WorldWideScience

Sample records for underlying medical diagnosis

  1. External dose estimation of the human associated with companion animals under veterinary nuclear medical diagnosis

    International Nuclear Information System (INIS)

    Ito, Nobuhiko; Hanawa, Asumi; Suzuki, Kanan

    2004-01-01

    This study was performed in order to make a safety guideline for veterinary nuclear medicine in Japan. Well often used radionuclides ( 18 F and 99 mTc) were employed for evaluating the external radiation exposures of veterinarians, animal owners, and the public. The human external radiation exposure from radiation sources in phantom likened to animal was considered by comparing the results of computer simulation and the actually measured exposure. The computer simulation was performed by using macro program of Microsoft Visual Basic for Applications (VBA). In this simulation calculation process, radiation absorption and buildup were taken into consideration with the gamma ray emitted from radioactive materials in the body of the animal. Both corresponded well though the simulation result tended to be overvalued from the actual measurement value. Therefore, it is thought that this system can be applied to the estimation of human's external exposure. When the calculation was done on the condition that the radioactive substance exists only in internal organs (heart, liver, kidneys, and bladder), the unequal distribution of the dose rate was found near the animal body. External radiation exposure estimation to the veterinarian, the animal owner and the public was performed under consideration of the actual working condition, the distance from the source, and the time of exposure. In the calculation, the radiation dose of the animal owner and the public did not exceed the dose limit (5 mSv/yr for the animal owner, and 1 mSv/yr for the general public: International Commission of Radiological Protection (ICRP) 1990) in the release after 24 hours of the radiopharmaceutical administering. The calculation condition used in this study was actually more excessive. So the authors consider these exposures would cause no significant issue by starting the veterinary nuclear medicine in Japan. Moreover, since injected radiopharmaceutical is excreted out of the body actually, the

  2. Image processing for medical diagnosis using CNN

    Science.gov (United States)

    Arena, Paolo; Basile, Adriano; Bucolo, Maide; Fortuna, Luigi

    2003-01-01

    Medical diagnosis is one of the most important area in which image processing procedures are usefully applied. Image processing is an important phase in order to improve the accuracy both for diagnosis procedure and for surgical operation. One of these fields is tumor/cancer detection by using Microarray analysis. The research studies in the Cancer Genetics Branch are mainly involved in a range of experiments including the identification of inherited mutations predisposing family members to malignant melanoma, prostate and breast cancer. In bio-medical field the real-time processing is very important, but often image processing is a quite time-consuming phase. Therefore techniques able to speed up the elaboration play an important rule. From this point of view, in this work a novel approach to image processing has been developed. The new idea is to use the Cellular Neural Networks to investigate on diagnostic images, like: Magnetic Resonance Imaging, Computed Tomography, and fluorescent cDNA microarray images.

  3. Image processing for medical diagnosis using CNN

    International Nuclear Information System (INIS)

    Arena, Paolo; Basile, Adriano; Bucolo, Maide; Fortuna, Luigi

    2003-01-01

    Medical diagnosis is one of the most important area in which image processing procedures are usefully applied. Image processing is an important phase in order to improve the accuracy both for diagnosis procedure and for surgical operation. One of these fields is tumor/cancer detection by using Microarray analysis. The research studies in the Cancer Genetics Branch are mainly involved in a range of experiments including the identification of inherited mutations predisposing family members to malignant melanoma, prostate and breast cancer. In bio-medical field the real-time processing is very important, but often image processing is a quite time-consuming phase. Therefore techniques able to speed up the elaboration play an important rule. From this point of view, in this work a novel approach to image processing has been developed. The new idea is to use the Cellular Neural Networks to investigate on diagnostic images, like: Magnetic Resonance Imaging, Computed Tomography, and fluorescent cDNA microarray images

  4. Diseases Diagnosis Using Medical Palmistry Fuzzy Model

    Directory of Open Access Journals (Sweden)

    Othman Zainab

    2016-01-01

    Full Text Available The design n, implementation, and use of biomedical information systems in the form of computer – aided decision support have become essential and widely used over the last two decades. Medical decision support systems play an increasingly important role in medical practice by assisting physicians who make clinical decisions. Medical scientists discovered that the hand can be used as an indicator for medical problems and the palm is the reflection of activities going on brain. The purpose of this research is to design and implement a decision support model for healthcare on the basis of medical palmistry to diagnose the diseases from palm colors. Database palm images for patients infected with specific disease is created from capturing live images from hospitals. Digital image processing techniques on input images are applied. Fuzzy Inference System is used to present medical knowledge as network diseases connected with each other by logical relations. The model is built to assist medical practitioners for taking diagnosis decision for four special diseases. The results obtained from this work are confidence.

  5. In vitro radionuclide techniques in medical diagnosis

    International Nuclear Information System (INIS)

    1998-02-01

    The use of radionuclide based microanalytical techniques for medical diagnosis has been increasing in recent years. Several such methods are in routine use in advanced laboratories in the industrialized world, but are often beyond the capability of developing countries. The IAEA has organized several training activities and seminars to bring the benefits of such advances to laboratories in developing Member States. The most recent was an interregional training course in Tokyo, March 1996, in collaboration with the Japanese Atomic Energy Research Institute (JAERI). The course was conducted by international experts, local staff, and IAEA staff. With the intention of giving the main techniques used at the course to a wider distribution they have been compiled into the present technical document. It is hoped that laboratories in developing Member States that did not have participants at the training course will find the information provided useful and sufficiently detailed to enable their application in their home institutions

  6. Medical image diagnosis of liver cancer using artificial intelligence

    International Nuclear Information System (INIS)

    Kondo, Tadashi; Ueno, Junji; Takao, Shoichiro

    2010-01-01

    A revised Group Method of Data Handling (GMDH)-type neural network algorithm using artificial intelligence technology for medical image diagnosis is proposed and is applied to medical image diagnosis of liver cancer. In this algorithm, the knowledge base for medical image diagnosis are used for organizing the neural network architecture for medical image diagnosis. Furthermore, the revised GMDH-type neural network algorithm has a feedback loop and can identify the characteristics of the medical images accurately using feedback loop calculations. The optimum neural network architecture fitting the complexity of the medical images is automatically organized so as to minimize the prediction error criterion defined as Prediction Sum of Squares (PSS). It is shown that the revised GMDH-type neural network can be easily applied to the medical image diagnosis. (author)

  7. Agent-based intelligent medical diagnosis system for patients.

    Science.gov (United States)

    Zhang, Yingfeng; Liu, Sichao; Zhu, Zhenfei; Si, Shubin

    2015-01-01

    According to the analysis of the challenges faced by the current public health circumstances such as the sharp increase in elderly patients, limited medical personnel, resources and technology, the agent-based intelligent medical diagnosis system for patients (AIMDS) is proposed in this research. Based on advanced sensing technology and professional medical knowledge, the AIMDS can output the appropriate medical prescriptions and food prohibition when the physical signs and symptoms of the patient are inputted. Three core modules are designed include sensing module, intuition-based fuzzy set theory/medical diagnosis module, and medical knowledge module. The result shows that the optimized prescription can reach the desired level, with great curative effect for patient disease, through a case study simulation. The presented AIMDS can integrate sensor technique and intelligent medical diagnosis methods to make an accurate diagnosis, resulting in three-type of optimized descriptions for patient selection.

  8. Diseases Diagnosis Using Medical Palmistry Fuzzy Model

    OpenAIRE

    Othman Zainab; Saleem Sarmad

    2016-01-01

    The design n, implementation, and use of biomedical information systems in the form of computer – aided decision support have become essential and widely used over the last two decades. Medical decision support systems play an increasingly important role in medical practice by assisting physicians who make clinical decisions. Medical scientists discovered that the hand can be used as an indicator for medical problems and the palm is the reflection of activities going on brain. The purpose of ...

  9. Reflection in Medical Diagnosis: A Literature Review

    Directory of Open Access Journals (Sweden)

    Silvia Mamede

    2017-06-01

    Discussion: Reflective reasoning can be a powerful tool to reduce diagnostic errors and increase diagnostic performance. For this to happen, reflection should be triggered for diagnosis verification and needs to interfere with initial diagnostic reasoning, which requires confrontation with evidence from the case.

  10. An expert system in medical diagnosis

    International Nuclear Information System (INIS)

    Raboanary, R.; Raoelina Andriambololona; Soffer, J.; Raboanary, J.

    2001-01-01

    Health problem is still a crucial one in some countries. It is so important that it becomes a major handicap in economic and social development. In order to solve this problem, we have conceived an expert system that we called MITSABO, which means TO HEAL, to help the physicians to diagnose tropical diseases. It is clear that by extending the data base and the knowledge base, we can extend the application of the software to more general areas. In our expert system, we used the concept of 'self organization' of neural network based on the determination of the eigenvalues and the eigenvectors associated to the correlation matrix XX t . The projection of the data on the two first eigenvectors gives a classification of the diseases which is used to get a first approach in the diagnosis of the patient. This diagnosis is improved by using an expert system which is built from the knowledge base.

  11. Nuclear medical diagnosis and therapy of pheochromocytoma

    International Nuclear Information System (INIS)

    Fischer, M.; Winterberg, B.; Vetter, H.; Mueller-Rensing, R.

    1984-01-01

    After prior labeling of the kidneys or the skeletal system for easier orientation, 0.3 - 0.7 mCi of I-131-MIBG (Henning-Berlin) were injected intravenously and scans were obtained with a gamma-camera-computer system 24 to 120 hours later. 22 patients showed clinical and biochemical evidence of pheochromocytoma; the diagnosis was confirmed surgically in 19. Two patients (16 years old) with metastatic pheochromocytoma and a female aged 73 years with intra-adrenal pheochromocytoma ineligible for surgery because of catecholamine-induced myocarditis currently undergo fractionated I-131-MIBG treatment with single doses of 65 - 135 mCi. The tumor response was assessed in 2 females by determining the volume of reference tumors with computer tomography; by 24-hour urinary catecholamine assays; and by checking drug consumption. Scintigraphy showed intra-adrenal pheochromocytoma to be present in 17 cases (left, n=11; right, n=5; bilateral, n=1). Two patients were found to have medullary hyperplasia, while 3 presented with multilocular malignant pheochromocytoma. Treatment substantially improved the clinical symptoms in 3 females. Determination of tumor volume by computer tomography showed a tumor reduction of 61% in 1 patient after a total dose of 415 mCi and of 10% after a total dose of 365 mCi in another patient. Experiences sofar available suggest that I-131-MIBG is a useful specific radionuclide for the diagnosis and treatment of pheochromocytoma. (Author)

  12. Major Approaches to Medical Diagnosis and their Drawbacks

    Directory of Open Access Journals (Sweden)

    Sabina MUNTEANU

    2009-12-01

    Full Text Available The ability to reason within a dynamical environment is of a crucial importance in Artificial Intelligence. Medical diagnosis is a dynamic and very complex field which needs special attention Our quest is for a system for medical diagnosis, that could model its search space efficiently and dynamically, while confronted with sequential tests. We present below some of the major approaches from literature, with their drawbacks, and conclude that a combinative hybridization of a certain type would be useful to overcome the failures.

  13. Multiple fuzzy c-means clustering algorithm in medical diagnosis.

    Science.gov (United States)

    Wu, Yanping; Duan, Huilong; Du, Shufeng

    2015-01-01

    In recent years, the use of the fuzzy c-means (FCM) clustering techniques in medical diagnosis has steadily increased, because of its effectiveness in recognizing systems in the medical database to help medical experts diagnosing diseases. However, its performance is highly dependent on the randomly initialized cluster centroids which may allow the diagnosis to be trapped into the problem of the local optimum. This paper proposes a multiple fuzzy c-means (MFCM) algorithm for medical diagnosis. The new method optimizes the initial optimizing cluster centers by comparing the Euclidean distance between patient data. Further, this paper assigns a set of weights to the features of a certain disease to equalize their difference influence as a substitute for data normalization. The performance of proposed MFCM algorithm was demonstrated through dividing complex primary headache data into Migraine, Tension-Type Headache (TTH), Trigeminal Autonomic Cephalalgias (TACs) and other primary headache disorders. In addition the superiority of MFCM algorithm was proven by comparing analytical results with other state-of-the-art clustering methods. This MFCM method has shown a new application in medical diagnosis.

  14. Addiction: lifestyle choice or medical diagnosis?

    Science.gov (United States)

    Nutt, David

    2013-06-01

    The concept of addiction is under threat from the current UK government's attempt to define it as a lifestyle choice rather than an illness. This overturns the previous government's rational policy on drug treatment and is both dishonest and damaging. It is dishonest because addiction fulfils all the criteria for an illness. It is damaging because proven treatments for many addictions exist and the failure to optimize these means that more patients will die, get blood-borne viruses, and encourage others into drug use. In this paper, I detail these issues and suggest ways to avoid irreparable damage to the current care provisions that are proving effective. © 2013 John Wiley & Sons Ltd.

  15. Proposed Electronic Medical Record with Emphasis on Hepatitis Diagnosis

    Directory of Open Access Journals (Sweden)

    Georgios Skapetis

    2013-01-01

    Full Text Available Introduction Medical domain is characterized, like many other domains, by an exponential evolution of the knowledge. There are a lot of tools which try to reduce the risk of error apparition in medical life. Medical decision becomes a very hard activity because the human experts, who have to make decisions, can hardly process the huge amounts of data. Diagnosis has a very important role here. It is the first step from a set of therapeutic actions, an error at this level can have dramatic consequences.The aim of this paper is to present a new electronic medical system for using it on patients with hepatitis virusinfection.Results: Hepatitis is a very complicated disease with numerous different types many of them can lead to serious diseases like cirrhosis and liver cancer. An early correct diagnosis and an adequate treatment could reduce the risks of liver cancer apparition or other severe diseases. The main goal of the system is to use artificial intelligence in order to offer predictions about patients infected with hepatitis virus and also to follow the healthcondition of the patient reevaluating at every time the initial diagnosis and suggesting tests and treatment. Our effort is to present a new electronic medical record that will “borrow” data from the standard health record of the patient and other resources where information is saved and will process it and give suggestions for the diagnosis and treatment of the patient and at the same time will use a simple operating environment, such as the internet, thus making it easy to use.Conclusions The medical record is a big step in improving health services in public hospitals. The proposed EMR with the use of artificial intelligence is the next logical step that will help in the diagnosis and early treatment of disease.

  16. MV–SYDIME : A Virtual Patient for Medical Diagnosis Apprenticeship

    Directory of Open Access Journals (Sweden)

    Bernabé Batchakui

    2012-11-01

    Full Text Available Shortage of medical personnel and the existence of inexperienced ones, are frequently the causes of false diagnosis, and call for a reflection on the methods of training of the later. One of the solutions might be the application of new technologies in the training of medical students, in order to counter the shortage of experts as well as training conditions which are usually inadequate (no patients available for practice. The aim of this paper is to propose a virtual patient, on which an expert can formulate pathology, and hand this patient to a learner for exercises on medical diagnostics.

  17. Objective confirmation of asthma diagnosis improves medication adherence

    DEFF Research Database (Denmark)

    Backer, V; Stensen, L; Sverrild, A

    2017-01-01

    OBJECTIVE: The impact of diagnostic work-up in asthma management on medication redemption and probably also drug adherence is largely unknown, but we hypothesized that a confirmed diagnosis of asthma in a hospital-based out-patient clinic increases the willingness to subsequent medication...... redemption in a real life setting. METHODS: In a retrospective register-based study, 300 medical records of patients referred with possible asthma during one year were examined, of whom 171 had asthma (57%). One-year data on dispensed medicine was collected using the Danish Registry of Medicinal Product...

  18. [Medical interviewing, initial key step in the disease diagnosis].

    Science.gov (United States)

    Scheen, A J

    2013-11-01

    Medicine combines the characteristics of both a science and an art. The main objective is to cure the patient (or at least to alleviate symptoms). The first step of the global medical approach is to make a diagnosis, which will determine the therapy. Since Hippocrates, semiology, i.e. the study of both symptoms and signs, is crucial to make or guide the disease diagnosis. The development of more and more sophisticated medical technologies may lead to believe that semiology is not useful anymore in medical practice. It is absolutely not true because a careful semiology can provide precise diagnoses in a majority of cases or, at least, can lead to a limited differential diagnosis that helps in the selection of a few well defined complementary investigations. The aim of this article targeting mainly medical students is to emphasize the key rules of a well done medical interviewing, which should progress from an "analytical" approach to a "syndromic" approach, combining knowledge, know-how and self-management skills.

  19. Diagnosis of rare diseases under focus: impacts for Canadian patients.

    Science.gov (United States)

    Esquivel-Sada, Daphne; Nguyen, Minh Thu

    2018-01-01

    This paper presents an in-depth qualitative analysis of the impact of diagnosis on the lives of rare disease (RD) patients. While diagnosis may be described as a watershed step for RD patients, no extensive account of non-medical outcomes following a RD diagnosis exists within the literature. This study aims to fill this knowledge gap through an analysis of the impact of diagnosis on the lives of RD patients according to their personal experiences. Qualitative research was conducted in three provinces across Canada, with a total of 23 participants, both adult and parents of children with RD, diagnosed and not yet diagnosed. A thematic approach guided the analysis of the transcripts. The results reveal that the impacts of a RD diagnosis for both adults and paediatric patients are multifold, ranging from social to personal and medical impacts (including cases where etiological treatments for the diseases are non-existent). Furthermore, the results shed light on distinct factors that affect the scope of impacts of a diagnosis.

  20. An intelligent medical system for diagnosis of bone diseases

    International Nuclear Information System (INIS)

    Hatzilygeroudis, I.; Vassilakos, P.J.; Tsakalidis, A.

    1994-01-01

    In this paper, aspects of the design of an intelligent medical system for diagnosis of bone diseases that can be detected by scintigraphic images are presented. The system comprises three major parts: a user interface (UI), a database management system (DBMS), and an expert system (ES). The DBMS is used for manipulation of various patient data. A number of patient cases are selected as prototype and stored in separate database. Diagnosis is performed via the ES, called XBONE, based on patient data. Knowledge is represented via an integrated formalism that combines production rules and a neural network. This results in better representation, and facilitates knowledge acquisition and maintenance. (authors)

  1. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

    Directory of Open Access Journals (Sweden)

    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  2. A Portable Kit for Rapid Diagnosis of Infectious Diseases under Field Conditions

    Science.gov (United States)

    1980-08-14

    counter Wallis, C. & Melnick , J. L. (1971). Enhanced detection current immunoelectrophoresis. Singapore Medical of Australia antigen in serum hepatitis...RESEARC CEWlE iir.’c.rpro~net~. P. 0. BOX 85122 ’i’J v’il bz la blact &Z SAN DIEGO, CALIFORNIA 92138 NAVAL MEDICAL RESEARCH AND) DEVELOPMENT COMMAND...DIAGNOSIS of INFECTIOUS DISEASES under FIELD CONDITIONS I / Warren R. Sanborn Head, Microbiology Branch Biological Sciences Division Naval Health

  3. The challenges of studying visual expertise in medical image diagnosis.

    Science.gov (United States)

    Gegenfurtner, Andreas; Kok, Ellen; van Geel, Koos; de Bruin, Anique; Jarodzka, Halszka; Szulewski, Adam; van Merriënboer, Jeroen Jg

    2017-01-01

    Visual expertise is the superior visual skill shown when executing domain-specific visual tasks. Understanding visual expertise is important in order to understand how the interpretation of medical images may be best learned and taught. In the context of this article, we focus on the visual skill of medical image diagnosis and, more specifically, on the methodological set-ups routinely used in visual expertise research. We offer a critique of commonly used methods and propose three challenges for future research to open up new avenues for studying characteristics of visual expertise in medical image diagnosis. The first challenge addresses theory development. Novel prospects in modelling visual expertise can emerge when we reflect on cognitive and socio-cultural epistemologies in visual expertise research, when we engage in statistical validations of existing theoretical assumptions and when we include social and socio-cultural processes in expertise development. The second challenge addresses the recording and analysis of longitudinal data. If we assume that the development of expertise is a long-term phenomenon, then it follows that future research can engage in advanced statistical modelling of longitudinal expertise data that extends the routine use of cross-sectional material through, for example, animations and dynamic visualisations of developmental data. The third challenge addresses the combination of methods. Alternatives to current practices can integrate qualitative and quantitative approaches in mixed-method designs, embrace relevant yet underused data sources and understand the need for multidisciplinary research teams. Embracing alternative epistemological and methodological approaches for studying visual expertise can lead to a more balanced and robust future for understanding superior visual skills in medical image diagnosis as well as other medical fields. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  4. Retrospective diagnosis: use and abuse in medical historiography.

    Science.gov (United States)

    Karenberg, A

    2009-01-01

    Medical papers on diseases of famous persons, sometimes called pathographies, constitute the by far largest section of publications dealing with historical diagnosis. The procedure of attaching modern diagnostic labels to illustrious personalities of the past, i.e. retrospective diagnosis, has stimulated an ongoing theoretical debate among clinicians and medical historians. The purpose of this paper is to clarify some of the issues involved. Key problems of retrospective diagnostics are reviewed and analysed. In addition, the case history of the Polish composer Fryderyk Chopin is used to highlight problems and pitfalls of this method. Whereas contemporary physicians are used to apply present-day nosological categories to individuals of the past or historical epidemics, medical historians are more cautious to do so. They argue that in the absence of definite proofs retrospective diagnoses often are nothing more than mere speculation. Another important counter-argument is that medical knowledge itself varies over time and historical changes in nosology must not be ignored. Future pathographies should use primary sources extensively, focus on historical context and minimize the pursuit of retrospective diagnoses or causes of death. Only with a fundamentally revised method, a more critical approach to retrospective diagnostics, and far more serious objectives will medical biographies be in a position to break new ground.

  5. A Distributed and Collaborative Intelligent System for Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Wided LEJOUAD-CHAARI

    2013-08-01

    Full Text Available In this paper, we present a distributed collaborative system assisting physicians in diagnosis when processing medical images. This is a Web-based solution since the different participants and resources are on various sites. It is collaborative because these participants (physicians, radiologists, knowledgebasesdesigners, program developers for medical image processing, etc. can work collaboratively to enhance the quality of programs and then the quality of the diagnosis results. It is intelligent since it is a knowledge-based system including, but not only, a knowledge base, an inference engine said supervision engine and ontologies. The current work deals with the osteoporosis detection in bone radiographies. We rely on program supervision techniques that aim to automatically plan and control complex software usage. Our main contribution is to allow physicians, who are not experts in computing, to benefit from technological advances made by experts in image processing, and then to efficiently use various osteoporosis detection programs in a distributed environment.

  6. Image processing for medical diagnosis of human organs

    International Nuclear Information System (INIS)

    Tamura, Shin-ichi

    1989-01-01

    The report first describes expectations and needs for diagnostic imaging in the field of clinical medicine, radiation medicine in particular, viewed by the author as an image processing expert working at a medical institute. Then, medical image processing techniques are discussed in relation to advanced information processing techniques that are currently drawing much attention in the field of engineering. Finally, discussion is also made of practical applications of image processing techniques to diagnosis. In the field of clinical diagnosis, advanced equipment such as PACS (picture archiving and communication system) has come into wider use, and efforts have been made to shift from visual examination to more quantitative and objective diagnosis by means of such advanced systems. In clinical medicine, practical, robust systems are more useful than sophisticated ones. It is difficult, though important, to develop completely automatized diagnostic systems. The urgent, realistic goal, therefore, is to develop effective diagnosis support systems. In particular, operation support systems equipped with three-dimensional displays will be very useful. (N.K.)

  7. Diagnosis and successful medical treatment of Acanthamoeba keratitis.

    Science.gov (United States)

    D'Aversa, G; Stern, G A; Driebe, W T

    1995-09-01

    To identify the methods that result in timely diagnosis and effective treatment of Acanthamoeba keratitis. We retrospectively reviewed the medical records of 12 consecutive patients whom we treated for culture-proved Acanthamoeba keratitis in 14 eyes. Contact lenses were worn in 13 of 14 affected eyes and substandard methods were often used to care for them. The diagnosis was established in all patients by laboratory analysis of corneal scrapings; corneal biopsies were not required. Acanthamoeba organisms were identified on smears from 12 of 14 eyes with use of standard, nonfluorescent stains and recovered in culture from all patients by inoculating scrapings on nonnutrient agar overlaid with Escherichia coli. Eleven of 14 eyes were medically cured with a combination of antiamebic drugs, most commonly propamidine isethionate, neomycin sulfate, and clotrimazole. Topical corticosteroids were used in only one patient. Two of the three eyes that required therapeutic keratoplasty were not treated before surgery according to our usual protocol; the third required keratoplasty for treatment of a severe bacterial superinfection. Twelve of 14 eyes recovered 20/50 or better visual acuity. Bacterial superinfections were a serious problem, with a total of six superinfections occurring in three treated eyes. With timely diagnosis and medical treatment with a combination of antiamebic drugs and avoidance of topical corticosteroids, most cases of Acanthamoeba keratitis can be cured, with an excellent prognosis for visual recovery.

  8. From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

    Science.gov (United States)

    Seising, Rudolf

    2006-11-01

    This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory

  9. Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania

    Science.gov (United States)

    John, Kunda; Kazwala, Rudovic; Mfinanga, Godfrey S

    2008-01-01

    Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis should be put on zoonotic

  10. An intelligent system based on fuzzy probabilities for medical diagnosis – a study in aphasia diagnosis

    Directory of Open Access Journals (Sweden)

    Majid Moshtagh Khorasani

    2009-04-01

    Full Text Available

    • BACKGROUND: Aphasia diagnosis is particularly challenging due to the linguistic uncertainty and vagueness, inconsistencies in the definition of aphasic syndromes, large number of measurements with  mprecision, natural diversity and subjectivity in test objects as well as in opinions of experts who diagnose the disease.
    • METHODS: Fuzzy probability is proposed here as the basic framework for handling the uncertainties in medical diagnosis and particularly aphasia diagnosis. To efficiently construct this fuzzy probabilistic mapping, statistical analysis is performed that constructs input membership functions as well as determines an effective set of input features.
    • RESULTS: Considering the high sensitivity of performance measures to different distribution of testing/training sets, a statistical t-test of significance is applied to compare fuzzy approach results with NN  esults as well as author’s earlier work using fuzzy logic. The proposed fuzzy probability estimator approach clearly provides better diagnosis for both classes of data sets. Specifically, for the first and second type of fuzzy probability classifiers, i.e. spontaneous speech and comprehensive model, P-values are 2.24E-08 and 0.0059, espectively, strongly rejecting the null hypothesis.
    • CONCLUSIONS: The technique is applied and compared on both comprehensive and spontaneous speech test data for diagnosis of four Aphasia types: Anomic, Broca, Global and Wernicke. Statistical analysis confirms that the proposed approach can significantly improve accuracy using fewer Aphasia features.
    • KEYWORDS: Aphasia, fuzzy probability, fuzzy logic, medical diagnosis, fuzzy rules.

  11. Medical tourism analysis under the innovation perspective

    Directory of Open Access Journals (Sweden)

    Keline Leão Ferreira

    2016-05-01

    Full Text Available Medical tourism, although being considered a recent phenomenon in Brazil, still represents an important opportunity for institutions that have health facilities, human resources and advanced technological level. This work aims to develop a reflection about this market based under the innovation theoretical perspectives. In order to support this analysis was conducted a multi case study in four health institutions located in the Brazilian south region. Results confirmed that these institutions developed innovations, classified as innovation in product, process, organizational and marketing. Moreover, the evidences indicated that the institution participation on medical tourism market, using innovation as a competitive advantage, helps to promote a new business design and organizational processes, adequate infrastructure, assigning a due importance to the marketing and management sectors, generating an external recognition, a larger network relationships, cooperation among peers, ensuring to these institutions an international standard of service delivery.

  12. Under diagnosis of adult ADHD: cultural influences and societal burden.

    Science.gov (United States)

    Asherson, Philip; Akehurst, Ron; Kooij, J J Sandra; Huss, Michael; Beusterien, Kathleen; Sasané, Rahul; Gholizadeh, Shadi; Hodgkins, Paul

    2012-07-01

    To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. A review of the literature over the past 10 years was performed using OVID. Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.

  13. An intelligent system based on fuzzy probabilities for medical diagnosis- a study in aphasia diagnosis.

    Science.gov (United States)

    Moshtagh-Khorasani, Majid; Akbarzadeh-T, Mohammad-R; Jahangiri, Nader; Khoobdel, Mehdi

    2009-03-01

    Aphasia diagnosis is particularly challenging due to the linguistic uncertainty and vagueness, inconsistencies in the definition of aphasic syndromes, large number of measurements with imprecision, natural diversity and subjectivity in test objects as well as in opinions of experts who diagnose the disease. Fuzzy probability is proposed here as the basic framework for handling the uncertainties in medical diagnosis and particularly aphasia diagnosis. To efficiently construct this fuzzy probabilistic mapping, statistical analysis is performed that constructs input membership functions as well as determines an effective set of input features. Considering the high sensitivity of performance measures to different distribution of testing/training sets, a statistical t-test of significance is applied to compare fuzzy approach results with NN results as well as author's earlier work using fuzzy logic. The proposed fuzzy probability estimator approach clearly provides better diagnosis for both classes of data sets. Specifically, for the first and second type of fuzzy probability classifiers, i.e. spontaneous speech and comprehensive model, P-values are 2.24E-08 and 0.0059, respectively, strongly rejecting the null hypothesis. THE TECHNIQUE IS APPLIED AND COMPARED ON BOTH COMPREHENSIVE AND SPONTANEOUS SPEECH TEST DATA FOR DIAGNOSIS OF FOUR APHASIA TYPES: Anomic, Broca, Global and Wernicke. Statistical analysis confirms that the proposed approach can significantly improve accuracy using fewer Aphasia features.

  14. [Application of terahertz technology in medical testing and diagnosis].

    Science.gov (United States)

    Qi, Na; Zhang, Zhuo-Yong; Xiang, Yu-Hong

    2013-08-01

    Terahertz science and technology is increasingly emphasized in science and industry, and has progressed significantly in recent years. There is an important aspect of attention in the application of terahertz technology to medicine. The overview of the terahertz characters, terahertz spectroscopy and terahertz imaging technology is introduced. This paper focuses on reviewing the use of and research progress in terahertz spectroscopy and terahertz imaging technology in medical testing and diagnosis. Furthermore, the problems to be solved and development directions of terahertz spectroscopy and terahertz imaging technology are discussed.

  15. Magnetic Resonance Imaging: From Spin Physics to Medical Diagnosis

    Science.gov (United States)

    Nacher, Pierre-Jean

    Two rather similar historical evolutions are evoked, each one originating in fundamental spin studies by physicists, and ending as magnetic resonance imaging (MRI), a set of invaluable tools for clinical diagnosis in the hands of medical doctors. The first one starts with the early work on nuclear magnetic resonance, the founding stone of the usual proton-based MRI, of which the basic principles are described. The second one starts with the optical pumping developments made to study the effects of spin polarization in various fundamental problems. Its unexpected outcome is a unique imaging modality, also based on MRI, for the study of lung physiology and pathologies.

  16. The differential diagnosis of anxiety. Psychiatric and medical disorders.

    Science.gov (United States)

    Cameron, O G

    1985-03-01

    This article has reviewed clinical and demographic features of the primary anxiety disorders and other psychiatric and medical disorders that often are associated with anxiety symptoms, highlighting differential diagnosis. In summary, phobic disorders (exogenous anxiety) are characterized by anxiety reliably elicited by specific environmental stimuli; the stimuli involved determine which type of phobia is diagnosed. In contrast, panic attacks and generalized anxiety (endogenous anxiety) involve symptoms of anxiety not associated only with specific eliciting stimuli. Panic disorder is differentiated from generalized anxiety disorder by the presence of discrete attacks; both disorders usually have some level of persistent anxiety. Obsessive-compulsive disorder is characterized by recurrent unwanted but irresistible thoughts and the ritualized repetitive acts resulting from these obsessions, in the absence of preexisting psychosis or depression. Finally, posttraumatic stress disorder involves various anxiety (and other) symptoms as a direct result of an obvious stressor. Depressive symptoms are frequently associated with anxiety. It is sometimes impossible to determine which is the primary disorder. Overlap of syndromes probably also occurs with other primary psychiatric disorders, especially somatoform disorders, adjustment disorder with anxious mood, and several personality disorders. Finally, primary anxiety can be confused with several medical syndromes, especially when the medical disorder has not been recognized. Nevertheless, research with patients with pheochromocytoma suggests that medical causes of anxiety may be qualitatively different from primary anxiety disorders, especially the psychic anxiety component. Attention to the clinical and demographic features listed in Table 4, as well as the use of newly-developed structured diagnostic interviews should usually lead to a correct diagnosis, as illustrated by the following examples. The onset of a fear of

  17. Intelligence system based classification approach for medical disease diagnosis

    Science.gov (United States)

    Sagir, Abdu Masanawa; Sathasivam, Saratha

    2017-08-01

    The prediction of breast cancer in women who have no signs or symptoms of the disease as well as survivability after undergone certain surgery has been a challenging problem for medical researchers. The decision about presence or absence of diseases depends on the physician's intuition, experience and skill for comparing current indicators with previous one than on knowledge rich data hidden in a database. This measure is a very crucial and challenging task. The goal is to predict patient condition by using an adaptive neuro fuzzy inference system (ANFIS) pre-processed by grid partitioning. To achieve an accurate diagnosis at this complex stage of symptom analysis, the physician may need efficient diagnosis system. A framework describes methodology for designing and evaluation of classification performances of two discrete ANFIS systems of hybrid learning algorithms least square estimates with Modified Levenberg-Marquardt and Gradient descent algorithms that can be used by physicians to accelerate diagnosis process. The proposed method's performance was evaluated based on training and test datasets with mammographic mass and Haberman's survival Datasets obtained from benchmarked datasets of University of California at Irvine's (UCI) machine learning repository. The robustness of the performance measuring total accuracy, sensitivity and specificity is examined. In comparison, the proposed method achieves superior performance when compared to conventional ANFIS based gradient descent algorithm and some related existing methods. The software used for the implementation is MATLAB R2014a (version 8.3) and executed in PC Intel Pentium IV E7400 processor with 2.80 GHz speed and 2.0 GB of RAM.

  18. Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records

    Directory of Open Access Journals (Sweden)

    Emir B

    2015-06-01

    characteristic curve confirmed the model's predictive accuracy using an independent test set (area under the curve, 0.810. To enhance interpretability, nine rules were developed that could be used with good predictive probability of an FM diagnosis and to identify no-FM subjects. Conclusion: Random forest modeling may help to quantify the predictive probability of an FM diagnosis. Rules can be developed to simplify interpretability. Further validation of these models may facilitate earlier diagnosis and enhance management. Keywords: fibromyalgia, random forest, predictive modeling, electronic medical records, health care resource utilization, real-world data

  19. Preimplantation genetic diagnosis and rational choice under risk or uncertainty.

    Science.gov (United States)

    Zuradzki, Tomasz

    2014-11-01

    In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct the PGD procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. [Assessing the conformity of medical devices for in vitro diagnosis: international and domestic experience].

    Science.gov (United States)

    Manzeniuk, I N; Shipulin, G A; Men'shikov, V V

    2009-10-01

    The conformity of medical articles was assessed for in vitro diagnosis is the most importance procedure for their entering the market. This paper describes the basic elements of assessment of the conformity of these articles, analyzes worldwide experience, shows differences in the Russian regulatory system in the circulation of medical articles for in vitro diagnosis, and gives recommendations for its improvement.

  1. Diagnosis and medical treatment of neuropathic pain in leprosy

    Directory of Open Access Journals (Sweden)

    Rogerio Del Arco

    Full Text Available ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5% had neuropathic pain (or a mixture of this pain and their existing pain and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5% of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12 for neuropathic pain, 5 (41.6% responded that they became better. For the other 7 (58.4% there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12 and those that were not, showed significant differences (value p=0.020. Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

  2. Medical Diagnosis Using Distance-Based Similarity Measures of Single Valued Neutrosophic Multisets

    Directory of Open Access Journals (Sweden)

    Shan Ye

    2015-01-01

    Full Text Available This paper proposes a generalized distance measure and its similarity measures between single valued neutrosophic multisets (SVNMs. Then, the similarity measures are applied to a medical diagnosis problem with incomplete, indeterminate and inconsistent information. This diagnosis method can deal with the diagnosis problem with indeterminate and inconsistent information which cannot be handled by the diagnosis method based on intuitionistic fuzzy multisets (IFMs.

  3. Large scale mining and evidence combination to support medical diagnosis

    NARCIS (Netherlands)

    Berrada, Ghita

    2015-01-01

    "Errare humanum est". Clinicians, however smart, caring and meticulous they may be, are only human, all too human. So they are bound to occasionally make mistakes, diagnosis errors (i.e delayed/missed or wrong diagnosis) in particular. With a prevalence of misdiagnosis of 15% in most areas of

  4. Preclinical diagnosis and emergency medical care in case of radiation accidents

    International Nuclear Information System (INIS)

    Ohlenschlaeger, L.

    1990-01-01

    Reference is made to preclinical diagnosis and emergency medical care at the site of a potential radiation accident. Possibilities and limits, respectively, of the medical measures are shown. Cooperation between the experts of the technical and medical rescue services is described. Exposition to radiation for the emergency medical staff resulting from the medical care of contaminated persons, is negligible if the personal precautions are observed. (orig.) [de

  5. The diagnosis and medical management of tuberculous meningitis ...

    African Journals Online (AJOL)

    ) treatment should be initiated as soon as possible after diagnosis. Owing to the low diagnostic yields of confirmatory tests, TBM is often diagnosed based on suggestive clinical and cerebrospinal fluid findings, evidence for TB outside the ...

  6. A Fuzzy Method for Medical Diagnosis of Headache

    Science.gov (United States)

    Ahn, Jeong-Yong; Mun, Kill-Sung; Kim, Young-Hyun; Oh, Sun-Young; Han, Beom-Soo

    In this note we propose a fuzzy diagnosis of headache. The method is based on the relations between symptoms and diseases. For this purpose, we suggest a new diagnosis measure using the occurrence information of patient's symptoms and develop an improved interview chart with fuzzy degrees assigned according to the relation among symptoms and three labels of headache. The proposed method is illustrated by two examples.

  7. Intraoperative fluorescence diagnosis in patients with brain metastases (medical technology

    Directory of Open Access Journals (Sweden)

    A. M. Zaytsev

    2014-01-01

    Full Text Available The technique of intraoperative fluorescence diagnosis with alasens for brain metastases includes visual assessment of alasens-induced protoporphyrin IX fluorescence and local spectroscopy. The technique allows to reduce the rate of misdiagnosis, to assess accurate local extent of brain metastases and to improve surgical radicality. When applying this technique the sensitivity of fluorescence diagnosis is 96.7%, the specificity is 100%. The technique is designed for neurosurgeons specialized on neurooncology. 

  8. Dice Similarity Measure between Single Valued Neutrosophic Multisets and Its Application in Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Shan Ye

    2014-12-01

    Full Text Available This paper introduces the concept of a single valued neutrosophic multiset (SVNM as a generalization of an intuitionistic fuzzy multiset (IFM and some basic operational relations of SVNMs, and then proposes the Dice similarity measure and the weighted Dice similarity measure for SVNMs and investigates their properties. Fi nally, the Dice similarity measure is applied to a medical diagnosis problem with SVNM information. This diagnosis method can deal with the medical diagnosis problem with indeterminate and inconsistent information which cannot be handled by the diagnosis method based on IFMs.

  9. Pediatric syncope: is detailed medical history the key point for differential diagnosis?

    Science.gov (United States)

    Ikiz, Mehmet Alper; Cetin, Ibrahim Ilker; Ekici, Filiz; Güven, Alev; Değerliyurt, Aydan; Köse, Gülşen

    2014-05-01

    Syncope is a transient loss of consciousness as a result of global cerebral hypoperfusion. It is generally benign but may be a sign of pathology. The purpose of this study was to analyze the frequency of syncope due to cardiac, neurocardiogenic, neurologic, situational, psychiatric, and other causes and make a differential diagnosis of syncope types according to detailed medical history and further investigations. We examined prospectively 268 children presented to pediatric polyclinics as well as cardiology and neurology departments (age range, 1-18 years) with a primary complaint of syncope for the study. Cardiac syncope was diagnosed in 12 patients, neurocardiogenic syncope in 232, neurologic syncope in 9, psychiatric syncope in 9, situational in 4, and benign paroxysmal positional vertigo in 2. The neurologic syncope group consists of patients diagnosed with epilepsy after evaluation. Eight patients in the cardiac syncope group were found to have diseases such as long QT syndrome, and the remaining patients had hypertrophic cardiomyopathy, atrioventricular nodal reentry tachycardia, ventricular tachycardia, and a second-degree heart block that can cause sudden death. In conclusion, syncope is a common problem in childhood that requires hospitalization. Because it may be the first finding of an underlying malignant cardiac or neurologic disease, clinicians must be very careful during medical evaluation. An electrocardiogram and a medical history including the details of the event, chronic diseases, and familial diseases are among the most important steps for the right diagnosis and prognosis. Instead of a routine procedure, further diagnostic workup should be directed according to medical history for high yield. Convulsive movements may be defined in all types of syncope related with cerebral hypoxia, and this may lead to a misdiagnosis of seizure by the clinician.

  10. Physics in Medical Diagnosis--An Optional Unit for High Schools.

    Science.gov (United States)

    Ronen, Micky; Ganiel, Uri

    1984-01-01

    Describes the general features of a new, optional learning unit that was developed and implemented in Israel high schools. The unit, which focuses on physics in medical diagnosis, deals with real practical problems and does not replace traditional physics. (JN)

  11. Integrated fatigue damage diagnosis and prognosis under uncertainties

    Data.gov (United States)

    National Aeronautics and Space Administration — An integrated fatigue damage diagnosis and prognosis framework is proposed in this paper. The proposed methodology integrates a Lamb wave-based damage detection...

  12. Tests and Medical Conditions Associated with Dementia Diagnosis

    Science.gov (United States)

    Burt, Diana B.; Primeaux-Hart, Sharon; Loveland, Katherine A.; Cleveland, Lynne A.; Lewis, Kay R.; Lesser, Jary; Pearson, Pamela L.

    2005-01-01

    Diagnosis of dementia in adults with intellectual disabilities requires documentation of clinically significant declines in memory and other cognitive skills, as well as changes in everyday and emotional functioning. To improve diagnostic accuracy in adults with Down syndrome, the authors examined conditions often associated with dementia, as well…

  13. A Framework for Intelligent Medical Diagnosis using Rough Set with Formal Concept Analysis

    OpenAIRE

    Tripathy, B. K.; Acharjya, D. P.; Cynthya, V.

    2013-01-01

    Medical diagnosis process vary in the degree to which they attempt to deal with different complicating aspects of diagnosis such as relative importance of symptoms, varied symptom pattern and the relation between diseases them selves. Based on decision theory, in the past many mathematical models such as crisp set, probability distribution, fuzzy set, intuitionistic fuzzy set were developed to deal with complicating aspects of diagnosis. But, many such models are failed to include...

  14. Diagnosis and medical treatment of neuropathic pain in leprosy.

    Science.gov (United States)

    Arco, Rogerio Del; Nardi, Susilene Maria Tonelli; Bassi, Thiago Gasperini; Paschoal, Vania Del Arco

    2016-08-08

    to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture. identificar as dificuldades em diagnosticar e tratar a dor neuropática causada pela hanseníase, bem como determinar as características principais dessa situação. examinaram-se 85 pacientes tratados no ambulatório de referência para hanseníase e referiam dor. Aplicou-se questionário, o teste Douleur Neuropathic 4, e criterioso exame neurológico pelo qual exclu

  15. Medical diagnosis through semiotics. Giving meaning to the sign.

    Science.gov (United States)

    Burnum, J F

    1993-11-01

    Physicians are engaged in incorporating quantitative methods for making clinical decisions into their practices. An acquaintance with semiotics, the doctrine of signs, may complement this project. A sign stands for something. We communicate indirectly through signs, and by interpreting what signs mean we make sense of our world and diagnose and understand our patients. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and staring eyes into thyrotoxicosis. Characteristically in diagnosis, beginning with an unstable inference, we test and otherwise ask questions likely to produce signs that support (or discredit) our hypothesis. In a literary sense, we join with the author to clarify and rewrite the text; creative interpretation is the key. Diagnosis is concluded through narration, by the meaning that is revealed by telling the story of the patient. Diagnosis will succeed only to the extent that we respect the principles and caveats of sign interpretation. The sign is both the key to the unknown and the master impersonator. The sign and its meaning are usually not the same; meaning has to be inferred. Because interpretations are made subjectively, they are circumscribed by the experience and bias of the clinician. Moreover, the contexts in which the sign appears shape the meaning of the sign and may change it altogether.

  16. Algorithms for Image Analysis and Combination of Pattern Classifiers with Application to Medical Diagnosis

    Science.gov (United States)

    Georgiou, Harris

    2009-10-01

    Medical Informatics and the application of modern signal processing in the assistance of the diagnostic process in medical imaging is one of the more recent and active research areas today. This thesis addresses a variety of issues related to the general problem of medical image analysis, specifically in mammography, and presents a series of algorithms and design approaches for all the intermediate levels of a modern system for computer-aided diagnosis (CAD). The diagnostic problem is analyzed with a systematic approach, first defining the imaging characteristics and features that are relevant to probable pathology in mammo-grams. Next, these features are quantified and fused into new, integrated radio-logical systems that exhibit embedded digital signal processing, in order to improve the final result and minimize the radiological dose for the patient. In a higher level, special algorithms are designed for detecting and encoding these clinically interest-ing imaging features, in order to be used as input to advanced pattern classifiers and machine learning models. Finally, these approaches are extended in multi-classifier models under the scope of Game Theory and optimum collective deci-sion, in order to produce efficient solutions for combining classifiers with minimum computational costs for advanced diagnostic systems. The material covered in this thesis is related to a total of 18 published papers, 6 in scientific journals and 12 in international conferences.

  17. Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children

    Science.gov (United States)

    Alexeeff, Stacey E.; Yau, Vincent; Qian, Yinge; Davignon, Meghan; Lynch, Frances; Crawford, Phillip; Davis, Robert; Croen, Lisa A.

    2017-01-01

    This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest…

  18. Influences of medical expertise on visual diagnosis in pathology

    NARCIS (Netherlands)

    Jaarsma, Thomas; Jarodzka, Halszka; Nap, Marius; Van Merriënboer, Jeroen; Boshuizen, Els

    2013-01-01

    Jaarsma, T., Jarodzka, H., Nap, M., Van Merriënboer, J. J. G., & Boshuizen, H. P. A. (2012, 9 November). Expertise development in clinical pathology: From novice to expert in a highly visual medical domain. Poster presented at the ICO Fall School, Girona, Spain.

  19. An approach for solving multi-level diagnosis in high sensitivity medical diagnosis systems through the application of semantic technologies.

    Science.gov (United States)

    Rodríguez-González, Alejandro; Alor-Hernández, Giner

    2013-01-01

    The capability of medical diagnosis systems to provide results in different situations depends on the modeling of the knowledge base. In the case of high sensitivity systems, the capability of having an adequate model allows to increase the accuracy of the system even in situations where the number of input elements is low. In this context the concept of multi-level diagnosis emerges, where a pathology can be assumed as a diagnostic element of another pathology (acting as a finding). In this paper this concept is studied in depth from the modeling point of view, providing a solution based on rule inference techniques modeled with semantic technologies, and allowing solving the problem generated by multi-level diagnosis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Teleworks: a CSCW application for remote medical diagnosis support and teleconsultation.

    Science.gov (United States)

    Makris, L; Kamilatos, I; Kopsacheilis, E V; Strintzis, M G

    1998-06-01

    The present paper describes methods for the design of both synchronous and asynchronous computer-supported cooperative work (CSCW) procedures suitable for the medical application area and specifically for the purpose of medical teleconsultation and remote diagnosis support. The experimental implementation of a CSCW system built upon a PC/Windows platform is detailed as an example of a low-cost system suitable for adoption in a wide range of medical teleconsultation applications.

  1. Machine learning, medical diagnosis, and biomedical engineering research - commentary.

    Science.gov (United States)

    Foster, Kenneth R; Koprowski, Robert; Skufca, Joseph D

    2014-07-05

    A large number of papers are appearing in the biomedical engineering literature that describe the use of machine learning techniques to develop classifiers for detection or diagnosis of disease. However, the usefulness of this approach in developing clinically validated diagnostic techniques so far has been limited and the methods are prone to overfitting and other problems which may not be immediately apparent to the investigators. This commentary is intended to help sensitize investigators as well as readers and reviewers of papers to some potential pitfalls in the development of classifiers, and suggests steps that researchers can take to help avoid these problems. Building classifiers should be viewed not simply as an add-on statistical analysis, but as part and parcel of the experimental process. Validation of classifiers for diagnostic applications should be considered as part of a much larger process of establishing the clinical validity of the diagnostic technique.

  2. Contemporary constellations of nuclear medical methods for diagnosis of hyperparathyroidism

    International Nuclear Information System (INIS)

    Radeva, M.; Doseva, V.

    2000-01-01

    There are selected contemporary methods for diagnosis of the primary and the secondary hyperparathyroidism. The serum concentration of the parathormone were determined by radioimmunoassay method for 178 patients with different stage of progress hyperparathyroidism. In 26 patients was performed scintigraphy by SPECT gamma camera for visualization of eventual parathyroid adenoma. The double isotope method namely 123 I for visualization thyroid gland and 99m Tc-MIBI for study parathyroid adenomas ware put into practice for the first time in Bulgaria. In consequence of the study in the part of the patients with primary and secondary hyperparathyroidism were visualized adenomas and determined the localization relationship of thyroid gland. The results were compared with echography and with serum level of Ca and P in the patients with primary hyperparathyroidism. (authors)

  3. A PSO-based rule extractor for medical diagnosis.

    Science.gov (United States)

    Hsieh, Yi-Zeng; Su, Mu-Chun; Wang, Pa-Chun

    2014-06-01

    One of the major bottlenecks in applying conventional neural networks to the medical field is that it is very difficult to interpret, in a physically meaningful way, because the learned knowledge is numerically encoded in the trained synaptic weights. In one of our previous works, we proposed a class of Hyper-Rectangular Composite Neural Networks (HRCNNs) of which synaptic weights can be interpreted as a set of crisp If-Then rules; however, a trained HRCNN may result in some ineffective If-Then rules which can only justify very few positive examples (i.e., poor generalization). This motivated us to propose a PSO-based Fuzzy Hyper-Rectangular Composite Neural Network (PFHRCNN) which applies particle swarm optimization (PSO) to trim the rules generated by a trained HRCNN while the recognition performance will not be degraded or even be improved. The performance of the proposed PFHRCNN is demonstrated on three benchmark medical databases including liver disorders data set, the breast cancer data set and the Parkinson's disease data set. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis.

    Science.gov (United States)

    Assaf, Dan; Amar, Eyal; Marwan, Norbert; Neuman, Yair; Salai, Moshe; Rath, Ehud

    2016-01-01

    The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable.

