结果:191例临床局限性前列腺癌患者行根治性切除术后病理发现包膜侵犯者45例(23.6%),单因素分析显示前列腺体积较小组、穿刺Gleason评分较高组和穿刺阳性百分数较大组术后病理包膜侵犯比例明显增高,多因素Logistic回归分析显示前列腺体积小(P=0.023)和穿刺Gl-eason评分高(P=0.019)是临床局限性前列腺癌根治性切除术后发现病理包膜侵犯的独立危险因素.结论:经临床评估为局限性前列腺癌的患者行前列腺根治性切除术后病理检查可能发现包膜侵犯,前列腺体积小和穿刺Gleason评分高是其独立危险因素,在临床工作中应予以重视.%Objective:To explore the risk factors for postoperative pathologic extra-capsular extension in clinically diagnosed localized prostate cancer after radical prostatectomy. Method: We retrospectively evaluated 191 patients who were biopsy proved prostatic carcinoma and clinically diagnosed localized prostate cancer. All patients included in the study had complete information for clinical variables, including age, body mass index(BMI), pre-operative PSA level, prostate volume(PV), number of biopsy cores obtained, percentage of clinical stage, biopsy Gleason score. We evaluated extra-capsular extension by operative pathologic test. Univariable and multivariable logistic regression analysis was used to

  18. 77 FR 40620 - AHRQ Workgroups on ICD-10-CM/PCS Conversion of Quality Indicators (QIs) - Extension Date for...

    Science.gov (United States)

    2012-07-10

    ... disease, infectious disease, neonatology and pediatric disease, miscellaneous) and at least two..., critical care and pulmonary disease, diabetes and endocrine disease, infectious disease, neonatology and..., infectious disease, neonatology and pediatric disease, miscellaneous), along with background...

  19. Systematic review of validated case definitions for diabetes in ICD-9-coded and ICD-10-coded data in adult populations

    Science.gov (United States)

    Khokhar, Bushra; Jette, Nathalie; Metcalfe, Amy; Cunningham, Ceara Tess; Kaplan, Gilaad G; Butalia, Sonia; Rabi, Doreen

    2016-01-01

    Objectives With steady increases in ‘big data’ and data analytics over the past two decades, administrative health databases have become more accessible and are now used regularly for diabetes surveillance. The objective of this study is to systematically review validated International Classification of Diseases (ICD)-based case definitions for diabetes in the adult population. Setting, participants and outcome measures Electronic databases, MEDLINE and Embase, were searched for validation studies where an administrative case definition (using ICD codes) for diabetes in adults was validated against a reference and statistical measures of the performance reported. Results The search yielded 2895 abstracts, and of the 193 potentially relevant studies, 16 met criteria. Diabetes definition for adults varied by data source, including physician claims (sensitivity ranged from 26.9% to 97%, specificity ranged from 94.3% to 99.4%, positive predictive value (PPV) ranged from 71.4% to 96.2%, negative predictive value (NPV) ranged from 95% to 99.6% and κ ranged from 0.8 to 0.9), hospital discharge data (sensitivity ranged from 59.1% to 92.6%, specificity ranged from 95.5% to 99%, PPV ranged from 62.5% to 96%, NPV ranged from 90.8% to 99% and κ ranged from 0.6 to 0.9) and a combination of both (sensitivity ranged from 57% to 95.6%, specificity ranged from 88% to 98.5%, PPV ranged from 54% to 80%, NPV ranged from 98% to 99.6% and κ ranged from 0.7 to 0.8). Conclusions Overall, administrative health databases are useful for undertaking diabetes surveillance, but an awareness of the variation in performance being affected by case definition is essential. The performance characteristics of these case definitions depend on the variations in the definition of primary diagnosis in ICD-coded discharge data and/or the methodology adopted by the healthcare facility to extract information from patient records. PMID:27496226

  20. Validity of PTSD diagnoses in VA administrative data: Comparison of VA administrative PTSD diagnoses to self-reported PTSD Checklist scores

    Directory of Open Access Journals (Sweden)

    Amy A. Gravely, MA

    2011-01-01

    Full Text Available Little research has been done on the validity of posttraumatic stress disorder (PTSD diagnoses that are found in Department of Veterans Affairs (VA administrative data, even though they are often used in VA research. We compared PTSD diagnoses found in VA administrative data with PTSD Checklist (PCL scores self-reported by 4,777 newly diagnosed participants in a national postal survey study. Using PCL scores of at least 50 as the gold standard, we compared positive predictive values (PPVs for at least one versus at least two PTSD diagnoses (found within 4 months of the first in VA administrative data overall and by subgroups of interest: age, sex, and clinic where first diagnosed. The overall PPV was 75% for at least one PTSD diagnosis and 82% for at least two PTSD diagnoses. Similarly, the PPV significantly increased for all subgroup analyses when at least two PTSD diagnoses were used. The increase in PPV was greatest for those first diagnosed in primary care and for those older than 65. To select a sample of veterans with more definitive PTSD from administrative data, researchers should select those veterans with at least two PTSD diagnoses as opposed to at least one.

  1. Novel approaches in diagnosing tuberculosis

    Science.gov (United States)

    Kolk, Arend H. J.; Dang, Ngoc A.; Kuijper, Sjoukje; Gibson, Tim; Anthony, Richard; Claassens, Mareli M.; Kaal, Erwin; Janssen, Hans-Gerd

    2011-06-01

    The WHO declared tuberculosis (TB) a global emergency. An estimated 8-9 million new cases occur each year with 2-3 million deaths. Currently, TB is diagnosed mostly by chest-X ray and staining of the mycobacteria in sputum with a detection limit of 1x104 bacteria /ml. There is an urgent need for better diagnostic tools for TB especially for developing countries. We have validated the electronic nose from TD Technology for the detection of Mycobacterium tuberculosis by headspace analysis of 284 sputum samples from TB patients. We used linear discriminant function analysis resulting in a sensitivity of 75% a specificity of 67% and an accuracy of 69%. Further research is still required to improve the results by choosing more selective sensors and sampling techniques. We used a fast gas chromatography- mass spectrometry method (GC-MS). The automated procedure is based on the injection of sputum samples which are methylated inside the GC injector using thermally assisted hydrolysis and methylation (THM-GC-MS). Hexacosanoic acid in combination with tuberculostearic acid was found to be specific for the presence of M. tuberculosis. The detection limit was similar to microscopy. We found no false positives, all microscopy and culture positive samples were also found positive with the THM-GC-MS method. The detection of ribosomal RNA from the infecting organism offers great potential since rRNA molecules outnumber chromosomal DNA by a factor 1000. It thus may possible to detect the organism without amplification of the nucleic acids (NA). We used a capture and a tagged detector probe for the direct detection of M. tuberculosis in sputum. So far the detection limit is 1x106 bacteria / ml. Currently we are testing a Lab-On-A-Chip Interferometer detection system.

  2. Meta-analysis of screening and case finding tools for depression in cancer: Evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group

    DEFF Research Database (Denmark)

    Mitchell, A. J.; Meader, N.; Davies, E.

    2012-01-01

    Background: To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard. Methods: We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer...... as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings. Conclusions: Although no single tool could be offered unqualified support, several tools are likely to improve upon...... unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy. (C) 2012 Elsevier B.V. All rights reserved....

  3. Diagnosing major depression in elderly primary care patients: nuances and determinants.

    NARCIS (Netherlands)

    Volkers, A.C.; Nuijen, J.; Verhaak, P.F.M.; Schellevis, F.G.

    2003-01-01

    The researchers studied how general practitioners (GPs) diagnosed elderly patients with depressive symptoms. Sociodemographic factors such as younger age, female sex and more education, clinical characteristics such as severe depression and comorbidity of anxiety disorders are suggested to improve t

  4. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serra Kayacetin

    2004-01-01

    Liver penetration is a rare but serious complication of peptic ulcer disease. Usually the diagnosis is made by operation or autopsy. Clinical and laboratory data were no specific. A 64-year-old man was admitted with upper gastrointestinal bleeding. Hepatic penetration was diagnosed as the cause of bleeding. Endoscopy showed a large gastric ulcer with a pseudotumoral mass protruding from the ulcer bed. Definitive diagnosis was established by endoscopic biopsies of the ulcer base.

  5. Diagnosing young onset dementia can be challenging.

    Science.gov (United States)

    Ahmed, Samrah; Baker, Ian; Butler, Christopher R

    2016-05-01

    Although the risk of developing dementia increases with age, onset can be as early as the third or fourth decade of life. Genetic influences play a more important role in younger than in older people with dementia, so young onset dementia may cluster in families. Diagnosing young onset dementia is challenging. The range of possible presenting features is broad, encompassing behavioural, cognitive, psychiatric and neurological domains, and symptoms are often subtle initially. Frequently the complaints are misattributed to stress or depression, and the patient is falsely reassured that they are too young to have dementia. The most common causes of young onset dementia are early onset forms of adult neurodegenerative conditions and alcohol. Vascular dementia is the second most common cause of young onset dementia after Alzheimer's disease. Conventional vascular risk factors may be absent and diagnosis relies on imaging evidence of cerebrovascular disease. Obtaining a detailed history remains the most important part of the workup and usually requires corroboration by a third party. Undertaking a basic neurological examination is also important. Those with suspected young onset dementia should be referred to a neurology-led cognitive disorders clinic where available as the differenti diagnosis is considerably broader tha in older adults and requires specialist investigation.

  6. Fetal MRI clues to diagnose cloacal malformations

    Energy Technology Data Exchange (ETDEWEB)

    Calvo-Garcia, Maria A.; Kline-Fath, Beth M.; Patel, Manish N.; Kraus, Steven [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); Levitt, Marc A.; Pena, Alberto [Cincinnati Children' s Hospital Medical Center, Colorectal Center for Children, Pediatric Surgery, Cincinnati, OH (United States); Lim, Foong-Yen; Crombleholme, Timothy M. [Cincinnati Children' s Hospital Medical Center, Fetal Care Center of Cincinnati, Pediatric Surgery, Cincinnati, OH (United States); Linam, Leann E. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States)

    2011-09-15

    Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis. To define the prenatal MRI findings in cloacal malformations. We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses. The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5-6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos. Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified. (orig.)

  7. Diagnosing Mitochondrial Disorder without Sophisticated Means

    Directory of Open Access Journals (Sweden)

    Josef Finsterer

    2015-10-01

    Full Text Available Mitochondrial disorders (MIDs require biochemical or genetic investigations for being diagnosed. In some cases, however, the diagnosis can be suspected upon the syndromic phenotype or upon clinical presentation and family history, as in the following case. The patient was a 74-year-old male admitted for worsening of pre-existing left-sided ptosis and ophthalmoparesis after a birthday party. The history was positive for arterial hypertension, hypertrophic cardiomyopathy with systolic dysfunction, diabetes-type 2, mild renal insufficiency, thyroiditis, and polyneuropathy. Instrumental investigations additionally revealed hepatopathy, hyperlipidemia, hyperuricemia, bifascicular block, white matter lesions, and subacute stroke. Systolic dysfunction resolved upon adequate cardiac treatment. On hospital day 11 the patient suddenly developed asystole. He was successfully resuscitated but died a few hours later from acute myocardial infarction. Surprisingly, a more extensive family history was positive for myopathy (patient, brother, daughter, neuropathy (patient, hypoacusis (patient, Parkinson syndrome (mother, spasticity (son, diabetes (patient, son, renal failure (patient, and generalized atherosclerosis (patient. The individual and family history was strongly suggestive of an MID. In conclusion, individual and family history may strongly suggest MID. Phenotypic variability may be high between family members affected by an MID. MID may be associated with an increasing atherosclerotic risk lastly resulting in coronary heart disease and death.

  8. Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS)

    Science.gov (United States)

    ... Clinical Information General Hantavirus Technical/Clinical Information Ecology Virology Airborne Transmission HPS Technical/Clinical Information Clinical Manifestation Treatment Histopathology Pathology/ Pathogenesis Diagnostics ...

  9. Diagnose og behandling af binyrebarkkarcinom

    DEFF Research Database (Denmark)

    Abildgaard, Julie; Pappot, Helle; Petersen, Peter Meidahl;

    2013-01-01

    Adrenocortical carcinomas (ACC) are rare tumours responsible for only 0.02% of the total number of malignant diseases. However the ACC are aggressive with a mean fiveyears survival of 20-50% and are often associated with increased production of adrenocortical hormones. The effect of the treatment...... is controversial and often based on small retrospective series or expert opinions. Centralization, international attention and collaboration in the treatment of ACC are mandatory. Randomized clinical trials are needed to determine the best treatment strategy in order to increase survival in patients with ACC....

  10. 瞬时弹性波扫描仪检查在慢性乙型肝炎患者肝纤维化诊断中的应用%Clinical value of transient elastography for diagnosing liver fibrosis in patients with chronic hepatitis B

    Institute of Scientific and Technical Information of China (English)

    蒋玉凤; 邹永胜; 唐瑞

    2012-01-01

      目的评估瞬时弹性波扫描仪检查(Fibroscan)在诊断慢性乙型肝炎患者肝纤维化中的应用。方法分别用 Fibroscan 对无症状 HBV 携带者、慢性乙型肝炎、乙肝肝硬化患者各40例进行肝脏硬度值(liver stiffness values,LSM)测定,然后分析各组患者间 LSM 有否差异。结果116例患者成功获得 LSM 值,肝硬化患者 LSM 值明显高于慢性乙型肝炎患者与无症状 HBV 携带者,差异有统计学意义,慢性乙型肝炎患者 LSM 值也明显高于无症状 HBV 携带者,差异有统计学意义。结论 Fibroscan 检查有助于肝病患者的肝纤维化诊断,具有临床应用价值。%  Objective To evaluate theclinical value of transient elastography( Fibroscan ) for diagnosing liver fibrosis in patients with chronic hepatitis B Methods Liver stiffness values(LSM) were assessed using transient elastography in totaly 120 subjects including 40 asymptomatic hepatitis B virus(HBV) carriers,40 patients with chronic hepatitis B(CHB)and 40 patients with HBV-related cirrhosis.LSM was used to evaluate the value of Fibroscan for diagnosing liver fibrosis. Results Failure of the measurement occurred in 4 cases. LSM in HBV carriers was lowest ,that in patients with HBV-related cirrhosis was highest, the differences were statisticaly significant(P < 0.05or P < 0.001).Conclusion Fibroscan is helpful to diagnose liver fibrosis, has clinical value.