  5. Proper medical diagnosis and treatment with computer aided system

    Science.gov (United States)

    Pedowski, Tomasz; Wasiewicz, Piotr; Maciejewski, Ryszard; Wallner, Grzegorz

    2009-06-01

    Nowadays computers successfully analyze medical data giving results used for futher treatment. Every year we develop new technology which gives us better and more precise diagnose. We chose esophageal manometry (EFT) which has been considered as a "gold standard" test for the evaluation of esophageal motility. EFT allows physicians to get informations about esophageal peristalsis, amplitude and duration of the esophageal contraction and liquid/viscous bolus transit time from mouth through stomach. We examined 80 patients during 2008 year. Everybody got EFT, endoscopy and X-Ray examination. It was important to ask about symptoms which we correlate and connect with data from EFT. We tried to find a good algorithm for this job in order to do a simple and helpful tool for physician to make right diagnose. Connection between data and symptoms seems to be right and clear, but finding a good algorithm for given data is the main problem.

  6. Experience in teaching of radionuclide diagnosis in radiology course at Bogomolets national medical university

    International Nuclear Information System (INIS)

    Tkachenko, M.M.; Romanenko, G.O.; Morozova, N.L.; Mironova, O.V.

    2017-01-01

    The article highlights aspects of teaching radionuclide diagnosis (RND) in the study of complex radiation diagnosis and radiotherapy. Teaching of radiation at undergraduate stage is based on the results of new scientific achievements in radiology and guiding principles of evidence-based medicine. At present studying RND is intended to support the aspiration of European medical community to create a unified science-based approaches to diagnosis and it shows promise of new forms of learning that promote active creative work of a student.

  7. Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland.

    Science.gov (United States)

    Zejda, Jan E; Farnik, Małgorzata; Smółka, Irena; Lawson, Joshua; Brożek, Grzegorz M

    2017-06-07

    Introduction. The presented study of 4,535 children aged 7-17 years in the Upper Silesian region of Poland yielded 186 cases of previously known asthma, and 44 children with newly diagnosed asthma. The aim of the presented study was to identify non-medical factors that could explain why children with a newly established diagnosis ('undiagnosed asthma') had not been diagnosed in the past. Materials and method. The study was performed according to a case-control design. Parents of the children answered questionnaires on socio-economic status and family-related factors. Statistical determinants of undiagnosed asthma were explored using raw (OR) and logistic odds ratios with their 95% confidence intervals (logOR, 95%CI). Results. Children with undiagnosed asthma were younger compared to the group with previously known asthma (11.3±2.1 vs. 12.6±2.5 years; p=0.0008). Newly diagnosed cases were more frequent in children who had less parental attention (less than 1 hour/day spent by parent with child - OR=4.36; 95%CI: 1.76-10.81) and who were not registered with specialized health care (OR=2.20; 95%CI: 0.95-5.06). Results of logistic regression analysis suggest that under-diagnosis of asthma is related to age below 12 years - logOR = 3.59 (95%CI: 1.28-10.36), distance to a health centre > 5 km - logOR = 3.45 (95%CI: 1.05-11.36), time spent with child Conclusion. Among non-medical determinants of undiagnosed asthma the age of a child plays a major role. Another factors of importance is the large distance between residence and health centre, and low parental attention at home.

  8. Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism.

    Science.gov (United States)

    Bruns, Florian; Chelouche, Tessa

    2017-04-18

    Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945. Nazi officials established lecturer positions for the new subject area, named Medical Law and Professional Studies, at every medical school. The appointed lecturers were mostly early members of the Nazi Party and imparted Nazi political and moral values in their teaching. These values included the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual's obligation to stay healthy, and the priority of public health over individual-patient care. This article shows that there existed not only a Nazi version of medical ethics but also a systematic teaching of such ethics to students in Nazi Germany. The findings illustrate that, from a historical point of view, the notion of "eternal values" that are inherent to the medical profession is questionable. Rather, the prevailing medical ethos can be strongly determined by politics and the zeitgeist and therefore has to be repeatedly negotiated.

  9. An Approach to Management of Health Care and Medical Diagnosis Using of a Hybrid Disease Diagnosis System

    Directory of Open Access Journals (Sweden)

    Hodjat Hamidi

    2017-02-01

    Full Text Available Introduction: In order to simplify the information exchange within the medical diagnosis process, a collaborative software agent’s framework is presented. The purpose of the framework is to allow the automated information exchange between different medicine specialists. Methods: This study presented architecture of a hybrid disease diagnosis system. The architecture employed a learning algorithm and used soft computing to build a medical knowledge base. These machine intelligences are combined in a complementary approach to overcome the weakness of each other. To evaluate the hybrid learning algorithm and compare it with other methods, 699 samples were used in each experiment, where 60% was for training, 20% was for cross validation, and 20% for testing. Results: The results were obtained from the experiments on the breast cancer dataset. Different methods of soft computing system were merged to create diagnostic software functionality. As it is shown in the structure, the system has the ability to learn and collect knowledge that can be used in the detection of new images. Currently, the system is at the design stage. The system is to evaluate the performance of hybrid learning algorithm. The preliminary results showed a better performance of this system than other methods. However, the results can be tested with hybrid system on larger data sets to improve hybrid learning algorithm. Conclusion: The purpose of this paper was to simplify the diagnosis process of a patient by splitting the medical domain concepts (e.g., causes, effects, symptoms, tests in human body systems (e.g., respiratory, cardiovascular, though maintaining the holistic perspective through the links between common concepts.

  10. Promoting Medication Adherence in Older Adults Through Early Diagnosis of Neurocognitive Disorders

    OpenAIRE

    George, Nika R.; Steffen, Ann M.

    2014-01-01

    Objective: Community-dwelling older adults with neurocognitive disorders experience high risk of and often suffer severe consequences from medication nonadherence. Due to the important role of informal caregivers in the care of patients with neurocognitive disorders, medication management involves both patients and families. A formal diagnosis of a neurocognitive disorder may improve both provider-patient and provider-family communications and resulting regimen adherence, yet many with signs ...

  11. Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records

    OpenAIRE

    Masters, Elizabeth T.; Emir,Birol; Mardekian,Jack; Clair,Andrew; Kuhn,Max; Silverman,Stuart

    2015-01-01

    Birol Emir,1 Elizabeth T Masters,1 Jack Mardekian,1 Andrew Clair,1 Max Kuhn,2 Stuart L Silverman,3 1Pfizer Inc., New York, NY, 2Pfizer Inc., Groton, CT, 3Cedars-Sinai Medical Center, Los Angeles, CA, USA Background: Diagnosis of fibromyalgia (FM), a chronic musculoskeletal condition characterized by widespread pain and a constellation of symptoms, remains challenging and is often delayed. Methods: Random forest modeling of electronic medical records was used to identify variables that may fa...

  12. Fuzzy Evidential Network and Its Application as Medical Prognosis and Diagnosis Models.

    Science.gov (United States)

    Janghorbani, Amin; Moradi, Mohammad Hassan

    2017-08-01

    Uncertainty is one of the important facts of the medical knowledge. Medical prognosis and diagnosis, as the essential parts of medical knowledge, is affected by different aspects of uncertainty, which must be managed. In the previous studies, different theories such as Bayesian probability theory, evidence theory, and fuzzy set theory have been developed to represent and manage different aspects of uncertainty. Recently, hybrid frameworks are suggested to deal with various types of uncertainty in a single framework. Evidential networks are general frameworks for dealing explicitly with total and partial ignorance and offer powerful combination rule of contradictory evidence. In this framework, the fuzziness of linguistic variables is neglected while these variables commonly appear in the medical domain knowledge and different sources of medical information. In addition, the evidential network parameters are determined based on the experts' knowledge and no data-driven algorithm is provided to learn these parameters. In this study, a novel hybrid framework called fuzzy evidential network was suggested to manage the imprecision and epistemic uncertainty of medical prognosis and diagnosis. Also, a data-driven algorithm based on the fuzzy set theory and the fuzzy maximum likelihood is provided to learn the network parameters from clinical databases. The performance of the proposed framework as various prognosis and diagnosis models, compared with well-known machine learning algorithms and the results showed its superiority. Also, an evidential method is suggested to handle the missing values and its results were compared with KNN imputation method. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Machine learning approaches in medical image analysis: From detection to diagnosis

    NARCIS (Netherlands)

    M. de Bruijne (Marleen)

    2016-01-01

    textabstractMachine learning approaches are increasingly successful in image-based diagnosis, disease prognosis, and risk assessment. This paper highlights new research directions and discusses three main challenges related to machine learning in medical imaging: coping with variation in imaging

  14. A User-Centered Cooperative Information System for Medical Imaging Diagnosis.

    Science.gov (United States)

    Gomez, Enrique J.; Quiles, Jose A.; Sanz, Marcos F.; del Pozo, Francisco

    1998-01-01

    Presents a cooperative information system for remote medical imaging diagnosis. General computer-supported cooperative work (CSCW) problems addressed are definition of a procedure for the design of user-centered cooperative systems (conceptual level); and improvement of user feedback and optimization of the communication bandwidth in highly…

  15. Laypersons can seek help from their Facebook friends regarding medical diagnosis

    DEFF Research Database (Denmark)

    Folkestad, Lars; Brodersen, Jacob Broder; Hallas, Peter

    2011-01-01

    of people or community (a crowd) through an open call. Our aim was to explore whether laypersons via Facebook friends could crowd source their way to a medical diagnosis based on a brief medical history, posted as a status update on Facebook. MATERIAL AND METHODS: The participants posted a brief case story......INTRODUCTION: In contrast to Internet search engines, social media on the Internet such as Facebook, Twitter, etc. reach a large number of people, who are ready to help answering questions. This type of information aggregation has been dubbed "crowdsourcing" i.e. outsourcing a task to a large group...... on their Facebook profile and asked their »Facebook friends" to come up with possible diagnoses. RESULTS: The correct diagnosis was suggested in five of the six case stories, and the correct diagnosis was made after a median of ten minutes. The quality of the responses varied from relevant differential diagnoses...

  16. Distributed medical image analysis and diagnosis through crowd-sourced games: a malaria case study.

    Directory of Open Access Journals (Sweden)

    Sam Mavandadi

    Full Text Available In this work we investigate whether the innate visual recognition and learning capabilities of untrained humans can be used in conducting reliable microscopic analysis of biomedical samples toward diagnosis. For this purpose, we designed entertaining digital games that are interfaced with artificial learning and processing back-ends to demonstrate that in the case of binary medical diagnostics decisions (e.g., infected vs. uninfected, with the use of crowd-sourced games it is possible to approach the accuracy of medical experts in making such diagnoses. Specifically, using non-expert gamers we report diagnosis of malaria infected red blood cells with an accuracy that is within 1.25% of the diagnostics decisions made by a trained medical professional.

  17. Cooperation project: medical physics in cancer diagnosis and therapy in Bangladesh

    International Nuclear Information System (INIS)

    Quast, Ulrich; Zakaria, Golam Abu; Hoever, Karl-Heinz; Ahmad, Gias uddin; Akhter, Shaheen

    1999-01-01

    Bangladesh requires 200 radiotherapy facilities, 4 are in use; 400 medical physicists are needed, 3 are employed. On a private basis, a DGMP working group started in 1996, annual workshops on medical physics in cancer diagnosis and treatment, joined by many working physicists interested to become medical physicists. Basic topics were the principles, applications, acceptance, dosimetry and planning of 60 Co radiotherapy. In 1998, the Bangladesh association of physicists in medicine (BMPA) was founded, a young scientific society requiring international co-operation. The long experience in Medical Physics in India, its neighbouring country, could be very helpful in providing excellent medical physics courses. To absorb new technology and science, it is necessary to change the education policy; creativity and innovativeness must be valued more than the old knowledge, being replaced quickly by new knowledge and new technologies. (author)

  18. Acute stress reactions among medical and non-medical personnel in a general hospital under missile attacks.

    Science.gov (United States)

    Koren, Danny; Caspi, Yael; Leiba, Ronit; Bloch, Doron; Vexler, Batia; Klein, Ehud

    2009-01-01

    Recent mass level traumatic events further boosted the growing interest in understanding the effects of primary (direct) and secondary (indirect) traumatic exposure on "helping professionals." The objectives of this study are: (1) to assess the rates and severity of PTSD symptoms (PS) among hospital workers operating under fire while treating war-related injured patients, (2) to explore the effect of PS on level of functioning in real time, and (3) to estimate the added effect of secondary traumatization over and above that of primary traumatization. Rates of PS, level of psychological distress, and level of functioning were assessed in 412 medical and non-medical personnel working in a hospital that was under missile attacks during the Second Lebanon War in the summer of 2006. The Posttraumatic Stress Disorder Scale (PSS) was used to assess severity of PS, as well as to estimate probable DSM-IV diagnosis of PTSD. The mean number of reported PS was 8.6 (SD=4.4). Forty-three (10.2%) of the participants met the symptom and severity threshold for a probable diagnosis of PTSD, however only 13 of these 43 reported impaired level of functioning. There were no significant differences between personnel who had direct exposure to injured or traumatized casualties of the war and those who were not on PS severity and frequency of probable PTSD. These findings suggest that hospital workers operating under prolonged life-threatening conditions are at moderate risk for PTSD. However, they do not support an incremental effect of secondary traumatic exposure. (c) 2008 Wiley-Liss, Inc.

  19. FDTD Analysis of Spatial Filtering of Scattered Waves for Optical CT of Medical Diagnosis

    Science.gov (United States)

    Miyazaki, Yasumitsu; Kouno, Kouhei

    Medical image diagnosis and computer aided diagnosis are modern important medical techniques developed with computer technology. Particularly, medical image diagnosis using optical waves of lasers is very important technical tools for physiological examination of human body. Transmission properties mainly depend on optical absorption effects due to biological characteristics consisting of atomic and molecular structures. Image responses of optical transmitted projection include optical scattering characteristics that disturb transmission properties through biological structures. Computer numerical simulations of spatial filtering for optical scattering waves superposed on transmitted and attenuated waves are discussed to improve image diagnosis. By numerical simulation of FDTD method, statistical characteristics of optical waves are discussed for optical propagation, attenuation and scattering in random inhomogeneous biological media that consist of random particle models given by random numbers programming. Spatial filtering characteristics of grid structure are shown for exact image optical projection excluding scattering effects through physiological media. Spatial filtering characteristics for off-axial scattering optical waves are graphically shown by propagation properties with large attenuation in lossy waveguide-type grids by FDTD method.

  20. The trends of relevance about telling lung cancer diagnosis: social constraints, medical practice in several clinics.

    Science.gov (United States)

    Doruk, Sibel; Sevinç, Can; Sever, Fidan; Itil, Oya; Akkoçlu, Atila

    2012-01-01

    The aim of this study is to assess the opinions of relatives about telling the lung cancer diagnosis to the patient and evaluate the implementation in our hospital. A survey questionnaire was designed, and applied on nurses and physicians working in oncology care units, 4th-6th grade medical students, and relatives of cancer and non-cancer patients. Totally 347 (228 males, 119 females) participants (64 physicians, 100 nurses, 61 medical students, and 122 relatives of patients) with a mean age of 28 were enrolled in the study. 62.5% of doctors, 53.2% of nurses, 59.5% of medical students and 45.9% of relatives of lung cancer patients thought that the patient should be informed about his/her cancer diagnosis. 29.5% of the physicians told their patients about their diagnosis of cancer. Gender, age, abroad experience, academic career, speciality, and period of professional experience were not determined to have any impact on physician's opinion and clinical practices. It was determined that physicians care more about patients' right to be informed than other participating groups. Generally, although physicians agree that the diagnosis of cancer should be told to the patient, their routine clinical practices do not reflect this viewpoint.

  1. The (gendered) construction of diagnosis interpretation of medical signs in women patients.

    Science.gov (United States)

    Malterud, K

    1999-06-01

    Medicine maintains a distinction between the medical symptom--the patient's "subjective" experience and expression, and the privileged medical sign--the "objective" findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the "undefined," medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within a sociopolitical context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault's ideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women's health, illness and disease.

  2. Risk factors associated with uncomplicated peptic ulcer and changes in medication use after diagnosis.

    Directory of Open Access Journals (Sweden)

    Antonio González-Pérez

    Full Text Available Few epidemiologic studies have investigated predictors of uncomplicated peptic ulcer disease (PUD separately from predictors of complicated PUD.To analyze risk factors associated with uncomplicated PUD and medication use after diagnosis.Patients diagnosed with uncomplicated PUD (n = 3,914 were identified from The Health Improvement Network database among individuals aged 40-84 years during 1997-2005, with no previous history of PUD. Prescription records for the year after the date of diagnosis were reviewed and a nested case-control analysis was performed to calculate the odds ratios for the association of potential risk factors with PUD.Medications associated with developing uncomplicated PUD included current use of acetylsalicylic acid (ASA, nonsteroidal anti-inflammatory drugs (NSAIDs, paracetamol, selective serotonin reuptake inhibitors, antidepressants, antihypertensives or acid suppressants. Uncomplicated PUD was significantly associated with being a current or former smoker and having had a score of at least 3 on the Townsend deprivation index. Approximately 50% of patients who were users of ASA (19% of patients or chronic users of NSAIDs (7% of patients at diagnosis did not receive another prescription of the medication in the 60 days after diagnosis, and 30% were not represcribed therapy within a year. Among patients who were current users of ASA or chronic NSAIDs at the time of the PUD diagnosis and received a subsequent prescription for their ASA or NSAID during the following year, the vast majority (80-90% also received a proton pump inhibitor coprescription.Our results indicate that several risk factors for upper gastrointestinal bleeding are also predictors of uncomplicated PUD, and that some patients do not restart therapy with ASA or NSAIDs after a diagnosis of uncomplicated PUD. Further investigation is needed regarding the consequences for these patients in terms of increased cardiovascular burden due to discontinuation of

  3. FDA Experience with Medical Countermeasures under the Animal Rule

    Directory of Open Access Journals (Sweden)

    Paul Aebersold

    2012-01-01

    Full Text Available The Food and Drug Administration issued a final rule in May 2002 to permit the Agency to approve drugs or license biological products on the basis of animal efficacy studies for use in ameliorating or preventing serious or life-threatening conditions caused by exposure to lethal or permanently disabling toxic biological, chemical, radiological, or nuclear substances. Only two drugs were approved in the first nine years of the “Animal Rule” despite massive investment by the federal government since 2001 to stimulate development of medical countermeasures to biological threats. This article therefore examines the Food and Drug Administration reviews made public after approval of those two drugs and the public discussion at the Agency's Anti-Infective Drugs Advisory Committee of one biological product under development under the Animal Rule. Despite the paucity of approved drugs or licensed biological products as medical countermeasures, several investigational drugs have been placed in the National Strategic Stockpile for use as medical countermeasures, if needed.

  4. Early diagnosis of Lemierre's syndrome based on a medical history and physical findings.

    Science.gov (United States)

    Murata, Yutaka; Wada, Mikio; Kawashima, Atsushi; Kagawa, Keizo

    2013-01-01

    A 37-year-old woman presented with fever and rigor after experiencing respiratory symptoms the previous week that had resolved within a few days. On presentation, her neck was swollen along the right sternocleidomastoid muscle, and chest CT showed pulmonary septic embolisms. Lemierre's syndrome was strongly suspected based on the patient's medical history and physical findings. Further examination revealed venous thrombus, and Fusobacterium necrophorum was later isolated from blood cultures. Antibiotics for anaerobes were administered before a final diagnosis was made, and the patient's symptoms thereafter improved. A rapid diagnosis is essential, since Lemierre's syndrome can be fatal with a diagnostic delay.

  5. Discussion on “A Fuzzy Method for Medical Diagnosis of Headache”

    Science.gov (United States)

    Hung, Kuo-Chen; Wou, Yu-Wen; Julian, Peterson

    This paper is in response to the report of Ahn, Mun, Kim, Oh, and Han published in IEICE Trans. INF. & SYST., Vol.E91-D, No.4, 2008, 1215-1217. They tried to extend their previous paper that published on IEICE Trans. INF. & SYST., Vol.E86-D, No.12, 2003, 2790-2793. However, we will point out that their extension is based on the detailed data of knowing the frequency of three types. Their new occurrence information based on intuitionistic fuzzy set for medical diagnosis of headache becomes redundant. We advise researchers to directly use the detailed data to decide the diagnosis of headache.

  6. The good, the bad, and the ugly of medication coverage: Is altering a diagnosis to ensure medication coverage ethical?

    Directory of Open Access Journals (Sweden)

    Gillian Weston, BS

    2016-06-01

    Full Text Available Recently, a patient presented to the dermatology clinic suffering from disabling, recurrent palmoplantar vesicles and pustules. Biopsy demonstrated nondiagnostic histologic findings without unequivocal evidence for psoriasis. The localized rash was recalcitrant to a host of standard therapies. An anti-tumor necrosis factor biologic was considered, and experience suggested that this expensive medication would only be approved for coverage if a diagnosis was submitted for a Food and Drug Administration–approved indication as psoriasis. All health-care providers face similar dilemmas in caring for their own patients. To whom is the physician’s primary responsibility when what is best for the patient may not align with the realities of our health-care system? Should a physician alter or exaggerate a medical diagnosis to obtain insurance coverage for a needed medication? What are the ethical implications of this action? If the physician’s fiduciary duty to the patient had no limits, there would be multiple potential consequences including compromise of the health-care provider’s integrity and relationships with patients, other providers, and third-party payers as well as the risk to an individual patient’s health and creation of injustices within the health-care system.

  7. [The development and transplantation of LCD module-based interface for medical diagnosis instrument].

    Science.gov (United States)

    Zhang, Huisheng; Liu, Xinyu; Li, Qiaoliang; Rao, Jie; Zhang, Xiaofei; Wang, Xiaoxuan; Lin, Shumei; Yin, Li; Chen, Siping; Wang, Tianfu

    2012-11-01

    Based on LCD Module and Visual C++ development environment, this paper proposes a new method which can quickly develop the human-machine interface .We define a LCD module programming interface by designing Serial Communication Class(SCS). On this basis,we achieve the transplantation on an Embedded ARM Platform to fulfil the requirements of Medical Diagnostic Instruments (MDI). Experimental results show that this method has advantages of short development cycle and high level transplantation which has broad application prospects in the field of Medical Diagnosis Instrument.

  8. Preimplantation genetic diagnosis (PGD) according to medical ethics and medical law.

    Science.gov (United States)

    Lutz, Emine Elif Vatanoğlu

    2012-01-01

    Assisted reproductive techniques not only nourish great and sometimes illusive hopes of couples who yearn for babies, but also spark new debates by reversing opinions, beliefs and values. Applications made to infertility clinics are increasing due to the influences such as broadcasts made by the media concerning assisted reproductive techniques and other infertility treatments, increase in the knowledge that people have about these problems, late marriages and postponement of childbearing age owing to sociological changes. Pre-implantation genetic diagnosis (PGD) is a technique applied to couples who are known to carry genetic diseases or who have children with genetic diseases. This technique is conducted by doctors in Turkey for its important contribution to decreasing the risk of genetic diseases and in order to raise healthy generations. In this paper, the general ethical debates and the legal situation in Turkey will be discussed.

  9. Advances in medical imaging for the diagnosis and management of common genitourinary cancers.

    Science.gov (United States)

    Bagheri, Mohammad H; Ahlman, Mark A; Lindenberg, Liza; Turkbey, Baris; Lin, Jeffrey; Cahid Civelek, Ali; Malayeri, Ashkan A; Agarwal, Piyush K; Choyke, Peter L; Folio, Les R; Apolo, Andrea B

    2017-07-01

    Medical imaging of the 3 most common genitourinary (GU) cancers-prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder-has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers. Published by Elsevier Inc.

  10. Quality assurance in X-ray medical diagnosis - a physicist's viewpoint

    International Nuclear Information System (INIS)

    Moores, B.M.

    1985-01-01

    The role of quality assurance in the overall framework of costs, risks and benefits in X-ray medical diagnosis is outlined. Justification for implementing quality assurance is highlighted in terms of the nature and extent of radiological practice, the levels of exposure involved and the cost of providing the service. Quality assurance is discussed in terms of (i) quantitation/assessment; (ii) administration/ management; (iii) organisation; (iv) implementation. In particular, the need to implement quality assurance cost-effectively is discussed. (author)

  11. [Laypersons can seek help from their Facebook friends regarding medical diagnosis].

    Science.gov (United States)

    Folkestad, Lars; Brodersen, Jacob Broder; Hallas, Peter; Brabrand, Mikkel

    2011-12-05

    In contrast to Internet search engines, social media on the Internet such as Facebook, Twitter, etc. reach a large number of people, who are ready to help answering questions. This type of information aggregation has been dubbed "crowdsourcing" i.e. outsourcing a task to a large group of people or community (a crowd) through an open call. Our aim was to explore whether laypersons via Facebook friends could crowd source their way to a medical diagnosis based on a brief medical history, posted as a status update on Facebook. The participants posted a brief case story on their Facebook profile and asked their "Facebook friends" to come up with possible diagnoses. The correct diagnosis was suggested in five of the six case stories, and the correct diagnosis was made after a median of ten minutes. The quality of the responses varied from relevant differential diagnoses to very silly diagnostic suggestions. Based on this study, we believe that laypersons can use his or her "Facebook friends" to identify the need to see a doctor for their symptoms rather than relying on them to give them a specific diagnosis for their symptoms.

  12. Exposure of the French population to ionizing radiations related to medical diagnosis procedures in 2012

    International Nuclear Information System (INIS)

    2014-01-01

    This report updates (for 2012) data concerning the exposure of the French population related to diagnosis imagery tests using ionizing radiations. It notably outlines the characteristics of this medical exposure with respect to imagery modality (conventional radiology, scans, diagnosis interventional radiology, and nuclear medicine), to anatomic examined region, to age and to patient gender, and the share of the French population (quantity, age, gender) actually submitted to diagnosis procedures in 2012. The authors report the selection of procedure types, the determination of their frequency, the assessment of associated doses (choice of the efficient dose as indicator, assessment of efficient doses associated with each procedure type), the exposure of the French population in 2012 (general assessment, distribution of procedures and of the collective efficient dose, distribution in terms of age and gender), the characteristics of the actually exposed population. The representativeness of data is discussed, as well as the evolution of diagnosis medical exposure from 2007 to 2012. Data are compared with European and international data

  13. Medicalization in psychiatry: the medical model, descriptive diagnosis, and lost knowledge.

    Science.gov (United States)

    Sedler, Mark J

    2016-06-01

    Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the "atheoretical" approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry's over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry.  As a result,  the field has suffered a loss of knowledge that may be difficult to recover.

  14. Underlying construct of empathy, optimism, and burnout in medical students.

    Science.gov (United States)

    Hojat, Mohammadreza; Vergare, Michael; Isenberg, Gerald; Cohen, Mitchell; Spandorfer, John

    2015-01-29

    This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.

  15. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg

    2013-03-01

    Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

  16. Fault Diagnosis for Rolling Bearings under Variable Conditions Based on Visual Cognition

    Directory of Open Access Journals (Sweden)

    Yujie Cheng

    2017-05-01

    Full Text Available Fault diagnosis for rolling bearings has attracted increasing attention in recent years. However, few studies have focused on fault diagnosis for rolling bearings under variable conditions. This paper introduces a fault diagnosis method for rolling bearings under variable conditions based on visual cognition. The proposed method includes the following steps. First, the vibration signal data are transformed into a recurrence plot (RP, which is a two-dimensional image. Then, inspired by the visual invariance characteristic of the human visual system (HVS, we utilize speed up robust feature to extract fault features from the two-dimensional RP and generate a 64-dimensional feature vector, which is invariant to image translation, rotation, scaling variation, etc. Third, based on the manifold perception characteristic of HVS, isometric mapping, a manifold learning method that can reflect the intrinsic manifold embedded in the high-dimensional space, is employed to obtain a low-dimensional feature vector. Finally, a classical classification method, support vector machine, is utilized to realize fault diagnosis. Verification data were collected from Case Western Reserve University Bearing Data Center, and the experimental result indicates that the proposed fault diagnosis method based on visual cognition is highly effective for rolling bearings under variable conditions, thus providing a promising approach from the cognitive computing field.

  17. Fault Diagnosis for Rolling Bearings under Variable Conditions Based on Visual Cognition.

    Science.gov (United States)

    Cheng, Yujie; Zhou, Bo; Lu, Chen; Yang, Chao

    2017-05-25

    Fault diagnosis for rolling bearings has attracted increasing attention in recent years. However, few studies have focused on fault diagnosis for rolling bearings under variable conditions. This paper introduces a fault diagnosis method for rolling bearings under variable conditions based on visual cognition. The proposed method includes the following steps. First, the vibration signal data are transformed into a recurrence plot (RP), which is a two-dimensional image. Then, inspired by the visual invariance characteristic of the human visual system (HVS), we utilize speed up robust feature to extract fault features from the two-dimensional RP and generate a 64-dimensional feature vector, which is invariant to image translation, rotation, scaling variation, etc. Third, based on the manifold perception characteristic of HVS, isometric mapping, a manifold learning method that can reflect the intrinsic manifold embedded in the high-dimensional space, is employed to obtain a low-dimensional feature vector. Finally, a classical classification method, support vector machine, is utilized to realize fault diagnosis. Verification data were collected from Case Western Reserve University Bearing Data Center, and the experimental result indicates that the proposed fault diagnosis method based on visual cognition is highly effective for rolling bearings under variable conditions, thus providing a promising approach from the cognitive computing field.

  18. [Differential Diagnosis of Schizophrenia: Psychotic Symptoms in Neurodevelopmental Disorders and Psychotic Disorders due to other Medical Conditions].

    Science.gov (United States)

    Kokurcan, Ahmet; Atbaşoğlu, Eşref Cem

    2015-01-01

    This review focuses on the differentiation of schizophrenia in the setting of adult psychiatry from neurodevelopmental disorders (NDD's) and psychosis due to other medical conditions (PDMC). Psychotic disorders in early adulthood are most frequently diagnosed with the schizophrenia spectrum or mood disorders. However, they may be the manifestation of neurologic, endocrine or immunologic disease. Individuals with NDD's such as the autism spectrum disorder (ASD) or intellectual developmental disorder (IDD) may also present initially in adulthood. Therefore it is not uncommon that the psychiatrist is the first physician to assess a psychotic patient with underlying medical illness or a NDD. Failure to identify the underlying cause will delay appropriate management. Overdiagnosis of primary psychiatric disorders may be misleading in planning the treatment, as evidence-based treatment algorithms relevant to psychosis are intended for primary psychotic disorders like schizophrenia, and symptomatic treatment may result in unnecessary exposure to antipsychotic drugs. Exclusion of other medical conditions and NDD's is essential before establishing a diagnosis of schizophrenia.

  19. Challenges of malaria diagnosis in clinical settings and disease surveillance under reduced malaria burden in Tanzania

    Directory of Open Access Journals (Sweden)

    Donath Samuel Tarimo

    2017-01-01

    Full Text Available Febrile illnesses that are caused by malaria and other infectious diseases are a major cause of morbidity and mortality in sub-Saharan Africa. In malaria endemic countries, malaria is considered as one of the most serious febrile illnesses. Over the last two decades, major investment in malaria control has witnessed a major achievement in decline of malaria burden, however, other causes of febrile illnesses have remained prevalent. The decline in malaria burden poses challenges for the diagnosis of malaria in clinical settings, research and disease surveillance. This review highlights the challenges facing the diagnosis of malarial and nonmalarial fevers under reduced malaria burden from the perspectives of parasite diagnosis and interpretations of the diagnoses of malarial and non-malarial fevers, and the possible approaches to address the challenges for a better understanding of the dynamics of febrile illnesses under reduced malaria burden.

  20. Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports

    International Nuclear Information System (INIS)

    Wiesinger, Isabel; Scharf, Gregor; Platz, Natascha; Dendl, Lena M.; Stroszczynski, Christian; Schreyer, Andreas G.; Pawlik, Michael T.

    2015-01-01

    To evaluate the clinical value and impact of radiological imaging in published medial case reports. We analysed 671 consecutively published case reports of a peer-reviewed medical journal for case reports. The general use of radiological imaging as well as the specific imaging modality used in each case (ultrasound, x-ray, fluoroscopy, CT, MRI) was documented, and most importantly the 'final problem solver', i.e. the diagnostic modality giving the final clue to the patient's diagnosis, was identified. In 511 of 671 (76.1 %) analysed case reports at least one radiological modality was used in the diagnostic cascade. In 28.6 % of all cases the final diagnosis was achieved by radiological imaging. All other cases were solved by the patient's history and physical examination (15.2 %), histology (12.4 %), and blood analysis (9.6 %). When radiology was the 'final problem solver', it was mainly CT (51.6 %) and MRI (30.6 %). In 52.2 % of the case reports the radiological image was included in the article. In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis. (orig.)

  1. Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports

    Energy Technology Data Exchange (ETDEWEB)

    Wiesinger, Isabel; Scharf, Gregor; Platz, Natascha; Dendl, Lena M.; Stroszczynski, Christian; Schreyer, Andreas G. [University Hospital Regensburg, Institute of Radiology, Regensburg (Germany); Pawlik, Michael T. [Intensive Care and Emergency Medicine, Institute of Anaesthesiology, Regensburg (Germany)

    2015-05-01

    To evaluate the clinical value and impact of radiological imaging in published medial case reports. We analysed 671 consecutively published case reports of a peer-reviewed medical journal for case reports. The general use of radiological imaging as well as the specific imaging modality used in each case (ultrasound, x-ray, fluoroscopy, CT, MRI) was documented, and most importantly the 'final problem solver', i.e. the diagnostic modality giving the final clue to the patient's diagnosis, was identified. In 511 of 671 (76.1 %) analysed case reports at least one radiological modality was used in the diagnostic cascade. In 28.6 % of all cases the final diagnosis was achieved by radiological imaging. All other cases were solved by the patient's history and physical examination (15.2 %), histology (12.4 %), and blood analysis (9.6 %). When radiology was the 'final problem solver', it was mainly CT (51.6 %) and MRI (30.6 %). In 52.2 % of the case reports the radiological image was included in the article. In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis. (orig.)

  2. Overweight and obesity may lead to under-diagnosis of airflow limitation

    DEFF Research Database (Denmark)

    Çolak, Yunus; Marott, Jacob Louis; Vestbo, Jørgen

    2015-01-01

    BACKGROUND: The prevalence of obesity has increased during the last decades and varies from 10-20% in most European countries to approximately 32% in the United States. However, data on how obesity affects the presence of airflow limitation (AFL) defined as a reduced ratio between forced expirato......-diagnosis and under-treatment of COPD among individuals with overweight and obesity....

  3. [Investigation of human brucellosis diagnosis and report quality in medical institutions in key areas of Shanxi province].

    Science.gov (United States)

    Zeng, L J; Yang, W W; Tie, P; Liu, X R; Gao, X R; Li, Z Y; Hou, P; Zhi, Y; Bai, Y F; Geng, M J; Chen, Q L; Cui, B Y; Li, Z J; Wang, L P

    2017-11-10

    Objective: To evaluate the accuracy of human brucellosis diagnosis and reporting in medical institutions in Shanxi province, and understand the performance of clinical doctors to diagnose human brucellosis according to diagnostic criteria. Methods: Field investigation was conducted in 6 medical institutions in the key areas of human brucellosis in Shanxi province. The diagnosis data of the reported brucellosis cases in 2015 were collected and reviewed retrospectively for the evaluation of the diagnosis accuracy with systematic sampling method. The database was established with Excel 2010 and the descriptive analysis and statistical test were conducted with software R 3.3.2. Results: The diagnosis consistent rate of the 377 brucellosis cases reviewed was 70.8% (267/377), the diagnosis consistent rates in medical institutions at city-level and country-level were 77.0% (127/165) and 66.0% (140/212) respectively, the differences had significance ( χ (2)=5.4, P =0.02). Among the reviewed cases, the diagnosis consistent rate of laboratory diagnosis and clinical diagnosis were 87.1% (256/294) and 13.3% (11/83) respectively, and the differences had significance ( χ (2)=170.7, P brucellosis cases within 24 hours after diagnosis. Conclusion: The accuracy of human brucellosis diagnosis in key areas of human brucellosis in Shanxi was low, and the performance of the clinical doctors to diagnose human brucellosis according to diagnostic and case classification criteria was unsatisfied.

  4. Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform.

    Science.gov (United States)

    Hansen, Helena; Bourgois, Philippe; Drucker, Ernest

    2014-02-01

    In 1996 the U.S. severely restricted public support for low income people, ending "welfare as we know it." This led to dramatic increases in medicalized forms of support for indigent people, who increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their "disabled" status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor". Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

    Science.gov (United States)

    Jia, Judy; Band, Roger; Abboud, Michael E; Pajerowski, William; Guo, Michelle; David, Guy; Mechem, C Crawford; Messé, Steven R; Carr, Brendan G; Mullen, Michael T

    2017-01-01

    Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration 270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h. Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.

  6. A survey of medical exposure during X-ray diagnosis in Aomori

    International Nuclear Information System (INIS)

    Kon, Masanori; Fukushi, Shouji; Oota, Fumio; Kawamura, Kouji; Shinohe, Tetsuo; Suwa, Kouki; Fujii, Kiyosuke; Yamagami, Hirofumi

    2000-01-01

    The purpose of this project was to survey medical exposure doses in Aomori Prefecture and compare them with guidance levels for X-ray diagnosis. A questionnaire survey on X-ray diagnosis was conducted at the main medical institutions in the prefecture. The questionnaire asked about technical conditions, and replies were obtained from 72.2% of the 79 institutions. The medical exposure doses (entrance surface doses) were calculated from the results of the questionnaires by the modified numerical dose determination (NDD) method. The distribution of the entrance surface doses at each site was calculated as the 1st quartile, median, 3rd quartile, average, standard deviation, maximum value and minimum value, by the quartile method. The distribution of exposed doses at each site showed a similar pattern with that of the national distribution. Some institutions used higher doses than the Japanese proposed guidance levels and International Atomic Energy Agency (IAEA) guidance levels. Re-assessment of radiographic conditions and photosensitive materials is needed to reduce exposure doses. (K.H.)

  7. An interdisciplinary community diagnosis experience in an undergraduate medical curriculum: development at Ghent University.

    Science.gov (United States)

    Art, Bruno; De Roo, Leen; Willems, Sara; De Maeseneer, Jan

    2008-07-01

    Since 2002, the medical curriculum at Ghent University has incorporated a community diagnosis exercise, teaming medical students with master of social work and social welfare studies students. The course focuses on the interaction between the individual and the community in matters of health and health care. During one week, small groups of students visit patients and their caregivers in six underserved urban neighborhoods, and they combine these experiences with public health data, to develop a community diagnosis. Local family physicians and social workers monitor sessions. The course requires students to design an intervention tackling one community health issue. At the end of the course, the students present their diagnoses and interventions to community workers and policy makers who provide feedback on the results. In the authors' experience, medical and social work students all value the joint learning experience. The occasional culture clash is an added value. The one-week course is very intensive for students, mentors, and cooperating organizations. Although students criticize time restraints, they feel that they reach the outlined objectives, and they rate the overall experience as very positive. The authors find that this interdisciplinary, community-oriented exercise allows students to appreciate health problems as they occur in society, giving them insight into the interaction of the local community with health and health care agencies. Combining public health data with experiences originating from a patient encounter mimics real-life primary care situations. This campus-community collaboration contributes to the social accountability of the university.

  8. [Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)].

    Science.gov (United States)

    Delclós, Jordi; Gimeno, David; Torá, Isabel; Martínez, José Miguel; Manzanera, Rafael; Jardí, Josefina; Alberti, Constança; G Benavides, Fernando

    2013-01-01

    We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  9. A Privacy-Preserving Intelligent Medical Diagnosis System Based on Oblivious Keyword Search

    Directory of Open Access Journals (Sweden)

    Zhaowen Lin

    2017-01-01

    Full Text Available One of the concerns people have is how to get the diagnosis online without privacy being jeopardized. In this paper, we propose a privacy-preserving intelligent medical diagnosis system (IMDS, which can efficiently solve the problem. In IMDS, users submit their health examination parameters to the server in a protected form; this submitting process is based on Paillier cryptosystem and will not reveal any information about their data. And then the server retrieves the most likely disease (or multiple diseases from the database and returns it to the users. In the above search process, we use the oblivious keyword search (OKS as a basic framework, which makes the server maintain the computational ability but cannot learn any personal information over the data of users. Besides, this paper also provides a preprocessing method for data stored in the server, to make our protocol more efficient.

  10. Computer aided diagnosis based on medical image processing and artificial intelligence methods

    International Nuclear Information System (INIS)

    Stoitsis, John; Valavanis, Ioannis; Mougiakakou, Stavroula G.; Golemati, Spyretta; Nikita, Alexandra; Nikita, Konstantina S.

    2006-01-01

    Advances in imaging technology and computer science have greatly enhanced interpretation of medical images, and contributed to early diagnosis. The typical architecture of a Computer Aided Diagnosis (CAD) system includes image pre-processing, definition of region(s) of interest, features extraction and selection, and classification. In this paper, the principles of CAD systems design and development are demonstrated by means of two examples. The first one focuses on the differentiation between symptomatic and asymptomatic carotid atheromatous plaques. For each plaque, a vector of texture and motion features was estimated, which was then reduced to the most robust ones by means of ANalysis of VAriance (ANOVA). Using fuzzy c-means, the features were then clustered into two classes. Clustering performances of 74%, 79%, and 84% were achieved for texture only, motion only, and combinations of texture and motion features, respectively. The second CAD system presented in this paper supports the diagnosis of focal liver lesions and is able to characterize liver tissue from Computed Tomography (CT) images as normal, hepatic cyst, hemangioma, and hepatocellular carcinoma. Five texture feature sets were extracted for each lesion, while a genetic algorithm based feature selection method was applied to identify the most robust features. The selected feature set was fed into an ensemble of neural network classifiers. The achieved classification performance was 100%, 93.75% and 90.63% in the training, validation and testing set, respectively. It is concluded that computerized analysis of medical images in combination with artificial intelligence can be used in clinical practice and may contribute to more efficient diagnosis

  11. Computer aided diagnosis based on medical image processing and artificial intelligence methods

    Energy Technology Data Exchange (ETDEWEB)

    Stoitsis, John [National Technical University of Athens, School of Electrical and Computer Engineering, Athens 157 71 (Greece)]. E-mail: stoitsis@biosim.ntua.gr; Valavanis, Ioannis [National Technical University of Athens, School of Electrical and Computer Engineering, Athens 157 71 (Greece); Mougiakakou, Stavroula G. [National Technical University of Athens, School of Electrical and Computer Engineering, Athens 157 71 (Greece); Golemati, Spyretta [National Technical University of Athens, School of Electrical and Computer Engineering, Athens 157 71 (Greece); Nikita, Alexandra [University of Athens, Medical School 152 28 Athens (Greece); Nikita, Konstantina S. [National Technical University of Athens, School of Electrical and Computer Engineering, Athens 157 71 (Greece)

    2006-12-20

    Advances in imaging technology and computer science have greatly enhanced interpretation of medical images, and contributed to early diagnosis. The typical architecture of a Computer Aided Diagnosis (CAD) system includes image pre-processing, definition of region(s) of interest, features extraction and selection, and classification. In this paper, the principles of CAD systems design and development are demonstrated by means of two examples. The first one focuses on the differentiation between symptomatic and asymptomatic carotid atheromatous plaques. For each plaque, a vector of texture and motion features was estimated, which was then reduced to the most robust ones by means of ANalysis of VAriance (ANOVA). Using fuzzy c-means, the features were then clustered into two classes. Clustering performances of 74%, 79%, and 84% were achieved for texture only, motion only, and combinations of texture and motion features, respectively. The second CAD system presented in this paper supports the diagnosis of focal liver lesions and is able to characterize liver tissue from Computed Tomography (CT) images as normal, hepatic cyst, hemangioma, and hepatocellular carcinoma. Five texture feature sets were extracted for each lesion, while a genetic algorithm based feature selection method was applied to identify the most robust features. The selected feature set was fed into an ensemble of neural network classifiers. The achieved classification performance was 100%, 93.75% and 90.63% in the training, validation and testing set, respectively. It is concluded that computerized analysis of medical images in combination with artificial intelligence can be used in clinical practice and may contribute to more efficient diagnosis.

  12. Remote consultation and diagnosis in medical imaging using a global PACS backbone network

    Science.gov (United States)

    Martinez, Ralph; Sutaria, Bijal N.; Kim, Jinman; Nam, Jiseung

    1993-10-01

    A Global PACS is a national network which interconnects several PACS networks at medical and hospital complexes using a national backbone network. A Global PACS environment enables new and beneficial operations between radiologists and physicians, when they are located in different geographical locations. One operation allows the radiologist to view the same image folder at both Local and Remote sites so that a diagnosis can be performed. The paper describes the user interface, database management, and network communication software which has been developed in the Computer Engineering Research Laboratory and Radiology Research Laboratory. Specifically, a design for a file management system in a distributed environment is presented. In the remote consultation and diagnosis operation, a set of images is requested from the database archive system and sent to the Local and Remote workstation sites on the Global PACS network. Viewing the same images, the radiologists use pointing overlay commands, or frames to point out features on the images. Each workstation transfers these frames, to the other workstation, so that an interactive session for diagnosis takes place. In this phase, we use fixed frames and variable size frames, used to outline an object. The data pockets for these frames traverses the national backbone in real-time. We accomplish this feature by using TCP/IP protocol sockets for communications. The remote consultation and diagnosis operation has been tested in real-time between the University Medical Center and the Bowman Gray School of Medicine at Wake Forest University, over the Internet. In this paper, we show the feasibility of the operation in a Global PACS environment. Future improvements to the system will include real-time voice and interactive compressed video scenarios.

  13. Conversion of a mobile educational reactor into a medical facility for diagnosis

    International Nuclear Information System (INIS)

    Tseng, Der-Ling; Weng, Pao-Shan; Chang, Pao-Shu.

    1987-01-01

    This work describes the conversion of a 0.1 W mobile educational reactor into a medical facility for diagnosis mainly for toxic metal contamination such as cadmium based on the principle of in vivo prompt γ activation analysis known as IVPGAA. The IVPGAA system consists of a liquid phantom and a detecting system in addition to the mobile educational reactor and well described. A comparison of all existing facilities using IVPGAA system is given, and the advantages of using a mobile reactor are presented together with the safety aspects of the reactor driven on highways and in operation. (author)

  14. MR diagnosis of retropatellar chondral lesions under compression. A comparison with histological findings

    International Nuclear Information System (INIS)

    Andresen, R.; Radmer, S.; Koenig, H.; Banzer, D.; Wolf, K.J.

    1996-01-01

    Purpose: The aim of the study was to improve the chondromalacia patellae (CMP) diagnosis by MR imaging under defined compression of the retropatellar cartilage, using a specially designed knee compressor. The results were compared with histological findings to obtain an MR classification of CMP. Method: MR imaging was performed in in vitro studies of 25 knees from cadavers to investigate the effects of compression on the rentropatellar articular cartilage. The results were verified by subsequent histological evaluations. Results: There was significant difference in cartilage thickness reduction and signal intensity behaviour under compression according to the stage of CMP. Conclusion: Based on the decrease in cartilage thickness, signal intensity behaviour under compression, and cartilage morphology, the studies permitted and MR classifiction of CMP into stages I-IV in line with the histological findings. Healthy cartilage was clearly distinguished, a finding which may optimize CMP diagnosis. (orig.)

  15. Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Judy Jia

    2017-09-01

    Full Text Available BackgroundAccurate recognition of stroke symptoms by Emergency Medical Services (EMS is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city.Methods and resultsPhiladelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5–9, OR 2.62, 95% CI 1.41–4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29–9.09 and weakness (OR 2.28, 95% CI 1.35–3.85, and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25–0.68. EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h.ConclusionPrehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.

  16. Study on 3D gamma-ray imaging for medical diagnosis with coded aperture

    International Nuclear Information System (INIS)

    Horiki, Kazunari; Shimazoe, Kenji; Ohno, Masashi; Takahashi, Hiroyuki; Kobashi, Keiji; Moro, Eiji

    2014-01-01

    The conventional methods for medical imaging have several disadvantages such as restriction on the energy and detection efficiency. Coded aperture imaging can be used for medical imagings without restriction on the energy, which makes it possible to use multiple tracers in diagnosis. The detection efficiency of Coded aperture imaging is ten times better than that of the pinhole collimator. First, simulations of the coded aperture imaging have been done to confirm M-array's effectiveness. Second, two experiments have been done with low-energy gamma-ray (122 keV( 57 Co)) and with high-energy gamma-ray (662 keV( 137 Cs)). In both cases reconstructed image was successfully acquired. The measured spatial resolution in the experiment using 57 Co is 4.3 mm (FWHM). (author)

  17. Examining the impact of psychiatric diagnosis and comorbidity on the medical lethality of adolescent suicide attempts.

    Science.gov (United States)

    McManama O'Brien, Kimberly H; Berzin, Stephanie C

    2012-08-01

    Specific psychiatric diagnoses and comorbidity patterns were examined to determine if they were related to the medical lethality of suicide attempts among adolescents presenting to an urban general hospital (N=375). Bivariate analysis showed that attempters with substance abuse disorders had higher levels of lethality than attempters without substance abuse. Regression results indicated having depression comorbid with any other diagnosis was not associated with medical lethality. However, having a substance abuse disorder was associated with higher suicide attempt lethality, highlighting the importance of substance abuse as a risk factor for lethal suicide attempts in adolescents. This finding stimulates critical thinking around the understanding of suicidal behavior in youth and the development and implementation of treatment strategies for suicidal adolescents with substance abuse disorders. © 2012 The American Association of Suicidology.

  18. A SUPPORT VECTOR MACHINE APPROACH FOR DEVELOPING TELEMEDICINE SOLUTIONS: MEDICAL DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Mihaela GHEORGHE

    2015-06-01

    Full Text Available Support vector machine represents an important tool for artificial neural networks techniques including classification and prediction. It offers a solution for a wide range of different issues in which cases the traditional optimization algorithms and methods cannot be applied directly due to different constraints, including memory restrictions, hidden relationships between variables, very high volume of computations that needs to be handled. One of these issues relates to medical diagnosis, a subset of the medical field. In this paper, the SVM learning algorithm is tested on a diabetes dataset and the results obtained for training with different kernel functions are presented and analyzed in order to determine a good approach from a telemedicine perspective.

  19. An interpretable fuzzy rule-based classification methodology for medical diagnosis.

    Science.gov (United States)

    Gadaras, Ioannis; Mikhailov, Ludmil

    2009-09-01

    The aim of this paper is to present a novel fuzzy classification framework for the automatic extraction of fuzzy rules from labeled numerical data, for the development of efficient medical diagnosis systems. The proposed methodology focuses on the accuracy and interpretability of the generated knowledge that is produced by an iterative, flexible and meaningful input partitioning mechanism. The generated hierarchical fuzzy rule structure is composed by linguistic; multiple consequent fuzzy rules that considerably affect the model comprehensibility. The performance of the proposed method is tested on three medical pattern classification problems and the obtained results are compared against other existing methods. It is shown that the proposed variable input partitioning leads to a flexible decision making framework and fairly accurate results with a small number of rules and a simple, fast and robust training process.