  11. 新确诊老年糖尿病降糖过快诱发心血管疾病患者的临床分析%Clinical analysis of the newly diagnosed elderly diabetes patients with hypoglycemic fast induced cardiovascular disease

    Institute of Scientific and Technical Information of China (English)

    王蓓

    2016-01-01

    Objective:To analyze the problems of the newly diagnosed elderly diabetes patients with hypoglycemic fast induced cardiovascular disease.Methods:80 cases of newly diagnosed elderly diabetes patients were selected.The control group was given conventional drug treatment.The observation group was given individualized drug treatment.The problems of the patients with hypoglycemic fast induced cardiovascular disease were compared.Results:The observation group had no hypoglycemic fast problems;the cardiovascular disease occurrence was significantly lower than that of the control group(P<0.05).The clinical treatment effect of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The implementation of individualized drug treatment for newly diagnosed elderly diabetes patients can effectively reduce the incidence of hypoglycemic fast induced cardiovascular disease.%目的:分析新确诊老年糖尿病降糖过快诱发心血管疾病的问题。方法:收治新确诊老年糖尿病患者80例,对照组给予常规药物治疗,观察组给予个性化药物治疗,对比两组患者的降糖速度过快诱发心血管疾病的问题。结果:观察组未发生降糖速度过快问题,心血管疾病发生率显著低于对照组(P<0.05);观察组的临床治疗效果显著高于对照组(P<0.05)。结论:对新确诊老年糖尿病患者实施个性化的药物治疗,能够有效降低降糖过快诱发心血管疾病的发生率。

  12. Determination of Accuracy of Nursing Diagnoses Used by Nursing Students in their Nursing Care Plans

    Directory of Open Access Journals (Sweden)

    Nursel Aydin

    2013-01-01

    Full Text Available Aim: The aim of this study was to determine and evaluate appropriateness of nursing diagnoses with NANDA taxonomy used by second year nursing students in their nursing care plans.Methods: Retrospective design.Findings: While care plans included 42 nursing diagnoses appropriate to NANDA II taxonomy, some phrases (n=30were used as nursing diagnoses. Risks for infection, pain, activity intolerance, anxiety were the most frequently used diagnoses while nursing diagnoses in domains of cognitive-perceptive, self perception and role relations are very few.Conclusio: Performing case studies in clinical settings by using NANDA diagnoses, specifying difficulties experienced by nursing students’ and determining levels of discomfort while assessing the patients and determining the perceptions of nursing students by doing qualitative studies are recommended.

  13. Gastric atrophy, diagnosing and staging

    Institute of Scientific and Technical Information of China (English)

    Hala MT El-Zimaity

    2006-01-01

    H pylori is now accepted as the cause of gastritis and gastritis-associated diseases, such as duodenal ulcer,gastric ulcer, gastric carcinoma, and gastric MALT lymphoma. The natural history of H pylori gastritis includes inflammation progressing from the antrum into the adjacent corpus resulting in an atrophic front of advancing injury leading to a reduction in acid secretion and eventual loss of parietal cells and development of atrophy. Sub-typing intestinal metaplasia has no clinical value to the patient, the pathologist, or the endoscopist.The pattern, extent, and severity of atrophy, with or without intestinal metaplasia, is a far more important predictor than is intestinal metaplasia subtype. The challenge remains to identify a reliable marker that relates to pre-malignant potential.

  14. Hemorheological Alteration in Patients Clinically Diagnosed with Chronic Liver Diseases.

    Science.gov (United States)

    Jang, Bohyun; Han, Ji Won; Sung, Pil Soo; Jang, Jeong Won; Bae, Si Hyun; Choi, Jong Young; Cho, Young I; Yoon, Seung Kew

    2016-12-01

    Since liver function is changed by chronic liver diseases, chronic liver disease can lead to different hemorheological alterations during the course of the progression. This study aims to compare alterations in whole blood viscosity in patients with chronic liver disease, focusing on the gender effect. Chronic liver diseases were classified into three categories by patient's history, serologic markers, and radiologic findings: nonalcoholic fatty liver disease (NAFLD) (n = 63), chronic viral hepatitis B and C (n = 50), and liver cirrhosis (LC) (n = 35). Whole blood viscosity was measured by automated scanning capillary tube viscometer, while liver stiffness was measured by transient elastography using FibroScan®. Both systolic and diastolic whole blood viscosities were significantly lower in patients with LC than NAFLD and chronic viral hepatitis (P chronic viral hepatitis. Our data suggest that whole blood viscosity test can become a useful tool for classifying chronic liver disease and determining the prognosis for different types of chronic liver diseases.

  15. Ethical Dimensions of Diagnosing: Considerations for Clinical Mental Health Counselors

    Science.gov (United States)

    Kress, Victoria E.; Hoffman, Rachel M.; Eriksen, Karen

    2010-01-01

    There are numerous ethical considerations inherent within the process of assigning a "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; "DSM-IV-TR"; American Psychiatric Association, 2000) diagnosis. In this article, general ethics considerations such as informed consent and confidentiality, accuracy of diagnosis, and…

  16. De dokter en de diagnose-verzamelaar

    NARCIS (Netherlands)

    Geersing, Geert-Jan

    2015-01-01

    In the course of the medical curriculum, medical students are trained to recognise diagnoses. They classify these in their minds, together with detailed information on laboratory and imaging tests, as collections of diagnoses. The downside of this could be overdiagnosis. This paper describes some of

  17. Nursing diagnoses in patients with immune-bullous dermatosis

    Directory of Open Access Journals (Sweden)

    Euzeli da Silva Brandão

    Full Text Available ABSTRACT Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11. 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology.

  18. Nursing diagnoses in patients with immune-bullous dermatosis 1

    Science.gov (United States)

    Brandão, Euzeli da Silva; dos Santos, Iraci; Lanzillotti, Regina Serrão; Ferreira, Adriano Menis; Gamba, Mônica Antar; Azulay-Abulafia, Luna

    2016-01-01

    ABSTRACT Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11). 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology. PMID:27533274

  19. The clinical values of 1H-MRS and DCE-MRI in diagnosing breast cancer%3.0T磁共振动态增强及波谱成像对乳腺癌定性诊断的价值

    Institute of Scientific and Technical Information of China (English)

    李洪松

    2014-01-01

    Objective To evaluate the clinical values of 1H-MRS and DCE-magnetic resonance imaging (MRI) with 3.0T MRI system in the diagnosis of breast cancer. Methods Retrospective analysis on 82 breast tumors (54 malignant and 28 benign tumor) which were confirmed by pathological results. Study the features of 1H-MRS and DCE-MRI,and the results of 1H-MRS and DCE-MRI were compared with the pathology respectively. Chi-square test was adopted for statistics processing. Results The sensitivity, specificity , accuracy, positive predictive value and negative predictive value of time-signal intensity curve in diagnosing breast cancer were 87%, 71%, 82%, 86% and 74% respectively.While the sensitivity, specificity , accuracy, positive predictive value and negative predictive value of 1H-MRS in diagnosing breast cancer were 91%, 86%, 89%, 92%and 83%respectively. And the sensitivity, speci-ficity and accuracy of 1H-MRS associated with DCE-MRI in diagnosing breast cancer were 98%, 82%and 93%. Con-clusion The sensitivity is lower by only using 1H-MRS or DCE-MRI than that using 1H-MRS associated with DCE-MRI in diagnosing breast cancer. 1H-MRS associated with DCE-MRI is useful in qualitative diagnosis of breast cancer.%目的:探讨3.0T磁共振动态增强扫描(DCE-MRI)与氢质子波谱(1H-MRS)成像在乳腺癌定性诊断中的临床应用价值。方法收集我院经手术后病理或穿刺活检病理证实的乳腺肿瘤患者78例,共计82个肿瘤作为研究组,其中乳腺癌54个,良性肿瘤28个。全部病例均于术前行磁共振动态增强后1H-MRS检查,回顾性分析本组病例的DCE-MRI及1H-MRS表现,并将MRI诊断结果与病理结果进行对比分析。统计学处理采用χ2检验等。结果 DCE-MRI检查单独诊断乳腺癌的敏感性为87%,特异性为71%,准确性为82%,阳性预测值为86%,阴性预测值为74%。1H-MRS检查单独诊断乳腺癌的敏感性为91%,特异性为86%,准确性为89

  20. 新诊断2型糖尿病患者血清25-羟维生素D3的临床意义%Clinical Significance of Serum 25-hydroxy Vitamin D3in Newly Diagnosed Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    程亮; 俞伟男; 胡文; 柏凤; 郝海荣

    2013-01-01

    目的 观察新诊断2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清25-羟维生素D3[25-hydroxy vitamin D3,25(OH)D3]水平的变化,分析血清25(OH)D3在新诊断T2DM患者中的意义.方法 通过比较118例新诊断T2DM患者与60例健康体检者血糖、血脂、胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA-IR)、胰岛β细胞功能指数(homeostasis model assessment islet β-cell function index,HOMA-β)及25(OH)D3等方面的差别,并分析25(OH)D3与HOMA-IR、HOMA -β的相关性.结果 T2DM组患者血糖、血脂、HOMA-IR高于正常对照组(P<0.05),而HOMA-β、25(OH)D3低于正常对照组(P<0.05),Pearson相关分析显示T2DM组患者血清25 (OH) D3与HOMA-IR呈负相关(r=-0.55,P均<0.05),与HOMA-β呈正相关(r =0.63,P<0.05).结论 新诊断T2DM患者血清25(OH)D3的缺乏与胰岛素抵抗和胰岛β细胞分泌功能下降有关.%Objective To investigate the changes of serum 25-hydroxy vitamin D3in newly diagnosed type 2 diabetes mellitus,and analysis the significance of serum 25-hydroxy vitamin D3 in newly diagnosed type 2 diabetes mellitus.Methods Totally 118 newly diagnosed type 2 diabetes mellitus patients were compared with 60 healthy individuals in clinical characteristics including blood glucose,lipid profiles,insulin resistance index,islet β-cell function index and 25-hydroxy vitamin D3.The correlation of 25-hydroxy vitamin D3 with insulin resistance index,islet β-cell function index was analyzed.Results The type 2 diabetes mellitus patients showed higher level of blood glucose,lipid profiles and insulin resistance index than healthy individuals (P < 0.05),but lower level of islet β-cell function index,25-hydroxy vitamin D3than healthy individuals(P < 0.05).Pearson correlation analysis showed that 25-hydroxy vitamin D3 was positively associated with islet β-cell function index(r =0.63,P < 0.05),and negative associated with insulin resistance index(r =-0.55,P all < 0

  1. 视听整合持续性操作测试在中国的适用性:基于临床和学校样本的评估结果%Values of the integrated visual and auditory continuous performance test in diagnosing children with attention deficit hyperactivity disorder in clinic and school in China

    Institute of Scientific and Technical Information of China (English)

    张微; 江叶萍; 莫书亮; 林红丽; 柯善玉

    2015-01-01

    Objective To explore the psychometric properties of the Chinese version of integrated visual and auditory continuous performance test (IVA-CPT) ,and to assess the diagnosis value of the Chinese version of IVA-CPT in two samples of children with attention deficit hyperactivity disorder (ADHD) in clinic and school.Methods 112 participants were divided into 4 groups:clinic group, clinic control group, school group and control group from school.The participants were measured by IVA-CPT and the results were compared.Results ①The integrated quotients of IVA-CPT had concordance with the dimensions of the DSM-ⅣV and ASRS.Each integrated quotients of IVA-CPT and each dimension of the DSM-ⅣV and ASRS were negatively correlated(school: r=-0.277, P<0.05;clinic: r=-0.423, P<0.05).The score of HI dimension was negatively correlated with integrated attention quotient and integrated inhibition quotient of IVA-CPT (r=-0.480, P<0.01;r=-0.452, P<0.01).② The results of the IVA-CPT and the comprehensive assessment had consistency for diagnosis of children with ADHD from the total subjects,the clinic ,and the school.And there were no difference between the sensitivity, the specificity, the coincidence rate, the missed diagnosis rate and the misdiagnosis rate of IVA-CPT when used to diagnose children with ADHD in clinic and school(x2=3.396, P>0.05).③The IVA-CPT evaluation system had good stability according to the retest of a random sample of 25 subjects(P<0.01).The pretest and posttest results of each full quotients of IVA-CPT were significantly correlated (P<0.01).Conclusion The IVA-CPT not only can be used as auxiliary diagnostic tools to diagnose children with ADHD in clinic,it can be used as auxiliary diagnostic tools to diagnose children with ADHD in the community.%目的 以临床和学校样本为对照,探索视听整合持续性操作测试(IVA-CPT)中文版对注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的评估效用.方法

  2. Diagnosing Coronary Heart Disease using Ensemble Machine Learning

    Directory of Open Access Journals (Sweden)

    Kathleen H. Miao

    2016-10-01

    Full Text Available Globally, heart disease is the leading cause of death for both men and women. One in every four people is afflicted with and dies of heart disease. Early and accurate diagnoses of heart disease thus are crucial in improving the chances of long-term survival for patients and saving millions of lives. In this research, an advanced ensemble machine learning technology, utilizing an adaptive Boosting algorithm, is developed for accurate coronary heart disease diagnosis and outcome predictions. The developed ensemble learning classification and prediction models were applied to 4 different data sets for coronary heart disease diagnosis, including patients diagnosed with heart disease from Cleveland Clinic Foundation (CCF, Hungarian Institute of Cardiology (HIC, Long Beach Medical Center (LBMC, and Switzerland University Hospital (SUH. The testing results showed that the developed ensemble learning classification and prediction models achieved model accuracies of 80.14% for CCF, 89.12% for HIC, 77.78% for LBMC, and 96.72% for SUH, exceeding the accuracies of previously published research. Therefore, coronary heart disease diagnoses derived from the developed ensemble learning classification and prediction models are reliable and clinically useful, and can aid patients globally, especially those from developing countries and areas where there are few heart disease diagnostic specialists.

  3. Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma

    Directory of Open Access Journals (Sweden)

    Diego Cassol Dozza

    2012-09-01

    Full Text Available Dysembryoplastic neuroepithelial tumor (DNT, described in 1988 and introduced in the WHO classification in 1993, affects predominantly children or young adults causing intractable complex partial seizures. Since it is benign and treated with surgical resection, its recognition is important. It has similarities with low-grade gliomas and gangliogliomas, which may recur and become malignant. OBJECTIVES: To investigate whether DNT was previously diagnosed as astrocytoma, oligodendroglioma, or ganglioglioma and to determine its frequency in a series of low-grade glial/glio-neuronal tumors. METHODS: Clinical, radiological, and histological aspects of 58 tumors operated from 1978 to 2008, classified as astrocytomas (32, including 8 pilocytic, oligodendrogliomas (12, gangliogliomas (7, and DNT (7, were reviewed. RESULTS: Four new DNT, one operated before 1993, previously classified as astrocytoma (3 and oligodendroglioma (1, were identified. One DNT diagnosed in 2002 was classified once more as angiocentric glioma. Therefore, 10 DNT (17.2% were identified. CONCLUSIONS: Clinical-radiological and histopathological correlations have contributed to diagnose the DNT.