  20. Variations in cardiovascular disease under-diagnosis in England: national cross-sectional spatial analysis

    Directory of Open Access Journals (Sweden)

    Walford Hannah

    2011-03-01

    Full Text Available Abstract Background There is under-diagnosis of cardiovascular disease (CVD in the English population, despite financial incentives to encourage general practices to register new cases. We compared the modelled (expected and diagnosed (observed prevalence of three cardiovascular conditions- coronary heart disease (CHD, hypertension and stroke- at local level, their geographical variation, and population and healthcare predictors which might influence diagnosis. Methods Cross-sectional observational study in all English local authorities (351 and general practices (8,372 comparing model-based expected prevalence with diagnosed prevalence on practice disease registers. Spatial analyses were used to identify geographic clusters and variation in regression relationships. Results A total of 9,682,176 patients were on practice CHD, stroke and transient ischaemic attack, and hypertension registers. There was wide spatial variation in observed: expected prevalence ratios for all three diseases, with less than five per cent of expected cases diagnosed in some areas. London and the surrounding area showed statistically significant discrepancies in observed: expected prevalence ratios, with observed prevalence much lower than the epidemiological models predicted. The addition of general practitioner supply as a variable yielded stronger regression results for all three conditions. Conclusions Despite almost universal access to free primary healthcare, there may be significant and highly variable under-diagnosis of CVD across England, which can be partially explained by persistent inequity in GP supply. Disease management studies should consider the possible impact of under-diagnosis on population health outcomes. Compared to classical regression modelling, spatial analytic techniques can provide additional information on risk factors for under-diagnosis, and can suggest where healthcare resources may be most needed.

  1. A broadband multimedia collaborative system for advanced teleradiology and medical imaging diagnosis.

    Science.gov (United States)

    Gómez, E J; del Pozo, F; Ortiz, E J; Malpica, N; Rahms, H

    1998-09-01

    This paper presents a new telemedicine system currently in routine clinical usage, developed within the European Union (EU) ACTS BONAPARTE project (1). The telemedicine system is developed on an asynchronous transfer mode (ATM) multimedia hardware/software platform comprising the following set of telemedicine services: synchronous cooperative work, high-quality video conference, multimedia mail, medical image digitizing, processing, storing and printing, and local and remote transparent database access. The medical information handled by the platform conforms to the Digital Imaging and Communications in Medicine (DICOM) 3.0 medical imaging standard. The telemedicine system has been installed for clinical routines in three Spanish hospitals since November 1997 and has been used in an average of one/two clinical sessions per week. At each clinical session, a usability and clinical evaluation of the system was carried out. Evaluation is carried out through direct observation of interactions and questionnaire-based subjective data. The usability evaluation methodology and the results of the system usability study are also presented in this article. The experience gained from the design, development, and evaluation of the telemedicine system is providing an indepth knowledge of the benefits and difficulties involved in the installation and clinical usage of this type of high-usability and advanced multimedia telemedicine system in the field of teleradiology and collaborative medical imaging diagnosis.

  2. Rhazes, a genius physician in diagnosis and treatment of kidney calculi in medical history.

    Science.gov (United States)

    Changizi Ashtiyani, Saeed; Cyrus, Ali

    2010-04-01

    Abu Bakr Mohammad Ibn Zakariya Razi, known in the west as Rhazes (865 to 925 AD), was born in the ancient city of Rayy, near Tehran, Iran. He was a renowned physician in medical history and not only followed Hippocrates and Galen, but also greatly extended the analytical approach of his predecessors. Based on the existing documents, he was known as the most distinguished character in the world of medicine up to the 17th century. A great number of innovations and pioneering works in the medical science have been recorded in the name of Rhazes. His fundamental works in urology as part of his research in the realm of medicine have remained unknown. Pathophysiology of the urinary tract, venereal diseases, and kidney and bladder calculi are among his main interests in this field. He also purposed and developed methods for diagnosis and treatment of kidney calculi for the first time in medical history. He also presented a very exact and precise description of neuropathic bladder followed by vertebral fracture. He advanced urine analysis and studied function and diseases of the kidneys. Rhazes recommendations for the prevention of calculi are quite scientific and practical and in accordance with current recommendations to avoid hypercalciuria and increased saturation of urine. Rhazes was not only one of the most important Persian physician-philosophers of his era, but for centuries, his writings became fundamental teaching texts in European medical schools. Some important aspects of his contributions to medicine are reviewed.

  3. Using random forest for reliable classification and cost-sensitive learning for medical diagnosis.

    Science.gov (United States)

    Yang, Fan; Wang, Hua-zhen; Mi, Hong; Lin, Cheng-de; Cai, Wei-wen

    2009-01-30

    Most machine-learning classifiers output label predictions for new instances without indicating how reliable the predictions are. The applicability of these classifiers is limited in critical domains where incorrect predictions have serious consequences, like medical diagnosis. Further, the default assumption of equal misclassification costs is most likely violated in medical diagnosis. In this paper, we present a modified random forest classifier which is incorporated into the conformal predictor scheme. A conformal predictor is a transductive learning scheme, using Kolmogorov complexity to test the randomness of a particular sample with respect to the training sets. Our method show well-calibrated property that the performance can be set prior to classification and the accurate rate is exactly equal to the predefined confidence level. Further, to address the cost sensitive problem, we extend our method to a label-conditional predictor which takes into account different costs for misclassifications in different class and allows different confidence level to be specified for each class. Intensive experiments on benchmark datasets and real world applications show the resultant classifier is well-calibrated and able to control the specific risk of different class. The method of using RF outlier measure to design a nonconformity measure benefits the resultant predictor. Further, a label-conditional classifier is developed and turn to be an alternative approach to the cost sensitive learning problem that relies on label-wise predefined confidence level. The target of minimizing the risk of misclassification is achieved by specifying the different confidence level for different class.

  4. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    Science.gov (United States)

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis.

    Science.gov (United States)

    So, Sokpoleak; Patel, Rita M; Orebaugh, Steven L

    2017-03-01

    Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real-time visualization of anatomic structures and relationships in vivo, holds potential for pre-clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound-based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176-189. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

  6. Medical diagnosis and treatment using high-resolution manometry with computer-aided system

    Science.gov (United States)

    Pedowski, Tomasz; Wasiewicz, Piotr; Maciejewski, Ryszard; Wallner, Grzegorz

    2010-09-01

    Nowadays computers analyze medical data almost in every diagnosis and treatment steps. We develop new technology which gives us better and more precise diagnosis. We chose esophageal high resolution manometry with impedance (HRMI) which has been considered as a "gold standard" test for esophageal motility. HRMI is the next generation of manometry explanation which is more sensitive and accurate to EFT. Examination allows physicians to ger information about esophageal peristalsis, amplitude and duration of the esophageal contraction and liquid/viscous bolus transit time from mouth through stomach. In 2008 we examined 80 patients using "old" EFT manometry and 80 patients in 2009 using high resolution manometry (HRMI). Everybody got manometry, endoscopy and x-ray examination. We asked about symptoms which we correlate and connect with data from EFT and HRMI. We tried to find a good algorithm for this purpose in order to do a simple and helpful tool for physician to make righta diagnosis and treatment decision. Connection between data and symptoms seems to be right and clear, but finding a good algorithm for given data is the main problem.

  7. Case based reasoning applied to medical diagnosis using multi-class classifier: A preliminary study

    Directory of Open Access Journals (Sweden)

    D. Viveros-Melo

    2017-02-01

    Full Text Available Case-based reasoning (CBR is a process used for computer processing that tries to mimic the behavior of a human expert in making decisions regarding a subject and learn from the experience of past cases. CBR has demonstrated to be appropriate for working with unstructured domains data or difficult knowledge acquisition situations, such as medical diagnosis, where it is possible to identify diseases such as: cancer diagnosis, epilepsy prediction and appendicitis diagnosis. Some of the trends that may be developed for CBR in the health science are oriented to reduce the number of features in highly dimensional data. An important contribution may be the estimation of probabilities of belonging to each class for new cases. In this paper, in order to adequately represent the database and to avoid the inconveniences caused by the high dimensionality, noise and redundancy, a number of algorithms are used in the preprocessing stage for performing both variable selection and dimension reduction procedures. Also, a comparison of the performance of some representative multi-class classifiers is carried out to identify the most effective one to include within a CBR scheme. Particularly, four classification techniques and two reduction techniques are employed to make a comparative study of multiclass classifiers on CBR

  8. CIMIDx: Prototype for a Cloud-Based System to Support Intelligent Medical Image Diagnosis With Efficiency.

    Science.gov (United States)

    Bhavani, Selvaraj Rani; Senthilkumar, Jagatheesan; Chilambuchelvan, Arul Gnanaprakasam; Manjula, Dhanabalachandran; Krishnamoorthy, Ramasamy; Kannan, Arputharaj

    2015-03-27

    The Internet has greatly enhanced health care, helping patients stay up-to-date on medical issues and general knowledge. Many cancer patients use the Internet for cancer diagnosis and related information. Recently, cloud computing has emerged as a new way of delivering health services but currently, there is no generic and fully automated cloud-based self-management intervention for breast cancer patients, as practical guidelines are lacking. We investigated the prevalence and predictors of cloud use for medical diagnosis among women with breast cancer to gain insight into meaningful usage parameters to evaluate the use of generic, fully automated cloud-based self-intervention, by assessing how breast cancer survivors use a generic self-management model. The goal of this study was implemented and evaluated with a new prototype called "CIMIDx", based on representative association rules that support the diagnosis of medical images (mammograms). The proposed Cloud-Based System Support Intelligent Medical Image Diagnosis (CIMIDx) prototype includes two modules. The first is the design and development of the CIMIDx training and test cloud services. Deployed in the cloud, the prototype can be used for diagnosis and screening mammography by assessing the cancers detected, tumor sizes, histology, and stage of classification accuracy. To analyze the prototype's classification accuracy, we conducted an experiment with data provided by clients. Second, by monitoring cloud server requests, the CIMIDx usage statistics were recorded for the cloud-based self-intervention groups. We conducted an evaluation of the CIMIDx cloud service usage, in which browsing functionalities were evaluated from the end-user's perspective. We performed several experiments to validate the CIMIDx prototype for breast health issues. The first set of experiments evaluated the diagnostic performance of the CIMIDx framework. We collected medical information from 150 breast cancer survivors from hospitals

  9. The Operator's Diagnosis Task under Abnormal Operating Conditions in Industrial Process Plant

    DEFF Research Database (Denmark)

    Goodstein, L.P.; Pedersen, O.M.; Rasmussen, Jens

    1974-01-01

    Analysis of serious accidents in connection with the operation of technical installations demonstrate that the diagnosis task which confronts personnel under non-normal plant conditions is a critical one. This report presents a preliminary outline of characteristic traits connected with the task...... of diagnosis for use in discussions of (a) the studies which are necessary in order to formulate the operator's diagnostic procedures and (b) the possibilities which exists for supporting these procedures through appropriate data processing and display in the control system. At the same time, attempts are made...... to connect ideas for display which currently are under consideration in the department to various phases of the diagnostic task which itself is postulated as being divided up into a sequence of subtasks each with its own typical features....

  10. The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer

    DEFF Research Database (Denmark)

    Jensen, Laura Schärfe; Overgaard, Charlotte; Garne, Jens Peter

    2017-01-01

    PURPOSE: Breast cancer and psychiatric disorders negatively impact work life, both positively associated with unemployment and early retirement. Our purpose was to assess whether being prescribed psychiatric medication, 2-4 yrs prior to a diagnosis of breast cancer, could impact the likelihood......-market participation. The association between historic psychiatric medication and return to work was estimated using a modified Poisson regression model. 'Return to work' was defined as being self-supporting one year after diagnosis of breast cancer. RESULTS: 16% of our cohort had used psychiatric medical treatment 2...... significant reduction in the resumption of working life one year after a diagnosis of breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: Although historic use of psychiatric medication may incur a minor effect on working life, further research is needed on the long-term social consequences for sub-groups....

  11. A hybrid approach to fault diagnosis of roller bearings under variable speed conditions

    Science.gov (United States)

    Wang, Yanxue; Yang, Lin; Xiang, Jiawei; Yang, Jianwei; He, Shuilong

    2017-12-01

    Rolling element bearings are one of the main elements in rotating machines, whose failure may lead to a fatal breakdown and significant economic losses. Conventional vibration-based diagnostic methods are based on the stationary assumption, thus they are not applicable to the diagnosis of bearings working under varying speeds. This constraint limits the bearing diagnosis to the industrial application significantly. A hybrid approach to fault diagnosis of roller bearings under variable speed conditions is proposed in this work, based on computed order tracking (COT) and variational mode decomposition (VMD)-based time frequency representation (VTFR). COT is utilized to resample the non-stationary vibration signal in the angular domain, while VMD is used to decompose the resampled signal into a number of band-limited intrinsic mode functions (BLIMFs). A VTFR is then constructed based on the estimated instantaneous frequency and instantaneous amplitude of each BLIMF. Moreover, the Gini index and time-frequency kurtosis are both proposed to quantitatively measure the sparsity and concentration measurement of time-frequency representation, respectively. The effectiveness of the VTFR for extracting nonlinear components has been verified by a bat signal. Results of this numerical simulation also show the sparsity and concentration of the VTFR are better than those of short-time Fourier transform, continuous wavelet transform, Hilbert–Huang transform and Wigner–Ville distribution techniques. Several experimental results have further demonstrated that the proposed method can well detect bearing faults under variable speed conditions.

  12. 76 FR 31684 - Agency Information Collection (Medical Expense Report) Activity Under OMB Review

    Science.gov (United States)

    2011-06-01

    ... AFFAIRS Agency Information Collection (Medical Expense Report) Activity Under OMB Review AGENCY: Veterans...: Medical Expense Report, VA Form 21-8416. OMB Control Number: 2900-0161. Type of Review: Extension of a... income-based benefits to report medical expenses paid. Unreimbursed medical expenses may be excluded as...

  13. Context-sensitive autoassociative memories as expert systems in medical diagnosis

    Directory of Open Access Journals (Sweden)

    Olivera Fernando

    2006-11-01

    Full Text Available Abstract Background The complexity of our contemporary medical practice has impelled the development of different decision-support aids based on artificial intelligence and neural networks. Distributed associative memories are neural network models that fit perfectly well to the vision of cognition emerging from current neurosciences. Methods We present the context-dependent autoassociative memory model. The sets of diseases and symptoms are mapped onto a pair of basis of orthogonal vectors. A matrix memory stores the associations between the signs and symptoms, and their corresponding diseases. A minimal numerical example is presented to show how to instruct the memory and how the system works. In order to provide a quick appreciation of the validity of the model and its potential clinical relevance we implemented an application with real data. A memory was trained with published data of neonates with suspected late-onset sepsis in a neonatal intensive care unit (NICU. A set of personal clinical observations was used as a test set to evaluate the capacity of the model to discriminate between septic and non-septic neonates on the basis of clinical and laboratory findings. Results We show here that matrix memory models with associations modulated by context can perform automatic medical diagnosis. The sequential availability of new information over time makes the system progress in a narrowing process that reduces the range of diagnostic possibilities. At each step the system provides a probabilistic map of the different possible diagnoses to that moment. The system can incorporate the clinical experience, building in that way a representative database of historical data that captures geo-demographical differences between patient populations. The trained model succeeds in diagnosing late-onset sepsis within the test set of infants in the NICU: sensitivity 100%; specificity 80%; percentage of true positives 91%; percentage of true negatives 100

  14. Identification as overweight by medical professionals: relation to eating disorder diagnosis and risk.

    Science.gov (United States)

    Kass, Andrea E; Wang, Annie Z; Kolko, Rachel P; Holland, Jodi C; Altman, Myra; Trockel, Mickey; Taylor, C Barr; Wilfley, Denise E

    2015-04-01

    Discussions about weight between medical professionals and young adults may increase risk of eating disorders (EDs). Clarifying the relation between screening for overweight and ED risk is needed. 548 college-age women were classified as at-risk (n=441) or with an ED (n=107), and were assessed for disordered eating attitudes, behaviors, and relevant history, including, "Has a doctor, nurse, or other medical professional ever told you that you were overweight?" Regression analyses were used to evaluate the relations between being identified as overweight and current disordered eating behaviors, attitudes, and ED diagnosis, without and with covariates (history of weight-related teasing, history of an ED, family history of being identified as overweight, and current body mass index). 146 (26.6%) women reported being previously identified as overweight by a medical professional. There was no relation between being previously identified as overweight and having an ED. Those identified as overweight were more likely to have weight/shape concerns above a high-risk cutoff, but showed no difference in dietary restraint, binge eating, purging behaviors, or excessive exercise compared to those not identified. Being previously identified as overweight by a medical professional was associated with increased weight/shape concerns but not with current disordered eating behaviors or ED status. Minimizing the potential negative effects of overweight screening on weight and shape concerns by providing patients with strategies to increase healthy lifestyle behaviors and long-term support for healthy weight loss goals may have a positive impact on reducing the public health problem of overweight and obesity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Gender differences and the medicalization of sexuality in the creation of sexual dysfunctions diagnosis

    Directory of Open Access Journals (Sweden)

    Fabíola Rohden

    Full Text Available The article aims to analyze critically the most important and updated contributions focused on the recent stage of the medicalization of sexuality. Most works center on the production of the category and the diagnosis of "sexual dysfunction," considering either the masculine case (more largely studied via "erectile dysfunction", or the feminine case (in many cases translated into the idea of a supposed complexity of women's sexuality. The perspective I utilize has as a reference the social studies of science and, in particular, the contributions of anthropology and history of medicine. In addition, it incorporates the matrix of the gender and science studies that have produced a powerful critical view of the scientific production of the two last centuries, revealing how the gender conditioners have crossed the relation between knowledge production and social context.

  16. The standard of medical care under the Australian Civil Liability Acts: ten years on.

    Science.gov (United States)

    Lee, Joseph

    2014-12-01

    It has been more than a decade since the modified Bolam test was legislatively enacted.by the Australian States following the medical indemnity crisis. Since its implementation, the modified Bolam test has been configured by judges as a defence to the common law standard of care in medical diagnosis and treatment. The article argues against this interpretation and suggests an alternative way of implementing this statutory test. It is proposed that the modified Bolam test ought to have been applied as a single yardstick to determine the required standard of care in diagnosis and treatment. Changes are also recommended to reform the test with a view to striking a balance between the interests of patients and doctors in medical disputes, and strengthening judicial supervision of the medical profession. These proposed reforms could resolve the shortcomings of the common law more effectively. They may also enhance the standard of medical care in Australia in the long run.

  17. [Medical education under the Revolution and the Empire].

    Science.gov (United States)

    Legaye, Jean

    2014-01-01

    After the suppression of medical education during the French revolution in 1793, the lack of caregivers is dramatic, especially in the army. The medical education is therefore rehabilitated in 1794 in 3 (then 6) Health Schools, which will become Schools of Medicine and Faculties of Medicine, incorporated in 1808 into then Imperial University. During 3 years, the courses are theoretical and also based on a practical teaching on the patient. The defense of a thesis provides access to the title of doctor in medicine or surgery and allows practicing for all the pathologies on the entire territory of the Empire. Meanwhile, medical courses are given in military hospitals to train officers of health. They are dedicated for the service of the army and for minor diseases in rural areas. They are authorized to practice only in the department in which they were received. The inspectors general provide medical education directly in the military medical structures and conduct examinations about medical care. This type of career is illustrated by the biography of Surgeon Major François Augustin Legaÿ.

  18. 29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

    Science.gov (United States)

    2010-07-01

    ... under OSHA standards. 1904.9 Section 1904.9 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... removal under OSHA standards. (a) Basic requirement. If an employee is medically removed under the medical surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation...

  19. Use of concept maps to promote electrocardiogram diagnosis learning in undergraduate medical students

    Science.gov (United States)

    Dong, Ruimin; Yang, Xiaoyan; Xing, Bangrong; Zou, Zihao; Zheng, Zhenda; Xie, Xujing; Zhu, Jieming; Chen, Lin; Zhou, Hanjian

    2015-01-01

    Concept mapping is an effective method in teaching and learning, however this strategy has not been evaluated among electrocardiogram (ECG) diagnosis learning. This study explored the use of concept maps to assist ECG study, and sought to analyze whether this method could improve undergraduate students’ ECG interpretation skills. There were 126 undergraduate medical students who were randomly selected and assigned to two groups, group A (n = 63) and group B (n = 63). Group A was taught to use concept maps to learn ECG diagnosis, while group B was taught by traditional methods. After the course, all of the students were assessed by having an ECG diagnostic test. Quantitative data which comprised test score and ECG features completion index was compared by using the unpaired Student’s t-test between the two groups. Further, a feedback questionnaire on concept maps used was also completed by group A, comments were evaluated by a five-point Likert scale. The test scores of ECGs interpretation was 7.36 ± 1.23 in Group A and 6.12 ± 1.39 in Group B. A significant advantage (P = 0.018) of concept maps was observed in ECG interpretation accuracy. No difference in the average ECG features completion index was observed between Group A (66.75 ± 15.35%) and Group B (62.93 ± 13.17%). According qualitative analysis, majority of students accepted concept maps as a helpful tool. Difficult to learn at the beginning and time consuming are the two problems in using this method, nevertheless most of the students indicated to continue using it. Concept maps could be a useful pedagogical tool in enhancing undergraduate medical students’ ECG interpretation skills. Furthermore, students indicated a positive attitude to it, and perceived it as a resource for learning. PMID:26221331

  20. Evaluation of disposable medical device packaging materials under ozone sterilization

    Directory of Open Access Journals (Sweden)

    Gerson Roberto Luqueta

    Full Text Available Abstract Introduction Ozonization is an alternative sterilization process for heat-sensitive medical devices. However, the side effects of this process on packaging materials should be verified. Methods Four types of commercial disposable packaging for medical devices were evaluated after undergoing ozone sterilization: crepe paper sheet, non-woven fabric sheet (SMS, medical grade paper-plastic pouch and Tyvec©-plastic pouch. For each material, the gas penetration through the microbiological barrier was measured. Other packaging properties, such as chemical composition, color, tactile and mechanical resistance, were also evaluated after sterilization, by using characterization techniques, namely microbiological indicators, infrared spectroscopy, tensile test and optical microscopy. Results All commercial disposable packaging showed good ozone penetration. Crepe paper and SMS were chemically and mechanically modified by ozone, while Tyvec© only suffered mechanical modification. Paper-plastic pouch was the packaging material which just experienced an acceptable reduction in tensile resistance, showing no variations on chemical or visual properties. Conclusion The results suggest that medical grade paper-plastic pouch is the most appropriate disposable medical device packaging to be sterilized by ozone when compared to other materials.

  1. Supervised hybrid feature selection based on PSO and rough sets for medical diagnosis.

    Science.gov (United States)

    Inbarani, H Hannah; Azar, Ahmad Taher; Jothi, G

    2014-01-01

    Medical datasets are often classified by a large number of disease measurements and a relatively small number of patient records. All these measurements (features) are not important or irrelevant/noisy. These features may be especially harmful in the case of relatively small training sets, where this irrelevancy and redundancy is harder to evaluate. On the other hand, this extreme number of features carries the problem of memory usage in order to represent the dataset. Feature Selection (FS) is a solution that involves finding a subset of prominent features to improve predictive accuracy and to remove the redundant features. Thus, the learning model receives a concise structure without forfeiting the predictive accuracy built by using only the selected prominent features. Therefore, nowadays, FS is an essential part of knowledge discovery. In this study, new supervised feature selection methods based on hybridization of Particle Swarm Optimization (PSO), PSO based Relative Reduct (PSO-RR) and PSO based Quick Reduct (PSO-QR) are presented for the diseases diagnosis. The experimental result on several standard medical datasets proves the efficiency of the proposed technique as well as enhancements over the existing feature selection techniques. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer: A case of medical liability?

    Science.gov (United States)

    Tozzo, Pamela; Caenazzo, Luciana; Rodriguez, Daniele; Bolcato, Matteo

    2017-01-01

    Wernicke's encephalopathy (WE) is a neurological syndrome caused by thiamine deficiency, and clinically characterized by ophthalmoplegia, ataxia and acute confusion. In developed countries, most cases of WE have been seen in alcohol misusers. Other reported causes are gastrointestinal tract surgery, hyperemesis gravidarum, chronic malnutrition, prolonged total parenteral nutrition without thiamine supplementation, and increased nutrient requirements as in trauma or septic shock. WE is a well-known postoperative complication of gastric restrictive surgery for morbid obesity, after which patients often experience protracted nausea and vomiting, leading to malnutrition and massive weight loss. This case report concerns WE occurring in a patient who underwent Roux-en-Y subtotal gastrectomy for gastric cancer, and subsequently experienced neurological symptoms that proved irreversible probably due to the lengthy time elapsing between their clinical presentation and the diagnosis of WE. There have been some reports of WE occurring after total or subtotal gastrectomy for gastric cancer in non-obese patients with no history of alcoholism, but monitoring for WE has yet to be recommended in the clinical guidelines in this setting (as it has for bariatric surgery). Because of its rarity and variable clinical presentation, WE is often under-diagnosed and under-treated, and confused with other neurological problems. There is an urgent need for the specific guidelines to take into account not only the neoplastic follow-up of such patients, but also the possible side effects of necessary surgery, since this could help to ensure the timely diagnosis and management of WE in this setting, and to avoid, when possible, claims for medical malpractice that may cause enormous costs both in economical and professional terms. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Transplant ethics under scrutiny – responsibilities of all medical professionals

    Science.gov (United States)

    Trey, Torsten; Caplan, Arthur L.; Lavee, Jacob

    2013-01-01

    In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices. PMID:23444249

  4. Cost-sensitive case-based reasoning using a genetic algorithm: application to medical diagnosis.

    Science.gov (United States)

    Park, Yoon-Joo; Chun, Se-Hak; Kim, Byung-Chun

    2011-02-01

    The paper studies the new learning technique called cost-sensitive case-based reasoning (CSCBR) incorporating unequal misclassification cost into CBR model. Conventional CBR is now considered as a suitable technique for diagnosis, prognosis and prescription in medicine. However it lacks the ability to reflect asymmetric misclassification and often assumes that the cost of a positive diagnosis (an illness) as a negative one (no illness) is the same with that of the opposite situation. Thus, the objective of this research is to overcome the limitation of conventional CBR and encourage applying CBR to many real world medical cases associated with costs of asymmetric misclassification errors. The main idea involves adjusting the optimal cut-off classification point for classifying the absence or presence of diseases and the cut-off distance point for selecting optimal neighbors within search spaces based on similarity distribution. These steps are dynamically adapted to new target cases using a genetic algorithm. We apply this proposed method to five real medical datasets and compare the results with two other cost-sensitive learning methods-C5.0 and CART. Our finding shows that the total misclassification cost of CSCBR is lower than other cost-sensitive methods in many cases. Even though the genetic algorithm has limitations in terms of unstable results and over-fitting training data, CSCBR results with GA are better overall than those of other methods. Also the paired t-test results indicate that the total misclassification cost of CSCBR is significantly less than C5.0 and CART for several datasets. We have proposed a new CBR method called cost-sensitive case-based reasoning (CSCBR) that can incorporate unequal misclassification costs into CBR and optimize the number of neighbors dynamically using a genetic algorithm. It is meaningful not only for introducing the concept of cost-sensitive learning to CBR, but also for encouraging the use of CBR in the medical area

  5. Late Diagnosis of Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy: Role of Socio-behavioral Factors and Medical Encounters

    Directory of Open Access Journals (Sweden)

    Yi-Chun Lo

    2011-05-01

    Conclusion: Late HIV diagnosis is not uncommon in Taiwan. Regular risk assessment and provision of routine HIV testing in medical encounters and increase of accessibility to voluntary HIV testing could facilitate earlier diagnosis of HIV infection.

  6. Infrared Thermographic Diagnosis Mechanism for Fault Detection of Ball Bearing under Dynamic Loading Conditions

    International Nuclear Information System (INIS)

    Seo, Jin Ju; Yoon, Hanvit; Kim, Dong Yeon; Hong, Dong Pyo; Kim, Won Tae

    2011-01-01

    Fault detection for dynamic loading conditions of rotational machineries was considered from the contactless, non-destructive infrared thermographic method, rather than the traditional diagnosis method. In this paper, by applying a rotating deep-grooved ball bearing, passive thermographic experiment was performed as an alternative way proceeding the traditional fault monitoring. In addition, the thermographic experiments were compared with the vibration spectrum analysis to evaluate the efficiency of the proposed method. Based on the results, it was concluded the temperature characteristics of the ball bearing under dynamic loading conditions were analyzed thoroughly

  7. Innovation under Regulatory Uncertainty: Evidence from Medical Technology.

    Science.gov (United States)

    Stern, Ariel Dora

    2017-01-01

    This paper explores how the regulatory approval process affects innovation incentives in medical technologies. Prior studies have found early mover regulatory advantages for drugs. I find the opposite for medical devices, where pioneer entrants spend 34 percent (7.2 months) longer than follow-on entrants in regulatory approval. Back-of-the- envelope calculations suggest that the cost of a delay of this length is upwards of 7 percent of the total cost of bringing a new high-risk device to market. Considering potential explanations, I find that approval times are largely unrelated to technological novelty, but are meaningfully reduced by the publication of objective regulatory guidelines. Finally, I consider how the regulatory process affects small firms' market entry patterns and find that small firms are less likely to be pioneers in new device markets, a fact consistent with relatively higher costs of doing so for more financially constrained firms.

  8. Epidemiology, medical genetics, diagnosis and treatment of harlequin ichthyosis in Japan.

    Science.gov (United States)

    Shibata, Akitaka; Akiyama, Masashi

    2015-08-01

    Ichthyoses are a group of disorders marked by whitish, brown or dark-brown scales on the skin of almost the whole body. Harlequin ichthyosis (HI) is the most severe form. Neonatal death from HI was once common. Due to intensive neonatal care and, probably, to the early introduction of oral retinoids, HI outcome has improved. For definitive diagnosis and the exclusion of other disorders, such as lamellar ichthyosis, which also shows a collodion baby phenotype, it is helpful to refer to electron microscopy of abnormal or absent lamellar granules and a heavy accumulation of lipid droplets in the keratinocytes. ATP-binding cassette transporter A12 (ABCA12) is known as the causative gene of HI. Severe ABCA12 deficiency results in malformation of intercellular lipid layers in the cornified layers and leads to epidermal lipid barrier disruption. In HI patients, at least one mutation on each allele must be a truncation or deletion mutation to cause serious loss of ABCA12 function. Identification of the gene underlying HI has enabled DNA-based prenatal diagnosis for HI at the earlier stages of pregnancy with low risk. There are no curative treatments for HI. Abca12-deficient mice were created as a model of HI. Treatment of the model mice with retinoid or steroid has not been successful. © 2015 Japan Pediatric Society.

  9. Diagnosis of Breast Cancer using a Combination of Genetic Algorithm and Artificial Neural Network in Medical Infrared Thermal Imaging

    Directory of Open Access Journals (Sweden)

    Hossein Ghayoumi zadeh

    2013-03-01

    Full Text Available Introduction This study is an effort to diagnose breast cancer by processing the quantitative and qualitative information obtained from medical infrared imaging. The medical infrared imaging is free from any harmful radiation and it is one of the best advantages of the proposed method. By analyzing this information, the best diagnostic parameters among the available parameters are selected and its sensitivity and precision in cancer diagnosis is improved by utilizing genetic algorithm and artificial neural network. Materials and Methods In this research, the necessary information is obtained from thermal imaging of 200 people, and 8 diagnostic parameters are extracted from these images by the research team. Then these 8 parameters are used as input of our proposed combinatorial model which is formed using artificial neural network and genetic algorithm. Results Our results have revealed that comparison of the breast areas; thermal pattern and kurtosis are the most important parameters in breast cancer diagnosis from proposed medical infrared imaging. The proposed combinatorial model with a 50% sensitivity, 75% specificity and, 70% accuracy shows good precision in cancer diagnosis. Conclusion The main goal of this article is to describe the capability of infrared imaging in preliminary diagnosis of breast cancer. This method is beneficial to patients with and without symptoms. The results indicate that the proposed combinatorial model produces optimum and efficacious parameters in comparison to other parameters and can improve the capability and power of globalizing the artificial neural network. This will help physicians in more accurate diagnosis of this type of cancer.

  10. Absenteeism and under-achievement in final year medical students.

    Science.gov (United States)

    Dhaliwal, Upreet

    2003-01-01

    Absenteeism among medical students has received little attention in the literature. The aim of this study was to determine the causes of absenteeism from didactic lectures in ophthalmology and its correlation with performance in formative assessment. The attendance of 101 final year medical students for lectures in ophthalmology was studied in three parts: terms 1, 2 and 3. Based on the attendance in all three terms, students were divided into groups I to V, where group I students had good attendance in all three terms down to group V, with very poor attendance in one or more terms. The marks scored in the first, second and third terminal theory tests were tabulated separately. Results of the second and final professional examinations were assessed for the five groups of students. Students were asked to list the causes of absenteeism in a proforma. Data were analysed by regression analysis and Chi-square test. Significance was obtained at 5% level. In each formative assessment, higher attendance was associated with better marks (p absenteeism in 62.6% of instances. Six of the 10 students who failed the ophthalmology professional examination were in groups IV and V and had failed the second professional examination as well. They were designated low achievers, as were 3 students who made several attempts to pass the second professional examination and failed in ophthalmology despite a fair-good attendance. Learner absenteeism may contribute to low achievement. However, absenteeism may be symptomatic of low achievers. Low achievers or students with learning handicaps must be identified before admission or early in the medical course and encouraged to improve their performance and thereby enhance their self-esteem. A support group of family, peers, faculty and psychologists could help.

  11. Contraception choices in women with underlying medical conditions.

    Science.gov (United States)

    Bonnema, Rachel A; McNamara, Megan C; Spencer, Abby L

    2010-09-15

    Primary care physicians often prescribe contraceptives to women of reproductive age with comorbidities. Novel delivery systems (e.g., contraceptive patch, contraceptive ring, single-rod implantable device) may change traditional risk and benefit profiles in women with comorbidities. Effective contraceptive counseling requires an understanding of a woman's preferences and medical history, as well as the risks, benefits, adverse effects, and contraindications of each method. Noncontraceptive benefits of combined hormonal contraceptives, such as oral contraceptive pills, include regulated menses, decreased dysmenorrhea, and diminished premenstrual dysphoric disorder. Oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes mellitus, depression, and uncomplicated valvular heart disease. However, women older than 35 years who smoke should avoid oral contraceptive pills. Contraceptives containing estrogen, which can increase thrombotic risk, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease. Progestin-only contraceptives are recommended for women with contraindications to estrogen. Depo-Provera, a long-acting injectable contraceptive, may be preferred in women with sickle cell disease because it reduces the frequency of painful crises. Because of the interaction between antiepileptics and oral contraceptive pills, Depo-Provera may also be considered in women with epilepsy. Implanon, the single-rod implantable contraceptive device, may reduce symptoms of dysmenorrhea. Mirena, the levonorgestrel-containing intrauterine contraceptive system, is an option for women with menorrhagia, endometriosis, or chronic pelvic pain.

  12. The practical of precaution/isolation from the medical diagnosis in infectious disease unit

    Directory of Open Access Journals (Sweden)

    Rosely Moralez de Figueiredo

    2006-12-01

    Full Text Available With the aim of analyzing the use of an infectious disease unit in a medium size general hospital, 95 patients records were examined; 72,6% of the patients were male; the average age was 41 and the average permanence in hospital was 15, 7 days. The death rate was 12,6%. The main medical diagnosis were AIDS in 52,4% and tuberculosis in 6,3% of patients. The speciality infectology was responsible for 35,8% of confinements. Regarding precautions for transmission 14,7% needed air precautions, 8,5% contact precautions, 1,1% droplets and the other 75,7% only standard precautions. A variety of criteria for confinement, not only the infectious nature of the disease, stands out in the unit; the generic term “isolation” is maintained in the records. Unification of the practical employed, education programs in service that aim at appropriation and the use of technical knowledge about precautions by the whole health team are advised.

  13. Medical use of cannabis in Australia: "medical necessity" defences under current Australian law and avenues for reform.

    Science.gov (United States)

    Martin, Charles

    2014-06-01

    The possession of cannabis is an offence in all Australian jurisdictions. No exception is made for medical use under any of the State and Territory Drug Acts, nor the Commonwealth's pharmaceutical regulation scheme. Nevertheless, questions remain about the scope for defences argued on the basis of necessitous medical use. More fundamentally the increasingly favourable light in which the medical use of cannabis is growing to be seen by state and national legislatures overseas raises important questions about the need for reform of Australian drug laws. This article explores those questions.

  14. Discharge of hospitalized under-fives against medical advice in ...

    African Journals Online (AJOL)

    DAMA) among under-fives in Benin City, document reasons for these discharges and suggest ways of reducing its occurrence. Methods: The admissions and discharges registers as well as the case-notes of all children aged between one and ...

  15. Method of specifying and verifying the characteristics of rotating anode X-ray tubes and X-ray tube assemblies used in medical diagnosis

    International Nuclear Information System (INIS)

    1981-01-01

    Under the direction of the Light Electrical Engineering Standards Committee, a British Standard method has been prepared for specifying and verifying the electrical, thermal and loading characteristics of rotating anode X-ray tubes and X-ray tube assemblies used in medical diagnosis. This standard is intended to provide a common basis for the indication of data of rotating anode X-ray tubes and X-ray tube assemblies and to facilitate the application of radiographic ratings by the user, basing these on standardized conditions as given in the accompanying documents. (U.K.)

  16. Topic Correlation Analysis for Bearing Fault Diagnosis Under Variable Operating Conditions

    Science.gov (United States)

    Chen, Chao; Shen, Fei; Yan, Ruqiang

    2017-05-01

    This paper presents a Topic Correlation Analysis (TCA) based approach for bearing fault diagnosis. In TCA, Joint Mixture Model (JMM), a model which adapts Probability Latent Semantic Analysis (PLSA), is constructed first. Then, JMM models the shared and domain-specific topics using “fault vocabulary” . After that, the correlations between two kinds of topics are computed and used to build a mapping matrix. Furthermore, a new shared space spanned by the shared and mapped domain-specific topics is set up where the distribution gap between different domains is reduced. Finally, a classifier is trained with mapped features which follow a different distribution and then the trained classifier is tested on target bearing data. Experimental results justify the superiority of the proposed approach over the stat-of-the-art baselines and it can diagnose bearing fault efficiently and effectively under variable operating conditions.

  17. Computed tomographic angiography under sedation in the diagnosis of suspected canine pancreatitis: a pilot study.

    Science.gov (United States)

    Adrian, A M; Twedt, D C; Kraft, S L; Marolf, A J

    2015-01-01

    Computed tomography (CT) is highly accurate for diagnosing pancreatitis in humans. The diagnosis of pancreatitis in dogs is based on clinical signs, laboratory findings, and ultrasonographic (US) changes. There are, however, inherent limitations in relying on laboratory and ultrasound findings for the clinical diagnosis of pancreatitis in dogs. We hypothesized that CT angiography would be a rapid and reliable method to confirm pancreatitis in dogs compared to ultrasonography. The aim was to describe the CT characteristics and compare them to ultrasound findings and correlate the CT appearance to the severity of the patients' clinical course. A prospective pilot case series; 10 dogs with pancreatitis were enrolled if the history, clinical signs, laboratory, and ultrasonographic findings were indicative of pancreatitis. A 3-phase angiographic CT was performed under sedation. Afterward, each dog had US-guided aspirates of the pancreas collected and blood drawn for cPLi assay. Images were evaluated for portion of visible pancreas, pancreatic size and margin, pancreatic parenchyma, presence of peripancreatic changes and contrast enhancement pattern. The results were compared with outcome. An enlarged, homogeneously to heterogeneously attenuating and contrast-enhancing pancreas with ill-defined borders was identified in all dogs. CT identified more features characterizing pancreatic abnormalities compared to US. Thrombi were found in 3/10 dogs. Three dogs with heterogeneous contrast enhancement had an overall poorer outcome than those with homogenous enhancement. CT angiography under sedation was used in dogs to confirm clinically suspected pancreatitis and identified clinically relevant and potentially prognostic features of pancreatitis in dogs. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  18. Electronic medical record data to identify variables associated with a fibromyalgia diagnosis: importance of health care resource utilization

    Directory of Open Access Journals (Sweden)

    Masters ET

    2015-03-01

    Full Text Available Elizabeth T Masters,1 Jack Mardekian,1 Birol Emir,1 Andrew Clair,1 Max Kuhn,2 Stuart L Silverman,31Pfizer, Inc., New York, NY, 2Pfizer, Inc., Groton, CT, 3Cedars-Sinai Medical Center, Los Angeles, CA, USABackground: Diagnosis of fibromyalgia (FM is often challenging. Identifying factors associated with an FM diagnosis may guide health care providers in implementing appropriate diagnostic and management strategies.Methods: This retrospective study used the de-identified Humedica electronic medical record (EMR database to identify variables associated with an FM diagnosis. Cases (n=4,296 were subjects ≥18 years old with ≥2 International Classification of Diseases, Ninth Revision (ICD-9 codes for FM (729.1 ≥30 days apart during 2012, associated with an integrated delivery network, with ≥1 encounter with a health care provider in 2011 and 2012. Controls without FM (no-FM; n=583,665 did not have the ICD-9 codes for FM. Demographic, clinical, and health care resource utilization variables were extracted from structured EMR data. Univariate analysis identified variables showing significant differences between the cohorts based on odds ratios (ORs.Results: Consistent with FM epidemiology, FM subjects were predominantly female (78.7% vs 64.5%; P<0.0001 and slightly older (mean age 53.3 vs 52.7 years; P=0.0318. Relative to the no-FM cohort, the FM cohort was characterized by a higher prevalence of nearly all evaluated comorbidities; the ORs suggested a higher likelihood of an FM diagnosis (P<0.0001, especially for musculoskeletal and neuropathic pain conditions (OR 3.1 for each condition. Variables potentially associated with an FM diagnosis included higher levels of use of specific health care resources including emergency-room visits, outpatient visits, hospitalizations, and medications. Units used per subject for emergency-room visits, outpatient visits, hospitalizations, and medications were also significantly higher in the FM cohort (P<0

  19. Classifier ensemble construction with rotation forest to improve medical diagnosis performance of machine learning algorithms.

    Science.gov (United States)

    Ozcift, Akin; Gulten, Arif

    2011-12-01

    Improving accuracies of machine learning algorithms is vital in designing high performance computer-aided diagnosis (CADx) systems. Researches have shown that a base classifier performance might be enhanced by ensemble classification strategies. In this study, we construct rotation forest (RF) ensemble classifiers of 30 machine learning algorithms to evaluate their classification performances using Parkinson's, diabetes and heart diseases from literature. While making experiments, first the feature dimension of three datasets is reduced using correlation based feature selection (CFS) algorithm. Second, classification performances of 30 machine learning algorithms are calculated for three datasets. Third, 30 classifier ensembles are constructed based on RF algorithm to assess performances of respective classifiers with the same disease data. All the experiments are carried out with leave-one-out validation strategy and the performances of the 60 algorithms are evaluated using three metrics; classification accuracy (ACC), kappa error (KE) and area under the receiver operating characteristic (ROC) curve (AUC). Base classifiers succeeded 72.15%, 77.52% and 84.43% average accuracies for diabetes, heart and Parkinson's datasets, respectively. As for RF classifier ensembles, they produced average accuracies of 74.47%, 80.49% and 87.13% for respective diseases. RF, a newly proposed classifier ensemble algorithm, might be used to improve accuracy of miscellaneous machine learning algorithms to design advanced CADx systems. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Potentially harmful side-effects: medically unexplained symptoms, somatization, and the insufficient illness narrative for viewers of mystery diagnosis.

    Science.gov (United States)

    Farkas, Carol-Ann

    2013-09-01

    Illness narrative has often been found to play a positive role in both patients' and providers' efforts to find meaning in the illness experience. However, illness narrative can sometimes become counterproductive, even pathological, particularly in cases of medical mystery--cases wherein biopsychosocial factors blur the distinction between bodily dysfunction and somatizing behavior. In this article, the author draws attention to two examples of medical mystery, the clinical presentation of medically unexplained symptoms, and the popular reality television program Mystery Diagnosis, to demonstrate the potentially harmful effects of illness narrative. The medical mystery's complex narrative structure reflects and tends to reinforce providers' and patients' mistaken assumptions, anxieties, and conflicts in ways which obstruct, rather than facilitate, healing.

  1. 78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

    Science.gov (United States)

    2013-08-16

    ... of Information Collection Under Emergency Review: Medical History and Examination for Foreign Service... submit comments by any of the following methods: Web: Persons with access to the Internet may use the... of Information Collection: Medical History and Examination for Foreign Service. OMB Control Number...

  2. A web-based knowledge management system integrating Western and Traditional Chinese Medicine for relational medical diagnosis.

    Science.gov (United States)

    Herrera-Hernandez, Maria C; Lai-Yuen, Susana K; Piegl, Les A; Zhang, Xiao

    2016-10-26

    This article presents the design of a web-based knowledge management system as a training and research tool for the exploration of key relationships between Western and Traditional Chinese Medicine, in order to facilitate relational medical diagnosis integrating these mainstream healing modalities. The main goal of this system is to facilitate decision-making processes, while developing skills and creating new medical knowledge. Traditional Chinese Medicine can be considered as an ancient relational knowledge-based approach, focusing on balancing interrelated human functions to reach a healthy state. Western Medicine focuses on specialties and body systems and has achieved advanced methods to evaluate the impact of a health disorder on the body functions. Identifying key relationships between Traditional Chinese and Western Medicine opens new approaches for health care practices and can increase the understanding of human medical conditions. Our knowledge management system was designed from initial datasets of symptoms, known diagnosis and treatments, collected from both medicines. The datasets were subjected to process-oriented analysis, hierarchical knowledge representation and relational database interconnection. Web technology was implemented to develop a user-friendly interface, for easy navigation, training and research. Our system was prototyped with a case study on chronic prostatitis. This trial presented the system's capability for users to learn the correlation approach, connecting knowledge in Western and Traditional Chinese Medicine by querying the database, mapping validated medical information, accessing complementary information from official sites, and creating new knowledge as part of the learning process. By addressing the challenging tasks of data acquisition and modeling, organization, storage and transfer, the proposed web-based knowledge management system is presented as a tool for users in medical training and research to explore, learn and

  3. Prescription of respiratory medication without an asthma diagnosis in children: a population based study.

    NARCIS (Netherlands)

    Zuidgeest, M.G.P.; Dijk, L. van; Smit, H.A.; Wouden, J.C. van der; Brunekreef, B.; Leufkens, H.G.M.; Bracke, M.

    2008-01-01

    BACKGROUND: In pre-school children a diagnosis of asthma is not easily made and only a minority of wheezing children will develop persistent atopic asthma. According to the general consensus a diagnosis of asthma becomes more certain with increasing age. Therefore the congruence between asthma

  4. Genetic Programming for the Generation of Crisp and Fuzzy Rule Bases in Classification and Diagnosis of Medical Data

    DEFF Research Database (Denmark)

    Dounias, George; Tsakonas, Athanasios; Jantzen, Jan

    2002-01-01

    programming system for the generation of fuzzy rule-based systems. Two different medical domains are used to evaluate the models. The first field is the diagnosis of subtypes of Aphasia. Two models for crisp rule-bases are presented. The first one discriminates between four major types and the second attempts...... systems. Comparisons on the system's comprehensibility and the transparency are included. These comparisons include for the Aphasia domain, previous work consisted of two neural network models....

  5. Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer: A case of medical liability?

    Directory of Open Access Journals (Sweden)

    Pamela Tozzo

    2017-01-01

    Conclusion: There is an urgent need for the specific guidelines to take into account not only the neoplastic follow-up of such patients, but also the possible side effects of necessary surgery, since this could help to ensure the timely diagnosis and management of WE in this setting, and to avoid, when possible, claims for medical malpractice that may cause enormous costs both in economical and professional terms.

  6. Design of a modified adaptive neuro fuzzy inference system classifier for medical diagnosis of Pima Indians Diabetes

    Science.gov (United States)

    Sagir, Abdu Masanawa; Sathasivam, Saratha

    2017-08-01

    Medical diagnosis is the process of determining which disease or medical condition explains a person's determinable signs and symptoms. Diagnosis of most of the diseases is very expensive as many tests are required for predictions. This paper aims to introduce an improved hybrid approach for training the adaptive network based fuzzy inference system with Modified Levenberg-Marquardt algorithm using analytical derivation scheme for computation of Jacobian matrix. The goal is to investigate how certain diseases are affected by patient's characteristics and measurement such as abnormalities or a decision about presence or absence of a disease. To achieve an accurate diagnosis at this complex stage of symptom analysis, the physician may need efficient diagnosis system to classify and predict patient condition by using an adaptive neuro fuzzy inference system (ANFIS) pre-processed by grid partitioning. The proposed hybridised intelligent system was tested with Pima Indian Diabetes dataset obtained from the University of California at Irvine's (UCI) machine learning repository. The proposed method's performance was evaluated based on training and test datasets. In addition, an attempt was done to specify the effectiveness of the performance measuring total accuracy, sensitivity and specificity. In comparison, the proposed method achieves superior performance when compared to conventional ANFIS based gradient descent algorithm and some related existing methods. The software used for the implementation is MATLAB R2014a (version 8.3) and executed in PC Intel Pentium IV E7400 processor with 2.80 GHz speed and 2.0 GB of RAM.

  7. Conjugation of quantum dots on carbon nanotubes for medical diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Madani SY

    2013-03-01

    Full Text Available Seyed Yazdan Madani,1 Farzad Shabani,3 Miriam V Dwek,2 Alexander M Seifalian1,3 1UCL Centre for Nanotechnology and Regenerative Medicine, University College, London, UK; 2Department of Molecular and Applied Biosciences, School of Life Sciences, University of Westminster, London, UK; 3Royal Free London NHS Foundation Trust Hospital, London, UK Abstract: Cancer is one of the leading causes of death worldwide and early detection provides the best possible prognosis for cancer patients. Nanotechnology is the branch of engineering that deals with the manipulation of individual atoms and molecules. This area of science has the potential to help identify cancerous cells and to destroy them by various methods such as drug delivery or thermal treatment of cancer. Carbon nanotubes (CNT and quantum dots (QDs are the two nanoparticles, which have received considerable interest in view of their application for diagnosis and treatment of cancer. Fluorescent nanoparticles known as QDs are gaining momentum as imaging molecules with life science and clinical applications. Clinically they can be used for localization of cancer cells due to their nano size and ability to penetrate individual cancer cells and high-resolution imaging derived from their narrow emission bands compared with organic dyes. CNTs are of interest to the medical community due to their unique properties such as the ability to deliver drugs to a site of action or convert optical energy into thermal energy. By attaching antibodies that bind specifically to tumor cells, CNTs can navigate to malignant tumors. Once at the tumor site, the CNTs enter into the cancer cells by penetration or endocytosis, allowing drug release, and resulting in specific cancer cell death. Alternatively, CNTs can be exposed to near-infrared light in order to thermally destroy the cancer cells. The amphiphilic nature of CNTs allows them to penetrate the cell membrane and their large surface area (in the order of 2600 m2

  8. Autism: Diagnosis

    Science.gov (United States)

    ... Information Publications Awards Partners Contact Us ¿Qué es Autismo? Donate Home What is Autism? What is Autism? ... Information Publications Awards Partners Contact Us ¿Qué es Autismo? Diagnosis Home / What is Autism? / Diagnosis Expand Medical ...