  4. Health care experiences among women diagnosed with gestational breast cancer.

    Science.gov (United States)

    Hammarberg, K; Sullivan, E; Javid, N; Duncombe, G; Halliday, L; Boyle, F; Saunders, C; Ives, A; Dickinson, J E; Fisher, J

    2017-03-24

    Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.

  5. Validity of the diagnosis of a single depressive episode in a case register

    Directory of Open Access Journals (Sweden)

    Gether Ulrik

    2009-02-01

    Full Text Available Abstract Objective To validate the ICD-10 diagnosis of a single depressive episode as used in daily clinical psychiatric practice and as recorded in the Danish Psychiatric Central Research Register. Methods Patients discharged with a diagnosis of a single depressive episode were consecutively sampled from the register and diagnosed according to an interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN. Results A total of 75.4% of 399 patients with a register diagnosis of a single depressive episode also got this diagnosis according to the SCAN interview (82.8% for severe type of a single depression, 76.0% for moderate type of a single depression and 65.2% for mild type of a single depression. Conclusion The ICD-10 diagnosis of a single depressive episode can be used in daily clinical practice with sufficient precision. The validity of the diagnosis is highest for severe and moderate type of depression and decreases for mild depression.

  6. Different Pathophysiological Phenotypes among Newly Diagnosed Type 2 Diabetes Patients

    DEFF Research Database (Denmark)

    Stidsen, Jacob

    2013-01-01

    Type 2 diabetes (T2D) can be considered a syndrome with several different pathophysiological mechanisms leading to hyperglycemia. Nonetheless, T2D is treated according to algorithms as if it was one disease entity. Methods: We investigated the prevalence of different pathophysiological phenotypes...... among newly diagnosed T2D patients in Denmark. Based on baseline data from a Danish national cohort study we investigated 1048 incident diagnosed T2D patients. The diagnosis T2D was made by general practitioners based on clinical judgement. Phenotypes were classified in the following groups: latent...... autoimmune diabetes (LADA) (GAD antibody titer >= 20 IE/ml and not T1D), secondary diabetes (recent history of pancreatitis, pancreatectomy or pancreas amylase > 65U/l, and GAD negativity), steroid-induced diabetes (oral glucocorticoid-treated subjects), insulinopenic (f-P-C-peptide

  7. APPLICATION OF POLYMERASE CHAIN REACTION FOR DIAGNOSING AMEBIC LIVER ABSCESS

    Institute of Scientific and Technical Information of China (English)

    郭增柱; 王正仪; 安亦军; 祝宏

    1996-01-01

    Polymerase chain reaction (PCR) has been applied in diagnosing amebic liver infection by detecting pathogenic Entamoeba histolytica DNA in liver aspirates. Oligonucleotide primers found to he specific for the gene encoding the 30 kDa molecule of this pathogenic ameba were used in the test. Liver aspirates obtained from 23 patients with amebic liver abscess substantiated by typical clinical rnanifastation or with very high titres of anti-E histtolytica antibodies by ELISA were found to he positive by PCR. Fourteen controlsamples (3 cases of bacterial liver abscess, I of liver cancer and 10 of other abscess) were all found to be negative to this reaction. The results suggested PCR to he a specific and sensitive tool for diagnosing amebic liver abscess infections.

  8. How Are Overweight and Obesity Diagnosed?

    Science.gov (United States)

    ... body mass index (BMI) and possibly a high waist circumference, and tests to rule out other medical conditions. ... diagnosed as obese if you have a large waist circumference that suggests increased amounts of fat in your ...

  9. How Is Sickle Cell Disease Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Sickle Cell Disease Diagnosed? Screening Tests People who do not ... Content: NEXT >> Featured Video Living With and Managing Sickle Cell Disease (Nicholas) 09/02/2011 In this video— ...

  10. Diagnosing Diabetes and Learning about Prediabetes

    Science.gov (United States)

    ... Size: A A A Listen En Español Diagnosing Diabetes and Learning About Prediabetes There are several ways ... mg/dl – 199 mg/dl Preventing Type 2 Diabetes You will not develop type 2 diabetes automatically ...

  11. Diagnosing Asthma in Very Young Children

    Science.gov (United States)

    ... Listen Español Text Size Email Print Share Diagnosing Asthma in Babies & Toddlers Page Content Article Body One ... family with recurrent bronchitis or sinus problems. When Asthma is Not the Cause Your pediatrician will listen ...

  12. 256层ICT探测冠状动脉钙化在不稳定心绞痛与稳定心绞痛患者中的对比%Detection of Coronary Artery Calcification Score and Compare it in Patients Diagnosed Clinically as Stable and Unstable Angina by 256 ICT

    Institute of Scientific and Technical Information of China (English)

    朱大光

    2013-01-01

    目的:探讨256层ICT在探测冠状动脉钙化积分中的意义。方法:采用256层ICT对2组患者进行冠状动脉钙化积分扫描,钙化积分由工作站软件自动获得,132例患者分为2组,55例稳定心绞痛,77不例稳定心绞痛。结果:不稳定心绞痛患者的钙化积分要显著大于稳定心绞痛患者(p<0.05),不稳定心绞痛患者的血管钙化数目要明显多于稳定心绞痛组。结论:不稳定心绞痛患者的钙化更明显,因此预测冠状动脉情况冠状动脉钙化积分可以作为重要指标。%Objective:To detect Coronary calcification score and compare it in patients diagnosed clinically of having stable and unsta -ble angina and they being more prone for cardiovascular risk .Methods:Coronary artery calcification was scanned and its scores ( CACS) were measured through 256-slice ICT in 132 patients diagnosed of having stable and unstable angina .(55 stable and 77 unstable angi-na).the result were analyzed statistically by 2-grouped test.Also some associated risk factors were also taken into concideraton (HTN, total cholesterol ,Triglycerides etc ) .Results:The calcification scores in patients with unstable angina were comparatively more than those with patients having stable angina (p<0.05).Also it found that 3-vesssel calcification was more significant with unstable angina ,where as 1-vesssel calcification was more significant with stable angina cases .Conclusion:Coronary artery calcification scores is of great value in predicting cardiovascular enets .

  13. Comparison of clinical efficacy and safety of sitagliptin and metformin in the treatment of newly diagnosed T2MD patients with 30 cases respectively%西格列汀与二甲双胍治疗初诊T2MD患者各30例临床疗效及安全性比较

    Institute of Scientific and Technical Information of China (English)

    李晓钟

    2015-01-01

    Objective:To explore the clinical efficacy and safety of sitagliptin and metformin in the treatment of newly diagnosed T2MD patients.Methods:60 cases of newly diagnosed T2MD patients were selected.They were randomly divided into the treatment group and the control group.The treatment group were given sitagliptin,and the control group were given metformin,then we compared the therapeutic effect of the two groups.Results:After 12 weeks of treatment,compared with before treatment,FBG,2hPG, HbA1c,BMI of two groups of patients were decreased significantly(P0.05).After treatment,the two groups in blood lipids,blood routine,liver and kidney function,blood pressure,adverse reaction were no significant difference(P>0.05).Conclusion:Compared with metformin,sitagliptin was used to treat T2MD,the efficacy and safety were basically the same,but the price was more expensive,the cost performance was low.%目的:探讨西格列汀与二甲双胍对初诊 2 型糖尿病(T2DM)患者的临床疗效及安全性.方法:将 60 例初诊T2MD患者随机分为治疗组1和治疗组2,治疗组1口服西格列汀片,治疗组2口服二甲双胍片,比较两组治疗效果.结果:治疗12周后,两组患者的FBG、2 hPG、HbA1c、BMI比治疗前均有明显下降(P0.05).治疗后两组在血脂、血常规、血压、肝肾功能、不良反应等方面差异无统计学意义(P>0.05).结论:使用西格列汀治疗T2MD与二甲双胍比较,疗效、安全性基本相当,但其价格较贵,性价比较低.

  14. The clinical value on the pre-operation of styloid process syndrome diagnosed by 128-slice spiral CT%128层螺旋 CT 在茎突综合征术前诊断中的临床价值

    Institute of Scientific and Technical Information of China (English)

    左开荣

    2014-01-01

    目的:探讨128层螺旋 CT 在茎突综合征术前诊断中的临床价值。方法回顾性分析50例(100侧)正常成人(对照组)和48例(96侧)经手术证实的茎突综合征患者(SPS 组)的临床及影像资料,并对两组患者的茎突长度和倾角分布的差异进行统计分析。结果对照组中,茎突过长(长度>30mm)8侧(8%),前倾角过大(角度>25°)2侧(2%),内倾角过大(角度>25°)4侧(4%);而 SPS 组中,茎突过长56侧(58.3%),前倾角过大14侧(14.6%),内倾角过大18侧(18.8%),茎突过长伴倾角异常10侧(10.4%)。经统计学分析,SPS 组的茎突过长及倾角过大的检出率明显高于对照组,差异具有统计学意义(P<0.05)。结论茎突综合征在影像学上主要表现为茎突过长和(或)倾角过大,128层螺旋 CT 三维重建技术能为临床提供可靠的影像学依据,在茎突综合征术前诊断中具有重要临床价值。%Objective To explore the clinical value on the pre-operation of styloid process syndrome diagnosed by 128-slice spiral CT. Methods Retrospectively analyzed 50 cases (100sides) of normal adult (control group) and 48 cases(96 sides) of styloid process syndrome diagnosed by operation (SPS group). The differences between two groups in the length and angle distribution of the styloid process were analyzed statistically. Results Eight sides of control group (8%) had the elon-gated styloid process (the lenght was more than 30mm),two sides (2%) had the larger anteversion angle (the angle was more than 25°),four sides (4%) had the larger inclination angle (more than 25°);48 cases of SPS group, 56 sides (58.3%) had the elongated styloid process,14 sides (14.6%) had the larger anteversion angle, 18 sides (18.8%) had the larger inclination an-gle,10 sides (10.4%) had the elongated styloid process coupled with abnormal inclination. Analyzed by statistics, the detection

  15. 99Tcm-甲氧基异丁基异腈双时相显像诊断甲状旁腺功能亢进症的临床价值%Clinical value of dual-phase 99Tcm-MIBI imaging in diagnosing hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    李家志

    2011-01-01

    目的 分析99Tcm-甲氧基异丁基异腈(MIBI)双时相显像在甲状旁腺功能亢进症(HPT)诊断中的临床价值.方法 29例临床诊断或高度怀疑HPT患者于颈部及上胸部行99Tcm-MIBI显像,采用双时相法并加做99Tcm-MIBI全身显像,阳性指标为延迟图像上出现异常增高的放射性聚集,显像资料均参照临床最终诊断结果进行评价,并与同期B超(29例)和CT检查(16例)结果进行对比.结果 29例患者中,25例确诊为HPT,其中甲状旁腺腺瘤23例,甲状旁腺增生1例,甲状旁腺癌1例.99Tcm-MIBI诊断灵敏度为84%,特异度为100%,准确度为86.21%,同期B超诊断灵敏度和准确度分别为72%和75.86%.CT检查的灵敏度为41.67%.99Tcm-MIBI双时相显像在腺瘤诊断方面较B超和CT具有更高的诊断效能(P<0.05).结论 99Tcm-MIBI双时相显像在定位诊断HPT疾患中具有较高的临床价值,可作为HPT术前定位诊断的主要手段.%Objective To evaluate the clinical value of dual-phase 99 Tcm-MIBI imaging in diagnosing hyperparathyroidism( HPT ).Methods Dual-phase 99Tcm-MIBI imaging was performed on 29 patients with HPT or highly suspectable HPT at neck and chest, abnormal increase radioactive accumulation in delay imaging stood for positive index.Imaging data were evaluated according to final clinical results ,followed by whole body imaging, and compared with contemporaneous ultrasound ( 29 cases ) and CT ( 16 cases ) results.Results In 29 patients,25 cases diagnosed as HPT,including 23 adenomas, 1 parathyroid hyperplasia and 1 parathyroid carcinoma.The sensitivity and specificity of 99Tcm-MIBI diagnosis were 84% and 100 % , respectively.The accuracy was 86.21%.The sensitivity and specificity of ultrasound were 72% and 75.86% , respectively.The sensitivity of CT was 41.67%.Compared with B-ultrasound and CT, dual-phase 99Tcm-MIBI imaging has a higher diagnostic performance in the diagnosis of adenoma ( P < 0.05 ).Conclusion Dual-phase 99Tcm

  16. 初诊2型糖尿病采用不同强化方案治疗的临床疗效比较%Comparison on Clinical Effect of Different Reinforcement Schemes in Treating Newly Diagnosed Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    郑贤; 刘兆进; 莫凤玲

    2016-01-01

    目的:研究不同强化方案治疗初诊2型糖尿病的临床效果。方法选取我院2013年9月至2015年9月期间收治的168例初诊2型糖尿病患者,根据使用的药物不同分为A、 B、 V三组,每组56例。 A组给予单纯的胰岛素治疗, B组给予二甲双胍+甘精胰岛素治疗, V组给予二甲双胍+格列美脲治疗。观察比较三组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)等的变化情况。结果三组患者治疗后, FBG、2hPBG、 HbA1c水平均较治疗前下降,且A组的下降水平更为显著(P<0.05)。 A组和B组治疗血糖达标的时间明显低于V组,差异具有统计学意义(P<0.05)。结论三种强化方案治疗初诊2型糖尿病,均可有效改善患者的糖代谢、细胞功能及胰岛素的敏感性,而糖代谢异常的患者单纯采用胰岛素治疗效果更显著。%Objective To study the clinical efficacy of different reinforcement schemes in treatment of newly diagnosed type 2 diabetes mellitus. Methods 168 cases of patients with newly diagnosed type 2 diabetes mellitus treated in our hospital from September 2013 to September 2015 were selected and divided into group A, group B and group C according to different medication, with 56 cases in each group. Group A was only given insulin therapy, group B was given metformin+insulin glargine therapy, group C was given metformin+glimepiride therapy. The changes of fasting blood-glucose (FBG), 2 h postprandial blood glucose (2hPBG) and glycosylated hemoglobin (HbA1c) in three groups before and after treatment were observed and compared. Results After treatment, the levels of FBG, 2hPBG and HbA1c of three groups decreased significantly, and the decrease degree of group A was obvious, P <0.05. The time of blood glucose returning to normal level of group A and group B was significantly lower than that of group C, with statistical difference (P <0.05). Conclusions Three kinds

  17. Lupus vulgaris diagnosed after 37 years: a case of delayed diagnosis.

    Science.gov (United States)

    Turan, Enver; Yurt, Nurdan; Yesilova, Yavuz; Celik, Ozgur Ilhan

    2012-05-15

    Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions are generally solitary and found on the head and neck region. Cutaneous tuberculosis can present with different clinical appearances. Therefore, it does not necessarily have characteristic findings and can be difficult to diagnose. Although there were typical clinical findings, the diagnosis of our case was delayed because of its asymptomatic course.