  9. Detecting impact signal in mechanical fault diagnosis under chaotic and Gaussian background noise

    Science.gov (United States)

    Hu, Jinfeng; Duan, Jie; Chen, Zhuo; Li, Huiyong; Xie, Julan; Chen, Hanwen

    2018-01-01

    In actual fault diagnosis, useful information is often submerged in heavy noise, and the feature information is difficult to extract. Traditional methods, such like stochastic resonance (SR), which using noise to enhance weak signals instead of suppressing noise, failed in chaotic background. Neural network, which use reference sequence to estimate and reconstruct the background noise, failed in white Gaussian noise. To solve these problems, a novel weak signal detection method aimed at the problem of detecting impact signal buried under heavy chaotic and Gaussian background noise is proposed. First, the proposed method obtains the virtual reference sequence by constructing the Hankel data matrix. Then an M-order optimal FIR filter is designed, which can minimize the output power of background noise and pass the weak periodic signal undistorted. Finally, detection and reconstruction of the weak periodic signal are achieved from the output SBNR (signal to background noise ratio). The simulation shows, compared with the stochastic resonance (SR) method, the proposed method can detect the weak periodic signal in chaotic noise background while stochastic resonance (SR) method cannot. Compared with the neural network method, (a) the proposed method does not need a reference sequence while neural network method needs one; (b) the proposed method can detect the weak periodic signal in white Gaussian noise background while the neural network method fails, in chaotic noise background, the proposed method can detect the weak periodic signal under a lower SBNR (about 8-17 dB lower) than the neural network method; (c) the proposed method can reconstruct the weak periodic signal precisely.

  10. Bearing fault diagnosis under unknown time-varying rotational speed conditions via multiple time-frequency curve extraction

    Science.gov (United States)

    Huang, Huan; Baddour, Natalie; Liang, Ming

    2018-02-01

    Under normal operating conditions, bearings often run under time-varying rotational speed conditions. Under such circumstances, the bearing vibrational signal is non-stationary, which renders ineffective the techniques used for bearing fault diagnosis under constant running conditions. One of the conventional methods of bearing fault diagnosis under time-varying speed conditions is resampling the non-stationary signal to a stationary signal via order tracking with the measured variable speed. With the resampled signal, the methods available for constant condition cases are thus applicable. However, the accuracy of the order tracking is often inadequate and the time-varying speed is sometimes not measurable. Thus, resampling-free methods are of interest for bearing fault diagnosis under time-varying rotational speed for use without tachometers. With the development of time-frequency analysis, the time-varying fault character manifests as curves in the time-frequency domain. By extracting the Instantaneous Fault Characteristic Frequency (IFCF) from the Time-Frequency Representation (TFR) and converting the IFCF, its harmonics, and the Instantaneous Shaft Rotational Frequency (ISRF) into straight lines, the bearing fault can be detected and diagnosed without resampling. However, so far, the extraction of the IFCF for bearing fault diagnosis is mostly based on the assumption that at each moment the IFCF has the highest amplitude in the TFR, which is not always true. Hence, a more reliable T-F curve extraction approach should be investigated. Moreover, if the T-F curves including the IFCF, its harmonic, and the ISRF can be all extracted from the TFR directly, no extra processing is needed for fault diagnosis. Therefore, this paper proposes an algorithm for multiple T-F curve extraction from the TFR based on a fast path optimization which is more reliable for T-F curve extraction. Then, a new procedure for bearing fault diagnosis under unknown time-varying speed

  11. Ultrasound guided closed pleural biopsy versus medical thoracoscopic pleural biopsy in diagnosis of pleural diseases

    Directory of Open Access Journals (Sweden)

    K. Sobhy

    2017-01-01

    Conclusion: Both TUS guided pleural biopsy and medical thoracoscopic pleural biopsy are available to diagnose different pleural lesions each of which has its advantages and disadvantages. The proper selection of the patients for each modality will result in raising the diagnostic yield of both modalities. TUS examination before medical thoracoscopy will allow proper selection of patients, reduce incidence of complications, guide for the best site of entry and raisethe diagnostic yield of medical thoracoscopy.

  12. Error-correction learning for artificial neural networks using the Bayesian paradigm. Application to automated medical diagnosis.

    Science.gov (United States)

    Belciug, Smaranda; Gorunescu, Florin

    2014-12-01

    Automated medical diagnosis models are now ubiquitous, and research for developing new ones is constantly growing. They play an important role in medical decision-making, helping physicians to provide a fast and accurate diagnosis. Due to their adaptive learning and nonlinear mapping properties, the artificial neural networks are widely used to support the human decision capabilities, avoiding variability in practice and errors based on lack of experience. Among the most common learning approaches, one can mention either the classical back-propagation algorithm based on the partial derivatives of the error function with respect to the weights, or the Bayesian learning method based on posterior probability distribution of weights, given training data. This paper proposes a novel training technique gathering together the error-correction learning, the posterior probability distribution of weights given the error function, and the Goodman-Kruskal Gamma rank correlation to assembly them in a Bayesian learning strategy. This study had two main purposes; firstly, to develop anovel learning technique based on both the Bayesian paradigm and the error back-propagation, and secondly,to assess its effectiveness. The proposed model performance is compared with those obtained by traditional machine learning algorithms using real-life breast and lung cancer, diabetes, and heart attack medical databases. Overall, the statistical comparison results indicate that thenovellearning approach outperforms the conventional techniques in almost all respects. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Computed Tomographic Angiography under Sedation in the Diagnosis of Suspected Canine Pancreatitis: A Pilot Study

    OpenAIRE

    Adrian, A.M.; Twedt, D.C.; Kraft, S.L.; Marolf, A.J.

    2014-01-01

    Background Computed tomography (CT) is highly accurate for diagnosing pancreatitis in humans. The diagnosis of pancreatitis in dogs is based on clinical signs, laboratory findings, and ultrasonographic (US) changes. There are, however, inherent limitations in relying on laboratory and ultrasound findings for the clinical diagnosis of pancreatitis in dogs. Hypothesis/Objectives We hypothesized that CT angiography would be a rapid and reliable method to confirm pancreatitis in dogs compared to ...

  14. Estimation of population dose from medical X-ray diagnosis and in vivo nuclear medicine examinations in Taiwan

    International Nuclear Information System (INIS)

    Liu, W.H.; Kusama, T.; Kai, M.; Aoki, Y.; Wada, O.; Chen, F.D.

    1993-01-01

    A national survey of radiation exposure had been conducted in Taiwan from May 3 to May 9, 1993, to establish the population dose. We investigated the frequency, type of examination, age and sex distribution of the X-ray diagnosis examination. We investigated 9 medical centers (75% of the total), 15 area hospitals (34% of the total) and 52 local hospitals (10.3% of the total) in Taiwan,. Details of 54,000 X-ray examinations were collected. Total numbers of 5162 X-ray examinations were performed annually per 10,000 inhabitants in Taiwan. The chest examination was the largest contribution, 45%, of all X-ray examinations, Different types of hospitals showed different frequencies and different distributions of age and sex of X-ray diagnosis. (3 figs., 3 tabs.)

  15. Machine learning techniques for medical diagnosis of diabetes using iris images.

    Science.gov (United States)

    Samant, Piyush; Agarwal, Ravinder

    2018-04-01

    Complementary and alternative medicine techniques have shown their potential for the treatment and diagnosis of chronical diseases like diabetes, arthritis etc. On the same time digital image processing techniques for disease diagnosis is reliable and fastest growing field in biomedical. Proposed model is an attempt to evaluate diagnostic validity of an old complementary and alternative medicine technique, iridology for diagnosis of type-2 diabetes using soft computing methods. Investigation was performed over a close group of total 338 subjects (180 diabetic and 158 non-diabetic). Infra-red images of both the eyes were captured simultaneously. The region of interest from the iris image was cropped as zone corresponds to the position of pancreas organ according to the iridology chart. Statistical, texture and discrete wavelength transformation features were extracted from the region of interest. The results show best classification accuracy of 89.63% calculated from RF classifier. Maximum specificity and sensitivity were absorbed as 0.9687 and 0.988, respectively. Results have revealed the effectiveness and diagnostic significance of proposed model for non-invasive and automatic diabetes diagnosis. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Image processing technology for medical diagnosis: knowledge of equipments and systems

    International Nuclear Information System (INIS)

    Oliveira, C.L.C.

    1989-01-01

    The expanding apllication of non-invasive techniques in the internal pathological diagnosis has resulted in the increasing diffusion of digital imaging equipments and systems. This growth has required knowledgze of activities relative to use, production and technologies of these products, searching for rationalization of investments, as well as the establishment of strategies and priorities to obtain capability in these activities. (author) [pt

  17. Radiation protection in medical equipment therapy and diagnosis in (RICK) and (MC)

    International Nuclear Information System (INIS)

    Mohammed, M.I.

    2006-04-01

    In the present research work we are trying to study the status of the radiation protection applications around some medical facilities in Khartoum. The rules and principles of radiation protection in Radiation and Isotope Center (Khartoum), and at Medical Corporation (MC) were investigated. It is found that the rules are applied in accordance with international recommendations. Results of the investigations, measurements and some concluding remarks to improve the situation are reported.(Author)

  18. Artificial Urine for Teaching Urinalysis Concepts and Diagnosis of Urinary Tract Infection in the Medical Microbiology Laboratory.

    Science.gov (United States)

    Khan, Latifa B; Read, Hannah M; Ritchie, Stephen R; Proft, Thomas

    2017-01-01

    Dipstick urinalysis is an informative, quick, cost-effective and non-invasive diagnostic tool that is useful in clinical practice for the diagnosis of urinary tract infections (UTIs), kidney diseases, and diabetes. We used dipstick urinalysis as a hands-on microbiology laboratory exercise to reinforce student learning about UTIs with a particular focus on cystitis, which is a common bacterial infection. To avoid exposure to potentially contaminated human urine samples, we prepared artificial urine using easily acquired and affordable ingredients, which allowed less-experienced students to perform urinalysis without the risk of exposure to pathogenic organisms and ensured reliable availability of the urine samples. This practical class taught medical students how to use urinalysis data in conjunction with medical history to diagnose diseases from urine samples and to determine a treatment plan for clinical scenarios.

  19. Assessing Prescribing Trends of Adjuvant Medication Therapy in Outpatients With a Diagnosis of Noncancer Chronic Pain.

    Science.gov (United States)

    Rasu, Rafia S; Vossen, Rachel K; Knell, Maureen E

    2017-09-01

    Chronic pain affects over 100 million adults in the United States, yet continues to be difficult to treat. Concerns continue to mount over the use of opioids to treat noncancer chronic pain (NCCP). Guidelines support the use of adjuvant medications as one of the preferred options for treating chronic pain over opioids. To examine reported usage of adjuvants in the treatment of chronic pain via the National Ambulatory Medical Care Survey (NAMCS). A retrospective, cross-sectional study evaluating reported usage of adjuvant pain medications for the treatment of NCCP was conducted using NAMCS data from 2000 to 2007. Weighted samples were analyzed with regard to several patient variables. Logistic regression models provided 95% confidence intervals and an adjusted odds ratio to determine statistically significant differences in reported usage for the evaluated patient variables. In total, 244,797,406 weighted visits were included for analysis. The analysis showed an almost 2-fold increase in adjuvant use during the study period. Statistically significant differences were identified for several factors evaluated. Younger age, female sex, care from a nonprimary care physician, comorbidities with pain, and >5 current medications were associated with higher rates adjuvant therapy use. Overall adjuvant usage dramatically increased during the study period. Analysis of data demonstrated adjuvant use in chronic pain varied based patient-specific characteristics. These results may allow clinicians, policy makers, and medical educators to identify potential gaps in adjuvant use in certain populations and target areas for clinical, populations-based, and educational improvements in managing NCCP.

  20. British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases.

    Science.gov (United States)

    Schelenz, Silke; Barnes, Rosemary A; Barton, Richard C; Cleverley, Joanne R; Lucas, Sebastian B; Kibbler, Christopher C; Denning, David W

    2015-04-01

    Invasive fungal diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientific literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive fungal diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identification of clinically significant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (<48 hours) and optimised imaging for patients with suspected invasive fungal infection. All 43 recommendations are auditable and should be used to ensure best diagnostic practice and improved outcomes for patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Effects of asymmetric medical insurance subsidy on hospitals competition under non-price regulation.

    Science.gov (United States)

    Wang, Chan; Nie, Pu-Yan

    2016-11-15

    Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation. We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction. The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is. This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources

  2. The professional medical ethics model of decision making under conditions of clinical uncertainty.

    Science.gov (United States)

    McCullough, Laurence B

    2013-02-01

    The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.

  3. Californians newly eligible for Medi-Cal under health care reform.

    Science.gov (United States)

    Pourat, Nadereh; Martinez, Ana E; Kominski, Gerald F

    2011-05-01

    About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010. Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currently enrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible low-income population is likely to improve their access to health services.

  4. Parent induced self-medication among under five children: an observational cross sectional study

    Directory of Open Access Journals (Sweden)

    Saima Nazir

    2015-04-01

    CONCLUSION: This study identifies the problem of self-medication in the under-five children and highlights the need for urgent educational measures for general public and drug dispensers in particular, to improve their knowledge and practices related to self-treatment of minor ailments. [TAF Prev Med Bull 2015; 14(2.000: 81-86

  5. Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care?

    Science.gov (United States)

    Melo, Magaly Carvalho Vieira de; Ximenes, Ricardo Arraes de Alencar; Falcão, Ilka Veras; Miranda-Filho, Demócrito de Barros

    2018-01-01

    The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006-2008) and another with those diagnosed by rapid testing (2010-2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p test group, the median period of time before the first consultation with an infectious disease specialist was 99 days, and for the rapid test group the time was 14 days (p test group (p test group (472) was higher than in the conventional test group (397) (p = 0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.

  6. Prevalence, correlates and under-diagnosis of clinical depression among adults on highly active antiretroviral therapy in a Tertiary Health Institution in northeastern Nigeria

    Directory of Open Access Journals (Sweden)

    Abdu Wakawa Ibrahim

    2014-11-01

    Full Text Available Clinical depression is a highly debilitating illness, which is often under-diagnosed and negatively impacts on the quality of life of its sufferers. When it co-exists with other medical conditions, its effect is even more incapacitating. Undiagnosed depression in the context of HIV infection leads to accelerated decline in CD4+ cell counts with concomitant increase in the viral load and poor adherence to the antiretroviral medications which lead to viral mutation and the evolution of resistant strains. This study examined the prevalence of depression, its correlates and the frequency of the diagnosis of the condition among HIV+ subjects on highly active antiretroviral therapy (HAART by the internists and general physicians at the University of Maiduguri Teaching Hospital in Northeastern Nigeria. Three hundred and fifty representative samples of HIV+ adults on HAART were drawn from the Antiretroviral Therapy Clinic of the Institution. Diagnosis of depression was made using the International Classification of Diseases-10 criteria based on Composite International Diagnostic Interview generated data. Socio-demographic and clinical variables were also analyzed for their correlation with depression in the subjects. About 20% of the respondents were diagnosed with clinical depression and no diagnosis of the condition was hitherto entertained in all the respondents. The independent determinants of depression in the participants were: female gender [odds ratio (OR=3.87 (95% confidence interval, CI: 2.089-7.183], past history of psychiatric illness [OR=43.81 (95% CI: 9.731-197.30] and family history of psychiatric illness in first-degree relatives of the subjects [OR=14.364 (95% CI=5.327- 38.729]. Depression is a relatively common psychiatric condition among adults on HAART, there is therefore the need for routine screening of this condition among HIV+ subjects in order to optimize patient care and improve clinical outcomes.

  7. A New Fault Diagnosis Algorithm for PMSG Wind Turbine Power Converters under Variable Wind Speed Conditions

    Directory of Open Access Journals (Sweden)

    Yingning Qiu

    2016-07-01

    Full Text Available Although Permanent Magnet Synchronous Generator (PMSG wind turbines (WTs mitigate gearbox impacts, they requires high reliability of generators and converters. Statistical analysis shows that the failure rate of direct-drive PMSG wind turbines’ generators and inverters are high. Intelligent fault diagnosis algorithms to detect inverters faults is a premise for the condition monitoring system aimed at improving wind turbines’ reliability and availability. The influences of random wind speed and diversified control strategies lead to challenges for developing intelligent fault diagnosis algorithms for converters. This paper studies open-circuit fault features of wind turbine converters in variable wind speed situations through systematic simulation and experiment. A new fault diagnosis algorithm named Wind Speed Based Normalized Current Trajectory is proposed and used to accurately detect and locate faulted IGBT in the circuit arms. It is compared to direct current monitoring and current vector trajectory pattern approaches. The results show that the proposed method has advantages in the accuracy of fault diagnosis and has superior anti-noise capability in variable wind speed situations. The impact of the control strategy is also identified. Experimental results demonstrate its applicability on practical WT condition monitoring system which is used to improve wind turbine reliability and reduce their maintenance cost.

  8. Laboratory diagnosis of malaria in children under five years in a ...

    African Journals Online (AJOL)

    The morbidity and mortality associated with malaria in children below 5 years is really worrisome especially in the rural communities with little or no laboratory diagnostic facilities. This study was carried out to compare microscopy with Malaria Pf test for the diagnosis of malaria in a rural community in Ideato North Local ...

  9. Clinical diagnosis of completeness of medical abortion by nurses: a reliability study in Mozambique

    NARCIS (Netherlands)

    Gebreselassie, Hailemichael; Ustá, Momade; Andersen, Kathryn L.; Mitchell, Ellen M. H.

    2012-01-01

    Background: The provision of medical abortion continues to rely on routine use of ultrasound to confirm expulsion of pregnancy. However, the absence of ultrasound in most of the health facilities in developing countries and the additional training required to enable providers to use ultrasound is

  10. Examining the Impact of Psychiatric Diagnosis and Comorbidity on the Medical Lethality of Adolescent "Suicide Attempts"

    Science.gov (United States)

    Mc Manama O'Brien, Kimberly H.; Berzin, Stephanie C.

    2012-01-01

    Specific psychiatric diagnoses and comorbidity patterns were examined to determine if they were related to the medical lethality of "suicide attempts" among adolescents presenting to an urban general hospital (N = 375). Bivariate analysis showed that attempters with substance abuse disorders had higher levels of lethality than attempters without…

  11. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement

    NARCIS (Netherlands)

    G. Gambaro (Giovanni); Croppi, E. (Emanuele); Coe, F. (Fredric); Lingeman, J. (James); Moe, O. (Orson); Worcester, E. (Elen); N.N.-P. Buchholz (Noor); Bushinsky, D. (David); Curhan, G.C. (Gary C.); Ferraro, P.M. (Pietro Manuel); Fuster, D. (Daniel); Goldfarb, D.S. (David S.); Heilberg, I.P. (Ita Pfeferman); B. Hess (Bernhard); Lieske, J. (John); Marangella, M. (Martino); Milliner, D. (Dawn); Preminger, G.M. (Glen M.); Reis Santos, J.M. (Jose’ Manuel); Sakhaee, K. (Khashayar); Sarica, K. (Kemal); R. Siener (Roswitha); Strazzullo, P. (Pasquale); Williams, J.C. (James C.); Bartoletti, R.; Buchholz, N.; Bushinsky, D.; Capasso, G.B.; Cicerello, E.; Coe, F.; Cupisti, A.; Curhan, G.C.; Desai, J.; Fabris, A.; Ferraro, P.M.; Fuster, D.; Gambaro, G.; Goldfarb, D.S.; Heilberg, I.P.; Hess, B.; Jaeger, P. (Ph); Z. Kirkali (Ziya); D.J. Kok (Dirk); Letavernier, E.; Lieske, J.; Lingeman, J.; Marangella, M.; Mazzaferro, S.; Moe, O.; Milliner, D.; Nouvenne, A.; Preminger, G.M.; Prie, D.; Reis Santos, J.; Rendina, D.; Sarica, K.; Siener, R.; Soldati, L.; Strazzullo, P.; Tasca, A.; Trinchieri, A.; Vezzoli, G.; Vitale, C.; Wu, W.; Williams, J.C.; Worcester, E.

    2016-01-01

    textabstractBackground: Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. Design: A steering committee identified 27 questions, which were

  12. Tracks to a Medical Diagnosis: Expertise Differences in Visual Problem Solving

    NARCIS (Netherlands)

    Jaarsma, Thomas; Boshuizen, Els; Jarodzka, Halszka; Nap, Marius; Verboon, Peter; Van Merriënboer, Jeroen

    2018-01-01

    This study focuses on the visual problem-solving process of clinical pathologists. Its aim is to find expertise-related differences in the temporal arrangement of this process, with a special focus on the orientation phase. A theoretical model of the visual diagnostic process of medical specialists

  13. Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland

    Directory of Open Access Journals (Sweden)

    Jan E. Zejda

    2017-06-01

    Among non-medical determinants of undiagnosed asthma the age of a child plays a major role. Another factors of importance is the large distance between residence and health centre, and low parental attention at home.

  14. 'On the doctor's orders': A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements

    NARCIS (Netherlands)

    Zwier, S.

    2017-01-01

    Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician

  15. Serological Diagnosis of Paracoccidioidomycosis: High Rate of Inter-laboratorial Variability among Medical Mycology Reference Centers

    Science.gov (United States)

    Vidal, Monica Scarpelli Martinelli; Del Negro, Gilda Maria Barbaro; Vicentini, Adriana Pardini; Svidzinski, Teresinha Inez Estivalet; Mendes-Giannini, Maria Jose; Almeida, Ana Marisa Fusco; Martinez, Roberto; de Camargo, Zoilo Pires; Taborda, Carlos Pelleschi; Benard, Gil

    2014-01-01

    Background Serological tests have long been established as rapid, simple and inexpensive tools for the diagnosis and follow-up of PCM. However, different protocols and antigen preparations are used and the few attempts to standardize the routine serological methods have not succeeded. Methodology/Principal findings We compared the performance of six Brazilian reference centers for serological diagnosis of PCM. Each center provided 30 sera of PCM patients, with positive high, intermediate and low titers, which were defined as the “reference” titers. Each center then applied its own antigen preparation and serological routine test, either semiquantitative double immunodifusion or counterimmmunoelectrophoresis, in the 150 sera from the other five centers blindly as regard to the “reference” titers. Titers were transformed into scores: 0 (negative), 1 (healing titers), 2 (active disease, low titers) and 3 (active disease, high titers) according to each center's criteria. Major discordances were considered between scores indicating active disease and scores indicating negative or healing titers; such discordance when associated with proper clinical and other laboratorial data, may correspond to different approaches to the patient's treatment. Surprisingly, all centers exhibited a high rate of “major” discordances with a mean of 31 (20%) discordant scores. Alternatively, when the scores given by one center to their own sera were compared with the scores given to their sera by the remaining five other centers, a high rate of major discordances was also found, with a mean number of 14.8 sera in 30 presenting a discordance with at least one other center. The data also suggest that centers that used CIE and pool of isolates for antigen preparation performed better. Conclusion There are inconsistencies among the laboratories that are strong enough to result in conflicting information regarding the patients' treatment. Renewed efforts should be promoted to improve

  16. Serological diagnosis of paracoccidioidomycosis: high rate of inter-laboratorial variability among medical mycology reference centers.

    Directory of Open Access Journals (Sweden)

    Monica Scarpelli Martinelli Vidal

    2014-09-01

    Full Text Available Serological tests have long been established as rapid, simple and inexpensive tools for the diagnosis and follow-up of PCM. However, different protocols and antigen preparations are used and the few attempts to standardize the routine serological methods have not succeeded.We compared the performance of six Brazilian reference centers for serological diagnosis of PCM. Each center provided 30 sera of PCM patients, with positive high, intermediate and low titers, which were defined as the "reference" titers. Each center then applied its own antigen preparation and serological routine test, either semiquantitative double immunodifusion or counterimmmunoelectrophoresis, in the 150 sera from the other five centers blindly as regard to the "reference" titers. Titers were transformed into scores: 0 (negative, 1 (healing titers, 2 (active disease, low titers and 3 (active disease, high titers according to each center's criteria. Major discordances were considered between scores indicating active disease and scores indicating negative or healing titers; such discordance when associated with proper clinical and other laboratorial data, may correspond to different approaches to the patient's treatment. Surprisingly, all centers exhibited a high rate of "major" discordances with a mean of 31 (20% discordant scores. Alternatively, when the scores given by one center to their own sera were compared with the scores given to their sera by the remaining five other centers, a high rate of major discordances was also found, with a mean number of 14.8 sera in 30 presenting a discordance with at least one other center. The data also suggest that centers that used CIE and pool of isolates for antigen preparation performed better.There are inconsistencies among the laboratories that are strong enough to result in conflicting information regarding the patients' treatment. Renewed efforts should be promoted to improve standardization of the serological diagnosis of PCM.

  17. Hepatobiliary functional scintiscanning (HBFS) - a nuclear medical method for diagnosis of icteric diseases

    International Nuclear Information System (INIS)

    Weber, K.

    1979-01-01

    The results of 146 hepatobiliary functional scintiscannings were analysed and compared with those results obtained by means of laboratory and roentgenologic methods. In 115 cases the obtained results could be examined by the final diagnosis. The accuracy of the HBFS was 87%. In hepatobiliary functional scintiscanning the indications are the differential diagnoses between hepatic and post-hepatic icterus and between total and subtotal obstruction. This method can be applied for all patients whose bilirubin concentration of the blood does not exceed 15 mg%. It can be performed even with serious syndromes or heavy contrast media allergies, because any side effects are absent. (orig.) [de

  18. Artificial intelligence in medicine and cardiac imaging: harnessing big data and advanced computing to provide personalized medical diagnosis and treatment.

    Science.gov (United States)

    Dilsizian, Steven E; Siegel, Eliot L

    2014-01-01

    Although advances in information technology in the past decade have come in quantum leaps in nearly every aspect of our lives, they seem to be coming at a slower pace in the field of medicine. However, the implementation of electronic health records (EHR) in hospitals is increasing rapidly, accelerated by the meaningful use initiatives associated with the Center for Medicare & Medicaid Services EHR Incentive Programs. The transition to electronic medical records and availability of patient data has been associated with increases in the volume and complexity of patient information, as well as an increase in medical alerts, with resulting "alert fatigue" and increased expectations for rapid and accurate diagnosis and treatment. Unfortunately, these increased demands on health care providers create greater risk for diagnostic and therapeutic errors. In the near future, artificial intelligence (AI)/machine learning will likely assist physicians with differential diagnosis of disease, treatment options suggestions, and recommendations, and, in the case of medical imaging, with cues in image interpretation. Mining and advanced analysis of "big data" in health care provide the potential not only to perform "in silico" research but also to provide "real time" diagnostic and (potentially) therapeutic recommendations based on empirical data. "On demand" access to high-performance computing and large health care databases will support and sustain our ability to achieve personalized medicine. The IBM Jeopardy! Challenge, which pitted the best all-time human players against the Watson computer, captured the imagination of millions of people across the world and demonstrated the potential to apply AI approaches to a wide variety of subject matter, including medicine. The combination of AI, big data, and massively parallel computing offers the potential to create a revolutionary way of practicing evidence-based, personalized medicine.

  19. Multispectral medical image fusion in Contourlet domain for computer based diagnosis of Alzheimer’s disease

    International Nuclear Information System (INIS)

    Bhateja, Vikrant; Moin, Aisha; Srivastava, Anuja; Bao, Le Nguyen; Lay-Ekuakille, Aimé; Le, Dac-Nhuong

    2016-01-01

    Computer based diagnosis of Alzheimer’s disease can be performed by dint of the analysis of the functional and structural changes in the brain. Multispectral image fusion deliberates upon fusion of the complementary information while discarding the surplus information to achieve a solitary image which encloses both spatial and spectral details. This paper presents a Non-Sub-sampled Contourlet Transform (NSCT) based multispectral image fusion model for computer-aided diagnosis of Alzheimer’s disease. The proposed fusion methodology involves color transformation of the input multispectral image. The multispectral image in YIQ color space is decomposed using NSCT followed by dimensionality reduction using modified Principal Component Analysis algorithm on the low frequency coefficients. Further, the high frequency coefficients are enhanced using non-linear enhancement function. Two different fusion rules are then applied to the low-pass and high-pass sub-bands: Phase congruency is applied to low frequency coefficients and a combination of directive contrast and normalized Shannon entropy is applied to high frequency coefficients. The superiority of the fusion response is depicted by the comparisons made with the other state-of-the-art fusion approaches (in terms of various fusion metrics).

  20. Multispectral medical image fusion in Contourlet domain for computer based diagnosis of Alzheimer's disease

    Science.gov (United States)

    Bhateja, Vikrant; Moin, Aisha; Srivastava, Anuja; Bao, Le Nguyen; Lay-Ekuakille, Aimé; Le, Dac-Nhuong

    2016-07-01

    Computer based diagnosis of Alzheimer's disease can be performed by dint of the analysis of the functional and structural changes in the brain. Multispectral image fusion deliberates upon fusion of the complementary information while discarding the surplus information to achieve a solitary image which encloses both spatial and spectral details. This paper presents a Non-Sub-sampled Contourlet Transform (NSCT) based multispectral image fusion model for computer-aided diagnosis of Alzheimer's disease. The proposed fusion methodology involves color transformation of the input multispectral image. The multispectral image in YIQ color space is decomposed using NSCT followed by dimensionality reduction using modified Principal Component Analysis algorithm on the low frequency coefficients. Further, the high frequency coefficients are enhanced using non-linear enhancement function. Two different fusion rules are then applied to the low-pass and high-pass sub-bands: Phase congruency is applied to low frequency coefficients and a combination of directive contrast and normalized Shannon entropy is applied to high frequency coefficients. The superiority of the fusion response is depicted by the comparisons made with the other state-of-the-art fusion approaches (in terms of various fusion metrics).

  1. Multispectral medical image fusion in Contourlet domain for computer based diagnosis of Alzheimer’s disease

    Energy Technology Data Exchange (ETDEWEB)

    Bhateja, Vikrant, E-mail: bhateja.vikrant@gmail.com, E-mail: nhuongld@hus.edu.vn; Moin, Aisha; Srivastava, Anuja [Shri Ramswaroop Memorial Group of Professional Colleges (SRMGPC), Lucknow, Uttar Pradesh 226028 (India); Bao, Le Nguyen [Duytan University, Danang 550000 (Viet Nam); Lay-Ekuakille, Aimé [Department of Innovation Engineering, University of Salento, Lecce 73100 (Italy); Le, Dac-Nhuong, E-mail: bhateja.vikrant@gmail.com, E-mail: nhuongld@hus.edu.vn [Duytan University, Danang 550000 (Viet Nam); Haiphong University, Haiphong 180000 (Viet Nam)

    2016-07-15

    Computer based diagnosis of Alzheimer’s disease can be performed by dint of the analysis of the functional and structural changes in the brain. Multispectral image fusion deliberates upon fusion of the complementary information while discarding the surplus information to achieve a solitary image which encloses both spatial and spectral details. This paper presents a Non-Sub-sampled Contourlet Transform (NSCT) based multispectral image fusion model for computer-aided diagnosis of Alzheimer’s disease. The proposed fusion methodology involves color transformation of the input multispectral image. The multispectral image in YIQ color space is decomposed using NSCT followed by dimensionality reduction using modified Principal Component Analysis algorithm on the low frequency coefficients. Further, the high frequency coefficients are enhanced using non-linear enhancement function. Two different fusion rules are then applied to the low-pass and high-pass sub-bands: Phase congruency is applied to low frequency coefficients and a combination of directive contrast and normalized Shannon entropy is applied to high frequency coefficients. The superiority of the fusion response is depicted by the comparisons made with the other state-of-the-art fusion approaches (in terms of various fusion metrics).

  2. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...... in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances....

  3. Exposure of the french population to ionizing radiation link to medical diagnosis act in 2007

    International Nuclear Information System (INIS)

    Etard, C.; Aubert, B.; Sinno-Tellier, S.

    2010-01-01

    The objective of this report is to update and complete the data relative to the medical exposure of the French population to diagnostic imaging examinations for the year 2007. The last published data correspond to the year 2002. The information supplied by this report precise: the medical exposure to diagnostic imaging examinations by imaging modality (conventional radiology, scanner, nuclear medicine, and diagnostic interventional imaging), by anatomical area, by age, and according to the sex of the patient and it also the part of the French population (strength, age, sex) who actually benefited of diagnostic acts using ionizing radiation in 2007. In 2007, 74.6 millions of diagnostic acts using ionizing radiation have been realised in france. These acts induce for the year 2007 to an efficient average dose of 1.3 MSv. (N.C.)

  4. Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records and health administrative data: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Chevendra Vijaya

    2010-12-01

    Full Text Available Abstract Background Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes. Methods We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006 - 31 March 2008 (N = 19,443. We systematically examined eight definitions for diabetes diagnosis, both established and proposed. Results The definition that identified the highest number of patients with diabetes (N = 2,180 while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75% and specificity (98%. Conclusions This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.

  5. Under-diagnosis of alcohol-related problems and depression in a family practice in Japan

    OpenAIRE

    Yamada, Kenshi; Maeno, Tetsuhiro; Waza, Kazuhiro; Sato, Takeshi

    2008-01-01

    Abstract Aim The aim of this survey was to assess the accuracy of a family physician's diagnosis of depression and alcoholism. Methods Consecutive new adult patients attending a family practice in Japan between April 2004 and August 2006 were enrolled. Excluded were those with dementia or visual disturbance, and emergency cases. Participants completed a questionnaire regarding their complaints and socio-demographics. A research nurse conducted the Japanese version of the Mini-International Ne...

  6. [Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases].

    Science.gov (United States)

    Villamil Cajoto, I; García Prim, J M; González Barcala, F J; Pose Reino, A; Paredes Vila, S; Calvo Alvarez, U; Valdés Cuadrado, L

    2009-02-01

    Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. To know the clinical characteristics in the presentation of the lung cancer in our health care area. All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell

  7. Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies

    OpenAIRE

    Sznitman, Sharon R.; Bretteville-Jensen, Anne Line

    2015-01-01

    Background Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes. Methods Robust reg...

  8. Macromodular splenic tuberculosis in a medically-treated AIDS patient: diagnosis and management by CT

    International Nuclear Information System (INIS)

    Galant, J., Marti-Bonmati, L.; Tornero, C.; Ferrer, M.D.

    1995-01-01

    We used computerized tomography (CT) in the study of eight patients with macronodular splenic tuberculosis prior to the microbiological diagnosis. These patients underwent additional CT controls during and after tuberculostatic therapy. All the patients studed presented the acquired immunodeficiency syndrome (AIDS). Splenomegaly and numerosous round, hypodense lesions that showed no contrast uptake were found in all the subjects. Only three patients presented evidence of tuberculosis in plain radiography and/or chest X-ray. Two patients presented abdominal lymph nodes. None of them showed evidence of hepatic lesions or ascites. follow-up CT scans revealed a progressive reduction of the lesions, which eventually disappeared completely, and splenomegaly was considerably reduced. Anthough it is uncommon, we should suspect splenic involvement in tuberculosis if the clinical and radiological contexts are appropriate. CT provides excellent monitoring of the efficacy of treatment in these patients. 17 refs

  9. Incidence of childhood cancer among Mexican children registered under a public medical insurance program.

    Science.gov (United States)

    Rivera-Luna, Roberto; Correa-González, Cecilia; Altamirano-Alvarez, Eduardo; Sánchez-Zubieta, Fernando; Cárdenas-Cardós, Rocio; Escamilla-Asian, Gabriela; Olaya-Vargas, Alberto; Bautista-Marquez, Aurora; Aguilar-Romo, Manuel

    2013-04-01

    Prior to 2005, 51% of children in Mexico diagnosed with cancer received no standardized optimal multidisciplinary medical care. A government-subsidized national cancer treatment program was therefore created for these patients and a National Cooperative Childhood Cancer Treatment Group was consequently formed for these patients. Pediatric patients with a proven diagnosis of leukemia, lymphoma or solid tumor and who were registered in the Popular Medical Insurance (PMI) program from January 2007 to December 2010, are described in this report. These patients had been enrolled and registered in one of the 49 nationwide certified medical institutions in Mexico. The national incidence and frequency data for childhood cancers were analyzed for the whole program. At the end of a 4-year study, the analysis revealed that 8,936 children from across Mexico had been diagnosed with cancer. The incidence rate for the PMI patients was 150.3/million/year (2010) for children of 0-18 years. The highest age incidence rate was 51.9 between 0 and 4 years and boys were the predominant group for all types of cancer. The leukemia incidence was 75.3/million/year (2010), and an average frequency of 50.75% throughout the 4 years. The overall mortality rate was measured at 5.4/100,000/year (2010). This study demonstrates a high frequency and incidence of childhood cancer and a beneficial impact of the PMI program over the quality of life in these children. Copyright © 2012 UICC.

  10. Preimplantation genetic diagnosis: an ambiguous legal status for an ambiguous medical and social practice.

    Science.gov (United States)

    Byk, Christian

    2008-09-01

    The controversy about to which extend PGD may be applies is particularly interesting because it stresses on a paradoxical point concerning PGD. Although this technique is strictly regulated in most European countries where it is regularly practised, the legal status of PGD may appear to some as unethical because it may be viewed as a facilitator for those who would like to select children for reason other than medical. The need to test human embryos before birth and the consequences that may occur to those detected with some abnormalities also revives the issue of the respect due to the human embryo.

  11. Diagnosis and authority in the early-twentieth-century medical practice of Richard C. Cabot.

    Science.gov (United States)

    Crenner, Christopher

    2002-01-01

    This paper examines diagnostic practices using the early twentieth-century medical literature and the patient correspondence and records from the clinic of Richard Cabot. What shaped medicine's rapidly growing persuasive authority in the twentieth century? Diagnostic expertise demonstrated the doctor's control over disease but offered a service of ambiguous value to patients. Cabot and his peers offered differing views on how new diagnostic techniques would influence their relationships to their patients. In his busy private clinic Cabot put into effect an exacting diagnostic process, modeled on his innovative Clinicopathological Conferences. The people who came to the clinic often sought his technical expertise but accepted his diagnostic practices and opinions sometimes only provisionally.

  12. Experience in the diagnosis and treatment of Kawasaki disease in the Saint-Petersburg State Pediatric Medical University Clinic and Saint Petersburg City Children’s Hospital One

    Directory of Open Access Journals (Sweden)

    A. V. Santimov

    2017-01-01

    Full Text Available Kawasaki disease (KD is acute systemic vasculitis of unknown etiology. Approximately 20–25% of untreated patients develop coronary artery changes with a range of severity from asymptomatic coronary artery dilatation to giant coronary artery aneurysms with thrombosis, myocardial infarction, and sudden death. To date there is no official data on the incidence of KD in Russia. In Russia, the disease is not enough known now to a wide circle of physicians and often masks other more common diseases. Since 2010, the detection rate of KD has dramatically increased in Saint-Petersburg.Objective: to analyze the experience in diagnosing and treating KD in two largest hospitals of Saint Petersburg.Patients and methods. The retrospective study included data on 30 children (18 boys, 12 girls who were hospitalized with a diagnosis of KD in the Saint-Petersburg State Pediatric Medical University Clinic and Children’s Hospital One (Saint Petersburg between January 2011 and September 2016. Data are represented by median and extreme values. The age of the children was 2.8 (0.2; 4.6 years; of them 5 (16.7% patients were under the age of 1 year. The children were hospitalized on 5 (1; 14 days of disease onset; KD was diagnosed on 9 (3; 52 day of the disease.Results. Immediately after diagnosis, 27 (90% children received aspirin. In early stages (before 10 days of the disease, intravenous immunoglobulin (IVIG therapy was performed in 15 (50% children, one of them received IVIG before disease day 5 (on day 3, but without effect. On disease days 11-20 (immediately after diagnosis, 10 (33.3% children were prescribed with IVIG; thereafter fever was abolished in all the patients. Their body temperature became normal on day 11 (6; 23. Ultrasonography revealed coronary artery lesions in 13 (43.3% patients. Out of the 30 children followed up, one baby who fell ill at the age of 3 months and received IVIG died on day 30 of the disease.Conclusion. Currently

  13. [CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP OF PATIENTS WITH MELANOMA].

    Science.gov (United States)

    Herceg, Davorin; Buzina, Daska Stulhofer; Ceović, Romana; Dotlić, Snjezana; Ilić, Ivana; Orehovec, Sanda Smuđ; Herceg, Gordana Horvatić; Mijatović, Davor; Separović, Robert; Silovski, Tajana; Vrbanec, Damir

    2016-01-01

    Melanoma in the Western world has an increasing incidence. One of the most important factor for the increase in incidence is sporadic, uncontrolled exposure to the sun. The basis for the treatment of primary melanoma is surgical treatment. Treatment of metastatic disease of melanoma in recent years experienced significant changes. BRAF and MEK inhibitors, immunotherapy with programmed cell-death immune checkpoint inhibitors (anti-PD-1-antibodies) are new options for the treatment of metastatic disease. A mulitidisiplinary team of Croatian Society for Medical Oncology provides recommendations for diagnosis, treatment and follow-up of melanoma primarily driven to the discovery of new drugs and therapeutic options, that change the prognosis of patients with metastatic melanoma.

  14. A deep convolutional neural network with new training methods for bearing fault diagnosis under noisy environment and different working load

    Science.gov (United States)

    Zhang, Wei; Li, Chuanhao; Peng, Gaoliang; Chen, Yuanhang; Zhang, Zhujun

    2018-02-01

    In recent years, intelligent fault diagnosis algorithms using machine learning technique have achieved much success. However, due to the fact that in real world industrial applications, the working load is changing all the time and noise from the working environment is inevitable, degradation of the performance of intelligent fault diagnosis methods is very serious. In this paper, a new model based on deep learning is proposed to address the problem. Our contributions of include: First, we proposed an end-to-end method that takes raw temporal signals as inputs and thus doesn't need any time consuming denoising preprocessing. The model can achieve pretty high accuracy under noisy environment. Second, the model does not rely on any domain adaptation algorithm or require information of the target domain. It can achieve high accuracy when working load is changed. To understand the proposed model, we will visualize the learned features, and try to analyze the reasons behind the high performance of the model.

  15. Assessing the Soil Physiological Potential Using Pedo-Biological Diagnosis Under Minimum-Tillage System and Mineral Fertilization

    Directory of Open Access Journals (Sweden)

    Lazar Bireescu

    2014-11-01

    Full Text Available The main objective of sustainable agriculture is the protection of environment and natural vegetal and soil resources. Accordingly, the objective of this research was to assess the impact of technological systems by minimum tillage on soil biological activity, using the Pedo-Biological Diagnosis of Soil Resources. Our research was conducted on haplic chernozem from Experimental Station of UASVM of Iasi, Romania, during the seasonal dynamic, to the soybean crop, on unfertilized and fertilized agrofond, using moderate mineral doses (N80P80 as average of 2009–2010 period, under minimum tillage (2x disk, paraplow, chisel compared to conventional (plugging at 20 cm and 30 cm. In the case of soil works with chisel and paraplow without return of furrow, the Pedo-Biological Diagnosis highlights an increase of soil physiological potential, in the both variants (unfertilized and fertilized, unlike the method of alternating the depth of plugging that proved to be ineffective.

  16. Halitosis--a common medical and social problem. A review on pathology, diagnosis and treatment.

    Science.gov (United States)

    Zalewska, A; Zatoński, M; Jabłonka-Strom, A; Paradowska, A; Kawala, B; Litwin, A

    2012-09-01

    Bad breath is a condition that has health and social implications. This paper provides a comprehensive review of the classification of halitosis, it's etiology, it's prevalence, diagnosis and treatment strategies for the condition. Halitosis is affecting about 25-30% of world's population. It includes categories of genuine halitosis, pseudo-halitosis and halitophobia. It is believed that in 80-90% of cases halitosis origins in the oral cavity and the most common causes are: gingival pathologies, caries and poor oral hygiene. Extraoral sources of halitosis are responsible for 10-20% of all cases and are caused by poor diet, alcohol abuse, tobacco smoking, certain drugs and diseases of other parts of digestive tract as well as some systemic conditions. Diagnostics of halitosis includes subjective methods (examiner's sense of smell) and objective methods (instrumental analysis). Simple, subjective examination is considered a "golden standard" in clinical practice. In case of pathological halitosis identifying the direct cause of halitosis is essential. After excluding, or after successful treatment, of all oral pathologies, in case of remaining fetor ex ore identification and treatment of halitosis often requires multidisciplinary approach. Many unknowns remain in causes and mechanisms of halitosis. It can significantly impair quality of life, social interactions, lead directly to depression,low self-esteem or other mood disorders, therefore it is important to properly identify, treat and continue research on halitosis.

  17. 'The BRCA clock is ticking!': negotiating medical concerns and reproductive goals in preimplantation genetic diagnosis.

    Science.gov (United States)

    Rubin, Lisa R; Werner-Lin, Allison; Sagi, Michal; Cholst, Ina; Stern, Rikki; Lilienthal, Debra; Hurley, Karen

    2014-09-01

    Despite research on BRCA1/2 mutation carriers attitudes towards preimplantation genetic diagnosis (PGD), considerably less is known about individuals' experience with its use. Through case reports of BRCA1/2 mutation carriers' thoughts on, and use of, PGD, this paper highlights how the option of PGD is experienced and negotiated in the context of reproductive and life-course goals. Drawing on qualitative interviews with 38 BRCA1/2 mutation carriers, this article focuses on a subsample of 10 interviewees who sought consultation for, and/or attempted, PGD, with in-depth reports of 3 cases and summary decisions of the remaining 7. Three couples decided against PGD, and one was deciding at the time of the interview. Interviewees discuss key aspects of their experience prior to, and going through, PGD for BRCA1/2, including potential challenges of becoming pregnant through PGD and of heightened pressure to achieve their reproductive goals more quickly. Despite considerable focus on ethical issues in screening embryos for mutations associated with adult-onset cancer risk, less attention has been paid to the technical, logistical, and related psychosocial issues. Narrative case reports may help individuals develop appropriate expectations of PGD for BRCA prepare for possibly challenging decisions and outcomes, and ultimately determine whether it is compatible with their reproductive goals.

  18. A molecular prevalence of Blastocystis hominis in patients referred to medical diagnosis laboratories in Khorramabad city

    Directory of Open Access Journals (Sweden)

    ebrahim Badparva

    2012-12-01

    Conclusion: The microscopic diagnosis is challenged by morphological characteristics and other intervening factors, and the PCR method, which has higher sensitivity and specification than other diagnostic methods, is recommended. Concerning the prevalence of the parasite, the world has been divided into two parts of developed and developing countries by the researchers, with 10% and 50% prevalence rates respectively. The 6.5% prevalence in the cited population in Khorramabad is in the range of the prevalence in the developed countries. Therefore, the result is justifiable since springs provide most of the drinking water in the region. However, since ranching is a popular occupation in the region, the prevalence rate is alarming. Therefore, following health instructions and appropriate clothing when exposing to livestock are recommended. In addition, the results of this study and similar studies in the developing countries, on the one hand, and the increasing prevalence of 23% in the US as a developed country, on the other hand, have disturbed the previous division.

  19. The diagnosis of sepsis using POCT in the Emergency Department – Medical and legal implications

    Directory of Open Access Journals (Sweden)

    Bogdan C. Teușdea

    2015-04-01

    Full Text Available Sepsis, severe sepsis and septic shock are some of the most serious affections which threaten the lives of the patients who come to the Emergency Department and which require fast treatment because the more severe the sepsis was, the higher the mortality, up to 50% higher in severe sepsis. That is why, at present, the 2013 Guides of Surviving Sepsis Campaign recommend that the potential source of infection should be confirmed as soon as possible, in the first 6 hours since the patient arrived in the Emergency Unit if possible, moreover the large spectrum antibiotics therapy must be administered in one hour after the severe sepsis or the septic shock were identified. That is why the identification of these patients at risk is very important and this identification can only be made using POCT type devices. This type of devices has the capacity to make precise determinations, in a short time (15-17 minutes, using minimum quantities of integral blood, without using test tubes, sepsis biomarkers and other additional material. The possibility to fast diagnose sepsis, offers the doctors from the Emergency Department, the capacity to fast initiate an antibiotic treatment, to hospitalize the patient and at the same time, it gives them the certainty that they did not miss the sepsis diagnosis, thus avoiding the situation of malpractice. A preliminary study, regarding the sepsis biomarkers, which took place in the Emergency Unit of University Central Emergency Military Hospital, is also presented within this article.

  20. [Diagnosis and medical care of raptors in a compilation of cases from 1985-1994].

    Science.gov (United States)

    Hatt, J M; Baumgartner, R; Isenbügel, E

    1996-01-01

    This article summarises the clinical findings in 554 birds of prey, that were admitted to the zoo animal and exotic pet clinic of the veterinary faculty in Zurich between 1 January 1985 and 31 December 1994. Details on the diagnosis, therapy and prognosis are intended to give the practitioner information on the possibilities for the management of diseased raptors. However, it has to be emphasized that the ultimate goal of treatment has to be the rehabilitation of an animal that will be able to survive to a suitable environment. The data presented shows that 31% of the birds of prey were successfully released. The most frequent reason for admission was trauma and 47% of the patients had one or more fractures. But only one out of three fractures was considered suitable for treatment. The management of birds that are starving is a challenge because they require a special dietary regimen. Successful work in the field of the treatment and rehabilitation of raptors requires detailed knowledge of their biology and medicine.

  1. Training for instructor in radiation protection courses in the medical diagnosis with X-Rays in Mexico

    International Nuclear Information System (INIS)

    Garcia Aguilar, J.; Rodriguez Aranda, F.; Dominguez Anaya, E.

    2003-01-01

    The General Regulation of Radiological Security establishes in its article 159 that the occupationally exposed professionals will have to count on the authorization of the National Commission of Nuclear Security and Safety (CNSNS) with respect to their training. The Mexican official norm NOM-157-SSA1-1996: Protection and radiological safety in the medical diagnosis with X-rays, indicates that the personnel must receive and accept the information, instructions and training related to the protection and radiological safety, in order to accomplish their work according to the requirements and obligations established in the outstanding procedures. Therefore it was designed an initial training course of instructors in the field of the radiological protection to train occupationally exposed professionals who work in the medical diagnosis establishments with X-rays. The didactic material was elaborated considering a period of training of 10 working days, 8.0 daily hours considering theoretical topics, as well as 11 practical. It is used a conventional radiology equipment, a ionization chamber of brand INOVISIOB model 451 P-DE-SI for increasing the radiation levels, and equipment Radical model 9015 with two ionization chambers of 150 cc and 150 cc respectively, as well as a calibrated plates game of aluminium type 110 and a phantom of acrylic as disperser. To date 73 persons have been trained, from which only 37% approved the initial training course. It has been seen that it is necessary to count on a previous training in the filed of the radiological protection to better profit from this training, since if students do not have good bases it is not possible for them to learn all the content in only 80 hours. To date it has been trained to 73 persons, of alone those which 37.0% approved the initial. (Author)

  2. Laboratory diagnosis of creatine deficiency syndromes: a technical standard and guideline of the American College of Medical Genetics and Genomics.

    Science.gov (United States)

    Sharer, J Daniel; Bodamer, Olaf; Longo, Nicola; Tortorelli, Silvia; Wamelink, Mirjam M C; Young, Sarah

    2017-02-01

    Disclaimer: These ACMG Standards and Guidelines are intended as an educational resource for clinical laboratory geneticists to help them provide quality clinical laboratory genetic services. Adherence to these standards and guidelines is voluntary and does not necessarily assure a successful medical outcome. These Standards and Guidelines should not be considered inclusive of all proper procedures and tests or exclusive of others that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, clinical laboratory geneticists should apply their professional judgment to the specific circumstances presented by the patient or specimen. Clinical laboratory geneticists are encouraged to document in the patient's record the rationale for the use of a particular procedure or test, whether or not it is in conformance with these Standards and Guidelines. They also are advised to take notice of the date any particular guideline was adopted, and to consider other relevant medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.Cerebral creatine deficiency syndromes are neurometabolic conditions characterized by intellectual disability, seizures, speech delay, and behavioral abnormalities. Several laboratory methods are available for preliminary and confirmatory diagnosis of these conditions, including measurement of creatine and related metabolites in biofluids using liquid chromatography-tandem mass spectrometry or gas chromatography-mass spectrometry, enzyme activity assays in cultured cells, and DNA sequence analysis. These guidelines are intended to standardize these procedures to help optimize the diagnosis of creatine deficiency syndromes. While biochemical methods are emphasized, considerations for confirmatory molecular testing are also discussed

  3. [Diagnosis and examination for COPD; medical interview/physical finding/ blood examination].

    Science.gov (United States)

    Sato, Susumu; Mishima, Michiaki

    2016-05-01

    Chronic obstructive pulmonary disease(COPD) is common disease. To diagnose COPD, pulmonary function test is required, however, usual physical examination and medical interview are both crucial. From both of them, we can acquire very important information and also this information will tell us much rather than pulmonary function test or images. In this article, we would like to summarize recent update about these topics. We focused on history taking from patients, examination of physical finding, and some possible biomarkers from blood examination. All of them may represent several important information of each patients, such as severity of disease, risk of future events, and also prognosis. For all physicians, it is necessary to evaluate these things.

  4. Justification of Individual Medical Exposures for Diagnosis: A HERCA Position Paper

    International Nuclear Information System (INIS)

    2014-01-01

    Improving the application of the justification principle in medical imaging is the responsibility of many stakeholders. This document is intended to provide clarity on the regulator's approach to the roles and responsibilities of the undertaking as well as a range of professionals involved in medical exposures. In doing so it considers the requirements of the new European Basic Safety Standards (BSS) Directive 2013/59/Euratom and discusses a number of emerging challenges associated with efficient, effective and rapidly changing health care systems. In summary, - the justification process should be completed prior to the exposure taking place and include consideration of the following: - adequate information regarding the clinical condition(s) of the patient, relevant to the imaging request -this must be available including known possible contraindications (e.g. pregnancy, breast feeding) - the diagnostic question(s) to be addressed - where practicable, information, with regard to possible previous/concurrent examinations - the decision on the appropriate imaging procedure including the option of one that does not involve ionising radiation - traceability of the above to the referrer and practitioner, - the role of the regulator is to provide, through regulations and associated guidance, a clear and unambiguous regulatory framework including requirements for the justification process and accountability within local procedures - these will be subject to inspection, - the role of the undertaking and the professionals involved is to demonstrate compliance with regulations through procedures and documentation associated with each individual exposure, showing beyond reasonable doubt that the elements of the justification process have been completed, and by whom, in accordance with the responsibilities laid down in procedures

  5. Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death.

    Science.gov (United States)

    Wenrich, M D; Curtis, J R; Shannon, S E; Carline, J D; Ambrozy, D M; Ramsey, P G

    2001-03-26

    Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care. Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed. The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope. Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.

  6. Gastric cancer in young people under 30 years of age: worse prognosis, or delay in diagnosis?

    International Nuclear Information System (INIS)

    López-Basave, Horacio Noé; Morales-Vásquez, Flavia; Ruiz-Molina, Juan Manuel; Ñamendys-Silva, Silvio A; Vela-Sarmiento, Itzel; Ruan, Javier Melchor; Rosciano, Alejandro E Padilla; Calderillo-Ruiz, German; Díaz-Romero, Consuelo; Herrera-Gómez, Angel; Meneses-García, Abelardo A

    2013-01-01

    Gastric cancer is an aggressive disease with nonspecific early symptoms. Its incidence and prognosis in young patients has shown considerable variability. Our objective was to retrospectively study patients from our institution aged <30 years with gastric carcinoma. The study was undertaken to describe the experience of gastric cancer in this population, and to demonstrate its specific clinical and pathological characteristics. We reviewed the cases of histologically confirmed gastric cancer between 1985 and 2006 at the Instituto Nacional de Cancerología of Mexico (INCan); emphasis in our review was placed on clinical presentation, diagnostic and therapeutic intervention, pathology, and the results. Thirty cases of gastric carcinoma were reviewed. The patients’ median age was 27 years (range, 18–30 years) and the male:female ratio was 1:1. Gastric cancer exhibits different behavior in patients aged, 30 years, but delay in diagnosis and the tumor’s behavior appear to be the most important factors in prognosis of the disease

  7. Under-diagnosis of alcohol-related problems and depression in a family practice in Japan

    Directory of Open Access Journals (Sweden)

    Yamada Kenshi

    2008-09-01

    Full Text Available Abstract Aim The aim of this survey was to assess the accuracy of a family physician's diagnosis of depression and alcoholism. Methods Consecutive new adult patients attending a family practice in Japan between April 2004 and August 2006 were enrolled. Excluded were those with dementia or visual disturbance, and emergency cases. Participants completed a questionnaire regarding their complaints and socio-demographics. A research nurse conducted the Japanese version of the Mini-International Neuropsychiatric Interview (J-MINI in the interview room. The doctor independently performed usual practice and recorded his own clinical diagnoses. A researcher listed the clinical diagnoses and complaints, including J-MINI or clinically-diagnosed alcoholism and depression, using the International Classifications for Primary Care, Second Edition (ICPC-2 and calculated kappa statistics between the J-MINI and clinical diagnoses. Results Of the 120 adult first-visit patients attending the clinics, 112 patients consented to participate in the survey and were enrolled. Fifty-one subjects were male and 61 female, and the average age was 40.7 ± 13.2 years. Eight alcohol-related disorders and five major depressions were diagnosed using the J-MINI, whereas no cases of alcoholism and eight depressions were diagnosed by the physician. Clinically overlooked patients tended to have acute illnesses like a common cold. Concordance between the clinical and research diagnosis was achieved only for three episodes of Major depression, resulting in a kappa statistic of 0.43. Conclusion Although almost half of the major depressions were identified, all alcoholism was missed. A mental health screening instrument might be beneficial in family practice, especially to detect alcoholism.

  8. Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes.

    Science.gov (United States)

    Blosnich, John R; Cashy, John; Gordon, Adam J; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Fine, Michael J

    2018-04-04

    Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients' clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity. Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients' clinician text notes were extracted and searched for transgender-related words and phrases. Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22 072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate. Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.

  9. Gear fault diagnosis under variable conditions with intrinsic time-scale decomposition-singular value decomposition and support vector machine

    Energy Technology Data Exchange (ETDEWEB)

    Xing, Zhanqiang; Qu, Jianfeng; Chai, Yi; Tang, Qiu; Zhou, Yuming [Chongqing University, Chongqing (China)

    2017-02-15

    The gear vibration signal is nonlinear and non-stationary, gear fault diagnosis under variable conditions has always been unsatisfactory. To solve this problem, an intelligent fault diagnosis method based on Intrinsic time-scale decomposition (ITD)-Singular value decomposition (SVD) and Support vector machine (SVM) is proposed in this paper. The ITD method is adopted to decompose the vibration signal of gearbox into several Proper rotation components (PRCs). Subsequently, the singular value decomposition is proposed to obtain the singular value vectors of the proper rotation components and improve the robustness of feature extraction under variable conditions. Finally, the Support vector machine is applied to classify the fault type of gear. According to the experimental results, the performance of ITD-SVD exceeds those of the time-frequency analysis methods with EMD and WPT combined with SVD for feature extraction, and the classifier of SVM outperforms those for K-nearest neighbors (K-NN) and Back propagation (BP). Moreover, the proposed approach can accurately diagnose and identify different fault types of gear under variable conditions.

  10. Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis.

    Science.gov (United States)

    Gebauer, Sarah; Salas, Joanne; Scherrer, Jeffrey F

    2017-01-01

    Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations. Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics. This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry. Eligibility criteria included age ≥18 years, free of HIV and cancer, and presenting to primary care with a new diagnosis of back pain, resulting in1646 patients included. Patients' nSES was determined using ZIP code and calculating a validated index of 7 census-tract variables. Multinomial logistic regression was used to measure the association between nSES and 3 treatment outcomes compared with no pharmacologic management. Outcomes included opioid prescription, nonsteroidal anti-inflammatory (NSAID)/muscle relaxant prescription, or combined opioid/nonopioid treatment within 90 days of initial presentation. Covariates included age, sex, race, high clinic utilization (HCU), depression, anxiety, substance use, obesity, comorbidities, smoking, number of pain conditions, and physical therapy (PT) referral. The cohort was 67.9% female with an average age of 55.72 years (Standard Error [SE] = 0.387). Compared with no pharmacologic treatment, individuals in the low nSES group had 63% higher odds of receiving an opioid only compared with the high nSES group (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.01 to 2.62). There was no significant association between nSES and odds of nonopioid or combined treatment compared with no pharmacotherapy (OR, 1.17; 95% CI, 0.97 to 1.50), (OR, 1.09; 95% CI, 0.67 to 1.78), respectively. Covariates associated with increased odds of opioid only included HCU, ever smoker, and increasing comorbidity index. PT referral was associated with NSAID/muscle relaxant only, and

  11. What is happening under the surface? Power, conflict and the performance of medical teams.

    Science.gov (United States)

    Janss, Rozemarijn; Rispens, Sonja; Segers, Mien; Jehn, Karen A

    2012-09-01

    The effect of teamwork on team performance is broadly recognised in the medical field. This recognition is manifested in educational programmes in which attention to interpersonal behaviours during teamwork is growing. Conflict and power differences influence interpersonal behaviours and are marked topics in studies of group functioning in the social and organisational psychology literature. Insights from the domain of social sciences put the ongoing improvement of teamwork into broader perspective. This paper shows how knowledge from the domain of social and organisational psychology contributes to the understanding of teamwork in the medical environment. More specifically, this paper suggests that unfolding the underlying issues of power and conflict within medical teams can be of extra help in the development of educational interventions aimed at improving team performance. We review the key social psychology and organisational behaviour literature concerning power and conflict, and relate the insights derived from this to the team process of ad hoc medical action teams. We present a theoretical framework in which insights into power and conflict are used to explain and predict team dynamics in ad hoc medical action teams. Power and conflict strongly influence interpersonal behaviour. Characteristics of medical action teams give rise to all kinds of issues of disagreement and are accompanied by complex issues of intra-team power distribution. We argue that how team members coordinate, cooperate and communicate is steered by members' personal motivations, which, in turn, strongly depend on their perceptions of power and conflict. Given the importance of the performance of these teams, we suggest future directions for the development of training interventions building on knowledge and theories derived from social and organisational psychology. © Blackwell Publishing Ltd 2012.

  12. Diagnosis and medical treatment of otitis externa in the dog and cat : review article

    Directory of Open Access Journals (Sweden)

    L.S. Jacobson

    2002-07-01

    Full Text Available Otitis externa is no longer viewed as an isolated disease of the ear canal, but is a syndrome that is often a reflection of underlying dermatological disease. Causes are classified as predisposing (increase the risk of otitis ; primary (directly induce otitis, secondary (contribute to otitis only in an abnormal ear or in conjunction with predisposing factors and perpetuating (result from inflammation and pathology in ear, prevent resolution of otitis. Common primary causes include foreign bodies, hypersensitivity (particularly atopy and food allergy, keratinisation disorders (most commonly primary idiopathic seborrhoea and hypothyroidism and earmites, particularly in cats. A systematic diagnostic procedure is required to identify causes and contributing factors. This should include history, clinical examination, otoscopy and cytology in all cases and culture and sensitivity as well as otitis media assessment and biopsy in severe and recurrent cases. Ancillary tests may be required depending on the underlying cause. Treatment consists of identifying and addressing predisposing and primary factors ; cleaning the ear canal ; topical therapy ; systemic therapy where necessary ; client education ; follow-up ; and preventive and maintenance therapy as required.

  13. Varsity Medical Ethics Debate 2015: should nootropic drugs be available under prescription on the NHS?

    Science.gov (United States)

    Thorley, Emma; Kang, Isaac; D'Costa, Stephanie; Vlazaki, Myrto; Ayeko, Olaoluwa; Arbe-Barnes, Edward H; Swerner, Casey B

    2016-09-13

    The 2015 Varsity Medical Ethics debate convened upon the motion: "This house believes nootropic drugs should be available under prescription". This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate.

  14. [Case report: Diagnosis under the microscope - disseminated echninococcosis, the multilocular form with protoscoleces].

    Science.gov (United States)

    Jůza, Tomáš; Jůzová, Alena; Gajdošová, Tatiana

    Echinococcosis (hydatidosis) is a rare severe tissue parasitosis. In the Czech Republic it is caused by two species of tapeworm: Echinococcus granulosus or Echinococcus multilocularis. The species differ in both their usual hosts during their life cycle as well as in the typical form of lesions in infested tissues. In both cases the liver is the most common primary infested organ.We describe an autopsy case of a massive hepatic parasitic lesion in an 81 year-old man. There were metastatic parasitic cysts in both lungs and the hepatic mass spread per continuitatem in the right adrenal gland. The lesion was microscopically represented by small cystic forms with PAS positive laminar membranes and frequent occurrence of protoscoleces in the peripheral parts of the liver and the adrenal gland.The diagnosis of echinococcosis was settled after microscopic exploration of necroptic material. The overall appearance and pattern of spreading corresponded to alveolar echinococcosis, however the massive presence of protoscoleces in the liver is very rare for E. multilocularis. Protoscoleces are usually found in infections caused by E. granulosus. Cystic echinococcosis typically presents with one larger cyst or a small number of bigger cysts with prominent fibrous rim. Because of the unavailability of molecular diagnostic methods (PCR, immunohistochemistry), that are able to distinguish individual species of parasite, the case was closed according to the typical histological findings as disseminated alveolar echinococcosis with the rare appearance of protoscoleces with possible association with immunosuppressive therapy.We have found about ten other cases of alveolar echinococcosis published in last ten years in the Czech Republic. All these cases were diagnosed in living patients. It is assumed that most of these patients were infected in the vicinity of their homes.

  15. Sexual dysfunction and the underlying medical problems in post-menopausal women

    Directory of Open Access Journals (Sweden)

    Soheila Nazarpour

    2016-02-01

    Full Text Available Background: Sexual dysfunction could be under the influence of some underlying medical problems. The purpose of this study is to examine the relationship between medical problems and sexual function in post-menopausal women. Methods: This is a community-based, descriptive-correlation study of 405 post-menopausal women residing in Chalus and Nowshahr cities, North of Iran, aged 40 to 65 years old from October 2013 to May 2014. A multistage, randomized sampling was conducted. The data was acquired through interviews using the Female Sexual Function Index (FSFI questionnaire and a researcher-made questionnaire, and was analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models. Results: 51.4% of the subjects had medical conditions. Cardiovascular disorders were the most common diseases among the subjects. 61% of the women were suffering from female sexual dysfunction (FSD. Sexual dysfunction in patients with medical conditions was significantly higher (P= 0.037. Scores of arousal (P= 0.000, orgasm (P= 0.018, and satisfaction (P= 0.026, as well as the FSFI total score (P= 0.005, were significantly lower in subjects with cardiovascular disorders. Scores of desire (P= 0.001, arousal (P= 0.006, lubrication (P= 0.010, orgasm (P= 0.004, and satisfaction (P= 0.022, as well as the FSFI total score (P= 0.017, were significantly lower in subjects with diabetes. Scores of pain were significantly lower in subjects with musculoskeletal disorders (P= 0.041, they experienced more pain during intercourse. In domains of arousal (P= 0.030, satisfaction (P= 0.040, and pain (P= 0.044, the scores of those taking antihypertensive medications were significantly lower than the scores of the rest of the subjects. Scores of desire (P= 0.001, arousal (P= 0.006, orgasm (P= 0.006, and satisfaction (P= 0.048, as well as the FSFI total score (P= 0.006, were significantly lower in those taking antidiabetic drugs. And lastly

  16. Medical attention proposal for patients under the iodo therapy in cardiac arrest cases

    International Nuclear Information System (INIS)

    Pinto, A.L.; Bacelar, A.; Campomar, A.; Fialkowski, S.; Zaluski, M.A.; Lucena, A.F.

    1996-01-01

    This research has like aim to present a proposition about how to attend the patients which are under the iodo therapy, and the possibility they can show a cardiac arrest during their hospitalization. The physical medical department with the nurse group and the team of ICU (Intensive Care Unit) looked for to establish basic norms of radiological protection in order to avoid the radiation and contamination of all workers involved with one patient, without changing the routine of attendance service. We analyzed all rules of service including the attendance the hospital room and mainly if it is necessary to lead the patient to the ICU. (authors). 4 refs

  17. The Experience in Nicaragua: Childhood Leukemia in Low Income Countries—The Main Cause of Late Diagnosis May Be “Medical Delay”

    Directory of Open Access Journals (Sweden)

    C. De Angelis

    2012-01-01

    Full Text Available Background. The event-free survival for pediatric leukemia in low-income Countries is much lower than in high-income countries. Late diagnosis, which is regarded as a contributing factor, may be due to “parental” or “medical” delay. Procedures. The present study analyses determinants of lag time from first symptoms to diagnosis of leukemia, comparing pediatric (0–16 years old patients in two referral centers, one in Nicaragua and one in Italy. An observational retrospective study was conducted to assess factors influencing the time to diagnosis. Results. 81 charts of children diagnosed with acute myeloid leukemia or lymphoblastic leukemia were analyzed from each centre. Median lag time to diagnosis was higher in Nicaragua than in Italy (29 versus 14 days, P<0.001 and it was mainly due to “physician delay” (16.5 versus 7 days, P<0.001, whereas “patient delay” from symptoms to first medical assessment was similar in the two centers (7 versus 5 days, P=0.27. Moreover, median lag time from symptoms to diagnosis was decreased in Nicaraguan districts were a specific training program upon childhood oncological diseases was carried out (20.5 versus 40 days, P=0.0019. Conclusions. Our study shows that delay in diagnosis of childhood leukemia is mainly associated with “physician delay” and it may be overcome by programs of continuous medical education.

  18. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: Executive Summary of recommendations

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...

  19. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia.

    Science.gov (United States)

    Bismark, Marie; Morris, Jennifer; Thomas, Laura; Loh, Erwin; Phelps, Grant; Dickinson, Helen

    2015-11-16

    To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles. Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. 30 medical practitioners who hold formal medical leadership roles. Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations. Published by the BMJ Publishing Group Limited. For permission to use

  20. Image Retrieval Based on Local Mesh Vector Co-occurrence Pattern for Medical Diagnosis from MRI Brain Images.

    Science.gov (United States)

    Jenitta, A; Samson Ravindran, R

    2017-08-31

    In modern health-care, for evidence-based diagnosis, there is a requirement for an efficient image retrieval approach to retrieve the cases of interest that have similar characteristics from the large image databases. This paper presents a feature extraction approach that aims at extracting texture features present in the medical images using Local Pattern Descriptor (LPD) and Gray-level Co-occurrence Matrix (GLCM). As a main contribution, a novel local pattern named Local Mesh Vector Co-occurrence Pattern (LMVCoP) has been proposed by concatenating the Local Mesh Co-occurrence Pattern (LMCoP) and the Local Vector Co-occurrence Pattern (LVCoP). The fusion of GLCM with the Local Mesh Pattern (LMeP) and the Local Vector Pattern (LVP) produces LMCoP and LVCoP respectively. The LMVCoP method has been investigated on the Open Access Series of Imaging Studies (OASIS): a Magnetic Resonance Imaging (MRI) brain image database. LMVCoP descriptor achieves 87.57% of ARP and 53.21% of ARR which are higher than the existing methods of LTCoP, PVEP, LBDP, LMeP and LVP. The LMVCoP method enhances the retrieval results of LMeP/LVP from 81.36%/83.52% to 87.57% in terms of ARP on OASIS MRI brain database.

  1. Incidence of academic failure and its underlying factors in Lorestan university of medical sciences

    Directory of Open Access Journals (Sweden)

    Farzad Ebrahimzadeh

    2016-02-01

    Full Text Available Background: Academic failure, conceived of as lack of success in one’s education, is of paramount importance for students of medical sciences and it might lead to more acute problems. The present study set out to investigate the prevalence and underlying reasons of academic failure in Lorestan University of medical sciences.  Materials and Methods: In this cohort study, academic records of all students of Lorestan University of Medical Sciences during the academic years of 2006-2011 were collected from education and student affair center and also, demographic and educational records were entered into a checklist. Inappropriate grade point average, being a provisional student, prolonged graduation, expulsion and dropout were taken into account as academic failure. To model the related effective factors, logistic regression was adopted and significance level was set at 0.05. Results: The cumulative incidence of academic failure was about 25.1%. Factors such as department, being self-funded or government-funded student, academic grade students are pursuing, the elapsed time between academic grades, gender and location of residence were related to academic failure (P<0.05. It is worth mentioning that no relationship was observed between the academic failure and being accepted based on quota system. Conclusion: The most important at risk groups were students of department of medicine and health, associate or medical doctoral students, self-funded students, students with a considerable time elapsed between their academic grades, male students and students living in dormitory. It is suggested that these students refer to consulting centers of university or educational supervisors and receive particular attention.

  2. MOVING FROM HISTOPATHOLOGY TO MOLECULAR TOOLS IN THE DIAGNOSIS OF MOLLUSKS DISEASES OF CONCERN UNDER EU LEGISLATION

    Directory of Open Access Journals (Sweden)

    Raquel Aranguren

    2016-11-01

    Full Text Available One of the main factors limiting molluscs production is the presence of pathogens and diseases. Disease agent transfer via transfers of live molluscs has been a major cause of disease outbreaks and epizootics. Because of that, the European Union has adopted several decisions and directives, the last in 2006 (2006/88/EC to control movements of marine organisms over the European countries. Once the disease is established in a determined area its eradication is a complicated task because life cycle of pathogens are not completely known and only a good and early diagnosis of the disease could be the most appropriate way to deal with it. Besides, molluscs do not have an adaptive immune response and vaccination strategies are not possibleMolluscs listed diseases under EU legislation are mainly protozoan parasites, that’s why histological techniques are recognized for their diagnosis. However, molecular techniques are being increasingly used primarily as confirmatory techniques of the presence of the pathogens but also in disease monitoring programs. Research perspectives are mainly focussed in the optimization, of the already described techniques to gain in sensitivity and sensibility and in the development of new molecular biology techniques (quantitative real time PCRs, that are faster and easier to apply and that allow a positive diagnosis even in early stages of infection. However, molecular tools detect DNA sequences of the pathogen which does not imply that pathogen is viable in the cell host and the infection is established. Consequently, it needs to be validated against other techniques, such as histology or in situ hybridization, so that its reliability can be determined.

  3. How learning analytics can early predict under-achieving students in a blended medical education course.

    Science.gov (United States)

    Saqr, Mohammed; Fors, Uno; Tedre, Matti

    2017-07-01

    Learning analytics (LA) is an emerging discipline that aims at analyzing students' online data in order to improve the learning process and optimize learning environments. It has yet un-explored potential in the field of medical education, which can be particularly helpful in the early prediction and identification of under-achieving students. The aim of this study was to identify quantitative markers collected from students' online activities that may correlate with students' final performance and to investigate the possibility of predicting the potential risk of a student failing or dropping out of a course. This study included 133 students enrolled in a blended medical course where they were free to use the learning management system at their will. We extracted their online activity data using database queries and Moodle plugins. Data included logins, views, forums, time, formative assessment, and communications at different points of time. Five engagement indicators were also calculated which would reflect self-regulation and engagement. Students who scored below 5% over the passing mark were considered to be potentially at risk of under-achieving. At the end of the course, we were able to predict the final grade with 63.5% accuracy, and identify 53.9% of at-risk students. Using a binary logistic model improved prediction to 80.8%. Using data recorded until the mid-course, prediction accuracy was 42.3%. The most important predictors were factors reflecting engagement of the students and the consistency of using the online resources. The analysis of students' online activities in a blended medical education course by means of LA techniques can help early predict underachieving students, and can be used as an early warning sign for timely intervention.

  4. Adverse pregnancy and birth outcomes associated with underlying diagnosis with and without assisted reproductive technology treatment.

    Science.gov (United States)

    Stern, Judy E; Luke, Barbara; Tobias, Michael; Gopal, Daksha; Hornstein, Mark D; Diop, Hafsatou

    2015-06-01

    To compare the risks for adverse pregnancy and birth outcomes by diagnoses with and without assisted reproductive technology (ART) treatment to non-ART pregnancies in fertile women. Historical cohort of Massachusetts vital records linked to ART clinic data from Society for Assisted Reproductive Technology Clinic Outcome Reporting System. Not applicable. Diagnoses included male factor (ART only), endometriosis, ovulation disorders, tubal (ART only), and reproductive inflammatory disorders (non-ART only). Pregnancies resulting in singleton and twin live births from 2004 to 2008 were linked to hospital discharges in women who had ART treatment (n = 3,689), women with no ART treatment in the current pregnancy (n = 4,098), and non-ART pregnancies in fertile women (n = 297,987). None. Risks of gestational diabetes, prenatal hospitalizations, prematurity, low birth weight, and small for gestational age were modeled using multivariate logistic regression with fertile deliveries as the reference group adjusted for maternal age, race/ethnicity, education, chronic hypertension, diabetes mellitus, and plurality (adjusted odds ratios [AORs] and 95% confidence intervals [CIs]). Risk of prenatal hospital admissions was increased for endometriosis (ART: 1.97, 1.38-2.80; non-ART: 3.34, 2.59-4.31), ovulation disorders (ART: 2.31, 1.81-2.96; non-ART: 2.56, 2.05-3.21), tubal factor (ART: 1.51, 1.14-2.01), and reproductive inflammation (non-ART: 2.79, 2.47-3.15). Gestational diabetes was increased for women with ovulation disorders (ART: 2.17, 1.72-2.73; non-ART: 1.94, 1.52-2.48). Preterm delivery (AORs, 1.24-1.93) and low birth weight (AORs, 1.27-1.60) were increased in all groups except in endometriosis with ART. The findings indicate substantial excess perinatal morbidities associated with underlying infertility-related diagnoses in both ART-treated and non-ART-treated women. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia

    Science.gov (United States)

    Bismark, Marie; Morris, Jennifer; Thomas, Laura; Loh, Erwin; Phelps, Grant; Dickinson, Helen

    2015-01-01

    Objective To elicit medical leaders’ views on reasons and remedies for the under-representation of women in medical leadership roles. Design Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. Setting Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. Participants 30 medical practitioners who hold formal medical leadership roles. Results Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a ‘natural’ result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains—perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. Conclusions While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations

  6. [Effects of critical ultrasonic management of Peking Union Medical College Hospital on the etiological diagnosis of patients with acute respiratory failure].

    Science.gov (United States)

    Zhao, Hua; Wang, Xiaoting; Liu, Dawei; Zhang, Hongmin; He, Huaiwu; Long, Yun

    2015-12-15

    To evaluate the diagnostic value and potential therapeutic impact of Peking Union Medical College Hospital critical ultrasonic management (PCUM) in the early management of critically ill patients with acute respiratory failure (ARF). Patients admitted into the ICU of Peking Union Medical College Hospital for ARF were consecutively recruited over a 18-month period. Patients were randomly divided into conventional group and PCUM group (critical care ultrasonic examination was added in addition to conventional examinations). The two groups were compared with respect to time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to treatment response, time to other examination. A total of 187 patients were included in this study. The two groups showed no significant differences in general clinical information or final diagnosis (P > 0.05). The PCUM group had a shorter time to preliminary diagnosis, time to final diagnosis, time to treatment response, time to X-ray/CT examination, and a higher diagnostic accuracy than the conventional group (P acute respiratory distress syndrome (ARDS) (sensitivity 92.0%, specificity 98.5%), acute pulmonary edema (sensitivity 94.7%, specificity 96.1%), pulmonary consolidation (sensitivity 85.7%, specificity 98.6%), COPD/asthma (sensitivity 84.2%, specificity 98.7%). The PCUM is seem to be an attractive complementary diagnostic tool and able to contribute to an early therapeutic decision for the patients with ARF.

  7. Instrumentation for medical diagnosis and research with radionuclides in the developing countries. Progress report, June 1, 1977--May 31, 1978

    Energy Technology Data Exchange (ETDEWEB)

    Dudley, R.A.

    1978-07-01

    This project seeks to bring about a more effective use of nuclear instruments in medical applications of radionuclides in developing countries by facilitating selection of appropriate applications, by stimulating the design of instruments capable of performing these applications satisfactorily under the conditions prevailing, and by encouraging improved maintenance. A pilot cost-effectiveness analysis of nuclear medicine applications has been completed, suggesting two topics for further investigation and demonstrating that such analyses can yield useful insights. In the realm of instrument design, we have further developed our prototype well scintillation counter, provided three such instruments for tests in the field, and encouraged its production by others. In addition, we have examined design issues for liquid scintillation counters, radiorespirometry counting devices, whole-body counters, and electrical power supplies. We have completed a survey of maintenance in 8 countries in Southeast Asia and are analyzing the results. Preparations are underway for surveys in three further regions.

  8. Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students.

    Science.gov (United States)

    Scott, Karen M; Berlec, Špela; Nash, Louise; Hooker, Claire; Dwyer, Paul; Macneill, Paul; River, Jo; Ivory, Kimberley

    2017-03-01

    A positive and respectful learning environment is fundamental to the development of professional identities in healthcare. Yet medical students report poor behaviour from healthcare professionals that contradict professionalism teaching. An interdisciplinary group designed and implemented a drama-based workshop series, based on applied theatre techniques, to help students develop positive professional qualities and interpersonal skills to deal with challenges in the healthcare setting. We piloted the workshops at the University of Sydney in 2015. Attendees completed evaluation questionnaires and participated in a focus group or interview. Of 30 workshop attendances, there were 29 completed questionnaires and three participants attended a focus group or interview. Workshop activities were rated as 'very good' or 'good' by 21/22 (95.5%). Thematic analysis of qualitative data highlighted the rationale for participation (to deal with bullying, prevent becoming a bully, learn social skills), workshop benefits (express emotions, learn about status dynamics and deconstructing personalities, empathy, fun), challenges (meeting participants' expectations, participants' need for further practice) and implications for medical education (need to develop awareness of others' perspectives). Our research has shown that there is momentum to challenge mistreatment in medical education. While a multipronged approach is needed to generate systemic change, this pilot offers a positive and creative innovation. It helps students improve their interpersonal skills and sense of self to deal with challenges in the healthcare setting, including mistreatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. The study of diagnosis status and, transfer time of stroke patients transferred by pre-hospital emergency medical system (EMS to Vali-Asr hospital in Arak City

    Directory of Open Access Journals (Sweden)

    Saiedeh Bahrampouri

    2013-08-01

    Full Text Available Introduction: Stroke is main cause of death and disability in worldwide and emergency care can decrease complications. Emergency Medical System transferred half of stroke patients to hospital, so improve accuracy of diagnosis may accelerated treatment. This study aimed to determine diagnosis status and, transfer time of stroke patients transferred by prehospital Emergency Medical System to hospital in Arak City. Methods: This study was descriptive -analytic study and all 43 patient’s records with a diagnosis of stroke that transferred by Emergency Medical System to hospital in Arak City was selected. The study Checklist was contained information about age, sex, type of accident prehospital, response time, scene time, transfer time and total time from inpatients records and Emergency Center statistics .Regarding data analysis,SPSS19 software and descriptive statistical tests were used. Results: Mean (SD of age all patients were 73/7±3/8 and 51/2% were women. Ambulance paramedics' stroke diagnosis was correct in 15 (34/9%,20(46/5%of false and 8(18/6% not diagnosed for stroke patients who initially presented to them. The most common non stroke conditions were confusion. Mean response time and scene time, transfer time and total time were 6/9,16/9,9/1 and 35/3 minutes, respectively. In patients with correct diagnose stroke, mean response, scene, transfer and total time were 7,17/1,3/9 and 35/7 minutes. The people with the wrong diagnosis or no diagnosis of stroke by emergency medical personnel were taken to hospital, Mean response, scene, transfer and total time were 6/9, 16/8,9/7 and 33/5 minutes. Conclusions: The results of this study showed that, the correct diagnosis by EMS personnel could be resulted faster transferring patient to definite treatment center.It is recommended to develop prehospital diagnosis tool of stroke, which is contextually adapted and appropriate to facilitate diagnose of strokes and improve the quality of care.

  10. Nano-systems for medical applications: biological detection, drug delivery, diagnosis and therapy; Applications medicales des nanoparticules: detection biologique, delivrance de medicaments, diagnostic, therapie

    Energy Technology Data Exchange (ETDEWEB)

    Riviere, Ch. [Nano-H SAS, 69 - Lyon (France); Roux, S.; Tillement, O. [Lyon-1 Univ. Claude Bernard, Lab. de Physico-Chimie des Materiaux Luminescents, UMR 5620 CNRS, 69 - Villeurbanne (France); Billotey, C. [Lyon-1 Univ. Claude Bernard, Lab. CREATIS-Animage, UMR 5515 CNRS, U630 INSERM, INSA de Lyon, 69 - Villeurbanne (France); Perriat, P. [Groupe d' Etudes de Metallurgie Physique et de Physique des Materiaux, UMR 5510 CNRS-INSA de Lyon, 69 - Villeurbanne (France)

    2006-05-15

    A review. For a couple of decades, greater and greater connections have been made between nano-technology, biology and medicine. After a rapid description of the particles most often used for biological and medical purposes, the review will detail their potential applications in both domains. In the field of biological detection, a large number of new detection systems is offered by noble metals and semi-conductors, which exhibit very specific nanometer-scale induced properties. In the field of diagnosis and therapeutic applications, particles become more and more sophisticated with an increased possibility of specific targeting, drug delivery triggering and combination of both diagnosis and therapy. (authors)

  11. Profile of medical care costs in patients with amyotrophic lateral sclerosis in the Medicare programme and under commercial insurance.

    Science.gov (United States)

    Meng, Lisa; Bian, Amy; Jordan, Scott; Wolff, Andrew; Shefner, Jeremy M; Andrews, Jinsy

    2018-02-01

    To determine amyotrophic lateral sclerosis (ALS)-associated costs incurred by patients covered by Medicare and/or commercial insurance before, during and after diagnosis and provide cost details. Costs were calculated from the Medicare Standard Analytical File 5% sample claims data from Parts A and B from 2009, 2010 and 2011 for ALS Medicare patients aged ≥70 years (monthly costs) and ≥65 years (costs associated with disability milestones). Commercial insurance patients aged 18-63 years were selected based on the data provided in the Coordination of Benefits field from Truven MarketScan® in 2008-2010. Monthly costs increased nine months before diagnosis, peaked during the index month (Medicare: $10,398; commercial: $9354) and decreased but remained high post-index. Costs generally shifted from outpatient to inpatient and private nursing after diagnosis; prescriptions and durable medical equipment costs were much higher for commercial patients post-diagnosis. Patients appeared to progress to disability milestones more rapidly as their disease progressed in severity (14.4 months to non-invasive ventilation [NIV] vs. 16.6 months to hospice), and their costs increased accordingly (NIV: $58,973 vs. hospice: $76,179). For newly diagnosed ALS patients in the U.S., medical costs are substantial and increase rapidly and substantially with each disability milestone.

  12. Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of "osteitis" be changed to "early osteomyelitis"?

    Science.gov (United States)

    Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy

    2017-10-01

    To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; "osteitis without osteomyelitis" (OW), "osteitis but cannot exclude early osteomyelitis" (OCEO) and "early osteomyelitis" (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters.

  13. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  14. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    Science.gov (United States)

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  15. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf

    2010-01-01

    decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area......American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical...

  16. Diagnosis and management of glycogen storage disease type I: a practice guideline of the American College of Medical Genetics and Genomics.

    Science.gov (United States)

    Kishnani, Priya S; Austin, Stephanie L; Abdenur, Jose E; Arn, Pamela; Bali, Deeksha S; Boney, Anne; Chung, Wendy K; Dagli, Aditi I; Dale, David; Koeberl, Dwight; Somers, Michael J; Wechsler, Stephanie Burns; Weinstein, David A; Wolfsdorf, Joseph I; Watson, Michael S

    2014-11-01

    Glycogen storage disease type I (GSD I) is a rare disease of variable clinical severity that primarily affects the liver and kidney. It is caused by deficient activity of the glucose 6-phosphatase enzyme (GSD Ia) or a deficiency in the microsomal transport proteins for glucose 6-phosphate (GSD Ib), resulting in excessive accumulation of glycogen and fat in the liver, kidney, and intestinal mucosa. Patients with GSD I have a wide spectrum of clinical manifestations, including hepatomegaly, hypoglycemia, lactic acidemia, hyperlipidemia, hyperuricemia, and growth retardation. Individuals with GSD type Ia typically have symptoms related to hypoglycemia in infancy when the interval between feedings is extended to 3–4 hours. Other manifestations of the disease vary in age of onset, rate of disease progression, and severity. In addition, patients with type Ib have neutropenia, impaired neutrophil function, and inflammatory bowel disease. This guideline for the management of GSD I was developed as an educational resource for health-care providers to facilitate prompt, accurate diagnosis and appropriate management of patients. A national group of experts in various aspects of GSD I met to review the evidence base from the scientific literature and provided their expert opinions. Consensus was developed in each area of diagnosis, treatment, and management. This management guideline specifically addresses evaluation and diagnosis across multiple organ systems (hepatic, kidney, gastrointestinal/nutrition, hematologic, cardiovascular, reproductive) involved in GSD I. Conditions to consider in the differential diagnosis stemming from presenting features and diagnostic algorithms are discussed. Aspects of diagnostic evaluation and nutritional and medical management, including care coordination, genetic counseling, hepatic and renal transplantation, and prenatal diagnosis, are also addressed. A guideline that facilitates accurate diagnosis and optimal management of patients with

  17. CT findings in initial diagnosis and follow-up in surgically and medically treated intracerebral hemorrhage of non-traumatic and non-aneurysmatic origin

    International Nuclear Information System (INIS)

    Nahser, H.C.; Loehr, E.; Nau, H.E.; Reinhardt, V.

    1980-01-01

    The potential of computerized tomography (CT) in diagnosis and follow-up of intracerebral hemorrhage is demonstrated. The study is based on 37 patients suffering from medical diseases such as high blood pressure, diabetics, generalized arteriosclerosis, valvular heart disease and anticoagulation therapy. Ensuing complications, such as rupture into the ventricles and hydrocephalus, are being discussed. Special effort is made to explain the finding of the hyperdense ring structure occurring after contrast enhancement. (orig.) 891 MG/orig. 892 MKO [de

  18. IR Spectra of Different O2-Content Hemoglobin from Computational Study: Promising Detector of Hemoglobin Variant in Medical Diagnosis.

    Science.gov (United States)

    Zhou, Su-Qin; Chen, Tu-Nan; Ji, Guang-Fu; Wang, En-Ren

    2017-06-01

    IR spectra of heme and different O 2 -content hemoglobin were studied by the quantum computation method at the molecule level. IR spectra of heme and different O 2 -content hemoglobin were quantificationally characterized from 0 to 100 THz. The IR spectra of oxy-heme and de-oxy-heme are obviously different at the frequency regions of 9.08-9.48, 38.38-39.78, 50.46-50.82, and 89.04-91.00 THz. At 24.72 THz, there exists the absorption peak for oxy-heme, whereas there is not the absorption peak for de-oxy-heme. Whether the heme contains Fe-O-O bond or not has the great influence on its IR spectra and vibration intensities of functional groups in the mid-infrared area. The IR adsorption peak shape changes hardly for different O 2 -content hemoglobin. However, there exist three frequency regions corresponding to the large change of IR adsorption intensities for containing-O 2 hemoglobin in comparison with de-oxy-hemoglobin, which are 11.08-15.93, 44.70-50.22, and 88.00-96.68 THz regions, respectively. The most differential values with IR intensity of different O 2 -content hemoglobin all exceed 1.0 × 10 4  L mol -1  cm -1 . With the increase of oxygen content, the absorption peak appears in the high-frequency region for the containing-O 2 hemoglobin in comparison with de-oxy-hemoglobin. The more the O 2 -content is, the greater the absorption peak is at the high-frequency region. The IR spectra of different O 2 -content hemoglobin are so obviously different in the mid-infrared region that it is very easy to distinguish the hemoglobin variant by means of IR spectra detector. IR spectra of hemoglobin from quantum computation can provide scientific basis and specific identification of hemoglobin variant resulting from different O 2 contents in medical diagnosis.

  19. Accuracy of acute burns diagnosis made using smartphones and tablets: a questionnaire-based study among medical experts.

    Science.gov (United States)

    Blom, Lisa; Boissin, Constance; Allorto, Nikki; Wallis, Lee; Hasselberg, Marie; Laflamme, Lucie

    2017-12-13

    Remote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined. A review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults. A web-based questionnaire was created with 51 images of burns representing those cases. Burns specialists from two countries (South Africa and Sweden (n = 8 and 7 respectively)) and emergency medicine specialists from South Africa (n = 11) were contacted by email and asked to assess each burn's total body surface area (TBSA) and depth using a smartphone or tablet. The accuracy and inter-rater reliability of the assessments were measured using intraclass correlation coefficients (ICC), both for all cases aggregated and for paediatric and adult burn cases separately. Eight participants repeated the questionnaire on a computer and intra-rater reliability was calculated. The assessments of TBSA are of high accuracy all specialists aggregated (ICC = 0.82 overall and 0.81 for both child and adult cases separately) and remain high for all three participant groups separately. The burn depth assessments have low accuracy all specialists aggregated, with ICCs of 0.53 overall, 0.61 for child and 0.46 for adult cases. The most accurate assessments of depth are among South African burns specialists (reaching acceptable for child cases); the other two groups' ICCs are low in all instances. Computer-based assessments were similar to those made on handheld devices. As was the case for computer-based studies, burns images viewed on handheld devices may be a suitable means of seeking expert advice even with limited additional information when it comes to burn size but

  20. 75 FR 74063 - Supplemental Funding Under the Food and Drug Administration's Convener of Active Medical Product...

    Science.gov (United States)

    2010-11-30

    ... dissemination of Patient Medication Information (PMI). With this FOA, FDA proposes to further expand the scope... paragraphs. Patient Medication Information (PMI) To be able to use prescription medications safely, consumers... Guides. Such changes to the delivery of PMI may require changes to the Federal Food, Drug, and Cosmetics...

  1. How did market competition affect outpatient utilization under the diagnosis-related group-based payment system?

    Science.gov (United States)

    Kim, Seung Ju; Park, Eun-Cheol; Kim, Sun Jung; Han, Kyu-Tae; Jang, Sung-In

    2017-06-01

    Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. Population-based retrospective observational study. We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  2. Decision support tool for early differential diagnosis of acute lung injury and cardiogenic pulmonary edema in medical critically ill patients.

    Science.gov (United States)

    Schmickl, Christopher N; Shahjehan, Khurram; Li, Guangxi; Dhokarh, Rajanigandha; Kashyap, Rahul; Janish, Christopher; Alsara, Anas; Jaffe, Allan S; Hubmayr, Rolf D; Gajic, Ognjen

    2012-01-01

    At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.

  3. Improving medical diagnosis reliability using Boosted C5.0 decision tree empowered by Particle Swarm Optimization.

    Science.gov (United States)

    Pashaei, Elnaz; Ozen, Mustafa; Aydin, Nizamettin

    2015-08-01

    Improving accuracy of supervised classification algorithms in biomedical applications is one of active area of research. In this study, we improve the performance of Particle Swarm Optimization (PSO) combined with C4.5 decision tree (PSO+C4.5) classifier by applying Boosted C5.0 decision tree as the fitness function. To evaluate the effectiveness of our proposed method, it is implemented on 1 microarray dataset and 5 different medical data sets obtained from UCI machine learning databases. Moreover, the results of PSO + Boosted C5.0 implementation are compared to eight well-known benchmark classification methods (PSO+C4.5, support vector machine under the kernel of Radial Basis Function, Classification And Regression Tree (CART), C4.5 decision tree, C5.0 decision tree, Boosted C5.0 decision tree, Naive Bayes and Weighted K-Nearest neighbor). Repeated five-fold cross-validation method was used to justify the performance of classifiers. Experimental results show that our proposed method not only improve the performance of PSO+C4.5 but also obtains higher classification accuracy compared to the other classification methods.

  4. Health payment-induced poverty under China's New Cooperative Medical Scheme in rural Shandong.

    Science.gov (United States)

    Sun, Xiaoyun; Sleigh, Adrian C; Carmichael, Gordon A; Jackson, Sukhan

    2010-09-01

    To measure the incidence and severity of health payment-induced poverty of rural households under the New Cooperative Medical Scheme (NCMS) in rural Shandong, China. We collected primary data from a household survey to identify catastrophic health payments and measure associated health payment-induced poverty in a county of Shandong province. From a stratified random cluster sample of 3101 households, 375 households that might be at risk of catastrophic payments were identified and interviewed. A validity test of the screening method was conducted, from which we obtained the adjusted total number of households with catastrophic payments in the sample of 3101. The health payment-induced poverty incidence and severity were compared without and with NCMS reimbursements. Before the NCMS intervention, 5.06% of the sample households fell below the national poverty line due to health payments in 2004, compared with 4.03% after reimbursements. With NCMS reimbursements, the health payment-induced poverty gap of those households still remaining below the Chinese national poverty line dropped by 19.2% to an average of 977.2 Yuan. Out-of-pocket health payments remain a severe burden for rural households. Financial protection from the NCMS was limited.

  5. Evaluation of S100B blood level as a biomarker to avoid computed tomography in patients with mild head trauma under antithrombotic medication.

    Science.gov (United States)

    David, A; Mari, C; Vignaud, F; Masson, D; Planche, L; Bord, E; Bourcier, R; Frampas, E; Batard, E; Desal, H

    The goal of this prospective study was to analyze the potential of S100B protein as a negative predictive marker for intracranial hemorrhage (ICH) after mild head trauma (MHT) in patient under antithrombotic medication. Patients under antithrombotic medication who had MHT were consecutively included in this study. S100B blood levels were determined from samples drawn within 6hours after injury and were analyzed with the results of head CT performed within the 24hours after injury. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of S100B levels for the detection of ICH, with a cut-off set at 0.105μg/L, were calculated. A total of 308 patients (151 men and 157 women) with a mean age of 79.1±10.5years (SD) were included in the analysis. CT was positive for the presence of ICH in 33 patients (10.7%; 95% CI: 7.5-14.7%). In the study population, S100B showed a sensitivity of 84.8% (95%CI: 68.1-94.9%), a specificity of 30.2% (95% CI: 24.8-36.0%), a NPV of 94.3% (95% CI: 87.2-98.1%), and a PPV of 12.7% (95% CI: 8.6-17.9%) for the diagnosis of ICH. The results of this study suggest that a S100B serum levelmild head trauma in patients under antithrombotic medication. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  6. Change in cardio-protective medication and health-related quality of life after diagnosis of screen-detected diabetes: Results from the ADDITION-Cambridge cohort.

    Science.gov (United States)

    Black, J A; Long, G H; Sharp, S J; Kuznetsov, L; Boothby, C E; Griffin, S J; Simmons, R K

    2015-07-01

    Establishing a balance between the benefits and harms of treatment is important among individuals with screen-detected diabetes, for whom the burden of treatment might be higher than the burden of the disease. We described the association between cardio-protective medication and health-related quality of life (HRQoL) among individuals with screen-detected diabetes. 867 participants with screen-detected diabetes underwent clinical measurements at diagnosis, one and five years. General HRQoL (EQ5D) was measured at baseline, one- and five-years, and diabetes-specific HRQoL (ADDQoL-AWI) and health status (SF-36) at one and five years. Multivariable linear regression was used to quantify the association between change in HRQoL and change in cardio-protective medication. The median (IQR) number of prescribed cardio-protective agents was 2 (1 to 3) at diagnosis, 3 (2 to 4) at one year and 4 (3 to 5) at five years. Change in cardio-protective medication was not associated with change in HRQoL from diagnosis to one year. From one year to five years, change in cardio-protective agents was not associated with change in the SF-36 mental health score. One additional agent was associated with an increase in the SF-36 physical health score (2.1; 95%CI 0.4, 3.8) and an increase in the EQ-5D (0.05; 95%CI 0.02, 0.08). Conversely, one additional agent was associated with a decrease in the ADDQoL-AWI (-0.32; 95%CI -0.51, -0.13), compared to no change. We found little evidence that increases in the number of cardio-protective medications impacted negatively on HRQoL among individuals with screen-detected diabetes over five years. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. Review of Medical Malpractice Issues in Malaysia under Tort Litigation System

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-01-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  8. A review of medical malpractice issues in Malaysia under tort litigation system.

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-04-07

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability.