  18. EYE DISEASE IN NEWLY-DIAGNOSED LEPROSY PATIENTS IN EASTERN NEPAL

    NARCIS (Netherlands)

    LUBBERS, WJ; SCHIPPER, A; HOGEWEG, M; DESOLDENHOFF, R

    1994-01-01

    To determine the magnitude of eye lesions in newly diagnosed leprosy patients we examined their eyes. The Eastern Leprosy Control Project was supported by The Netherlands Leprosy Relief Association; we used the regional clinic in Biratnagar and 5 mobile clinics in surrounding districts as our survey

  19. Diagnósticos de enfermagem documentados para pacientes de clínica médica Diagnósticos de enfermería documentados para pacientes de clínica médica Documented nursing diagnoses for medical clinic patients

    Directory of Open Access Journals (Sweden)

    Cassiana Mendes Bertoncello Fontes

    2007-09-01

    deterioro de la integridad cutánea (36,7% y Deterioro de la integridad cutánea (33,3%. Son presentados los resultados e intervenciones para los 3 más frecuentes.This paper reports a descriptive study, based on nursing records, of nursing diagnoses documented three months after the implementation of the NANDA-I classification at the University of São Paulo's Hospital Universitário (HU-USP and proposes outcomes and interventions for the 3 most frequent diagnoses. The convenience sample (34% of the month's admissions consisted of 30 charts of patients admitted in the Medical Clinic in August of 2004 (60% female, average age 60.9±23.1 years, mean length of stay = 5.8±2.7 days. The diagnoses documented on the admission day were manually transcribed from the charts and analyzed according to their frequency. There were 144 diagnoses (31 categories, with an average of 4.8±4.0 diagnoses per patient (range = 1-10. The most frequent were: acute pain (66.7%, impaired tissue integrity (63.3%, ineffective airway clearance (43.3%, risk of impaired skin integrity (36.7%, and impaired skin integrity (33.3%. The proposed outcomes and interventions are presented.

  20. [The Cambridge Mental Disorders of the Elderly Examination. Validation of the Spanish adaptation].

    Science.gov (United States)

    Vilalta, J; Llinàs, J; López Pousa, S; Amiel, J; Vidal, C

    1990-04-01

    A neurologist and a psychiatrist diagnosed independently, according to DSM-III-R and ICD-10 criteria, to 15 subjects with dementia, 15 with depression and 15 without any of two previous diagnostics. Later, a psychologist held an interview with them by means of the structured interview CAMDEX. The lump levels of agreement between clinical diagnostic and DSM-III-R diagnostic obtained through CAMDEX is of Kappa = 0.63. These levels are increased to one Kappa = 0.76 if we compare the clinical diagnostic with CAMDEX diagnostic according to the ICD-10. On the other hand, we value the outputs of some instruments that are included in the CAMDEX: Mini Examen Cognoscitivo, Mini-Mental State, CAMCOG, Organicity Scale, Blessed Scale and Depressión Scale.

  1. Bronchial Sparganosis mansoni accompanied by abnormal hyperplasia diagnosed by bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    BAI Jing; HE Zhi-yi; LIU Guang-nan; ZHANG Jian-quan; DENG Jing-min; LI Mei-hua; ZHONG Xiao-ning

    2012-01-01

    Pulmonary sparganosis mansoni is rare in humans and bronchial sparganosis mansoni has not been reported.We reported a patient with a soft-tissue mass in the right hilum area on a chest computed tomography (CT) scan that was suspected of being lung cancer.Bronchoscopy identified sparganum larvae.Bronchial sparganosis mansoni accompanied by abnormal hyperplasia was diagnosed by histopathology.We introduced our experience and reviewed the clinical characteristics of three pulmonary sparganosis mansoni cases and three pleural cavity sparganosis mansoni cases that have been reoorted.

  2. Effect of Acupotomy Therapy on Lateral Epicondylitis Diagnosed by Ultrasonography

    Directory of Open Access Journals (Sweden)

    Lim Nara

    2011-06-01

    Full Text Available Purpose: This observation was to report the clinical effects of acupotomy in treating lateral epicondylitis. Methods: Three patients diagnosed with lateral epicondylitis were treated with acupotomy. Two were male and one was female. The improvement of symptom were evaluated by visual analog scale (VAS and self-consciousness symptoms of Cozen test. Results: After one treatments, patient's chief complaint and the pain near the lateral epicondyle while cozen test were notably improved. Conclusions: This study demonstrates that oriental medical treatment with acuputomy therapy has significant effect in improving symptoms of lateral epicondylitis. As though we had not wide experienced in this treatment, more research is needed.

  3. Injury Patterns among Individuals Diagnosed with Infantile Autism during Childhood

    DEFF Research Database (Denmark)

    Mouridsen, Svend-Erik; Rich, Bente; Isager, Torben

    2016-01-01

    Background: To date, injury risk among people with infantile autism (IA) has been a relatively poorly researched issue.Objective:The purpose of our study was to compare the prevalence and types of injuries in a clinical sample of 118 patients diagnosed with IA during childhood with those of 336 age......-and sex-matched controls from the general population.Method: All participants werescreened through the nationwide Danish National Hospital Register. The average amount of time that the participants were observed was 30.3 years (range, 27.3 to 30.4 years), and the mean patient age at the end....... The difference is statistically significant (P

  4. NIH Pediatric Rheumatology Clinic

    Science.gov (United States)

    ... to diagnose and treat children with arthritis, periodic fever syndromes, and rheumatic diseases. This clinic will also help doctors and ... are juvenile arthritis including spondyloarthritis, lupus, and periodic ... how juvenile rheumatic diseases affect them and what treatments work best. ...

  5. CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study

    OpenAIRE

    Kurashima, Kazuyoshi; Fukuda, Chiaki; Nakamoto, Keitaro; Takaku, Yotaro; Hijikata, Naoya; Hoshi, Toshiko; Kanauchi, Tetsu; Ueda, Miyuki; Takayanagi, Noboru; Sugita, Yutaka; Araki, Ryuichiro

    2013-01-01

    Objective CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema. Design Retrospective cohort study. Setting Referral centre hospital for respiratory disease. Participants 1272 patients aged over 40 years w...

  6. Nursing diagnoses in hospitalized elderly, according to the International Classification of Nursing Practice

    OpenAIRE

    Marina Moralles Caldeira de Andrada; Marlon França; Ângela Maria Alvarez; Karina Silveira de Almeida Hammerschmidt

    2015-01-01

    Objective: to identify the nursing diagnoses characteristic of hospitalized elderly at the Medical Clinic of a university hospital in southern Brazil, according to the International Classification of Nursing Practice, version 1.0. Methods: it is a descriptive, cross-sectional study involving 24 elderly. Results: 158 nursing diagnoses were obtained gathered in 23 groups, grouped into 14 macro-groups presented by similarities: cardiovascular system, impaired self-care, compromised respiratory ...