  9. Electronic health records and online medical records: an asset or a liability under current conditions?

    Science.gov (United States)

    Allen-Graham, Judith; Mitchell, Lauren; Heriot, Natalie; Armani, Roksana; Langton, David; Levinson, Michele; Young, Alan; Smith, Julian A; Kotsimbos, Tom; Wilson, John W

    2018-02-01

    Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records

  10. Critical evaluation of quality assurance in laboratory diagnosis of tuberculosis in selected nearby microscopic centers under RNTCP

    Directory of Open Access Journals (Sweden)

    Anuradha

    2013-01-01

    Full Text Available Objective: RNTCP relies on sputum smear microscopy for diagnosis, categorization of patients for treatment and assessment of their program. Therefore, it is crucial that the smear microscopy services provided are of highest quality possible. The current study is undertaken to do on site evaluation and Random blinded rechecking (RBRC of slides at selected microscopic centers. Material & Methods: Five microscopic centers were selected for onsite evaluation and Random Blinded rechecking. Slides were collected monthly from the respective DMCs. A questionnaire was developed to assess the overall operational conditions at the DMCs and a checklist was prepared to record the observation during the visit. RBRC slides were read by two microbiologists independently and results were compared with RNTCP results. Slides were read before and after restaining the slides. Results: After the evaluation of checklist and questionnaire, it was found that 100% centers were following the charts for smear preparation, staining and grading with adequate stock supply. One out of 5 centers had maximum number of slides with poor quality of smear (16.7%, 8% uneven smear and 14% slides with improper thickness. There was 100% concordance when reading five positive and five negative smears. The mean time spent on microscopic examination was 4.4 minutes, compared with recommended time of 10 minutes. Out of 828 slides rechecked under RBRC one low false negative error was found. Conclusion: The evaluation of quality control practices was found satisfactory. The laboratory staff was able to incorporate simple quality control procedures for AFB microscopy into their routine practice, resulting in reliable service. Onsite evaluation and RBRC are viable measures of laboratory performance and both should be continued.

  11. Critical evaluation of quality assurance in laboratory diagnosis of tuberculosis in selected nearby microscopic centers under RNTCP

    Directory of Open Access Journals (Sweden)

    Anuradha

    2013-08-01

    Full Text Available Objective: RNTCP relies on sputum smear microscopy for diagnosis, categorization of patients for treatment and assessment of their program. Therefore, it is crucial that the smear microscopy services provided are of highest quality possible. The current study is undertaken to do on site evaluation and Random blinded rechecking (RBRC of slides at selected microscopic centers. Material & Methods: Five microscopic centers were selected for onsite evaluation and Random Blinded rechecking. Slides were collected monthly from the respective DMCs. A questionnaire was developed to assess the overall operational conditions at the DMCs and a checklist was prepared to record the observation during the visit. RBRC slides were read by two microbiologists independently and results were compared with RNTCP results. Slides were read before and after restaining the slides. Results: After the evaluation of checklist and questionnaire, it was found that 100% centers were following the charts for smear preparation, staining and grading with adequate stock supply. One out of 5 centers had maximum number of slides with poor quality of smear (16.7%, 8% uneven smear and 14% slides with improper thickness. There was 100% concordance when reading five positive and five negative smears. The mean time spent on microscopic examination was 4.4 minutes, compared with recommended time of 10 minutes. Out of 828 slides rechecked under RBRC one low false negative error was found. Conclusion: The evaluation of quality control practices was found satisfactory. The laboratory staff was able to incorporate simple quality control procedures for AFB microscopy into their routine practice, resulting in reliable service. Onsite evaluation and RBRC

  12. The Logic of Problem-Solving in Clinical Diagnosis: A Course for Second-Year Medical Students.

    Science.gov (United States)

    Miller, Randolph A.; Schaffner, Kenneth F.

    1982-01-01

    A course to introduce medical students to formal models of medical diagnostic reasoning at the University of Pittsburgh School of Medicine is described. The students are encouraged to integrate facts and concepts from the basic sciences into strategies of diagnostic reasoning. (MLW)

  13. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Science.gov (United States)

    2010-07-01

    .... Consent may be express (i.e., given orally or in writing) or implied under the circumstances specified in... of 38 U.S.C. 1151(a): (1) Hospital care or medical services furnished under a contract made under 38...

  14. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services.

    Science.gov (United States)

    Paton, Carol; Crawford, Michael J; Bhatti, Sumera F; Patel, Maxine X; Barnes, Thomas R E

    2015-04-01

    Guideline recommendations for the pharmacologic treatment of personality disorder lack consensus, particularly for emotionally unstable personality disorder (EUPD), and there is limited information on current prescribing practice in the United Kingdom. To characterize the nature and quality of current prescribing practice for personality disorder across the United Kingdom, as part of a quality improvement program. A cross-sectional survey of self-selected psychiatric services providing care for adults with personality disorder (ICD-10 criteria) was conducted. Data were collected during May 2012. Of 2,600 patients with a diagnosis of personality disorder, more than two-thirds (68%) had a diagnosis of EUPD. Almost all (92%) patients in the EUPD subgroup were prescribed psychotropic medication, most commonly an antidepressant or antipsychotic, principally for symptoms and behaviors that characterize EUPD, particularly affective dysregulation. Prescribing patterns were similar between those who had a diagnosed comorbid mental illness and those who had EUPD alone, but the latter group was less likely to have had their medication reviewed over the previous year, particularly with respect to tolerability (53% vs 43%). The use of psychotropic medication in EUPD in the United Kingdom is largely outside the licensed indications. Whether the treatment target is identified as intrinsic symptoms of EUPD or comorbid mental illness may depend on the diagnostic threshold of individual clinicians. Compared with prescribing for EUPD where there is judged to be a comorbid mental illness, the use of off-label medication for EUPD alone is less systematically reviewed and monitored, so opportunities for learning may be lost. Treatment may be continued long term by default. © Copyright 2015 Physicians Postgraduate Press, Inc.

  15. Acute Medical conditions in under five year old children at a Public ...

    African Journals Online (AJOL)

    Objective: To determine the prevalence of childhood preventable and treatable medical conditions and the parent's/guardian's knowledge about the conditions and their management. Design: A descriptive cross-sectional study. Setting: Paediatric medical wards at Kenyatta National hospital Subjects: All children aged 0-60 ...

  16. Using Schemata for Diagnosis*

    OpenAIRE

    Turner, Roy M.

    1988-01-01

    Medical diagnosis is a planning task in which the operators are actions such as asking for information and drawing an inference. Diagnosis involves interleaving planning and plan execution, since information gathered by the diagnostician may change the future course of diagnosis. In this paper we present an approach to computer-based medical diagnosis called schema-based reasoning. This approach represents the reasoner's planning knowledge as packets of procedural information called schemata;...

  17. 20 CFR 725.702 - Claims for medical benefits only under section 11 of the Reform Act.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Claims for medical benefits only under section 11 of the Reform Act. 725.702 Section 725.702 Employees' Benefits EMPLOYMENT STANDARDS... Reform Act. (a) Section 11 of the Reform Act directs the Secretary of Health, Education and Welfare to...

  18. "At times these ancient facts seem to lie before me like a patient on a hospital bed'--retrospective diagnosis and ancient medical history.

    Science.gov (United States)

    Leven, K H

    2004-01-01

    Research in ancient medical history, Greek and Roman as well as Mesopotamian and Egyptian, is usually done by philologically trained scholars; the ability to read texts in their original language is fundamental (though not sufficient) for any substantial work. There is, however, in such works the notion that something may be missing in fully understanding medicine of a certain time and culture. Does a medical historian of ancient medicine need, in addition to his philological and historical skills, a medical education? And in what way is a 'medical approach' to ancient medicine useful? Is it possible to stand at the bedside of a Hippocratic patient as a clinician or reconstruct the 'pathocoenosis', as Mirko D. Grmek (+ 2000) coined it, of ancient Greece? The present paper outlines the problem of applying present medical knowledge to ancient sources and touches on the topic of primary perception of disease and illness. An important aspect is that disease entities change in their socio-cultural setting. Examples ranging from the supposed Lupus erythematodes of the Assyrian king Esarhaddon to cases in the Hippocratic Epidemiae and plague descriptions of Greek authors illustrate the problem of retrospective diagnosis.

  19. Medical Humanitarianism Under Atmospheric Violence: Health Professionals in the 2013 Gezi Protests in Turkey.

    Science.gov (United States)

    Aciksoz, Salih Can

    2016-06-01

    During the 2013 Gezi protests in Turkey, volunteering health professionals provided on-site medical assistance to protesters faced with police violence characterized by the extensive use of riot control agents. This led to a government crackdown on the medical community and the criminalization of "unauthorized" first aid amidst international criticisms over violations of medical neutrality. Drawing from ethnographic observations, in-depth interviews with health care professionals, and archival research, this article ethnographically analyzes the polarized encounter between the Turkish government and medical professionals aligned with social protest. I demonstrate how the context of "atmospheric violence"-the extensive use of riot control agents like tear gas-brings about new politico-ethical spaces and dilemmas for healthcare professionals. I then analyze how Turkish health professionals framed their provision of health services to protestors in the language of medical humanitarianism, and how the state dismissed their claims to humanitarian neutrality by criminalizing emergency care. Exploring the vexed role that health workers and medical organizations played in the Gezi protests and the consequent political contestations over doctors' ethical, professional, and political responsibilities, this article examines challenges to medical humanitarianism and neutrality at times of social protest in and beyond the Middle East.

  20. Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice.

    Science.gov (United States)

    Paton, Carol; Bhatti, Sumera; Purandare, Kiran; Roy, Ashok; Barnes, Tre

    2016-12-05

    To determine the prevalence and quality of antipsychotic prescribing for people with intellectual disability (ID). A clinical audit of prescribing practice in the context of a quality improvement programme. Practice standards for audit were derived from relevant, evidence-based guidelines, including NICE. Data were mainly collected from the clinical records, but to determine the clinical rationale for using antipsychotic medication in individual cases, prescribers could also be directly questioned. 54 mental health services in the UK, which were predominantly NHS Trusts. Information on prescribing was collected for 5654 people with ID. Almost two-thirds (64%) of the total sample was prescribed antipsychotic medication, of whom almost half (49%) had a schizophrenia spectrum or affective disorder diagnosis, while a further third (36%) exhibited behaviours recognised by NICE as potentially legitimate targets for such treatment such as violence, aggression or self-injury. With respect to screening for potential side effects within the past year, 41% had a documented measure of body weight (range across participating services 18-100%), 32% blood pressure (0-100%) and 37% blood glucose and blood lipids (0-100%). These data from mental health services across the UK suggest that antipsychotic medications are not widely used outside of licensed and/or evidence-based indications in people with ID. However, screening for side effects in those patients on continuing antipsychotic medication was inconsistent across the participating services and the possibility that a small number of these services failed to meet basic standards of care cannot be excluded. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Under-utilization of controller medications and poor follow-up rates among hospitalized asthma patients.

    Science.gov (United States)

    Lintzenich, Annie; Teufel, Ronald J; Basco, William T

    2011-07-01

    Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. South Carolina Medicaid data from 2007-2009 were analyzed. Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identified factors that predict controller medications and follow-up. Five hundred five patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confidence interval, 1.1-2.6). Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and follow-up attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations.

  2. Opinion and knowledge among hospital medical staff regarding diagnosis of diabetes and proper usage of a specific test tube for glucose analysis.

    Science.gov (United States)

    Bar-Dayan, Y; Bogaiov, A; Boaz, M; Landau, Z; Wainstein, J

    2014-02-01

    Accuracy of blood sugar values, as examined by glucose analysis, has significant importance on the diagnosis of diabetes and follow up of diabetes treatment. Usage of a designated test tube significantly improves the accuracy of measurement. Knowledge of the medical staff is a major determinant in the current usage of such a technology. The aim of the study was to assess the level of knowledge exhibited by medical staff in the diabetes field and specifically for the usage of a designated tube to test blood glucose level. A prospective study. The staff of the internal and surgical departments and outpatient clinics at the Wolfson Medical Center completed a questionnaire that assessed the level of knowledge about the designated glucose test tube, other randomly used test tubes, the parameters that influence the blood glucose values in a non-designated tube and the diagnosis of diabetes. A number of 160 questionnaires (50% from internal departments, 36% from surgical departments and 14% from outpatient clinics) were analysed. The majority of the staff members (65%) knew that diabetes is diagnosed by glucose levels in blood. Of the 35% that did not know, 91% were nurses. The majority (75%) knew that diabetes is diagnosed during fasting conditions; however, most of the staff indicated that 12 h is needed. Only 25% knew of the designated test tube, and most of the staff indicated that a regular chemistry tube was the tube of choice for them. The staff exhibited poor level of knowledge regarding the parameters that influence the quality of the test. Staff members are not aware of the various aspects of diabetes diagnosis and the designated test tube for glucose measurements, and most of them use a tube that gives inaccurate measurements, therefore there is an urgent need to improve diabetes knowledge among staff members. © 2013 John Wiley & Sons Ltd.

  3. A history of the INTERNIST-1 and Quick Medical Reference (QMR) computer-assisted diagnosis projects, with lessons learned.

    Science.gov (United States)

    Miller, R A

    2010-01-01

    The INTERNIST-1/Quick Medical Reference (QMR) diagnostic decision support project spans four decades, from 1971-onward. This paper describes the history of the project and details insights gained of relevance to the general clinical and informatics communities.

  4. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-01-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration...... until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing...

  5. Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students.

    Science.gov (United States)

    Afrisham, Reza; Sadegh-Nejadi, Sahar; SoliemaniFar, Omid; Kooti, Wesam; Ashtary-Larky, Damoon; Alamiri, Fatima; Aberomand, Mohammad; Najjar-Asl, Sedigheh; Khaneh-Keshi, Ali

    2016-11-01

    The purpose of this study was to evaluate the salivary testosterone levels under psychological stress and its relationship with rumination and five personality traits in medical students. A total of 58 medical students, who wanted to participate in the final exam, were selected by simple random sampling. Two months before the exam, in the basal conditions, the NEO Inventory short form, and the Emotional Control Questionnaire (ECQ) were completed. Saliva samples were taken from students in both the basal conditions and under exam stress. Salivary testosterone was measured by ELISA. Data was analyzed using multivariate analysis of variance with repeated measures, paired samples t-test, Pearson correlation and stepwise regression analysis. Salivary testosterone level of men showed a significant increase under exam stress (pstress. Salivary testosterone reactivity to stress can be determined by sexual differences, personality traits, and emotional control variables which may decrease or increase stress effects on biological responses, especially the salivary testosterone.

  6. Segmentation and Classification of Bone Marrow Cells Images Using Contextual Information for Medical Diagnosis of Acute Leukemias.

    Directory of Open Access Journals (Sweden)

    Carolina Reta

    Full Text Available Morphological identification of acute leukemia is a powerful tool used by hematologists to determine the family of such a disease. In some cases, experienced physicians are even able to determine the leukemia subtype of the sample. However, the identification process may have error rates up to 40% (when classifying acute leukemia subtypes depending on the physician's experience and the sample quality. This problem raises the need to create automatic tools that provide hematologists with a second opinion during the classification process. Our research presents a contextual analysis methodology for the detection of acute leukemia subtypes from bone marrow cells images. We propose a cells separation algorithm to break up overlapped regions. In this phase, we achieved an average accuracy of 95% in the evaluation of the segmentation process. In a second phase, we extract descriptive features to the nucleus and cytoplasm obtained in the segmentation phase in order to classify leukemia families and subtypes. We finally created a decision algorithm that provides an automatic diagnosis for a patient. In our experiments, we achieved an overall accuracy of 92% in the supervised classification of acute leukemia families, 84% for the lymphoblastic subtypes, and 92% for the myeloblastic subtypes. Finally, we achieved accuracies of 95% in the diagnosis of leukemia families and 90% in the diagnosis of leukemia subtypes.

  7. Segmentation and Classification of Bone Marrow Cells Images Using Contextual Information for Medical Diagnosis of Acute Leukemias.

    Science.gov (United States)

    Reta, Carolina; Altamirano, Leopoldo; Gonzalez, Jesus A; Diaz-Hernandez, Raquel; Peregrina, Hayde; Olmos, Ivan; Alonso, Jose E; Lobato, Ruben

    2015-01-01

    Morphological identification of acute leukemia is a powerful tool used by hematologists to determine the family of such a disease. In some cases, experienced physicians are even able to determine the leukemia subtype of the sample. However, the identification process may have error rates up to 40% (when classifying acute leukemia subtypes) depending on the physician's experience and the sample quality. This problem raises the need to create automatic tools that provide hematologists with a second opinion during the classification process. Our research presents a contextual analysis methodology for the detection of acute leukemia subtypes from bone marrow cells images. We propose a cells separation algorithm to break up overlapped regions. In this phase, we achieved an average accuracy of 95% in the evaluation of the segmentation process. In a second phase, we extract descriptive features to the nucleus and cytoplasm obtained in the segmentation phase in order to classify leukemia families and subtypes. We finally created a decision algorithm that provides an automatic diagnosis for a patient. In our experiments, we achieved an overall accuracy of 92% in the supervised classification of acute leukemia families, 84% for the lymphoblastic subtypes, and 92% for the myeloblastic subtypes. Finally, we achieved accuracies of 95% in the diagnosis of leukemia families and 90% in the diagnosis of leukemia subtypes.

  8. Medical therapeutic itineraries of women with breast cancer diagnosis affiliated to the People's Health Insurance in San Luis Potosí, central Mexico

    Directory of Open Access Journals (Sweden)

    Luz María Tejada-Tayabas

    2015-01-01

    Full Text Available This study aims to describe the medical itineraries followed by breast cancer women affiliated to the People's Health Insurance in San Luis Potosí, central Mexico. We used an ethnographic approach based on oral histories of 12 women diagnosed with breast cancer in the year prior to the first meeting. Two face-to-face sessions per participant lasting 60 minutes each were conducted followed by a telephone interview. Content and diachronic analyses were used. Three main itineraries were identified: (1 diagnostic process, (2 final diagnosis to treatment, and (3 cancer control and relapse. Findings suggested that infrastructure and human resources to adequately screen and timely diagnose breast cancer were scant and insufficiently trained, respectively. Deferral of medical assessment was related with lack of information about breast cancer consequences, with women being afraid of a positive result, and with economic constraints. The current screening program needs to be redesigned to prevent diagnostic delays, as these seem to explain the high frequency of advanced stages reported at the time of diagnosis.

  9. Factors associated with delayed entry into HIV medical care after HIV diagnosis in a resource-limited setting: Data from a cohort study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2013-06-01

    Full Text Available Studies from sub-Saharan Africa have shown that a substantial proportion of patients diagnosed with HIV enter into HIV medical care late. However, data from low or middle-income countries outside Africa are scarce. In this study, we investigated risk factors associated with delayed entry into care stratified by gender in a large cohort study in India. 7701 patients were diagnosed with HIV and 5410 entered into care within three months of HIV diagnosis. Nearly 80% entered into care within a year, but most patients who did not enter into care within a year remained lost to follow up or died. Patient with risk factors related to having a low socio-economic status (poverty, being homeless, belonging to a disadvantaged community and illiteracy were more likely to enter into care late. In addition, male gender and being asymptomatic at the moment of HIV infection were factors associated with delayed entry into care. Substantial gender differences were found. Younger age was found to be associated with delayed entry in men, but not in women. Widows and unmarried men were more likely to enter into care within three months. Women belonging to disadvantaged communities or living far from a town were more likely to enter into care late. The results of this study highlight the need to improve the linkage between HIV diagnosis and HIV treatment in India. HIV programmes should monitor patients diagnosed with HIV until they engage in HIV medical care, especially those at increased risk of attrition.

  10. Medical malpractice and sarcoma care--a thirty-three year review of case resolutions, inciting factors, and at risk physician specialties surrounding a rare diagnosis.

    Science.gov (United States)

    Mesko, Nathan W; Mesko, Jennifer L; Gaffney, Lauren M; Halpern, Jennifer L; Schwartz, Herbert S; Holt, Ginger E

    2014-12-01

    We reviewed medico-legal cases related to extremity sarcoma malpractice in order to recognize those factors most commonly instigating sarcoma litigation. Over one million legal cases available in a national legal database were searched for malpractice verdicts and settlements involving extremity sarcoma spanning 1980-2012. We categorized verdict/settlement resolutions by state, year, award amount, nature of the complaint/injury, specialty of the physician defendant, and academic affiliation of defendant-amongst other variables. Of the 216 cases identified, 57% of case resolutions favored the plaintiff, with a mean indemnity payment of $2.30 million (range $65,076-$12.66 million). Delay in diagnosis (81%), unnecessary amputation (11%), and misdiagnosis (7%) accounted for the majority of complaints. The greatest numbers of claims were filed against primary care specialties (34%), orthopaedic surgeons (23%), and radiologists (12%). Individual state tort reform measures were not protective against case resolution outcome. Reported medico-legal claims involving sarcoma care continue to rise, with mean indemnity payments approaching 10 times that for other reported medical/surgical specialties. Primary care and orthopaedic specialties are the most commonly named physician defendants, citing a delay in diagnosis. This suggests further education in the front line diagnosis and management of sarcomas is needed. © 2014 Wiley Periodicals, Inc.

  11. Reduction of radiation dose of computed tomography in children with traumatic brain injury does not compromise the diagnosis and medical conduct

    Directory of Open Access Journals (Sweden)

    Mônica de Oliveira Bernardo

    2017-01-01

    Full Text Available Introduction: The worldwide increases in availability and request of computed tomography in children have brought concern about the cumulative effect of radiation. Traumatic brain injury is a clinical situation in which tomography is frequently necessary. Objectives: 1. Evaluating if the reduction of the radiation dose of head computed tomography in children with head trauma would affect the diagnosis and medical conduct; 2. Promoting a radioprotection campaign in a private health care system. Method: We selected two groups of computed tomography from children with head trauma: 30 performed before the study period, with usual doses of radiation; and 30 tomographies performed during the project, in which we applied the protocol of The Radiation Safety The Alliance for Imaging in Pediatric with 50% radiation dose reduction. The two series of exams were presented to 19 pediatricians, 2 neurosurgeons and 7 radiologists who were unaware of the technical differences and they answered a questionnaire. Results: The professionals had no difficulty in making a diagnosis and establish a conduct with both series of exams. Four participants noted more grainy images in the exams with lower radiation dose. A radioprotection campaign distributed 17,000 radioprotection wallets for children up to 12 years. Professionals involved and parents joined the campaign strongly and rationally. Conclusions: It is possible to reduce the computed tomography radiation dose for children with head trauma without any prejudice to the diagnosis and treatment. The radioprotection campaign was effective and well accepted by professionals and family and will become a national campaign.

  12. Exploring Eye Movements of Experienced and Novice Readers of Medical Texts Concerning the Cardiovascular System in Making a Diagnosis

    Science.gov (United States)

    Vilppu, Henna; Mikkilä-Erdmann, Mirjamaija; Södervik, Ilona; Österholm-Matikainen, Erika

    2017-01-01

    This study used the eye-tracking method to explore how the level of expertise influences reading, and solving, two written patient cases on cardiac failure and pulmonary embolus. Eye-tracking is a fairly commonly used method in medical education research, but it has been primarily applied to studies analyzing the processing of visualizations, such…

  13. [State under the influence of drugs or psychotropic agents--a comparison of toxicological and medical examinations in materials of the Department of Forensic Medicine and Toxicology, Silesian University of Medicine, Katowice].

    Science.gov (United States)

    Korczyńska, Małgorzata; Kulikowska, Joanna; Celiński, Rafał; Nowicka, Joanna; Rojek, Sebastian; Uttecht-Pudełko, Anna

    2011-01-01

    In the paper, the authors present the results of toxicological examinations of blood samples taken from drivers during road check procedures or from perpetrators of traffic road accidents, which--taking into consideration the kind of the determined agents and their concentrations--were compared with the results of medical examinations from blood sampling protocols studied in the Department of Forensic Medicine and Toxicology, Silesian University of Medicine. All the blood samples were first analyzed using an immunoenzymatic assay (ELISA). Then, the LC-MS method was used. The positive results of screening for the presence of cannabinols were verified by GC-MS. Out of 329 blood samples, 145 were positive. The presence of cannabinols, amphetamine or MDMA was the most predominant finding. Diazepam was determined in 4 cases and opiates in 1 case. Only in 31% cases did positive results of toxicological examinations correspond to deviations found during the medical examinations constituting the basis for the final diagnosis of state "under the influence". In practice, appraisal of drug influence during medical examination seems to be limited and dependent on variable reactions of the examined individuals to a psychoactive agent, time lapse between the traffic road event and the examination or concomitant symptoms associated with ethylene alcohol activity. The final diagnosis of state "under the influence of drugs" or "under the influence of psychotropic agents" given by the physician does not result from the effect of these substances observed during the medical examination, but is very often formulated based on the medical history or police findings. The analysis of the above mentioned cases where Delta9THC or/and amphetamine was detected showed no correlation between the concentration of the psychoactive agent determined in blood and symptoms triggered by its action as described by the physician.

  14. Prevalence of self-reported medical diagnosis of uterine leiomyomas in a Brazilian population: demographic and socioeconomic patterns in the Pro-Saúde Study.

    Science.gov (United States)

    Boclin, Karine de Lima Sírio; Faerstein, Eduardo

    2013-06-01

    Uterine leiomyomas (UL) are considered the most common tumors of the female reproductive system. However, there are few epidemiological studies about this condition in Brazil. To estimate the prevalence of self-reported history of UL according to demographic and socioeconomic characteristics, and to markers of access to health care. We analyzed data from 1,733 university employees who participated at the baseline waves of the Pro-Saude Study (1999-2001), in relation to three outcomes: (1) self-reported medical diagnosis of UL, (2) UL with symptoms prior to diagnosis, and (3) cases with hysterectomy due to UL. Prevalence and 95% confidence intervals (95% CI) were estimated in relation to strata of variables related to demographic (age, color/race) and socioeconomic characteristics (education, income) and of markers of access to health care (Pap smear, breast clinical exam and private health insurance status). The prevalence of medically-diagnosed UL was 23.3% (95% CI - 21.3, 25.2), the UL with symptoms prior to diagnosis of 13.3% (95% CI - 11.7, 15.0) and hysterectomy due to UL, 8.4% (95% CI - 7.5, 10.3). Among participants younger than 45 years old, higher prevalence was observed among women with worse socioeconomic conditions and of black color/race. Among those with 45 years or more, there was higher prevalence among women with better access to health care. In this study population of Brazilian women, UL is a relevant health problem, and its prevalence and associated socio-demographic gradients are similar to those observed in other countries.

  15. INCIDENCE OF SUB - CLINICAL AIRFLOW OBSTRUCTION IN APPARENTLY HEALTHY MEDICAL PERSONNEL; DIAGNOSIS AND COMPARISION BY SPIROMETRY AND PEAK FLOW METRY

    Directory of Open Access Journals (Sweden)

    Subba Rao

    2015-03-01

    Full Text Available AIM & OBJE CTIVES OF THE STUDY: To diagnose sub - clinical airflow obstruction in apparently healthy medical personnel, and to compare Peak Expiratory Flow Rate (PEFR by using Spirometry and by Wright’s peak flow meter. METHODOLOGY: About 80 apparently healthy medical students including Post Graduates, internees and medical technicians were taken in to the study, all of them had no past history of Bronchial Asthma or any allergies. Spirometry was performed by Spirowin version 0.2 and simultaneously peak expiratory flow rate by Wright’s peak flow meter was done and FVC, FEV1, FEV1/FVC, PEFR were recorded. RESULTS: About 13 subjects (16.25% showed moderate obstruction (FEV1 about 70%, and at that point a family history of atopies and allergies could be elicited in most of them. PEFR showed a variation - 3.42 to 2.76 ltrs/sec ( - 205.74 to 165.62 ltrs/min between Spirometry and Wright’s peak flow meter. INTERPRETATION AND C ONCLUSION : In spite of being medical personnel and having a family history of Bronchial Asthma and other atopies none of the 13 (16.25% subjects with sub clinical obstruction had ever approached us for a pulmonary function test. This shows that Spirometry has to be popularized in medical personnel as well as in lay men as a means to diagnose Bronchial Asthma and COPD. Also there is difference in PEFR measured by Spirometry and Wright’s peak flow metry though the difference is not significant with a p=0.5398 .

  16. [Medical ethics under the bioethics' point of view: the moral surgical practice].

    Science.gov (United States)

    Antonio, Eliana Maria Restum; Fontes, Tereza Maria Pereira

    2011-01-01

    The professional practice of medicine today has a strong biological approach due to the increasing specialization of medical science. Often, science itself does not help to address and resolve a particular situation of a medical professional, and this is where human and social sciences, and especially other disciplines such as bioethics, can give a more humane and socialist approach, by systematically studying human behavior in the field of life and health sciences, considering moral values and principles. As part of this study, the segment that is limited to the analysis of ethical conflicts arising from the practice of medicine and patient care is known as medical ethics. Medical ethics, in the context of surgery, involves the integration of the surgical patient with the nature of the surgeon, influenced by his training and experience, his sensitivity to identify what is right. Ethics should not only be in the procedure, the surgery itself or in what happens in an operating room or even in the exercise of surgery as a specialty. Ethics must be in the life and conduct of the surgeon, so that all life and professional acts should be ethically valid.

  17. Bashing Positivism and Reversing a Medical Model under the Guise of Evidence

    Science.gov (United States)

    Wampold, Bruce E.

    2003-01-01

    In her advocacy of a model to train counseling psychologists as "evidence-based practitioners," Chwalisz (2003) (this issue) criticizes research based on positivism and advocates for methodological pluralism but ironically suggests the adoption of a medical model to influence the discourse on practice. In this comment, the author examines (a)…

  18. Medical diagnosis system and method with multispectral imaging. [depth of burns and optical density of the skin

    Science.gov (United States)

    Anselmo, V. J.; Reilly, T. H. (Inventor)

    1979-01-01

    A skin diagnosis system includes a scanning and optical arrangement whereby light reflected from each incremental area (pixel) of the skin is directed simultaneously to three separate light filters, e.g., IR, red, and green. As a result, the three devices simultaneously produce three signals which are directly related to the reflectance of light of different wavelengths from the corresponding pixel. These three signals for each pixel after processing are used as inputs to one or more output devices to produce a visual color display and/or a hard copy color print, for one usable as a diagnostic aid by a physician.

  19. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  20. Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness.

    Science.gov (United States)

    Dalseth, Natasha; Reed, Regina Szucs; Hennessy, Michael; Eisenberg, Marlene M; Blank, Michael B

    2018-01-01

    The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. clinicaltrials.gov 29 identifier NCT00264823.

  1. A blinded prospective study comparing four current noninvasive approaches in the differential diagnosis of medical versus surgical jaundice

    International Nuclear Information System (INIS)

    O'Connor, K.W.; Snodgrass, P.J.; Swonder, J.E.; Mahoney, S.; Burt, R.; Cockerill, E.M.; Lumeng, L.

    1983-01-01

    A prospective study was undertaken to compare the diagnostic accuracy of clinical evaluation, ultrasound, computed tomography, and technetium 99m-HIDA or -PIPIDA biliary scans in distinguishing between intrahepatic and extrahepatic jaundice. A final diagnosis was established in each of the 50 patients who completed the study, among whom 29 had intrahepatic cholestasis and 21 had extrahepatic obstruction. In the diagnosis of extrahepatic obstruction, the sensitivities of clinical evaluation, ultrasound, computed tomography, and nuclear medicine biliary scan were 95%, 55%, 63%, and 41%, respectively; the specificities were 76%, 93%, 93%, and 88%; and the overall accuracies were 84%, 78%, 81%, and 68%. These data support the conclusion that when the clinical evaluation is carefully performed, it is the single most effective noninvasive means of detecting extrahepatic biliary obstruction in a jaundiced patient. Although ultrasound, computed tomography, and radionuclide biliary scan are less sensitive, they are highly reliable if they indicate that extrahepatic obstruction is present. A flow chart of invasive and noninvasive approaches for evaluation of the jaundiced patient is presented

  2. Wind Turbine Diagnosis under Variable Speed Conditions Using a Single Sensor Based on the Synchrosqueezing Transform Method.

    Science.gov (United States)

    Guo, Yanjie; Chen, Xuefeng; Wang, Shibin; Sun, Ruobin; Zhao, Zhibin

    2017-05-18

    The gearbox is one of the key components in wind turbines. Gearbox fault signals are usually nonstationary and highly contaminated with noise. The presence of amplitude-modulated and frequency-modulated (AM-FM) characteristics compound the difficulty of precise fault diagnosis of wind turbines, therefore, it is crucial to develop an effective fault diagnosis method for such equipment. This paper presents an improved diagnosis method for wind turbines via the combination of synchrosqueezing transform and local mean decomposition. Compared to the conventional time-frequency analysis techniques, the improved method which is performed in non-real-time can effectively reduce the noise pollution of the signals and preserve the signal characteristics, and hence is suitable for the analysis of nonstationary signals with high noise. This method is further validated by simulated signals and practical vibration data measured from a 1.5 MW wind turbine. The results confirm that the proposed method can simultaneously control the noise and increase the accuracy of time-frequency representation.

  3. Comparison of medical-grade and calibrated consumer-grade displays for diagnosis of subtle bone fissures.

    Science.gov (United States)

    Pinto Dos Santos, Daniel; Welter, Jonas; Emrich, Tilman; Jungmann, Florian; Dappa, Evelyn; Mildenberger, Peter; Kloeckner, Roman

    2017-12-01

    To compare the diagnostic accuracy of medical-grade and calibrated consumer-grade digital displays for the detection of subtle bone fissures. Three experienced radiologists assessed 96 digital radiographs, 40 without and 56 with subtle bone fissures, for the presence or absence of fissures in various bones using one consumer-grade and two medical-grade displays calibrated according to the DICOM-Grayscale Standard Display Function. The reference standard was consensus reading. Subjective image quality was also assessed by the three readers. Statistical analysis was performed using receiver operating characteristic analysis and by calculating the sensitivity, specificity, and Youden's J for each combination of reader and display. Cohen's unweighted kappa was calculated to assess inter-rater agreement. Subjective image quality was compared using the Wilcoxon signed-rank test. No significant differences were found for the assessment of subjective image quality. Diagnostic performance was similar across all readers and displays, with Youden's J ranging from 0.443 to 0.661. The differences were influenced more by the reader than by the display used for the assessment. No significant differences were found between medical-grade and calibrated consumer-grade displays with regard to their diagnostic performance in assessing subtle bone fissures. Calibrated consumer-grade displays may be sufficient for most radiological examinations. • Diagnostic performance of calibrated consumer-grade displays is comparable to medical-grade displays. • There is no significant difference with regard to subjective image quality. • Use of calibrated consumer-grade displays could cut display costs by 60-80%.

  4. Prenatal Diagnosis

    Directory of Open Access Journals (Sweden)

    Ozge Ozalp Yuregir

    2012-02-01

    Full Text Available Prenatal diagnosis is the process of determining the health or disease status of the fetus or embryo before birth. The purpose is early detection of diseases and early intervention when required. Prenatal genetic tests comprise of cytogenetic (chromosome assessment and molecular (DNA mutation analysis tests. Prenatal testing enables the early diagnosis of many diseases in risky pregnancies. Furthermore, in the event of a disease, diagnosing prenatally will facilitate the planning of necessary precautions and treatments, both before and after birth. Upon prenatal diagnosis of some diseases, termination of the pregnancy could be possible according to the family's wishes and within the legal frameworks. [Archives Medical Review Journal 2012; 21(1.000: 80-94

  5. Use of the medical information on the internet by pregnant patients with a prenatal diagnosis of neonatal disease requiring surgery.

    Science.gov (United States)

    Usui, Noriaki; Kamiyama, Masafumi; Tani, Gakuto; Kanagawa, Takeshi; Fukuzawa, Masahiro

    2011-12-01

    The purpose of this study was to clarify the current status and the problems associated with using medical information on the internet during pregnancy in patients prenatally diagnosed with fetal abnormalities at a single Japanese institution. A written, anonymous questionnaire survey was conducted in 155 pregnant patients who had been prenatally diagnosed as having neonatal surgical diseases between January 2000 and December 2009, and their families. Forty-three out of the 75 responding families (57.3%) had used medical information available on the internet during their pregnancy. The availability of information, assessed during 2 year-increments, has increased rapidly in the past 4 years. When the explanation of a physician was compared with the information provided by the internet, the knowledge or impression of the disease was different in 60% of cases and similar in 33% of cases. More importantly, 60% of the patients felt that the information obtained from the internet was more pessimistic than the physician's explanation. The number of pregnant patients who have used medical information on the internet has rapidly increased in the recent years. Subjects who used this information were more likely to experience a sense of anxiety and feelings regarding the seriousness of the disease.

  6. The politics of choice: roles of the medical profession under Nazi rule.

    Science.gov (United States)

    Lekisch, K; McDonald, J H

    1989-06-01

    In 1933, when Adolf Hitler took power, the German medical community was faced with intense crisis and change. Because social processes become more clearly defined in times of crisis, the days of Nazi rule offer an excellent opportunity to examine health care and moral issues. This article describes historical events that illustrate physicians' and medical students' role in the political process. In addition, we detail four types of responses made by physicians and students: flight, conformism, individual resistance, and group resistance. We conclude that if the role of physicians is to aid and protect patients against disease or experimentation on humans, then he or she must maintain heightened political awareness in order to deal with social crises before they overwhelm any response.

  7. Breast cancer diagnosis by thermal imaging in the fields of medical and artificial intelligence sciences: review article

    Directory of Open Access Journals (Sweden)

    Hossein Ghayoumi Zadeh

    2016-09-01

    Full Text Available Breast cancer is the most common cancer in women and one of the leading of death among them. The high and increasing incidence of the disease and its difficult treatment specifically in advanced stages, imposes hard situations for different countries’ health systems. Body temperature is a natural criteria for the diagnosis of diseases. In recent decades extensive research has been conducted to increase the use of thermal cameras and obtain a close relationship between heat and temperature of the skin's physiology. Thermal imaging (thermography applies infrared method which is fast, non-invasive, non-contact and flexibile to monitor the temperature of the human body. This paper investigates highly diversified studies implemented before and after the year 2000. And it emphasizes mostly on the newely published articles including: performance and evaluation of thermal imaging, the various aspects of imaging as well as The available technology in this field and its disadvantages in the diagnosis of breast cancer. Thermal imaging has been adopted by researchers in the fields of medicine and biomedical engineering for the diagnosis of breast cancer. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field.  Thermography does not provide information on the structures of the breast morphology, but it provides performance information of temperature and breast tissue vessels. It is assumed that the functional changes occured before the start of the structural changes which is the result of disease or cancer. These days, thermal imaging method has not been established as an applicative method for screening or diagnosing purposes in academic centers. But there are different centers that adopt this method for the diognosis and examining purposes. Thermal imaging is an effective method which is

  8. Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions.

    Science.gov (United States)

    Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C

    1993-11-01

    The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

  9. Diagnosis and management of acute kidney injury: deficiencies in the knowledge base of non-specialist, trainee medical staff.

    Science.gov (United States)

    Muniraju, T M; Lillicrap, M H; Horrocks, J L; Fisher, J M; Clark, R M W; Kanagasundaram, N S

    2012-06-01

    Enhanced education has been recommended to improve non-specialist management of acute kidney injury (AKI). However, the extent of any gaps in knowledge has yet to be defined fully. The aim of this study was to assess understanding of trainee doctors in the prevention, diagnosis and initial management of AKI. An anonymised questionnaire was completed by hospital-based trainees across Newcastle Renal Unit's catchment area. Responses were evaluated against a panel of pre-defined ideal answers. The median score was 9.5 out of 20 (n = 146; range 0-17) and was lower in more junior trainees. Fifty percent of trainees could not define AKI, 30% could not name more than two risk factors for AKI and 37% could not name even one indication for renal referral. These serious gaps in knowledge highlight the need for enhanced education aimed at all training grades. Organisational changes may also be required to optimise patient safety.

  10. 3D hierarchical geometric modeling and multiscale FE analysis as a base for individualized medical diagnosis of bone structure.

    Science.gov (United States)

    Podshivalov, L; Fischer, A; Bar-Yoseph, P Z

    2011-04-01

    This paper describes a new alternative for individualized mechanical analysis of bone trabecular structure. This new method closes the gap between the classic homogenization approach that is applied to macro-scale models and the modern micro-finite element method that is applied directly to micro-scale high-resolution models. The method is based on multiresolution geometrical modeling that generates intermediate structural levels. A new method for estimating multiscale material properties has also been developed to facilitate reliable and efficient mechanical analysis. What makes this method unique is that it enables direct and interactive analysis of the model at every intermediate level. Such flexibility is of principal importance in the analysis of trabecular porous structure. The method enables physicians to zoom-in dynamically and focus on the volume of interest (VOI), thus paving the way for a large class of investigations into the mechanical behavior of bone structure. This is one of the very few methods in the field of computational bio-mechanics that applies mechanical analysis adaptively on large-scale high resolution models. The proposed computational multiscale FE method can serve as an infrastructure for a future comprehensive computerized system for diagnosis of bone structures. The aim of such a system is to assist physicians in diagnosis, prognosis, drug treatment simulation and monitoring. Such a system can provide a better understanding of the disease, and hence benefit patients by providing better and more individualized treatment and high quality healthcare. In this paper, we demonstrate the feasibility of our method on a high-resolution model of vertebra L3. Copyright © 2010 Elsevier Inc. All rights reserved.

  11. Predictors of medical student remediation and their underlying causes: early lessons from a curriculum change in the University of Auckland Medical Programme.

    Science.gov (United States)

    Grainger, Brian; Yielder, Jill; Reid, Papaarangi; Bagg, Warwick

    2017-08-11

    The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change. A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 2013 and 2014, combined with thematic qualitative analysis of educator perspectives derived by interview on factors underlying remediation and the quality of that currently provided by the faculty. 17.7% of all students required some form of remedial assistance and 93% of all students offered remediation passed their year of study. Multivariate analysis showed international students (OR 4.59 95% CI 2.62-7.98) and students admitted via the Māori and Pacific Admission Scheme (OR 3.43 2.29-5.15) were significantly more likely to require remediation. Male students were also slightly more likely than their female classmates to require assistance. No effect was observed for rural origin students, completion of a prior degree or completion of clinical placement in a peripheral hospital. Knowledge application and information synthesis were the most frequently identified underlying problems. Most faculty believed remediation was successful, however, flexibility in the programme structure, improved diagnostics and improved access to dedicated teaching staff were cited as areas for improvement. Remediation is required by nearly a fifth of University of Auckland medical students, with MAPAS and international students being particularly vulnerable groups. Remediation is largely successful, however, interventions addressing reasoning and knowledge application may improve its effectiveness.

  12. Rheological analysis of irradiated crosslinkable and scissionable polymers used for medical devices under different radiation conditions

    Science.gov (United States)

    Satti, A. J.; Ressia, J. A.; Cerrada, M. L.; Andreucetti, N. A.; Vallés, E. M.

    2018-03-01

    The effects on different synthetic polymers of distinct types of radiation, gamma rays and electron beam, under different atmospheres are followed by changes in their viscoelastic behavior. Taking into account the two main radioinduced reactions, crosslinking and scissioning of polymeric chains, liquid polydimethylsiloxane has been used as example of crosslinkable polymer and semi crystalline polypropylene as example of scissionable polymer. Propylene - 1-hexene copolymers have been also evaluated, and the effects of both reactions were clearly noticed. Accordingly, samples of those aforementioned polymers have been irradiated with 60Co gamma irradiation in air and under vacuum, and also with electron beam, at similar doses. Sinusoidal dynamic oscillation experiments showed a significant increase in branching and crosslinking reactions when specimens are irradiated under vacuum, while scissioning reactions were observed for the different polymers when irradiation takes place under air with either gamma irradiation or electron beam.

  13. [Medical diagnosis of pain between myth and reality--chronic lower back pain, as an illness of upright walking].

    Science.gov (United States)

    Albrecht, H

    2001-10-01

    Chronic therapy-resistant low back pain is a major problem in medical care. In Germany there are many millions concerned, and the treatment expenses range at the top. Many of these patients underwent non-successful operations at the vertebral column and suffered a long-lasting odyssey of therapies before they are treated psychosomatically for the first time. Chronic low back pain is a disease including social, psychological as well as physiological aspects, and not only a problem of bones, muscles, or intervertebral disks. The problem is similar to that of fibromyalgia. On the basis of 9,000 case reports obtained during psychosomatic orthopedic treatment, character structures, unsolved problems of life and repressed emotional disturbances such as anger, jealousy, fear, and mourning could be identified as major psychosomatic risk factors for chronic low back pain. There is a high coincidence with other psychosomatically influenced diseases such as gastric and duodenal ulcera, asthma bronchiale, migraine with depressions, anxiety disorders, character neuroses, and narcissistic and other structural disturbances of the self. Exclusively somatic treatments without considering the existential situation and psychological methods hold the danger of a symptom shifting. The inpatient treatment from 9 a.m. to 5 p.m. ('Tagesklinik') with a combination of medical, physiotherapeutic and psychotherapeutic methods promotes a social training that counteracts the increasing constrictions in the accustomed life surroundings caused by low back pain. Chronic low back pain is an 'illness of the upright walk' in an anthropological, ethical sense. Considering low back pain as a strictly somatic disease is a modern myth of a medical treatment without existential understanding of human illness. It provokes failure of treatment and an enhancement of treatment cost. Copyright 2001 S. Karger GmbH, Freiburg

  14. OFSETH: smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging.

    Science.gov (United States)

    De Jonckheere, J; Narbonneau, F; Jeanne, M; Kinet, D; Witt, J; Krebber, K; Paquet, B; Depre, A; Logier, R

    2009-01-01

    The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging is presented. We report on two pure optical sensing technologies for respiratory movements monitoring - a macro bending sensor and a Bragg grating sensor, designed to measure the elongation due to abdominal and thoracic motions during breathing. We demonstrate that the two sensors can successfully sense textile elongation between, 0% and 3%, while maintaining the stretching properties of the textile substrates for a good comfort of the patient.

  15. Predictive Capability of an iPad-Based Medical Device (medx) for the Diagnosis of Vertigo and Dizziness.

    Science.gov (United States)

    Feil, Katharina; Feuerecker, Regina; Goldschagg, Nicolina; Strobl, Ralf; Brandt, Thomas; von Müller, Albrecht; Grill, Eva; Strupp, Michael

    2018-01-01

    Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. In this study we examined the performance of the iPad based program me d x in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The "gold standard diagnosis" was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient's case in the constellatory diagnostic system of me d x based on an algorithm using all available clinical information. These diagnoses were compared to the "gold standard" by retrospective review of the charts of the patients. The accuracy provided by me d x was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity), of being test negative when a disease was absent (specificity), of having the disease when the test is positive (positive predictive value) and of not having the disease when the test is negative (negative predictive value) for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by me d x. A total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of me d x in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%), Menière's disease (77.8, 97.6, 87.0, and 95.3%), benign paroxysmal positional

  16. Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Dunkelmann, Simone; Kuenstner, Hubertus; Nabavi, Elham; Rohde, Bettina; Groth, Peter; Schuemichen, Carl [University of Rostock, Clinic of Nuclear Medicine, Rostock (Germany)

    2007-02-15

    This study evaluated the thyroidal kinetics of radioiodine in Graves' disease under continued thiamazole medication and after discontinuation of thiamazole for 1-2 days, with a view to keeping the period of discontinuation as short as possible and to exploring the underlying mechanism of a postulated radioprotective effect of antithyroid drugs. In 316 patients, diagnostic and therapeutic radioiodine kinetics were followed up for 2 days by ten uptake measurements each and were defined mathematically by a two-compartment model. Without thiamazole or when thiamazole was discontinued for at least 2 days, all uptake curves could be fitted perfectly by a simple in- and output function; the mean square error (mse) was 0.38 (test) and 0.28 (therapy). Under continued thiamazole medication (11.0{+-}7.0 mg/day), the energy dose delivered to the thyroid was lowered by factor of 2.5. Uptake curves were deformed (mse: 1.06, test and 0.86, therapy) and appeared two peaked, suggesting coexistence of follicles with blocked and follicles with intact hormone synthesis and hence heterogeneous radioiodine uptake in the thyroid. In patients with maximally altered uptake curves, the success rate was as low as 31%. One day after discontinuation of thiamazole, mse was still increased (0.78, test), while 2 days afterwards it had normalised (0.36, test) and 3 days afterwards (mse: 0.24, therapy) the success rate was 87%. Efficacy of radioiodine therapy under continued thiamazole medication is reduced not only by a lower uptake and shorter half-life of radioiodine, but also by a heterogeneous energy dose distribution in the thyroid. Discontinuation of thiamazole (but probably not of propylthiouracil) for at least 2 days is required to restore the efficacy of radioiodine. (orig.)

  17. Infant Botulism: a network to improve the diagnosis and treatment of a rare and under-diagnosed disease

    Directory of Open Access Journals (Sweden)

    Davide Lonati

    2008-12-01

    Full Text Available Infant Botulism is a form of human botulism in which ingested spores of Clostridium botulinum germinate, colonize the infant’s colon, in which they produce botulinum neurotoxin. After the toxin is absorbed, binding to peripheral cholinergic synapses occurs, causing flaccid paralysis. The incidence of infant botulism is low, but some underestimation is likely to exist: the disease is difficult to diagnose because its wide spectrum of clinical manifestations which are not pathognomic. Moreover, failure to recognise the disease is probably related to the low index of suspicion: in fact, the experience of clinicians is fundamental in recognising infant botulism. A specific project has been promote to improve knowledge of the disease by training physicians (pediatricians, neurologists, clinical toxicologists to look out for the possible presence of Infant Botulism cases and improving public awareness through a prevention program. Standardization of therapeutic protocol also by treatment with specific therapeutic measures will be disseminated. A staff of physicians specialized in Clinical Toxicology will be available, 24 hours a day and seven days/week in the Pavia Poison Centre – National Toxicology Information Center. According to the project, this Centre acts as Reference Center for the clinical diagnosis and the treatment of infant botulism for the correct recognition of typical syndrome, the early diagnosis and the possible therapy with particular attention to antidotic treatment. The National Reference Centre for Botulism at the Istituto Superiore di Sanità will offer a 24-hours diagnostic laboratory service to support diagnose in suspected cases of botulism.

  18. WHAT ROLE SHOULD PUBLIC OPINION PLAY IN ETHICO-LEGAL DECISION MAKING? THE EXAMPLE OF SELECTING SEX FOR NON-MEDICAL REASONS USING PREIMPLANTATION GENETIC DIAGNOSIS.

    Science.gov (United States)

    Fovargue, Sara; Bennett, Rebecca

    2016-01-01

    In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice. © The Author 2016. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project.

    Science.gov (United States)

    Keller, Heather H; Valaitis, Renata; Laur, Celia V; McNicholl, Tara; Xu, Yingying; Dubin, Joel A; Curtis, Lori; Obiorah, Suzanne; Ray, Sumantra; Bernier, Paule; Gramlich, Leah; Stickles-White, Marilee; Laporte, Manon; Bell, Jack

    2018-03-22

    Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing

  20. 99mTc-HMPAO-SPECT in the diagnosis of senile dementia of Alzheimer's type - a study under clinical routine conditions

    International Nuclear Information System (INIS)

    Stoppe, G.; Staedt, J.; Schuetze, R.; Kunert, H.J.; Ruether, E.; Koegler, A.; Sandrock, D.; Emrich, D.

    1995-01-01

    This study was designed to evaluate whether investigations of cerebral blood flow can be a helpful diagnostic tool in the differential diagnosis between (senile) dementia of Alzheimer's type [(S)DAT] and geriatric depression with cognitive impairment. Under clinical routine conditions we performed Single Photon Emission Computed Tomography (SPECT) using 99m Tc-Hexamethylpropyleneamine Oxime (HMPAO) in 23 patients with (S)DAT (14 f, 9 m; mean age 68.9 y), 17 patients with geriatric depression (9 f, 8 m; mean age 66.4 y) and 12 age-matched controls (9 f, 3 m; mean age 69.2 y). Semiquantitative analysis (corticocerebellar ratios) of eight different regions of interest (ROI) revealed a significantly ( p 99m Tc-HMPAO SPECT is a valuable additional tool in the differential diagnosis of depression and dementia in the elderly. (author)

  1. Changes in the 'medical research' licensing procedure under the German Radiation Protection Ordinance

    International Nuclear Information System (INIS)

    Habeck, M.; Minkov, V.; Griebel, J.; Brix, G.; Epsch, R.; Langer, M.

    2012-01-01

    This publication outlines the 'medical research' licensing procedure as specified in the amendment of the German Radiation Protection Ordinance of November 1, 2011. The general licensing requirements for the use of radiation have not been changed by the amendment. Three so-called use restrictions (i.e., dose limits of 10 mSv and 20 mSv, age limit of 50 years) have been modified. They will only apply to healthy volunteers in the future. In addition, there are considerable simplifications with respect to applications and licensing procedures of the Federal Office for Radiation Protection (Bundesamt fuer Strahlenschutz, BfS) regarding the use of radiation in the newly introduced 'accompanying diagnostics' ('Begleitdiagnostik') case group. The newly established, independent panel of experts at the German Radiological Society (Deutsche Roentgengesellschaft, DRG) may provide essential support to principal investigators, qualified physicians and sponsors for differentiating between 'medical research' and 'health care', the latter not being subject to licensing. An expert statement will be issued by the DRG within four weeks of an inquiry. This consulting service is subject to confidentiality, and is free of charge for inquirers and without any commitment. (orig.)

  2. [Changes in the "medical research" licensing procedure under the German Radiation Protection Ordinance].

    Science.gov (United States)

    Habeck, M; Epsch, R; Minkov, V; Langer, M; Griebel, J; Brix, G

    2012-06-01

    This publication outlines the "medical research" licensing procedure as specified in the amendment of the German Radiation Protection Ordinance of November 1, 2011. The general licensing requirements for the use of radiation have not been changed by the amendment. Three so-called use restrictions (i. e., dose limits of 10 mSv and 20 mSv, age limit of 50 years) have been modified. They will only apply to healthy volunteers in the future. In addition, there are considerable simplifications with respect to applications and licensing procedures of the Federal Office for Radiation Protection (Bundesamt für Strahlenschutz, BfS) regarding the use of radiation in the newly introduced "accompanying diagnostics" ("Begleitdiagnostik") case group. The newly established, independent panel of experts at the German Radiological Society (Deutsche Röntgengesellschaft, DRG) may provide essential support to principal investigators, qualified physicians and sponsors for differentiating between "medical research" and "health care", the latter not being subject to licensing. An expert statement will be issued by the DRG within four weeks of an inquiry. This consulting service is subject to confidentiality, and is free of charge for inquirers and without any commitment. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Quantitative assessment of postoperative blood collection in brain tumor surgery under valproate medication.

    Science.gov (United States)

    Psaras, T; Will, B E; Schoeber, W; Rona, S; Mittelbronn, M; Honegger, J B

    2008-11-01

    The aim of the study was to evaluate whether valproate (VPA) increases the risk of bleeding complications in patients undergoing brain tumor surgery. A retrospective chart review of 85 patients operated on between January and December 2005 was performed. 19 patients received VPA, 22 patients were given other anti-epileptic drugs (AEDs), 44 patients received no AEDs. Data analyzed included intraoperative blood loss, transfusion, important comorbidity factors and concomitant diseases. Preoperative and postoperative laboratory data included hemoglobin, hematocrit, fibrinogen, platelet count, INR, prothrombin time, partial thromboplastin time and RBC count. The tumor volume was evaluated by preoperative MRI and CT scans of the brain. All 85 patients underwent a native CT scan of the brain on the first day after the operation. The volume of the resection cavity and the volume of blood were documented. We could show that the volume of the tumor had a significant effect on the amount of blood in the tumor cavity, whereas VPA medication had no effect. In our dataset, we found that tumor size had a significant effect on postoperative blood volume. In contrast, no serious bleeding complications occurred in the patients receiving VPA. Therefore, the present study does not provide any evidence for the need to discontinue VPA medication prior to and during surgery.

  4. Trouble with ataxia: A longitudinal qualitative study of the diagnosis and medical management of a group of rare, progressive neurological conditions

    Science.gov (United States)

    Ealing, John; Greenfield, Julie; Kingston, Helen; Sanders, Caroline; Payne, Katherine

    2013-01-01

    Objectives: An exploratory investigation of diagnosis and management in progressive ataxias: rare neurological conditions usually affecting balance, mobility and speech. Methods: A longitudinal qualitative study into the experiences of people with ataxia and neurologists. Thematic analysis and follow-up interviews were used to determine diagnosis and management issues over time. Results: People with ataxia recruited via two hospital departments and Ataxia UK were interviewed at baseline (n = 38) and 12-month follow-up (n = 31). Eight consultant neurologists were interviewed once. Patient accounts were diverse, but many expressed frustration at having an incurable condition and dissatisfaction with service outcomes. At follow-up, there was variation in their contact and satisfaction with helping agencies. Service issues regarding continuity of care and the primary/secondary care interface were evident. Neurologists’ accounts also varied. One-half reported that there is nothing that can be done, and one-half favoured specialist referral to increase the likelihood of finding an underlying aetiology within budget constraints. Conclusions: Diagnostic uncertainties existing at baseline remained for patients at follow-up interviews, although some had learned to deal with the uncertainties brought by the diagnosis of a largely untreatable condition. Care pathways only seemed to operate in the case of defined conditions, such as Friedreich’s Ataxia, the most commonly inherited cause. The findings point to a need to develop the evidence base to inform the relative utility of diagnostic procedures in the context of finite resources for patient care and support. PMID:26770684

  5. A Method for Fuzzy Soft Sets in Decision Making Based on Grey Relational Analysis and D-S Theory of Evidence: Application to Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Ningxin Xie

    2014-01-01

    Full Text Available A method based on grey relational analysis and D-S theory of evidence is proposed for fuzzy soft sets in decision making. Firstly, grey relational analysis is used to calculate grey mean relational degrees and determine uncertain degrees of parameters. Then based on uncertain degrees, suitable mass functions of different independent alternatives with different parameters can be constructed. Next, D-S rule of evidence combination is applied to aggregate these alternatives into a collective alternative. Finally, these alternatives are ranked and the best alternative(s are obtained. Moreover, the effectiveness and feasibility of this method are demonstrated by comparing with the mean potentiality approach and giving an application to medical diagnosis.

  6. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    with a host of demographic, labor market and financial regressors. The panel structure of the data allows following individuals year by year from the age of 50 and precisely measure changes in objectively measured health and other regressors, as well as labor market status. We consider 12 broad, mutually......, unemployment, and others (including out of the labor force and welfare). We estimate both single risk models, lumping all retirement states, and competing risk specifications, including all separate exit routes. Throughout, females are included in the estimations, and we present separate results by gender. We....... Furthermore, unemployment followed by early retirement is different from unemployment followed by other programs regarding marital status, gender, income, and health. These comparisons hinge on the competing risk framework. Finally, even when using objective medical diagnosis measures we still find...

  7. [Extended medical quality management exemplified by the tracer diagnosis multiple trauma. Pilot study in the air rescue service].

    Science.gov (United States)

    Helm, M; Hauke, J; Schlafer, O; Schlechtriemen, T; Lampl, L

    2012-02-01

    Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality. A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in  > 10% of the cases) occurred, process data was included (vital data, measurements and events). In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time  ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys))  ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys)  ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0

  8. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Vardan Galstyan

    2017-12-01

    Full Text Available Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  9. Porous TiO₂-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis.

    Science.gov (United States)

    Galstyan, Vardan

    2017-12-19

    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO₂, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO₂-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO₂ may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  10. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

    Science.gov (United States)

    2017-01-01

    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material. PMID:29257076

  11. Medical imaging

    CERN Document Server

    Townsend, David W

    1996-01-01

    Since the introduction of the X-ray scanner into radiology almost 25 years ago, non-invasive imaging has become firmly established as an essential tool in the diagnosis of disease. Fully three-dimensional imaging of internal organs is now possible, b and for studies which explore the functional status of the body. Powerful techniques to correlate anatomy and function are available, and scanners which combine anatomical and functional imaging in a single device are under development. Such techniques have been made possible through r ecent technological and mathematical advances. This series of lectures will review both the physical basis of medical imaging techniques using X-rays, gamma and positron emitting radiosiotopes, and nuclear magnetic resonance, and the mathematical methods used to reconstruct three-dimentional distributions from projection data. The lectures will trace the development of medical imaging from simple radiographs to the present-day non-invasive measurement of in vivo biochemistry. They ...

  12. First on-line survey of an international multidisciplinary working group (MightyMedic) on current practice in diagnosis, therapy and follow-up of dyslipidemias.

    Science.gov (United States)

    Stefanutti, C; D'Alessandri, G; Petta, A; Harada-Shiba, M; Julius, U; Soran, H; Moriarty, P M; Romeo, S; Drogari, E; Jaeger, B R

    2015-05-01

    The MightyMedic (Multidisciplinary International Group for Hemapheresis TherapY and MEtabolic DIsturbances Contrast) Working Group has been founded in 2013. The leading idea was to establish an international network of interdisciplinary nature aimed at working to cross national borders research projects, clinical trials, educational initiatives (meetings, workshops, summer schools) in the field of metabolic diseases, namely hyperlipidemias, and diabetes, preventive cardiology, and atherosclerosis. Therapeutic apheresis, its indications and techniques, is a parallel field of investigation. The first on-line survey of the Group has been completed in the first half of 2014. The survey included # 24 Centers in Italy, Germany, Greece, UK, Sweden, Japan and USA. Relevant data have been collected on current practice in diagnosis, therapy and follow-up of dyslipidemias. 240 subjects with hyperlipidemia and treated with lipoprotein apheresis have been reported in the survey, but a large percentage of patients (35%) who could benefit from this therapeutic option are still treated by conventional drug approach. Genetic molecular diagnosis is performed in only 33% of patients while Lipoprotein(a) (Lp(a)) is included in cardiovascular disease risk assessment in 71% of participating Centers. New detailed investigations and prospective multicenter studies are needed to evaluate changes induced by the impact of updated indications and strategies, as well as new treatment options, targeting standardization of therapeutic and diagnostic approaches. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Impacts of regulated competition on pricing in Chinese pharmaceutical market under urban employee basic medical insurance.

    Science.gov (United States)

    Zhao, Mingyue; Wu, Jing

    2017-06-01

    Examine the effects of regulated competition on the drug pricing in China. Based on product-level data, a regression method was employed for pricing by using data from Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. The market competition measures distinguished generic competition within the same molecule from therapeutic competition within the same therapeutic class. The increases in pricing are inversely related to the number of generic competitions. The generic sub-group results vary from the originator sub-group. For the generics, generic competition has a significantly reduced effect on the price; however, only therapeutic competition has a significantly reduced effect on the originator price. Regulated competition has a positive role in shaping the pharmaceutical market. Furthermore, regulated competition affects the price differently for the sub-groups. The promotion of competition between generic and originator in order to reap full competition benefit and reduce frictions among policies are necessary.

  14. Breaks in continuity of care and the rural senior transferred for medical care under regionalisation

    Directory of Open Access Journals (Sweden)

    H. Jay Biem

    2003-09-01

    Full Text Available Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity, for continuity of care, there is a need for integrative system approaches, such as: (1 policy and standards, disease management programs, integrated clinical pathways (management continuity, (2 electronic health information systems and telecommunications technology (communication continuity. The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.

  15. How inflammation underlies physical and organ function in acutely admitted older medical patients

    DEFF Research Database (Denmark)

    Klausen, Henrik Hedegaard; Bodilsen, Ann Christine; Petersen, Janne

    2017-01-01

    OBJECTIVES: To investigate whether systemic inflammation in acutely admitted older medical patients (age >65 years) is associated with physical performance and organ dysfunction. Organ dysfunction´s association with physical performance, and whether these associations are mediated by systemic...... inflammation, was also investigated. METHODS: A cross-sectional study in an Emergency Department. Physical performance was assessed by handgrip strength and de Morton Mobility Index (DEMMI), and organ dysfunction by FI-OutRef, the number of standard blood tests outside the reference range. Systemic...... inflammation was assessed by suPAR, TNFα, and IL-6. Associations were investigated by regression analyses adjusted for age, sex, cognitive impairment, CRP, and VitalPAC Modified Early Warning Score. RESULTS: A total of 369 patients were evaluated. In adjusted analyses, suPAR and TNFα was associated with both...

  16. Missed opportunities in the diagnosis and management of protein energy malnutrition among children under 5 years in Wakiso district, Uganda.

    Science.gov (United States)

    Akugizibwe, Roselyne; Kasolo, Josephine; Makubuya, Duncan B; Damani, Ali M

    2013-11-30

    Protein energy malnutrition (PEM) is one of the leading causes of death among children below 5 years in Uganda. It develops after acute childhood illnesses despite children having received treatment from health facilities. This study assessed knowledge and practices of health workers in the diagnosis and management of PEM, which was used to establish missed opportunities to prevent severe acute malnutrition (SAM) in its management. This was a cross sectional descriptive study that used questionnaires and observation of health workers at Health Center IV (HCIV) in Wakiso district, Uganda. The clinical nutrition diagnosis of the children was then obtained. There were 44 health workers that assessed 225 children. Most of the health workers 32 (72.7%) had education in PEM management and over 60% of them knew the forms of PEM, clinical signs of kwashiorkor and marasmus and the factors that predispose to PEM. Health workers did not weigh 56 (24.9%) of the children, 193 (86%) children had no height taken and only 32 (14.2%) had mid upper arm circumference measured. The weight for height of 223 (99.2%) and weight for age of 109 (93%) children was not calculated. Only 38 (16.89%) were examined for edema and 40 (17.78%) for muscle wasting. Health workers diagnosed only 21 (9%) children with malnutrition, while researchers found 94 (31.9%) with malnutrition. Children who missed opportunity to have malnutrition diagnosed at the health facility were 73 (32.9%). The knowledge of health workers on PEM is adequate, but their practice is inadequate. There is missed opportunity to diagnose and manage PEM among children who present with acute illnesses at the health centers, hence missed opportunity to prevent SAM.

  17. Predictive Capability of an iPad-Based Medical Device (medx for the Diagnosis of Vertigo and Dizziness

    Directory of Open Access Journals (Sweden)

    Katharina Feil

    2018-02-01

    Full Text Available BackgroundMaking the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging.ObjectiveIn this study we examined the performance of the iPad based program medx in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them.Patients and methodsThe data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The “gold standard diagnosis” was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient’s case in the constellatory diagnostic system of medx based on an algorithm using all available clinical information. These diagnoses were compared to the “gold standard” by retrospective review of the charts of the patients. The accuracy provided by medx was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity, of being test negative when a disease was absent (specificity, of having the disease when the test is positive (positive predictive value and of not having the disease when the test is negative (negative predictive value for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by medx.ResultsA total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of medx in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%, Menière’s disease

  18. Cognitive Medical Multiagent Systems

    Directory of Open Access Journals (Sweden)

    Barna Iantovics

    2010-01-01

    Full Text Available The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems. This paper analyses the increased intelligence of the CMDS system, which motivates its use for different medical problem’s solving.

  19. A Randomised Controlled Experimental Study on the Influence of Patient Age on Medical Decisions in Respect to the Diagnosis and Treatment of Depression in the Elderly

    Directory of Open Access Journals (Sweden)

    Michael Linden

    2009-01-01

    Full Text Available Background. Elderly patients are often treated differently than younger patients, even when suffering from the same disorder. Objective. The study examines the influence of “patient age” on the perception of symptoms and conclusions of physicians in respect to diagnosis and treatment. Methods. In a randomised controlled experimental study on medical decision-making, 121 general practitioners were given two case vignettes which contained all the criteria for major depression according to ICD-10, but differed in respect to the age of the patient (39 or 81. Reaction time, diagnostic conclusions and therapeutic recommendations were assessed by computer. Results. Depression and anxiety were significantly seen as more probable in the young cases and dementia and physical illness in the old. In young age, psychotherapy, pharmacotherapy and referral to a specialist or inpatient treatment were significantly more recommended than in old age, for whom supportive counselling was significantly more recommended. The time needed for a decision was significantly longer in the older patients. Conclusion. Ageing stereotypes can also form medical illness concepts and have a significant influence on diagnostic and therapeutic decisions.

  20. Methodologic Guide for Evaluating Clinical Performance and Effect of Artificial Intelligence Technology for Medical Diagnosis and Prediction.

    Science.gov (United States)

    Park, Seong Ho; Han, Kyunghwa

    2018-03-01

    The use of artificial intelligence in medicine is currently an issue of great interest, especially with regard to the diagnostic or predictive analysis of medical images. Adoption of an artificial intelligence tool in clinical practice requires careful confirmation of its clinical utility. Herein, the authors explain key methodology points involved in a clinical evaluation of artificial intelligence technology for use in medicine, especially high-dimensional or overparameterized diagnostic or predictive models in which artificial deep neural networks are used, mainly from the standpoints of clinical epidemiology and biostatistics. First, statistical methods for assessing the discrimination and calibration performances of a diagnostic or predictive model are summarized. Next, the effects of disease manifestation spectrum and disease prevalence on the performance results are explained, followed by a discussion of the difference between evaluating the performance with use of internal and external datasets, the importance of using an adequate external dataset obtained from a well-defined clinical cohort to avoid overestimating the clinical performance as a result of overfitting in high-dimensional or overparameterized classification model and spectrum bias, and the essentials for achieving a more robust clinical evaluation. Finally, the authors review the role of clinical trials and observational outcome studies for ultimate clinical verification of diagnostic or predictive artificial intelligence tools through patient outcomes, beyond performance metrics, and how to design such studies. © RSNA, 2018.

  1. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Medical and surgical management for pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Majdy M. Idrees

    2014-01-01

    Full Text Available Prior to the availability of the pulmonary arterial hypertension (PAH-specific therapy, PAH was a dreadful disease with a very poor prognosis. Better understanding of the complex pathobiology of PAH has led to a major therapeutic evolution. International regulatory agencies have approved many specific drugs with different pharmacologic pathways and routes of administration. In the year 2013, two new drugs with great potentials in managing PAH have been added to the treatment options, macitentan and riociguat. Additional drugs are expected to come in the near future. A substantial body of evidence has confirmed the effectiveness of pulmonary arterial hypertension (PAH-specific therapies in improving the patients′ symptomatic status and slowing down the rate of clinical deterioration. the newer modern medications have significantly improved the survival of patients with PAH, it remains a non-curable and fatal disease. Lung transplantation (LT remains the only therapeutic option for selected patients with advanced disease who continue to deteriorate despite optimal therapy.

  2. Why tell children: A synthesis of the global literature on reasons for disclosing or not disclosing an HIV diagnosis to children 12 and under

    Directory of Open Access Journals (Sweden)

    Beatrice J. Krauss

    2016-09-01

    Full Text Available While the psychological and health benefits of knowing one’s HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child’s worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child—e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence, understanding social reactions, and maintaining the child-adult relationship—a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during and after disclosure and to advance the research agenda by broadening samples and refining approaches.

  3. Study on the prevalence and underlying factors of myopia among the students of a medical college in Kerala

    Directory of Open Access Journals (Sweden)

    Shiny George, Biju Baby Joseph

    2014-04-01

    Full Text Available Background: Few decades earlier, wearing spectacles was a province of adults over 40 years of age. Now we see more children and adolescents with spectacles/contact lenses. Various studies in Asian population show a dramatic increase in refractive error, especially myopia among school and college students. More advanced levels of education like medical education that involves extensive near work such as reading and writing have been repeatedly associated with greater myopia prevalence Objective: To study the prevalence and the underlying factors of myopia in MBBS students of a Medical college in Kerala. Research methodology: One hundred and sixty two MBBS students (2009 – 2012 batches were examined. 40 students were selected from each class by systematic random sampling technique, their visual acuity was checked using Snellen’s Chart and Diopters were obtained. Details of factors were obtained using a questionnaire. Results: Prevalence of myopia was observed as 39.5%. First and second year students had a greater percentage of myopia with 40% & 52.5% respectively. 40.6% of myopics had positive family history of myopia (p = 0.003. Duration of TV watching and computer use showed a significant relation with myopia. (p = 0. 033, 0.009. Reading hours, type of light used, playing or texting with cell phone and sleeping habits of students were not significant. Conclusion: Prevalence of myopia was high among medical students (39.5%. Significance of genetic predisposition was well appreciated in our study.

  4. Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland.

    Science.gov (United States)

    Bennett, D; Dornan, T; Bergin, C; Horgan, M

    2015-03-01

    In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate. The objectives of this study were to collate existing data relating to trainees and training programmes at three stages of training and to examine the career plans of junior trainees. Data from application forms for training programmes, commencing July 2012, under the Royal College of Physicians of Ireland (n = 870), were integrated with data from other existing sources. Candidates entering basic specialist training were surveyed with regard to career plans. Descriptive and comparative analysis was performed in SPSS version 18. Graduates of Irish medical schools made up over 70 % of appointees. Over 80 % of BST trainees aspired to work as consultants in Ireland, but 92.5 % planned to spend time working abroad (response rate 77 %). Decisions to leave the Irish system were linked to lifestyle, but also to failure to be appointed to higher specialist training. Significant numbers of trainees return to Ireland after a period abroad. The trainee "exodus" is more complex than is often portrayed. The desire to spend time working outside Ireland must be accounted for in workforce planning and configuration of training programmes. Expansion of HST is a potential solution to reduce the numbers of graduates leaving Ireland post-BST.

  5. Factors affecting exposure level for medical staff during orthopedic procedures under fluoroscopic control

    Directory of Open Access Journals (Sweden)

    Maria A. Staniszewska

    2017-02-01

    Full Text Available Background: Extended control of staff exposure in interventional radiology has been legally required over the last few years. This is determined by a number of factors, including the type of procedure, technical conditions and methodology. In orthopedic procedures fluoroscopy is used to control surgical reconstructions. An influence of particular factors on the registered values of doses received by the members of medical team performing osteosynthesis for limb fractures is presented in this paper. Material and Methods: Doses received by individual interventional team members performing specific functions, operator, assisting physicians and scrub nurse, during a series of the procedures were measured. Each person was equipped with 4 dosimetric tools, containing thermoluminescent dosimeters, to measure the equivalent doses for the eyes, hand skin and the neck (outside the shield and to evaluate effective doses. The investigations were performed in operational theatres of 3 hospitals in Łódź. Results: The equivalent doses per one procedure for the eyes and hand skin of the operator were 0.029–0.073 mSv and 0.366–1.604 mSv, respectively. Significantly higher doses were noted during the procedures of intramedullary osteosynthesis, especially for the operator. An average age and body mass index (BMI of patients treated in the monitored hospitals did not differ statistically. Conclusions: Based on the dosimetric measurements the following conclusions can be drawn: in orthopedic procedures of interventional radiology (IR the exposure of the staff is mostly determined by the type of procedure and more precisely by its complexity and by the optimized use of X-ray unit, including pulsed fluoroscopy. It is also revealed that the operator is the most exposed person in the interventional team. Med Pr 2017;68(1:75–83

  6. Assisting cytopathology training in medically under-resourced countries: defining the problems and establishing solutions.

    Science.gov (United States)

    Field, A S; Geddie, W; Zarka, M; Sayed, S; Kalebi, A; Wright, C A; Banjo, A; Desai, M; Kaaya, E

    2012-03-01

    Cytology is able to deliver rapid accurate diagnoses with minimal equipment and laboratory infrastructure at minimal cost, and this is especially so for fine needle biopsy (FNB), which is a powerful diagnostic tool in medically resource-poor environments, where histopathology laboratories are small in number and poorly supported financially. The crucial element in the development of cytology services is to train a sufficient number of well trained cytopathologists and cytotechnologists to create a 'critical mass' of personnel who not only provide routine diagnostic services, but also can train an ever expanding number of pathologists, cytotechnologists, and health workers. A review of practical programs to train cytopathologists and cytotechnologists in their own countries will be presented, including a recent series of FNB and cytology tutorials run in sub Saharan Africa. The need for local cytopathology programs and the potential for both local and visiting cytopathologists to provide a faculty will be discussed, as well as a range of possible programs which can bring African pathologists and trainee pathologists to Western institutions for periods of their training. Ideally, the regional Societies of Cytology, including the recently formed West African Society of Cytology, will establish their own diagnostic protocols, training programs, syllabuses, examinations and accreditation and career pathways for both cytopathologists and cytotechnologists, and organize tutorials where they will invite overseas faculty to contribute. Crucially, these new societies will empower cytopathologists and cytotechnologists to approach health services and governments to state the need for cytology services as a cost-effective accurate diagnostic service that enhances patient care. Copyright © 2011 Wiley Periodicals, Inc.

  7. Paracentetic methods of diagnosis and treatment under the control of ultrasound, CT, and X-Ray teleimage

    International Nuclear Information System (INIS)

    Nudnov, N.V.; Kosheleva, N.V.; Kut'in, G.K.

    1997-01-01

    Exploratory and therapeutical punctures were made in 454 patients under the control of ultrasound, CT, and X-Ray teleimage. Diagnostic biopsies established the cytological and histological nature of diseases in 6,7% of cases, positive ultrasound-, CT-, and X-Ray teleimage-controlled biopsies being 76,3, 64,9, and 71,4%, respectively. Beneficial effects of therapeutical interventions were obtained in 89,5% of patients

  8. Bearing Fault Diagnosis under Variable Speed Using Convolutional Neural Networks and the Stochastic Diagonal Levenberg-Marquardt Algorithm

    Directory of Open Access Journals (Sweden)

    Viet Tra

    2017-12-01

    Full Text Available This paper presents a novel method for diagnosing incipient bearing defects under variable operating speeds using convolutional neural networks (CNNs trained via the stochastic diagonal Levenberg-Marquardt (S-DLM algorithm. The CNNs utilize the spectral energy maps (SEMs of the acoustic emission (AE signals as inputs and automatically learn the optimal features, which yield the best discriminative models for diagnosing incipient bearing defects under variable operating speeds. The SEMs are two-dimensional maps that show the distribution of energy across different bands of the AE spectrum. It is hypothesized that the variation of a bearing’s speed would not alter the overall shape of the AE spectrum rather, it may only scale and translate it. Thus, at different speeds, the same defect would yield SEMs that are scaled and shifted versions of each other. This hypothesis is confirmed by the experimental results, where CNNs trained using the S-DLM algorithm yield significantly better diagnostic performance under variable operating speeds compared to existing methods. In this work, the performance of different training algorithms is also evaluated to select the best training algorithm for the CNNs. The proposed method is used to diagnose both single and compound defects at six different operating speeds.

  9. Rates of Autism Spectrum Disorder Diagnosis Under the DSM-5 Criteria Compared to DSM-IV-TR Criteria in a Hospital-Based Clinic.

    Science.gov (United States)

    Hartley-McAndrew, Michelle; Mertz, Jana; Hoffman, Martin; Crawford, Donald

    2016-04-01

    We aimed to determine whether there was a decrease in the number of children diagnosed on the autism spectrum after the implementation of the new diagnostic criteria as outlined in the Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition published in May 2013. We reviewed 1552 charts of children evaluated at the Women and Children's Hospital of Buffalo, Autism Spectrum Disorders Clinic. A comparison was made of children diagnosed with autism spectrum disorder (autism, Asperger disorder, pervasive developmental disorder-not otherwise specified) from 2010 to May 2013 using the Diagnostic and Statistical Manual of Mental Health Disorders Fourth Edition, Text Revision criteria with children diagnosed from June 2013 through June 2015 under the Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition. Using χ(2) analysis, the 2013-2015 rate of autism spectrum disorder diagnosis (39%) was significantly lower (P disorder diagnosis was significantly lower under the recently implemented Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition criteria. Published by Elsevier Inc.

  10. 45 CFR 233.145 - Expiration of medical assistance programs under titles I, IV-A, X, XIV and XVI of the Social...

    Science.gov (United States)

    2010-10-01

    ... Social Security Act for aid or assistance in the form of medical or any other type of remedial care for... 45 Public Welfare 2 2010-10-01 2010-10-01 false Expiration of medical assistance programs under titles I, IV-A, X, XIV and XVI of the Social Security Act. 233.145 Section 233.145 Public Welfare...

  11. 42 CFR 440.170 - Any other medical care or remedial care recognized under State law and specified by the Secretary.

    Science.gov (United States)

    2010-10-01

    ... medical transportation brokerage program. At the option of the State, and notwithstanding § 431.50... transportation brokerage program in order to more cost-effectively provide non-emergency medical transportation... provided under contract with individuals or entities that meet the following requirements: (A) Is selected...

  12. Red Cross Under Fire: The future of the Geneva Convention's Distinctive Emblem on the Future Combat System - Medical Variant Vehicle

    National Research Council Canada - National Science Library

    Bagwell, Randall J

    2005-01-01

    The Future Combat System-Medical Variant (FCS-MV) vehicle offers self defense, sensor, communication, and medical capabilities that will make it the safest and most advanced medical evacuation vehicle in history...

  13. Fault diagnosis

    Science.gov (United States)

    Abbott, Kathy

    1990-01-01

    The objective of the research in this area of fault management is to develop and implement a decision aiding concept for diagnosing faults, especially faults which are difficult for pilots to identify, and to develop methods for presenting the diagnosis information to the flight crew in a timely and comprehensible manner. The requirements for the diagnosis concept were identified by interviewing pilots, analyzing actual incident and accident cases, and examining psychology literature on how humans perform diagnosis. The diagnosis decision aiding concept developed based on those requirements takes abnormal sensor readings as input, as identified by a fault monitor. Based on these abnormal sensor readings, the diagnosis concept identifies the cause or source of the fault and all components affected by the fault. This concept was implemented for diagnosis of aircraft propulsion and hydraulic subsystems in a computer program called Draphys (Diagnostic Reasoning About Physical Systems). Draphys is unique in two important ways. First, it uses models of both functional and physical relationships in the subsystems. Using both models enables the diagnostic reasoning to identify the fault propagation as the faulted system continues to operate, and to diagnose physical damage. Draphys also reasons about behavior of the faulted system over time, to eliminate possibilities as more information becomes available, and to update the system status as more components are affected by the fault. The crew interface research is examining display issues associated with presenting diagnosis information to the flight crew. One study examined issues for presenting system status information. One lesson learned from that study was that pilots found fault situations to be more complex if they involved multiple subsystems. Another was pilots could identify the faulted systems more quickly if the system status was presented in pictorial or text format. Another study is currently under way to

  14. Vaginitis: diagnosis and management.

    Science.gov (United States)

    Quan, Martin

    2010-11-01

    Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.

  15. Assessment of hepatic function, operative candidacy, and medical management after liver resection in the patient with underlying liver disease.

    Science.gov (United States)

    Wagener, Gebhard

    2013-08-01

    Liver resection in patients with underlying liver disease remains a formidable challenge. It requires adequate patient selection, a precise surgical plan, and avoidance of additional ischemic insults during surgery. Precise estimation of the residual liver volume using computed tomography or magnetic resonance imaging and computer-assisted volumetry allows the calculation of residual to total liver volume (RLV/TLV) ratios. Although RLV/TLV ratios over 20 to 25% are considered sufficient in healthy livers, patients with cirrhosis may only tolerate resections that result in RLV/TLV ratios over 40% and higher. Conventional laboratory tests may not be able to sufficiently predict liver reserve after resection. Dynamic tests such as indocyanine green clearance have been used to assess residual liver function and assist in deciding about operability of patients with underlying liver disease undergoing extensive resections. Intraoperative management should focus on avoiding blood loss and ischemic injury to the liver. Low central venous pressure may reduce blood loss and is recommended if tolerated without impeding renal perfusion. Portal vein and hepatic artery occlusion during resection can reduce blood loss, but will cause ischemic insult to the liver that may jeopardize residual liver function and induce postoperative hepatic failure. When feasible, vascular occlusion should be avoided in patients with underlying liver disease. The postoperative recovery is usually fast if sufficient liver remains. However, vigilance is required to detect liver dysfunction and treat its complications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Symptoms and Diagnosis

    Science.gov (United States)

    ... Special Events Faces of Dystonia Donate Donate Online Membership Find an Event Donor Bill of Rights About Dystonia Symptoms & Diagnosis Forms of Dystonia Genetics Glossary Treatment Find a Doctor Oral Medications Botulinum Neurotoxin Neurosurgery ...

  17. Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab.

    Science.gov (United States)

    Matsumoto, Akihiko; Sasaki, Masanori; Schmelzeisen, Rainer; Oyama, Yukiko; Mori, Yoshihide; Voss, Pit Jacob

    2017-01-01

    Some recent reports have indicated that local infection causes osteonecrosis of the jaw and described that tooth extraction may not be a direct cause of developing medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive medications. Tooth extraction and elimination of the source of infection are expected to reduce the risk of developing MRONJ. However, there is no data regarding prevention for developing osteonecrosis of the jaw in patients receiving denosumab. Therefore, the aim of this study was to investigate the outcome of tooth extractions with proper wound closure in patients receiving denosumab. Forty teeth in 19 patients treated with denosumab therapy were extracted under preoperative intravenous antibiotics. Patients who had already developed MRONJ in the extraction sites or who had a history of radiation therapy were excluded. During surgery, bone edges were smoothed and all wounds were closed using the double-layered technique. Thirty-seven extraction sites (92.5 %) in 17 out of 19 patients (89.5 %) were healed. However, three extraction sites in two patients had complications; one patient had exposed bone and developed MRONJ (stage 1) and the other developed a mucosa fistula. Additional surgical procedures were performed and all wounds were completely healed. Tooth extractions in patients receiving denosumab can be performed in an appropriate manner and result in good outcomes. This study indicated that tooth extraction with proper wound closure to avoid secondary infection may be effective for the prevention of MRONJ even in high-risk patients.

  18. O residente ideal em radiologia e diagnóstico por imagem The ideal medical resident for radiology and imaging diagnosis

    Directory of Open Access Journals (Sweden)

    Evandro Guimarães de Sousa

    2004-12-01

    Full Text Available A Comissão Nacional de Residência Médica, em 2003, estabeleceu novos critérios para o credenciamento de programas de Residência Médica em Radiologia e Diagnóstico por Imagem. Apesar dessas normas representarem um avanço no treinamento do residente, outras competências e habilidades específicas deverão ser desenvolvidas no sentido de acompanhar o rápido desenvolvimento técnico e científico, e para atender as novas exigências do mercado de trabalho. Os autores apresentam as principais competências e habilidades que complementam a formação do radiologista, sugerindo modificação nos atuais programas para que os residentes possam adquiri-las.In 2003, the National Committee of Medical Residency established new criteria for the accreditation of Radiology and Imaging Diagnosis Residency programs. Although these rules represent an advance to the resident's training, other specific abilities and skills should be developed in order to keep up with the technical and scientific advances and with the new requirements of the career. The authors' present the must important competencies and skills that complement the radiologist's education and suggest a change in current programs so that the resident can acquire these competencies and skills.

  19. Impact on medical economics of [18F]FDG-PET application in health insurance of diagnosis of tumors unapproved in the present insurance

    International Nuclear Information System (INIS)

    Honda, Norinari; Ito, Kengo; Torizuka, Kanji

    2008-01-01

    Medical costs were estimated for the assumed case of approval of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) and/or PET-CT diagnoses (D) of all tumors which are now unapproved in the national health insurance system. The number of D was predicted to be 275,785 examinations in 2008, based on results of 3 questionnaires to PET facilities in 2004-2006. The average D examination fee was found to be 78,350 Japanese yen when calculated from the proportion of examinations with the fee of 20% reduction and ratio of PET/PET-CT examinations. Frequency of surgical operation was assumed to be reduced by 27% because of precised D for the stage decision of malignant neoplasm. These assumptions resulted in the impact of 3,164,258,753 Japanese yen decrease by D approval in the insurance. Integration of precise D image reading by experts, patients' anamnesis, physical and biochemical findings, and other imaging diagnosis enables the decision of the stage of malignancy more accurate; based on which establishment of rational therapeutic planning is possible; which is important both for saving the cost of medicare and for improving its quality. (R.T.)

  20. Diagnosis of hepatobiliary disease by Technetium-99m-HIDA and BIDA cholecystography in 210 patients treated at ''Soroka Medical Center'' between 1977 - 1979

    International Nuclear Information System (INIS)

    Garty, I.; Silberman, C.

    1979-01-01

    Cholescintigraphy experience with Tc 99 m-HIDA and BIDA in 210 patients with gallbladder disease treated at the Soroka Medical Center between the years 1977 - 1979 is described. In this work the utility of the method in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice up to 26 mg% of Bilirubin is demosntrated. Four patients were diagnosed as suffering from Atresia of biliary duct. The most common findings in our series are: all normal gallbladders exhibited filling; absence of visualization indicated gallbladder disease and/or cystic duct obstruction; visualization of the gallbladder after a fatty meal-induced emptying excluded an obstructed cystic duct and acute cholecystitis; a definite diagnosis of hepato-cellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemia. No diagnostic failures due to too low concentration of the tracer in the biliary tract, were observed. Radiation exposure is somewhat greater than in cholecystography and cholangiography. Cholescintigraphy is a suitable complementary or alternative investigation to intravenous cholangiography, especially when poor excretion of the contrast medium or adverse reaction impair the result of the latter. In some of our cases this method proved to be the first choice non invasive procedure, especially in cases with high serum bilirubin up to 26 mg%. (B.G.)

  1. [Study on medical pattern of traditional Chinese medicine and western medicine diagnosis and treatment of hypertension patients in 30 034 cases in real world].

    Science.gov (United States)

    Ma, Jin-hui; Wang, Zhi-fei; Xie, Yan-ming; Yang, Wei; Yang, Zhi-xin; Zhuang, Yan; Wang, Yong-yan

    2014-09-01

    Select patients diagnosed of hypertension in the first place in 16 hospitals and the patients were described by association rules analysis and distribution for the analysis in the study,in order to understand the information of diagnosis and treatment in hypertension patients in real world. The information include age, gender, admission condition, inpatient department, hospitalization expenses, western medicine comorbidities, the traditional Chinese medicine (TCM) syndrome and the medicine. The average age of patients was 64 years in the study. The proportion of men to women about 1. 10: 1. Admission condition is critical for about 10.12% of the total and more concentrated in the cardiovascular department. Hospital stay ranged from 8 to 14 d. Inpatients with medical insurance is 62.93%. Total hospitalization cost distribution most is the 5 000-10 000 RMB. Hypertension complicated with coronary heart disease, blood lipoprotein disorder disease; phlegm and blood stasis and Yin deficiency of liver and kidney are the most in TCM syndrome type. Promoting blood circulation and removing blood stasis is the major in Chinese medicine treatment. Western medicine treatment basically conforms to the guidelines. The most antihypertensive drugs is calcium antagonistst, accounting for about 81.2% of the total number. Class ACEI, class ARB, beta blockers, diuretics class are accounted for 43.0%, 43.4%, 42.4%, 42.4%, fixed compound is only 2 393, accounting for about 8%. the total frequency of five classes of antihypertensive drugs is 78 206 times. The principal conclusions of this analysis are as follows: the elderly people is the most in hypertension, more men than women; medical insurance is the majority type in hospitalization cost; nearly half of the population is combined with coronary heart disease; phlegm and blood stasis and yin deficiency of liver and kidney are the most in TCM syndrome type; western medicine treatment basically conforms to the guidelines. Combination

  2. Bordetella pertussis diagnosis in children under five years of age in the Regional Hospital of Cajamarca, Northern Peru.

    Science.gov (United States)

    Del Valle-Mendoza, Juana; Casabona-Oré, Veronica; Petrozzi-Helasvuo, Veronica; Cornejo-Tapia, Angela; Weilg, Pablo; Pons, Maria J; Cieza-Mora, Erico; Bazán-Mayra, Jorge; Cornejo-Pacherres, Hernan; Ruiz, Joaquin

    2015-11-30

    Bordetella pertussis is an important human pathogen that causes whooping cough (pertussis), an endemic illness responsible of significant morbidity and mortality, especially in infants and children. Worldwide, there are an estimated of 16 million cases of pertussis, resulting in about 195,000 child deaths per year. In Peru, pertussis is a major health problem that has been on the increase despite immunization efforts. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age suspected to have whopping cough in Cajamarca, Peru. Children diagnosed with whooping cough admitted to the Hospital Regional de Cajamarca from August 2010 to July 2013 were included. Nasopharyngeal samples were obtained for B. pertussis culture and polymerase chain reaction (PCR) detection. In 133 children, the pertussis toxin and IS481 gene were detected in 38.35% (51/133) of the cases by PCR, while only 9.02% (12/133) of the Bordetella cultures were positive. The most frequent symptoms in patients with positive B. pertussis were paroxysm of coughing 68.63% (35/51), cyanosis 56.86% (29/51), respiratory distress 43.14% (22/51), and fever 39.22% (20/51). Pneumonia and acute bronchial obstructive syndrome were present in 17.65% (9/51) and 13.72% (7/51) of the cases, respectively. B. pertussis is responsible for an important proportion of whooping cough in hospitalized children in Cajamarca. Epidemiologic surveillance programs for B. pertussis are essential in Peru, especially in children who could most benefit from the vaccine.

  3. Sensitivity and specificity of thallium-201 perfusion scintigrams under exercise in the diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Verani, M.S.; Marcus, M.L.; Razzak, M.A.; Ehrhardt, J.C.

    1978-01-01

    The specificity and sensitivity of thallium-201 myocardial perfusion imaging (MPI), under exercise, in patients with suspected coronary-obstructive disease was compared with graded exercise ECG tests (GTX) in patients with angiographically normal (N = 34) and obstructed (N = 48) coronary arteries. Of the 34 patients with normal coronaries, only one had a perfusion defect on the MPI (specificity 97%). Of the 48 patients with coronary obstructive disease (>50% obstruction of at least one coronary vessel), MPI was positive in 38 (sensitivity 79%). In contrast, the GTX had a specificity of 62% and sensitivity of 88% if nondiagnostic GTX tests are excluded. When the MPI and the GTX were used in combination, however, the sensitivity of detecting patients with coronary obstructive disease was increased to 94% (p < 0.01). The MPI was particularly useful in the evaluation of the 26 patients with nondiagnostic GTX. In this group, 24 of the 26 patients were correctly identified by the MPI with respect to the presence or absence of coronary-obstructive disease. In the 14 patients with a history of classical angina but with normal coronaries, the MPI was negative in 13 and positive in one, thus suggesting that in the majority of these patients transient transmural myocardial ischemia probably does not occur during exercise. The presence or absence of angiographically demonstrable coronary collateral vessels did not seem to influence the exercise MPI in patients with coronary-obstructive disease. Thus, although the MPI does not correctly identify all patients with either coronary-obstructive disease or normal coronary arteries, it is helpful in patients who have a nondiagnostic GTX. Furthermore, when used in combination with the GTX, the MPI significantly increases the likelihood that significant coronary-obstructive disease is present when both tests are positive, and that coronary disease is absent when both tests are negative

  4. Medical radiation

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    This leaflet in the At-a-Glance Series describes the medical use of X-rays, how X-rays help in diagnosis, radiation protection of the patient, staff protection, how radioactive materials in nuclear medicine examinations help in diagnosis and the use of radiation in radiotherapy. Magnetic resonance imaging, a diagnostic technique involving no ionizing radiation, is also briefly examined. The role of the NRPB in the medical use of radiation is outlined. (UK).

  5. Joint High-Order Synchrosqueezing Transform and Multi-Taper Empirical Wavelet Transform for Fault Diagnosis of Wind Turbine Planetary Gearbox under Nonstationary Conditions.

    Science.gov (United States)

    Hu, Yue; Tu, Xiaotong; Li, Fucai; Meng, Guang

    2018-01-07

    Wind turbines usually operate under nonstationary conditions, such as wide-range speed fluctuation and time-varying load. Its critical component, the planetary gearbox, is prone to malfunction or failure, which leads to downtime and repair costs. Therefore, fault diagnosis and condition monitoring for the planetary gearbox in wind turbines is a vital research topic. Meanwhile, the signals measured by the vibration sensors mounted in the gearbox exhibit time-varying and nonstationary features. In this study, a novel time-frequency method based on high-order synchrosqueezing transform (SST) and multi-taper empirical wavelet transform (MTEWT) is proposed for the wind turbine planetary gearbox under nonstationary conditions. The high-order SST uses accurate instantaneous frequency approximations to obtain a sharper time-frequency representation (TFR). As the acquired signal consists of many components, like the meshing and rotating components of the gear and bearing, the fault component may be masked by other unrelated components. The MTEWT is used to separate the fault feature from the masking components. A variety of experimental signals of the wind turbine planetary gearbox under nonstationary conditions have been analyzed to demonstrate the effectiveness and robustness of the proposed method. Results show that the proposed method is effective in diagnosing both gear and bearing faults.

  6. Revisiting the medical diagnosis problem

    DEFF Research Database (Denmark)

    Ejersbo, Lisser Rye; Leron, Uri

    2014-01-01

    psychological research as a theoretical base, we design a new “bridging” task, which is on the one hand formally equivalent to the given “difficult” task, but on the other hand is much more accessible to students’ intuitions. Furthermore, this new task would serve as "stepping stone", enabling students to solve...... of such cognitive challenges? In our view, pointing out the clash is not enough; we'd like to help students build bridges between the intuitive and analytical ways of seeing the problem, thus hopefully creating a peaceful co-existence between these two modes of thought. In this article, we investigate this question...

  7. SARCOSPORIDIOSIS - MEDICAL IMPORTANCE AND DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Milena Misic

    2004-07-01

    Full Text Available Sarcosporidiosis (Sarcocystis infection is caused by an intracellular protozoan parasite that predominantly affects animals. It can rarely be found in human skeletal and cardiac muscle in humans. There are two different forms of sarcosporidiosis in humans. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals thus permitting the contamination of food and drink with sporocystis shed by these definitive hosts. The second mode of infection for humans is ingested animal tissues which containing sporozoites (e.g., undercooked meats. These sporozoited directly intestinal epithelial cells and can enter the circulation in an manner similiar to those released from oocysts from the intermediate or accidental host.

  8. Liquid scintillation in medical diagnosis

    International Nuclear Information System (INIS)

    Painter, K.

    1976-01-01

    With the tremendous increase in the application of radioassay, particularly radioimmunoassay, in the clinical laboratory liquid scintillation counting became an indispensable tool in diagnostic medicine. Few publications, however, have concerned themselves with problem areas which occur with the method in the clinical laboratory. The purpose of this presentation is to summarize our experiences with the liquid scintillation technique in the clinical situation

  9. Multispectral imaging for medical diagnosis

    Science.gov (United States)

    Anselmo, V. J.

    1977-01-01

    Photography technique determines amount of morbidity present in tissue. Imaging apparatus incorporates numerical filtering. Overall system operates in near-real time. Information gained from this system enables physician to understand extent of injury and leads to accelerated treatment.

  10. Sonographic diagnosis of

    Directory of Open Access Journals (Sweden)

    Stroever, Brigitte

    2005-11-01

    Full Text Available Introduction: The acute abdomen is the main term for an at first unclear emergency situation of the abdominal cavity. The acute abdomen belongs to the three most important reasons for the admission of patients into the emergency room. Further, this illness ranks 40% of all consultations in the ambulant care sector. The acute abdomen requires an early and direct diagnosis because of its potential of having a life threatening differential diagnosis. This HTA report aimed to assess the ultrasound diagnosis of the acute abdomen considering children and adults. This will be done from a medical and economic perspective. The differential diagnosis respectively the cause of the acute abdomen binds high direct treatment costs, especially in the stationary sector. Ultrasound diagnosis is a procedure that plays a big part in the differential diagnosis process and it is widely used in practise. Other research methods of diagnosing acute abdominal illness are: clinical examinations with inspection and palpation, surgical exploration and laparocopy as well as computer tomography and x-ray examination. Objectives: The main objective of this HTA report is to assess what significance sonography should have within the examination strategy of the acute abdomen from the medical and economical view. Second, this HTA report will evaluate under which circumstances the ultrasonographic diagnosis of the acute abdomen, considering medical and economical quality classifications, is the alternative of choice to comparable diagnostic measures. Methods: The target population this HTA report is aimed at are children and adults with acute abdomen or embedded differential diagnosis. A systematic literature search was conducted covering all relevant medical and HTA-databases. Furthermore, handsearch was conducted inside of the known data bases of HTA-institutions as well as from medical and economical journals. The following databases were searched in cooperation with DIMDI to

  11. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine.

    Science.gov (United States)

    Koulouri, Olympia; Auldin, Mohammed A; Agarwal, Ravi; Kieffer, Veronica; Robertson, Carole; Falconer Smith, James; Levy, Miles J; Howlett, Trevor A

    2011-06-01

    Achieving optimal thyroid hormone replacement is more difficult in TSH deficiency compared to primary hypothyroidism because of the inability to be guided by serum TSH levels. A combination of clinical symptoms and free thyroxine levels (fT4) are typically used to make a diagnosis and monitor replacement. We investigated the diagnosis of TSH deficiency in patients with pituitary disease and the adequacy of levothyroxine replacement compared with primary thyroid disease. Using our department's clinical information system, we identified all patients with a diagnosis of any type of pituitary tumour who had been seen in clinic over a 2-year period. We divided the patients into those at high risk and low risk of TSH deficiency based on the presence of macroadenoma and/or intervention by surgery or radiotherapy. We compared fT4 values in these patients with values in patients with primary thyroid disease in our thyrotoxicosis shared-care scheme (TSC) and hypothyroid register within the same timescale, assessing only those samples considered euthyroid in which TSH was in the normal range. A database query identified 525 patients with a pituitary tumour of whom 344 were considered at high risk of TSH deficiency. A free T4 (fT4) value was found for 514 patients (97·9%). TSC and thyroid register databases revealed fT4 values for comparison with simultaneous normal TSH in patients on no treatment (n = 3777 samples) or on levothyroxine alone (n = 11,805). fT4 levels overall were lower in pituitary patients than in equivalent controls. Of the high risk group not taking levothyroxine 17% had a free T4 ≤ 11 pmol/l compared to only 8·4% of untreated controls. Furthermore, 38·9% of patients on levothyroxine had a free T4 ≤ 13 pmol/l compared to 9·5% of controls on levothyroxine with previous thyrotoxicosis and 13·4% of controls with primary hypothyroidism. Median fT4 in controls on levothyroxine was 16 pmol/l and 20-80th centile range was 14-19 pmol/l. Levothyroxine doses

  12. Medical resource inventory model for emergency preparation with uncertain demand and stochastic occurrence time under considering different risk preferences at the airport.