  7. 髋关节置换后凝血纤溶相关指标监测对预防诊断下肢深静脉血栓的临床意义%The clinical significance of monitoring of coagulation and fibrinolysis related indexes after hip replacement for preventing and diagnosing lower extremity deep venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    詹谦

    2015-01-01

    目的:评价髋关节置换术后监测D‐二聚体、纤维蛋白原及纤维蛋白降解产物对预防诊断下肢深静脉血栓的临床意义。方法选取2013年4月至2015年4月在该院骨科行髋关节置换术的患者66例,其中有下肢深静脉血栓者纳入观察组,无下肢深静脉血栓者纳入对照组,术后均严密监测D‐二聚体、纤维蛋白原及纤维蛋白降解产物水平并进行比较分析。结果两组纤维蛋白原及纤维蛋白降解产物水平在各时间点比较,差异均无统计学意义(P>0.05);而D‐二聚体水平在各时间点比较,差异均有统计学意义(P<0.05)。结论髋关节置换术后监测D‐二聚体、纤维蛋白原及纤维蛋白降解产物对预防诊断下肢深静脉血栓具有一定的临床意义。%Objective To evaluate the clinical significance of monitoring of D‐dimer ,fibrinogen and fibrin degradation products after hip replacement for diagnosing and preventing the lower extremity deep venous thrombosis .Methods A total of 66 cases of patients who carried out hip replacement from April 2013 to April 2015 in the department of orthopaedic in this hospital were se‐lected .Patients complicated with lower extremity deep venous thrombosis were enrolled into the observation group ,while patients without lower extremity deep venous thrombosis were enrolled into the control group .Levels of D‐dimer ,fibrinogen and fibrin deg‐radation products were strictly monitored after hip replacement and were comparatively analysed .Results There were no statisti‐cally significant differences in levels of fibrinogen and fibrin degradation products between the two groups (P>0 .05) ,while statisti‐cally significant difference was found in level of D‐dimer between the two groups(P<0 .05) .Conclusion The monitoring of D‐di‐mer ,fibrinogen and fibrin degradation products after hip replacement could have clinical significance for diagnosing and

  8. Delayed Diagnoses: Nonspecific Findings and Diagnostic Challenges in Eating Disorders

    Directory of Open Access Journals (Sweden)

    Dan Schwarz

    2009-01-01

    Full Text Available Objective. Eating disorders commonly present with nonspecific findings, masquerading as other, more common etiologies of malnutrition and wasting. In low-prevalence populations, these ambiguities can complicate clinicians’ diagnostic reasoning, resulting in delayed or missed diagnoses. Method. We report the atypical case of a 51-year-old male with a five-year history of unexplained weight loss despite extensive past medical evaluation. Previous documentation of profound lymphopenia and bone marrow atrophy had not been linked to a known association with eating disorders. Results. Evaluation for medical etiologies of wasting was negative. Following psychiatric evaluation, the patient was diagnosed with an eating disorder, not otherwise specified, and admitted to a specialized nutritional rehabilitation program. Conclusion. The nonspecific clinical history, physical exam, and laboratory abnormalities of eating disorders can make these diagnoses challenging and delay appropriate treatment. Clinicians should consider eating disorders in patients with malnutrition, severe lymphopenias, and gelatinous marrow transformation early in their workup, so as to avoid potentially negative outcomes.

  9. How to manage a late diagnosed Hirschsprung′s disease

    Directory of Open Access Journals (Sweden)

    Mohamed Ouladsaiad

    2016-01-01

    Full Text Available Background: How to manage a late diagnosed Hirschsprung′s disease (HD and how to avoid calibre discrepancy? Subjects and Methods: A retrospective study of all patients diagnosed with HD over 2 years in our hospital from January 2009 to December 2012. Data were analysed for clinical presentations, investigations, surgical procedures and post-operative outcome. Results: Fifteen patients, operated by one single surgeon, were included in this study. The mean age was 6 years (2-16 years. Patients had an ultra-short segment type in 4 cases, rectosigmoid type in 9 cases and descending colonic aganglionosis in 2 cases. Rectal wash out was effective in 12 patients. A blowhole transverse colostomy was performed in 2 patients. Twelve patients underwent one single stage endorectal pull-through. Anastomosis incongruence was avoided by a plication procedure never described before. The assessment of post-operative outcomes by the paediatric incontinence and constipation scoring system revealed a normal continence function in all our patients, but 3 patients suffered from soiling secondary to constipation. Conclusion: One single stage pull-through can be safe and effective in children with late diagnosed HD. Routine rectal washout is a good way to prepare the colon. In some cases, blowhole colostomy can be an option. Anastomosis incongruence is a challenge; we describe a plication procedure to avoid it.

  10. To evaluate the clinical diagnosic value of anti-cyclic citrul inated peptide(anti-CCP) antibody and rheumatoid factor(RF) in patients with rheumatoid arthritis(RA)%联合检测抗CCP抗体与RF对类风湿关节炎诊断的临床意义

    Institute of Scientific and Technical Information of China (English)

    赵海燕

    2014-01-01

    目的:探讨联合检测抗环瓜氨酸肽抗体(抗CCP抗体)及类风湿因子(RF)对类风湿性关节炎(RA)的临床诊断价值。方法:分别检测130例RA患者,98例非RA的风湿病患者及40例正常人血清的抗CCP抗体和RF。结果:抗CCP抗体和RF联合检测的特异性,阳性预测值,阳性似然比,阴性似然比与任何单一项检测比较均有显著差异(P<0.05)。结论:联合检测抗CCP抗体和RF可明显提高类风湿性关节炎的诊断率。%Objective: To evaluate the clinical diagnosic value of anti-cyclic citrul inated peptide(anti-CCP) antibody and rheumatoid factor(RF) in patients with rheumatoid arthritis(RA). Methods: Anti-CCP antibody was defected by quantitative ELISA and rheumatoid factor by BNP nephelometer in 130 cases of RA, 98 cases of non-RA rheumatic diseases and 40 cases of healthy individuals. Results: The diagnosis specificity, positive predictive value, positive/negative likelihood ratios of combinate determination of anti-CCP antibody and RF were significantly higher than either one. Conclusion: The measurements of anti-CCP antibody and rheumatoid factor wil remarkably improve the accuracy of diagnosis of RA.

  11. From inverse problems in mathematical physiology to quantitative differential diagnoses.

    Directory of Open Access Journals (Sweden)

    Sven Zenker

    2007-11-01

    Full Text Available The improved capacity to acquire quantitative data in a clinical setting has generally failed to improve outcomes in acutely ill patients, suggesting a need for advances in computer-supported data interpretation and decision making. In particular, the application of mathematical models of experimentally elucidated physiological mechanisms could augment the interpretation of quantitative, patient-specific information and help to better target therapy. Yet, such models are typically complex and nonlinear, a reality that often precludes the identification of unique parameters and states of the model that best represent available data. Hypothesizing that this non-uniqueness can convey useful information, we implemented a simplified simulation of a common differential diagnostic process (hypotension in an acute care setting, using a combination of a mathematical model of the cardiovascular system, a stochastic measurement model, and Bayesian inference techniques to quantify parameter and state uncertainty. The output of this procedure is a probability density function on the space of model parameters and initial conditions for a particular patient, based on prior population information together with patient-specific clinical observations. We show that multimodal posterior probability density functions arise naturally, even when unimodal and uninformative priors are used. The peaks of these densities correspond to clinically relevant differential diagnoses and can, in the simplified simulation setting, be constrained to a single diagnosis by assimilating additional observations from dynamical interventions (e.g., fluid challenge. We conclude that the ill-posedness of the inverse problem in quantitative physiology is not merely a technical obstacle, but rather reflects clinical reality and, when addressed adequately in the solution process, provides a novel link between mathematically described physiological knowledge and the clinical concept of