    Directory of Open Access Journals (Sweden)

    Wei Pan

    Full Text Available With the high accident rate of civil aviation, medical resource inventory becomes more important for emergency management at the airport. Meanwhile, medical products usually are time-sensitive and short lifetime. Moreover, we find that the optimal medical resource inventory depends on multiple factors such as different risk preferences, the material shelf life and so on. Thus, it becomes very complex in a real-life environment. According to this situation, we construct medical resource inventory decision model for emergency preparation at the airport. Our model is formulated in such a way as to simultaneously consider uncertain demand, stochastic occurrence time and different risk preferences. For solving this problem, a new programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the optimal medical resource inventory for emergency preparation with uncertain demand and stochastic occurrence time under considering different risk preferences at the airport.

  13. Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China.

    Science.gov (United States)

    Zeng, Jiazhi; Shi, Leiyu; Zou, Xia; Chen, Wen; Ling, Li

    2015-01-01

    China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants' experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool--Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants' quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients' perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence

  14. Carrier Diagnosis

    Science.gov (United States)

    ... Inheritance of Hemophilia Definitions & Terminology Bleeding Symptoms Carrier Diagnosis When to Test for Carrier Status Family Planning and Pregnancy Conception Options Prenatal Diagnosis Fetal Sex ...

  15. Increased risk among older veterans of prescribing psychotropic medication in the absence of psychiatric diagnoses.

    Science.gov (United States)

    Wiechers, Ilse R; Kirwin, Paul D; Rosenheck, Robert A

    2014-06-01

    This study uses Veterans Health Administration (VHA) pharmacy and encounter claims to evaluate the use of psychotropic medications without a psychiatric diagnosis across age groups. National VHA administrative data for fiscal year 2010 (FY2010) were used to identify all veterans who filled a prescription for at least one psychotropic medication from VHA (N = 1.85 million). Bivariate and multivariate analyses were used to compare the proportion of these veterans without any psychiatric diagnosis, across age groups, adjusting for possible medical indications. Analyses were repeated for six different classes of psychotropic medications and comparing mental health utilizers and non-mental health utilizers. Comparisons were made to prescribing of HIV and diabetes medications without an indicated diagnosis. Of all VHA patients prescribed a psychotropic medication in FY2010, 30% had no psychiatric diagnosis, with highest proportions among veterans ages 65-85. This practice was most frequent among nonmental health utilizers and far more prevalent for psychotropic medications than for HIV or diabetes medications. Logistic regression analysis found that age greater than 65 was the strongest predictor of being prescribed a psychotropic without a psychiatric diagnosis. Adjustment for possible medical use of psychotropics and overall medical comorbidity did not substantially alter these trends. Older veterans, especially those not using specialty mental healthcare, are more likely to be prescribed psychotropic medications in the absence of a psychiatric diagnosis, perhaps representing unnecessary use, under-diagnosis of mental illness, or incomplete documentation. Published by Elsevier Inc.

  16. Robust Diagnosis Method Based on Parameter Estimation for an Interturn Short-Circuit Fault in Multipole PMSM under High-Speed Operation.

    Science.gov (United States)

    Lee, Jewon; Moon, Seokbae; Jeong, Hyeyun; Kim, Sang Woo

    2015-11-20

    This paper proposes a diagnosis method for a multipole permanent magnet synchronous motor (PMSM) under an interturn short circuit fault. Previous works in this area have suffered from the uncertainties of the PMSM parameters, which can lead to misdiagnosis. The proposed method estimates the q-axis inductance (Lq) of the faulty PMSM to solve this problem. The proposed method also estimates the faulty phase and the value of G, which serves as an index of the severity of the fault. The q-axis current is used to estimate the faulty phase, the values of G and Lq. For this reason, two open-loop observers and an optimization method based on a particle-swarm are implemented. The q-axis current of a healthy PMSM is estimated by the open-loop observer with the parameters of a healthy PMSM. The Lq estimation significantly compensates for the estimation errors in high-speed operation. The experimental results demonstrate that the proposed method can estimate the faulty phase, G, and Lq besides exhibiting robustness against parameter uncertainties.

  17. Robust Diagnosis Method Based on Parameter Estimation for an Interturn Short-Circuit Fault in Multipole PMSM under High-Speed Operation

    Directory of Open Access Journals (Sweden)

    Jewon Lee

    2015-11-01

    Full Text Available This paper proposes a diagnosis method for a multipole permanent magnet synchronous motor (PMSM under an interturn short circuit fault. Previous works in this area have suffered from the uncertainties of the PMSM parameters, which can lead to misdiagnosis. The proposed method estimates the q-axis inductance (Lq of the faulty PMSM to solve this problem. The proposed method also estimates the faulty phase and the value of G, which serves as an index of the severity of the fault. The q-axis current is used to estimate the faulty phase, the values of G and Lq. For this reason, two open-loop observers and an optimization method based on a particle-swarm are implemented. The q-axis current of a healthy PMSM is estimated by the open-loop observer with the parameters of a healthy PMSM. The Lq estimation significantly compensates for the estimation errors in high-speed operation. The experimental results demonstrate that the proposed method can estimate the faulty phase, G, and Lq besides exhibiting robustness against parameter uncertainties.

  18. Diagnosis and therapy of cutaneous radiation syndrome. Individual radiosensitivity assessment in patients undergoing medical exposures presenting severe cutaneous radiation induced lesions

    International Nuclear Information System (INIS)

    Di Giorgio, Marina; Vallerga, Maria B.; Perez, Maria R.; Portas, Mercedes

    2007-01-01

    Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires (Burn Center) is one of the reference hospitals of the Medical Radiological Emergency Response Network of Argentina. In the frame of an agreement between the Burn Center and the Nuclear Regulatory Authority of Argentina, a research project for an approach based on diagnosis and therapy of cutaneous radiation induced lesions is in progress. Individual radiosensitivity assessment was conducted in patients included in this research protocol that showed acute and/or late cutaneous reactions with grades 3 and 4 of the Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). DNA repair capacity and its kinetics were evaluated in human peripheral blood lymphocytes using alkaline comet assay and micronucleus test. In this paper, two representative cases, in which the research protocol was applied, are presented. Therapeutic response and its correlation with radiosensitivity test results are described. Case 1: female patient undergoing external radiotherapy for invasive ductal breast cancer that presented acute cutaneous radiotoxicity, grade 3 (confluent moist epithelitis, )that led to treatment break. Case 2: male patient undergoing coronary angioplasty (interventional radiology), which developed late cutaneous radiotoxicity, grade 4 (ulceration at the dorsal region). Patients were treated with: topic administration of trolamine and silver sulfadiazine with lidocaine, associated with systemic administration of pentoxiphiline and anti-oxidants. The therapeutic response was evaluated through clinical follow-up, serial photographic record and complementary tests (tele thermography and high frequency ultrasonography). Case 1 response was positive (favorable) with early local recovery and complete remission of signs and symptoms after 5 months. Both MN frequencies and comet assay showed values compatible with normal radiosensitivity

  19. ICHD-II Criteria in Diagnosis of Pediatric Migraine

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-12-01

    Full Text Available The sensitivity of the new International Classification of Headache Disorders-2nd edition (ICHD-II criteria in the diagnosis of childhood migraine was evaluated in 260 patients, ages 18 and under, seen at 2 large pediatric headache centers, and reported from Children’s Hospital Medical Center, Cincinnati, OH; The Cleveland Clinic, OH; and other centers.

  20. Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland.

    LENUS (Irish Health Repository)

    Bennett, D

    2014-03-09

    In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate.

  1. Measuring Medical Students' Empathy : Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-Report Instruments in Five Countries

    NARCIS (Netherlands)

    Costa, Patrício; de Carvalho-Filho, Marco Antonio; Schweller, Marcelo; Thiemann, Pia; Salgueira, Ana; Benson, John; Costa, Manuel João; Quince, Thelma

    PURPOSE: Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments-Davis's Interpersonal

  2. Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

    International Nuclear Information System (INIS)

    Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy

    2017-01-01

    To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

  3. Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

    Energy Technology Data Exchange (ETDEWEB)

    Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, PO Box 850, Hershey, PA (United States)

    2017-10-15

    To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

  4. Effort-Based Reinforcement Processing and Functional Connectivity Underlying Amotivation in Medicated Patients with Depression and Schizophrenia.

    Science.gov (United States)

    Park, Il Ho; Lee, Boung Chul; Kim, Jae-Jin; Kim, Joong Il; Koo, Min-Seung

    2017-04-19

    Amotivation is a common phenotype of major depressive disorder and schizophrenia, which are clinically distinct disorders. Effective treatment targets and strategies can be discovered by examining the dopaminergic reward network function underlying amotivation between these disorders. We conducted an fMRI study in healthy human participants and medicated patients with depression and schizophrenia using an effort-based reinforcement task. We examined regional activations related to reward type (positive and negative reinforcement), effort level, and their composite value, as well as resting-state functional connectivities within the meso-striatal-prefrontal pathway. We found that integrated reward and effort values of low effort-positive reinforcement and high effort-negative reinforcement were behaviorally anticipated and represented in the putamen and medial orbitofrontal cortex activities. Patients with schizophrenia and depression did not show anticipation-related and work-related reaction time reductions, respectively. Greater amotivation severity correlated with smaller work-related putamen activity changes according to reward type in schizophrenia and effort level in depression. Patients with schizophrenia showed feedback-related putamen hyperactivity of low effort compared with healthy controls and depressed patients. The strength of medial orbitofrontal-striatal functional connectivity predicted work-related reaction time reduction of high effort negative reinforcement in healthy controls and amotivation severity in both patients with schizophrenia and those with depression. Patients with depression showed deficient medial orbitofrontal-striatal functional connectivity compared with healthy controls and patients with schizophrenia. These results indicate that amotivation in depression and schizophrenia involves different pathophysiology in the prefrontal-striatal circuitry. SIGNIFICANCE STATEMENT Amotivation is present in both depression and schizophrenia

  5. [Diagnosis, clinical course, and differential diagnosis of schizophrenia].

    Science.gov (United States)

    Hori, Hikaru; Nakamura, Jun

    2013-04-01

    Schizophrenia is a disease whose symptoms are shown to a little less than 1% at adolescence. Since the morbidity elucidation is not yet made many of psychiatry diseases including schizophrenia, a useful biological marker or image inspection, and a physiological inspection are not in diagnosis. About diagnosis of a psychiatric disorder, the symptoms study diagnostic method never must be used. Then, diagnosis needs to be made appropriately and carefully and differential diagnosis must also perform it exactly. It is because medical treatment may differ depending on diagnosis. If this is not made appropriately, it may lead to medication of an unnecessary and aimless antipsychotic. In this paper, diagnosis and differential diagnosis of schizophrenia, and clinical course were summarized.

  6. Physical and rehabilitation medicine section and board of the European Union of Medical Specialists. Community context; history of European medical organizations; actions under way.

    Science.gov (United States)

    De Korvin, G; Delarque, A

    2009-01-01

    The European Community is based on a series of treaties and legal decisions, which result from preliminary documents prepared long before by different organizations and lobbies. The European union of medical specialists (Union européenne des médecins specialists [UEMS]) came into being in order to address the questions raised by European directives (e.g., free circulation of people and services, reciprocal recognition of diplomas, medical training, quality improvements). The specialty sections of the UEMS contribute actively to this work. The physical and rehabilitation medicine (PRM) section is composed of three committees: the PRM board is devoted to initial and continuing education and has published a harmonized teaching programme and organized a certification procedure, which can be considered as a European seal of quality; the Clinical Affairs Committee is concerned with the quality of PRM care, and it has set up a European accreditation system for PRM programs of care, which will help to describe PRM clinical activity more concretely; and the Professional Practice Committee works on the fields of competence in our specialty. This third committee has already published a White Book, and further documents are being prepared, based on both the International classification of functioning, disability and health (ICF) and reference texts developed by the French Federation of PRM.

  7. Polymyositis: Medical Management

    Science.gov (United States)

    ... email share facebook twitter google plus linkedin Medical Management Polymyositis (PM) is a highly treatable disease. Some ... PM) Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research Find your MDA Care Center Grants at ...

  8. Dermatomysitis: Medical Management

    Science.gov (United States)

    ... email share facebook twitter google plus linkedin Medical Management Dermatomysitis is a highly treatable disease. Some people, ... Dermatomyositis Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research Find your MDA Care Center Search for ...

  9. Dual Diagnosis

    Science.gov (United States)

    A person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. In particular, ... to emotional and mental problems. Someone with a dual diagnosis must treat both conditions. For the treatment ...

  10. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

    International Nuclear Information System (INIS)

    Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

    2015-01-01

    There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care

  11. Medical Services at an International Summer Camp Event Under Hot and Humid Conditions: Experiences From the 23rd World Scout Jamboree, Japan.

    Science.gov (United States)

    Watanabe, Takemasa; Mizutani, Keiji; Iwai, Toshiyasu; Nakashima, Hiroshi

    2018-03-09

    The 23rd World Scout Jamboree (WSJ) was a 10-day summer camp held in Japan in 2015 under hot and humid conditions. The attendees comprised 33,628 people from 155 countries and territories. The aim of this study was to examine the provision of medical services under such conditions and to identify preventive factors for major diseases among long-term campers. Data were obtained from WSJ medical center records and examined to clarify the effects of age, sex, and period on visit frequencies and rates. Medical records from 3215 patients were examined. Mean daytime temperatures were 31.5±3.2°C and mean relative humidity was 61±13%. The initial visit rates among scouts and adults were 72.2 and 77.2 per 1000 persons, respectively. No significant age difference was observed in the initial visit rate; however, it was significantly higher among female patients than male patients. Significant differences were also seen in the adjusted odds ratios by age, sex, and period for disease distributions of initial visit frequencies. In addition, a higher initial visit frequency for heat strain-related diseases was seen among the scouts. Initial visit frequencies for heatstroke and/or dehydration increased just after opening day and persisted until closing day. Our findings suggest the importance of taking effective countermeasures against heat strain, fatigue, and unsanitary conditions at the WSJ. Medical services staff should take attendees' age, sex, and period into consideration to prevent heat strain-related diseases during such camps under hot and humid conditions. Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  12. Blood circulation of the inner ear under the influence of medications. Radiotracer experiments using guinea pig cochlea

    International Nuclear Information System (INIS)

    Neumeier, A.

    1987-01-01

    The dependence of the blood circulation in the inner ear on various medications is discussed. By means of a radiotracer clearance technique the cochlear clearance curves for the guinea pig cochlea after the administration of various circulation stimulants were determined. (MBC) [de

  13. Multisensor Fused Fault Diagnosis for Rotation Machinery Based on Supervised Second-Order Tensor Locality Preserving Projection and Weighted k-Nearest Neighbor Classifier under Assembled Matrix Distance Metric

    Directory of Open Access Journals (Sweden)

    Fen Wei

    2016-01-01

    Full Text Available In order to sufficiently capture the useful fault-related information available in the multiple vibration sensors used in rotation machinery, while concurrently avoiding the introduction of the limitation of dimensionality, a new fault diagnosis method for rotation machinery based on supervised second-order tensor locality preserving projection (SSTLPP and weighted k-nearest neighbor classifier (WKNNC with an assembled matrix distance metric (AMDM is presented. Second-order tensor representation of multisensor fused conditional features is employed to replace the prevailing vector description of features from a single sensor. Then, an SSTLPP algorithm under AMDM (SSTLPP-AMDM is presented to realize dimensional reduction of original high-dimensional feature tensor. Compared with classical second-order tensor locality preserving projection (STLPP, the SSTLPP-AMDM algorithm not only considers both local neighbor information and class label information but also replaces the existing Frobenius distance measure with AMDM for construction of the similarity weighting matrix. Finally, the obtained low-dimensional feature tensor is input into WKNNC with AMDM to implement the fault diagnosis of the rotation machinery. A fault diagnosis experiment is performed for a gearbox which demonstrates that the second-order tensor formed multisensor fused fault data has good results for multisensor fusion fault diagnosis and the formulated fault diagnosis method can effectively improve diagnostic accuracy.

  14. Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management

    Directory of Open Access Journals (Sweden)

    Rajeev Thekumpadam Puthenveetil

    2015-10-01

    Conclusion: Ultrasound bladder parameters are useful tools for measuring the treatment response in BPH patients. Our study shows that RI and DWT significantly correlate with the treatment response in BPH patients. More importantly, pretreatment values of increased IPP and PUA determines the non-improvement of symptoms in BPH patients. Our study suggests the importance of transabdominal ultrasonography (KUB–P with Doppler for evaluating treatment responses to medical management.

  15. Monitoring trifluridine incorporation in the peripheral blood mononuclear cells of colorectal cancer patients under trifluridine/tipiracil medication.

    Science.gov (United States)

    Nakanishi, Ryota; Kitao, Hiroyuki; Kiniwa, Mamoru; Morodomi, Yosuke; Iimori, Makoto; Kurashige, Junji; Sugiyama, Masahiko; Nakashima, Yuichiro; Saeki, Hiroshi; Oki, Eiji; Maehara, Yoshihiko

    2017-12-05

    Trifluridine/tipiracil (TFTD, TAS-102) is an orally administrated anti-cancer drug with efficacy validated for patients with metastatic colorectal cancer (mCRC). Trifluridine (FTD) is an active cytotoxic component of TFTD and mediates the anticancer effect via its incorporation into DNA. However, it has not been examined whether FTD is incorporated into the tissues of patients who received TFTD medication. By detecting FTD incorporation into DNA by a specific antibody, we successfully detected FTD in the bone marrow and spleen cells isolated from FTD-challenged mice as well as human peripheral blood mononuclear cells (PBMCs) activated with phytohemagglutinin-P and exposed to FTD in vitro. FTD was also detected in PBMCs isolated from mCRC patients who had administrated TFTD medication. Intriguingly, weekly evaluation of PBMCs from mCRC patients revealed the percentage of FTD-positive PBMCs increased and decreased in parallel with the administration and cessation of TFTD medication, respectively. To our knowledge, this is the first report to detect an active cytotoxic component of a chemotherapeutic drug in clinical specimens using a specific antibody. This technique may enable us to predict the clinical benefits or the adverse effects of TFTD in mCRC patients.

  16. Parkinson's Disease: Diagnosis and Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Parkinson's Disease Parkinson's Disease: Diagnosis and Treatment Past Issues / Winter 2014 Table of Contents Medications for Parkinson's disease can help many patients live productive lives and ...

  17. A Study to Determine a Training Plan for the Medical Record Technicians of Naval Hospital, San Diego in Preparation for the Implementation of the Diagnosis Related Group System

    Science.gov (United States)

    1989-12-13

    om0 Stufflebeam et al, stated that evaluation is "the 0 process of delineating, obtaining, and providing useful < z information for judging decision...in the Medical Records M z Department. Hospitals, pp. 100, 102, 104. K z -4 m Stufflebeam , D. (1971). Educational Evaluation and z Decision Making

  18. Students' responses under “negative pressure” to respiratory questions at the 15th physiology quiz international event: 100 medical school teams from 22 countries

    Directory of Open Access Journals (Sweden)

    Hwee-Ming Cheng

    2017-01-01

    Full Text Available The annual Inter-medical School Physiology Quiz (IMSPQ reached a milestone in August 2017 with the participation of 100 university medical schools at the 15th IMSPQ. A total of 440 students from 22 countries competed. The written test on day 1 shortlisted 48 of the 100 teams for the 2nd day oral quiz stimulating sessions, conducted before a live audience. The IMSPQ provides a unique sample of international students, taught under a diverse spectrum of medical curriculums, designed to meet the university and national priorities of the countries. The written test, taken by all 440 students, is a challenging 75-min paper with 100 physiology statements covering all organ systems. Certainty in students' answers was targeted by a true/false response, with no marks for unattempted questions but with a negative mark on incorrect answers. The insights from an analysis of responses to the lung physiology, including cardiorespiratory mechanism, are helpful and enlightening for Physiology teachers. They show common areas of difficulty and imprecise understanding. This brief teaching note will describe and give some comments on the students' respiratory responses under pressure of negative marking.

  19. OFSETH: optical technologies embedded in smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging

    Science.gov (United States)

    Narbonneau, F.; De Jonckheere, J.; Jeanne, M.; Kinet, D.; Witt, J.; Krebber, K.; Paquet, B.; Depré, A.; D'Angelo, L. T.; Thiel, T.; Logier, R.

    2010-04-01

    The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging (MRI) is now proved. We report how two pure optical technologies can successfully sense textile elongation between, 0% and 3%, while maintaining the stretching properties of the textile substrates for a good comfort of the patient. Investigating influence of different patients' morphology as well as textile integration issues to let free all vitals organs for medical staff actions, the OFSETH harness allows a continuous measurement of respiration movements. For example, anaesthesia for MRI examination uses the same drugs as for any surgical procedure. Even if spontaneous respiration can be preserved most of the time, spontaneous respiration is constantly at risk of being impaired by anaesthetic drugs or by upper airway obstruction. Monitoring of the breathing activity is needed to assess adequate ventilation or to detect specific obstruction patterns. Moreover artefacts due to physiological motions induce a blooming effect on the MRI result. The use of synchronisation devices allows reducing these effects. Positioned at certain strategic places according to the investigated organ, the presented sensors could constitute an efficient and adapted solution for respiratory synchronisation of the MRI acquisition.

  20. Differential diagnosis of neuroses and vegetative dystonias among medical personnel exposed to chronic effect of occupational low dose irradiation. Part 2

    International Nuclear Information System (INIS)

    Jonkova, A.

    1987-01-01

    An ttempt to differentiate the importance of radiation factor in the origination of functional changes in nervous activity is made. Clinical methods are applied to 456 madical workers occupationally exposed to ionizing radiation as well as to a control group of 300 medical workers. 100 subjects from each group have been investigated by inquiry psychological methods. No dependence is established between the incidence of neurasthenic neuroses and the duration of service, the cumulative equivalent doses respectively, being within the range of 25 mSv - 1.6 Sv. Asthenic states of the nervous system, not included in the clinical picture of neuroses and other diseases, have not been diagnosed. The significantly higher incidence of vegetative dystonias among the female medical personnel, working with sources and environment of ionizing radiation with a length of service over 15 years, is discussed in causal relationship with the radiation factor. 4 tabs., 15 refs

  1. 171 ROYAL DECREE 1891/1991 of 30 December 1991 on the installation and use of X-ray equipment for the purposes of medical diagnosis

    International Nuclear Information System (INIS)

    1992-01-01

    The Decree lays down the rules enabling government authorities to monitor the proper functioning of such appliances. It takes account of the Council of European Communities' Directive 80/836/Euratom amended by Directive 84/466/Euratom on basic safety standards for the health protection of the general public and workers against the dangers of ionization and Directive 84/467/Euratom laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. The Decree provides for a register of firms authorised to sell and maintain medical X-ray equipment, and a register of the equipment installed. It also sets out requirements relating to third party liability insurance, and to the qualifications and training of personnel operating the equipment. (NEA)

  2. A multi-method approach to the molecular diagnosis of overt and borderline 11p15.5 defects underlying Silver-Russell and Beckwith-Wiedemann syndromes.

    Science.gov (United States)

    Russo, Silvia; Calzari, Luciano; Mussa, Alessandro; Mainini, Ester; Cassina, Matteo; Di Candia, Stefania; Clementi, Maurizio; Guzzetti, Sara; Tabano, Silvia; Miozzo, Monica; Sirchia, Silvia; Finelli, Palma; Prontera, Paolo; Maitz, Silvia; Sorge, Giovanni; Calcagno, Annalisa; Maghnie, Mohamad; Divizia, Maria Teresa; Melis, Daniela; Manfredini, Emanuela; Ferrero, Giovanni Battista; Pecile, Vanna; Larizza, Lidia

    2016-01-01

    Multiple (epi)genetic defects affecting the expression of the imprinted genes within the 11p15.5 chromosomal region underlie Silver-Russell (SRS) and Beckwith-Wiedemann (BWS) syndromes. The molecular diagnosis of these opposite growth disorders requires a multi-approach flowchart to disclose known primary and secondary (epi)genetic alterations; however, up to 20 and 30 % of clinically diagnosed BWS and SRS cases remain without molecular diagnosis. The complex structure of the 11p15 region with variable CpG methylation and low-rate mosaicism may account for missed diagnoses. Here, we demonstrate the relevance of complementary techniques for the assessment of different CpGs and the importance of testing multiple tissues to increase the SRS and BWS detection rate. Molecular testing of 147 and 450 clinically diagnosed SRS and BWS cases provided diagnosis in 34 SRS and 185 BWS patients, with 9 SRS and 21 BWS cases remaining undiagnosed and herein referred to as "borderline." A flowchart including complementary techniques and, when applicable, the analysis of buccal swabs, allowed confirmation of the molecular diagnosis in all borderline cases. Comparison of methylation levels by methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) in borderline and control cases defined an interval of H19/IGF2:IG-DMR loss of methylation that was distinct between "easy to diagnose" and "borderline" cases, which were characterized by values ≤mean -3 standard deviations (SDs) compared to controls. Values ≥mean +1 SD at H19/IGF2: IG-DMR were assigned to borderline hypermethylated BWS cases and those ≤mean -2 SD at KCNQ1OT1: TSS-DMR to hypomethylated BWS cases; these were supported by quantitative pyrosequencing or Southern blot analysis. Six BWS cases suspected to carry mosaic paternal uniparental disomy of chromosome 11 were confirmed by SNP array, which detected mosaicism till 10 %. Regarding the clinical presentation, borderline SRS were representative

  3. 42 CFR 413.88 - Incentive payments under plans for voluntary reduction in number of medical residents.

    Science.gov (United States)

    2010-10-01

    ... training year in which the plan is effective; (3) FTE counts for the base number of residents, as defined... period; and (B) It wishes to adjust future annual targets for the remaining years of the plan in order to... SKILLED NURSING FACILITIES Specific Categories of Costs § 413.88 Incentive payments under plans for...

  4. Near-peer role modeling: Can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course?

    Directory of Open Access Journals (Sweden)

    Mimi McEvoy

    2016-09-01

    Full Text Available Introduction: Humanism is cultivated through reflection and self-awareness. We aimed to employ fourth-year medical students, recognized for their humanism, to facilitate reflective sessions for second-year medical students with the intention of positively influencing reflective process toward humanistic development. Methods/Analysis: A total of 186 students were randomly assigned to one of three comparison arms: eight groups of eight students (64 students were facilitated by a fourth-year student who was a Gold Humanism Honor Society member (GHHS; eight groups (64 students by a volunteer non-GHHS student; and seven groups (58 students were non-facilitated. Before sessions, second-year students set learning goals concerning interactions with patients; fourth-year students received training materials on facilitation. Groups met twice during their 10 clinical site visits. At the last session, students completed a reflective assignment on their goal progress. Comparative mixed method analyses were conducted among the three comparison arms on reflection (reflective score on in-session assignment and session satisfaction (survey in addition to a thematic analysis of responses on the in-session assignment. Results: We found significant differences among all three comparison arms on students’ reflective scores (p=0.0003 and satisfaction (p=0.0001. T-tests comparing GHHS- and non-GHHS-facilitated groups showed significantly higher mean reflective scores for GHHS-facilitated groups (p=0.033; there were no differences on session satisfaction. Thematic analysis of students’ reflections showed attempts at self-examination, but lacked depth in addressing emotions. There was a common focus on achieving comfort and confidence in clinical skills performance. Discussion/Conclusions: Near peers, recognized for their humanism, demonstrated significant influence in deepening medical students’ reflections surrounding patient interactions or humanistic

  5. Near-peer role modeling: Can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course?

    Science.gov (United States)

    McEvoy, Mimi; Pollack, Staci; Dyche, Lawrence; Burton, William

    2016-01-01

    Introduction Humanism is cultivated through reflection and self-awareness. We aimed to employ fourth-year medical students, recognized for their humanism, to facilitate reflective sessions for second-year medical students with the intention of positively influencing reflective process toward humanistic development. Methods/Analysis A total of 186 students were randomly assigned to one of three comparison arms: eight groups of eight students (64 students) were facilitated by a fourth-year student who was a Gold Humanism Honor Society member (GHHS); eight groups (64 students) by a volunteer non-GHHS student; and seven groups (58 students) were non-facilitated. Before sessions, second-year students set learning goals concerning interactions with patients; fourth-year students received training materials on facilitation. Groups met twice during their 10 clinical site visits. At the last session, students completed a reflective assignment on their goal progress. Comparative mixed method analyses were conducted among the three comparison arms on reflection (reflective score on in-session assignment) and session satisfaction (survey) in addition to a thematic analysis of responses on the in-session assignment. Results We found significant differences among all three comparison arms on students' reflective scores (p=0.0003) and satisfaction (p=0.0001). T-tests comparing GHHS- and non-GHHS-facilitated groups showed significantly higher mean reflective scores for GHHS-facilitated groups (p=0.033); there were no differences on session satisfaction. Thematic analysis of students' reflections showed attempts at self-examination, but lacked depth in addressing emotions. There was a common focus on achieving comfort and confidence in clinical skills performance. Discussion/Conclusions Near peers, recognized for their humanism, demonstrated significant influence in deepening medical students' reflections surrounding patient interactions or humanistic development. Overall, students

  6. Magnetic Resonance Imaging Plaque Hemorrhage for Risk Stratification in Carotid Artery Disease With Moderate Risk Under Current Medical Therapy.

    Science.gov (United States)

    Hosseini, Akram A; Simpson, Richard J; Altaf, Nishath; Bath, Philip M; MacSweeney, Shane T; Auer, Dorothee P

    2017-03-01

    Magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64-16.34; P =0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1-16.8; P =0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without ( P medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification. © 2017 American Heart Association, Inc.

  7. Evaluation of the medical imaging procedures for the diagnosis of liver diseases: Part I. Experiments on the effectiveness of diagnostic image reading in 93 cases collected in Japan

    International Nuclear Information System (INIS)

    Fukuhisa, Kenjiro; Tateno, Yukio; Matsumoto, Toru; Fukuda, Morimichi; Sasaki, Yasuhito; Shishido, Fumio

    1996-01-01

    In 1989 the IAEA published the Atlas of Liver Imaging (IAEA-TECDOC-501). This report is a large compilation of the ''Evaluation of nuclear medicine imaging procedures for the diagnosis of liver diseases'' project conducted over the 5-year period from 1984 to 1988. The purpose of the project was to assess the actual state of nuclear medicine diagnostic technical know-how in the management of liver diseases in the countries of Asia. The work related to the project was conducted in three phases: first, on the investigation of the state of maintenance of the diagnostic equipment of nuclear medicine (gamma cameras or scintillation scanners) in each participating country, second, on the use of the phantoms for nuclear medicine specifically prepared and distributed by the IAEA, to assess objectively the detection capabilities of nuclear medicine equipment in routine diagnostic use, and third, collection of scintigrams of patients who have actually been diagnosed by nuclear medicine procedure from each country accompanied by clinical information, including the definite diagnosis, information on the imaging conditions etc. The physicians in each country participated in the interpretation and assessment of specific features. The atlas cited above, included the results of the 2nd and 3rd surveys, and, in addition, described images of typical cases used in the third experiment. At present, liver diseases still pose a threat to human health and welfare. The diagnostic technology has shown continuous expansion. Nuclear medicine (NM) is being used practically in all countries, including developed countries. In addition, ultrasound tomography (US) and X-ray CT are used in parallel. MRI is also being used in Japan, the United States and most of the developed and developing countries. In view of these situations, the IAEA extended its previous cooperative research one step further, deciding to survey the current status of the diagnosis of liver diseases by NM and US in the countries

  8. Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records.

    Science.gov (United States)

    Ryu, Euijung; Chamberlain, Alanna M; Pendegraft, Richard S; Petterson, Tanya M; Bobo, William V; Pathak, Jyotishman

    2016-04-26

    Major depressive disorder (MDD) is often comorbid with other chronic mental and physical health conditions. Although the literature widely acknowledges the association of many chronic conditions with the risk of MDD, the relative importance of these conditions on MDD risk in the presence of other conditions is not well investigated. In this study, we aimed to quantify the relative contribution of selected chronic conditions to identify the conditions most influential to MDD risk in adults and identify differences by age. This study used electronic health record (EHR) data on patients empanelled with primary care at Mayo Clinic in June 2013. A validated EHR-based algorithm was applied to identify newly diagnosed MDD patients between 2000 and 2013. Non-MDD controls were matched 1:1 to MDD cases on birth year (±2 years), sex, and outpatient clinic visits in the same year of MDD case diagnosis. Twenty-four chronic conditions defined by Chronic Conditions Data Warehouse were ascertained in both cases and controls using diagnosis codes within 5 years of index dates (diagnosis dates for cases, and the first clinic visit dates for matched controls). For each age group (45 years or younger, between 46 and 60, and over 60 years), conditional logistic regression models were used to test the association between each condition and subsequent MDD risk, adjusting for educational attainment and obesity. The relative influence of these conditions on the risk of MDD was quantified using gradient boosting machine models. A total of 11,375 incident MDD cases were identified between 2000 and 2013. Most chronic conditions (except for eye conditions) were associated with risk of MDD, with different association patterns observed depending on age. Among 24 chronic conditions, the greatest relative contribution was observed for diabetes mellitus for subjects aged ≤ 60 years and rheumatoid arthritis/osteoarthritis for those over 60 years. Our results suggest that specific chronic

  9. Accuracy of drug advertisements in medical journals under new law regulating the marketing of pharmaceutical products in Switzerland.

    Science.gov (United States)

    Santiago, Macarena Gonzalez; Bucher, Heiner C; Nordmann, Alain J

    2008-12-31

    New legal regulations for the marketing of pharmaceutical products were introduced in 2002 in Switzerland. We investigated whether claims in drug advertisements citing published scientific studies were justified by these studies after the introduction of these new regulations. In this cross-sectional study, two independent reviewers screened all issues of six major Swiss medical journals published in the year 2005 to identify all drug advertisements for analgesic, gastrointestinal and psychopharmacologic drugs and evaluated all drug advertisements referring to at least one publication. The pharmaceutical claim was rated as being supported, being based on a potentially biased study or not to be supported by the cited study according to pre-specified criteria. We also explored factors likely to be associated with supported advertisement claims. Of 2068 advertisements 577 (28%) promoted analgesic, psychopharmacologic or gastrointestinal drugs. Among them were 323 (56%) advertisements citing at least one reference. After excluding multiple publications of the same drug advertisement and advertisements with non-informative references, there remained 29 unique advertisements with at least one reference to a scientific study. These 29 advertisements contained 78 distinct pairs of claims of analgesic, gastrointestinal and psychopharmacologic drugs and referenced studies. Thirty-seven (47%) claims were supported, 16 (21%) claims were not supported by the corresponding reference, and 25 (32%) claims were based on potentially biased evidence, with no relevant differences between drug groups. Studies with conflict of interest and studies stating industry funding were more likely to support the corresponding claim (RR 1.52, 95% CI 1.07-2.17 and RR 1.50, 95% CI 0.98-2.28) than studies without identified conflict of interest and studies without information on type of funding. Following the introduction of new regulations for drug advertisement in Switzerland, 53% of all assessed

  10. [Reimbursement. Case report: Medical implication as precondition for reimbursement by German health insurance on the example of HRpQCT diagnosis of osteoporosis].

    Science.gov (United States)

    Weber-Endress, S; Nothaas, R

    2011-10-01

    The main condition that has to be met for reimbursement is the medical implication of the chosen method. This issue is discussed based on the case of a 72-year-old patient suffering from osteoporotic fractures of the spine. Drug treatment of osteoporosis was observed with a high-resolution peripheral CT (HR-pQCT/XtremeCT). A German court came to the conclusion that there is no added value of the procedure in comparison with the well-established DXA. Judges rejected the need for reimbursement in that particular case and ruled in favor of the insurance company, which had originally refused the refund. 

  11. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf

    2010-01-01

    decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area...... are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances....

  12. First Rescue Under the Rubble: The Medical Aid in the First Hours After the Earthquake in Amatrice (Italy) on August 24, 2016.

    Science.gov (United States)

    Blasetti, Angelo Geremia; Petrucci, Emiliano; Cofini, Vincenza; Pizzi, Barbara; Scimia, Paolo; Pozone, Tullio; Necozione, Stefano; Fusco, Pierfrancesco; Marinangeli, Franco

    2018-02-01

    Specific Event Identifiers a. Event Type: Earthquake measuring 6.2 (SD=0.016) on the moment magnitude; b. Event Onset: August 24, 2016 - 03:36:32 CEST (01:36 UTC); c. Location of Event: Central Italy, in the town of Amatrice; d. Geographic Coordinates: latitude (DMS): 42°37'45.77″N; longitude (DMS): 13°17'18.14″E; elevation: 955 meters above sea-level; e. Dates: August 24, 2016 at 4:48 AM; f. Response Type: Medical Relief. On August 24, 2016, an earthquake hit the town of Amatrice (Italy). This study aims to document the first medical aid provided to earthquake victims in Amatrice immediately following the earthquake. Patient data were collected and recorded during the first clinical evaluation and before definitive hospitalization. Blood gas tests were performed on survivors extricated from the rubble using the iSTAT (Abbott Point of Care Inc.; Princeton, New Jersey USA) handheld blood analyzer. Performing "victim-side" blood gas tests could provide concrete information to facilitate clinical evaluation and decision making when treating buried victims. After a natural disaster, it is essential to provide effective analgo-sedation to victims. Blasetti AG , Petrucci E , Cofini V , Pizzi B , Scimia P , Pozone T , Necozione S , Fusco P , Marinangeli F . First rescue under the rubble: the medical aid in the first hours after the earthquake in Amatrice (Italy) on August 24, 2016. Prehosp Disaster Med. 2018;33(1):109-113.

  13. Therapeutic effectiveness and safety parathyroid adenoma ablation with percutaneous ethanol injection under sonographic guidance in patients with chronic renal failure and secondary hyperparathyroidism refractory to medical treatment

    International Nuclear Information System (INIS)

    De Nubila, Eduardo; Vega, Jose; Garcia Luz; Murillo, Marlyn; Mercado, Jaime

    2010-01-01

    Secondary hyperparathyroidism unresponsive to medical treatment is a common complication in patients with chronic renal failure and prolonged dialysis therapy, which requires surgery of the parathyroid glands, with the risks and costs of surgery. Objective: To evaluate the therapeutic effectiveness and safety of ablation of parathyroid adenomas by percutaneous ethanol injection under ultrasound guidance. Method: After approval by the institutional medical ethics committee, informed written consent was obtained in 15 patients who met the inclusion criteria. Sonographically guided ethanol was injected consecutively into adenomas, with an interval of time less than six months. Results: Size, Doppler vascularity of adenomas, and the levels of parathyroid hormone, calcium and phosphorus were measured before and after ablation as criteria for treatment response in 15 patients. Of all patients, six (40%) had no therapeutic response. Therapeutic response was observed in nine patients (60%). In the latter group, five patients (33.3%) had successful response and symptomatic improvement, in two patients (13.3%), therapeutic response was suboptimal, and in two patients (13.3%), the response was unsatisfactory. The procedure was safe. Local pain, transient dysphonia and cough were considered minor complications and were the most common, with resolution in all cases. There were no major complications. Conclusion: Ablation of parathyroid adenomas with percutaneous ethanol injection and ultrasound guidance, in uremic patients with secondary hyperparathyroidism unresponsive to medical treatment is an effective and safe therapy. Studies involving more patients and longer follow up are needed in order to stablish more conclusive results

  14. Self-esteem and spiritual health in cancer patients under chemotherapy in Semnan University of Medical Sciences in 2014

    Directory of Open Access Journals (Sweden)

    Farah Abbasian

    2016-12-01

    Full Text Available Background and Objectives: Cancer as a frightening disease may affect people's confidence in their abilities, sense of controlling over their lives, and in other words self-esteem. Spiritual health as the main aspect of health can be an important source for calmness, decrease in existential distress, improvement of self-esteem and coping with the disease. This study was conducted to investigate the correlation between spiritual health and self-esteem in Iranian cancer patients. Methods: This cross-sectional study was accomplished by obtaining Rosenberg Self-Esteem and Paloutzian & Ellison scales questionnaire from a  convenience sample of 170 cancer patients who were referred for chemotherapy to hospitals of SEMNAN University of Medical Sciences. Data were analyzed by SPSS using one-way analysis of variance and Pearson correlation, and level of significance (P was considered <0.05. Results: Study group has shown a mean self-esteem score of 18.5±3.5 and 98.1±13.2 for spiritual well- being. There was a direct correlation between spiritual health and self- esteem after adjustment for sex, age, education level and marital status (r=0.55. Conclusion: This study demonstrated that spiritual health was significantly associated with self-esteem in cancer patients. Considering critical conditions of cancer patients and their urgent need for maintaining and improving spiritual well-being, enhancement of spiritual health and self-esteem should be further emphasized in the treatment programs of these patients such that they and their families that represent a large population can be assisted to overcome the critical conditions.

  15. Use of primary diagnosis during hospitalization in the Unified Health System (Sistema Único de Saúde) to qualify information regarding the underlying cause of natural deaths among the elderly.

    Science.gov (United States)

    Cascão, Angela Maria; Jorge, Maria Helena Prado de Mello; Costa, Antonio José Leal; Kale, Pauline Lorena

    2016-01-01

    Ill-defined causes of death are common among the elderly owing to the high frequency of comorbidities and, consequently, to the difficulty in defining the underlying cause of death. To analyze the validity and reliability of the "primary diagnosis" in hospitalization to recover the information on the underlying cause of death in natural deaths among the elderly whose deaths were originally assigned to "ill-defined cause" in their Death Certificate. The hospitalizations occurred in the state of Rio de Janeiro, in 2006. The databases obtained in the Information Systems on Mortality and Hospitalization were probabilistically linked. The following data were calculated for hospitalizations of the elderly that evolved into deaths with a natural cause: concordance percentages, Kappa coefficient, sensitivity, specificity, and the positive predictive value of the primary diagnosis. Deaths related to "ill-defined causes" were assigned to a new cause, which was defined based on the primary diagnosis. The reliability of the primary diagnosis was good, according to the total percentage of consistency (50.2%), and fair, according to the Kappa coefficient (k = 0.4; p system and neoplasia occurred with the highest frequency among the deaths and the hospitalizations and presented a higher consistency of positive predictive values per chapter and grouping of the International Classification of Diseases. The recovery of the information on the primary cause occurred in 22.6% of the deaths with ill-defined causes (n = 14). The methodology developed and applied for the recovery of the information on the natural cause of death among the elderly in this study had the advantage of effectiveness and the reduction of costs compared to an investigation of the death that is recommended in situations of non-linked and low positive predictive values. Monitoring the mortality profile by the cause of death is necessary to periodically update the predictive values.

  16. Export of pharmaceuticals and medical devices under the federal Food, Drug & Cosmetic Act: FDA's striking change in interpretation post-Shelhigh.

    Science.gov (United States)

    Basile, Edward M; Tolomeo, Deborah; Gluck, Elizabeth

    2009-01-01

    With no communication to industry except court filings in United States v. Undetermined Quantities of Boxes of Articles of Device (Shelhigh) and a draft guidance document, the Food and Drug Administration (FDA) has articulated new policies regarding export of pharmaceutical products and medical devices. FDA's departure from its historic interpretation of the export provisions of the Federal Food, Drug, and Cosmetic Act (FDCA) significantly limits the ability of manufacturers to export misbranded drugs and medical devices that FDA deems "adulterated," contrary to the plain language and legislative intent of the FDCA. To further exacerbate the issue, FDA has begun to implement these policies without the notice-and-comment rulemaking required by the Administrative Procedures Act (APA), but rather through an enforcement proceeding brought in the United States District Court for the District of New Jersey. In a letter opinion, the District Court prevented the export of Current Good Manufacturing Practices (CGMP) --adulterated medical devices that complied with FDCA Section 801(e)(1), at least as historically interpreted by FDA. The purpose of this article is to review the history of FDA's export policies for pharmaceuticals and medical devices, particularly those aspects of the export policies that are affected by FDA's recent change in position. Three changes in FDA's interpretation of the export provisions of the FDCA will be addressed: 1) unapproved devices that a manufacturer reasonably believes are eligible for Section 510(k) clearance may no longer be exported under Section 801(e) and now must be exported under Section 802, in substantial compliance with Current CGMP; 2) adulterated devices and misbranded drugs can only be exported if the foreign purchaser's specifications cause the product to be adulterated; and 3) an article may not be exported if a like article has ever been sold or offered for sale in domestic commerce. FDA's new interpretations of FDCA

  17. The evaluation of 25-hydroxy vitamin D, calcium, phosphate and alkaline phosphatase levels in epileptic children under antiepileptic medication

    Directory of Open Access Journals (Sweden)

    Keyhani doost Z

    2011-01-01

    Full Text Available "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Epilepsy is a common disease in the pediatric neurology. There are frequent anti-epileptic drugs which are used in management of epilepsy. Anti-epileptic drugs may have some complications on bone and vitamin-D metabolism. In this study we aimed to evaluate vitamin-D metabolism in epileptic children."n"nMethods: The study was a prospective and cross sectional one. A total 89 epileptic children who were taking anti-epileptic drugs for longer than six months with no underlying disorder in Imam Khomeini and Bahrami Hospitals in Tehran, Iran were enrolled in our study"n"nResults: Forty nine boys and 40 girls were enrolled in this study; mean age of the patients was 7.8±2.1 years. Mean duration of anti-epileptic drug therapy was 2.3 years (SD=0.4, 70 of patients were under monotherapy and 19 were under polytherapy. None of the patients had signs of rickets. Serum calcium and phosphor levels were within normal ranges. Serum alkaline phosphates levels were increased more than two times in 43%. 42% had vitamin-D deficiency (25-OH Vit D<10 ng/ml and another 33% had vitamin-D insufficiency (10<25-oh Vit D<20 ng/ml. 29 patients (32% were taking prophylactic supplemental Vit D (200-400 IU/day. There was significant difference between patients taking supplemental vitamin-D as prophylaxis and patients who did not (p=0.04. There was no significant difference in vitamin-D levels between patients according to age, gender or different drugs."n"nConclusion: Periodic

  18. Follow-up two years after diagnosis of diabetes in patients with psychosocial problems receiving an intervention by a medical social worker.

    Science.gov (United States)

    Gåfvels, Catharina; Rane, Kristina; Wajngot, Alexandre; Wändell, Per Erik

    2014-01-01

    We followed up the psychosocial situation two years after diabetes diagnosis in patients (n = 82) aged 18-65 years, with psychosocial problems (PSP; n = 27) or not (NPSP; n = 55). We used a social questionnaire, the Hospital Anxiety and Depression scale (HAD), the Sense of Coherence scale (SOC), and the General Coping Questionnaire (GCQ). The PSP group had a more difficult situation with more strained economy, lower social support, more anxiety and depression, and lower SOC on both occasions. Being in the PSP group predicted experiencing a strong negative influence of the disease at follow-up. Regarding coping strategies, "problem focusing" decreased in both PSP and NPSP over time. "Social trust" and "intrusion" decreased only in NPSP. Otherwise the coping pattern was unchanged, with PSP showing lower scores on "self-trust" and "minimization" and higher scores on "protest," "isolation," and "intrusion." The most influenced areas at follow-up in the PSP group were work, relationship to partner and economy, and in the NPSP leisure-time activities, sexual life and work. Our findings underline the need to identify patients with psychosocial problems early.

  19. [The contribution of pathologic diagnosis and research of the faculty members engaged in teaching histology and embryology to undergraduate medical studies].

    Science.gov (United States)

    Somer, Ljiljana; Dusan, Lalosević; Dolai, Matilda

    2007-01-01

    The theoretical and practical aspects of teaching are generally defined by the curriculum, but professional experience plays an important role as well. The teaching experience of the faculty members is developed through health services, education and research. THE DEPARTMENT OFHISTOLOGY AND EMBRIOLOGY: This paper reviews the activities of the teaching staff of the Department of Histology and Embryology, pointing to the importance of pathologic diagnostics and research. It underlines the necessity of using some non-standard histologic staining methods on some tissues, organs and pathogens, as well as the results of experimental studies of the endocrine system. The experimental tumor models are used to demonstrate the interdependence of the endocrine and immune systems. Modalities and possibilities of regeneration of the digestive tract and connective tissue mucosa are explained This paper also deals with histologic criteria used for assessment of fetal age and in the diagnosis of developmental malformations. Linear and stereologic methods, used in quantification of normal morphology, the degree of pathologic changes, and regeneration of normal structures in the courses of and after therapy, are given. The authors particularly emphasized the importance of above-mentioned activities in the teaching of Histology and Embryology to undergraduate students.

  20. EMERALD: Emergency visit audit of patients treated under medical oncology in a tertiary cancer center: Logical steps to decrease the burden.

    Science.gov (United States)

    Joshi, Amit; Patil, Vijay M; Noronha, Vanita; Ramaswamy, Anant; Gupta, Sudeep; Bhattacharjee, Atanu; Bonda, Avinash; Chandrakanth, M V; Ostwal, Vikas; Khattry, Navin; Banavali, Shripad; Prabhash, Kumar

    2017-01-01

    We are a tertiary care cancer center and have approximately 1000-1500 emergency visits by cancer patients undergoing treatment under the adult medical oncology unit each month. However, due to the lack of a systematic audit, we are unable to plan steps toward the improvement in quality of emergency services, and hence the audit was planned. All emergency visits under the adult medical oncology department in the month of July 2015 were audited. The cause of visit, the demographic details, cancer details, and chemotherapy status were obtained from the electronic medical records. The emergency visits were classified as avoidable or unavoidable. Descriptive statistics were performed. Reasons for avoidable emergency visits were sought. Out of 1199 visits, 1168 visits were classifiable. Six hundred and ninety-six visits were classified as unavoidable (59.6%, 95% CI: 56.7-62.4), 386 visits were classified as probably avoidable visit (33.0%, 95% CI: 30.4-35.8) whereas the remaining 86 (7.4%, 95% CI: 6.0-9.01) were classified as absolutely avoidable. Two hundred and ninety-seven visits happened on weekends (25.6%) and 138 visits converted into an inpatient admission (11.9%). The factors associated with avoidable visits were curative intention of treatment (odds ratio - 2.49), discontinued chemotherapy status (risk ratio [RR] - 8.28), and private category file status (RR - 1.89). A proportion of visits to emergency services can be curtailed. Approximately one-fourth of patients are seen on weekends, and only about one-tenth of patients get admitted.

  1. Classification, disease, and diagnosis.

    Science.gov (United States)

    Jutel, Annemarie

    2011-01-01

    Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.

  2. Training for instructor in radiation protection courses in the medical diagnosis with X-Rays in Mexico; Formaacion de instructores para cursos de proteccion raidologica en el diagnostico medico con rayos X en Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Aguilar, J.; Rodriguez Aranda, F.; Dominguez Anaya, E.

    2003-07-01

    The General Regulation of Radiological Security establishes in its article 159 that the occupationally exposed professionals will have to count on the authorization of the National Commission of Nuclear Security and Safety (CNSNS) with respect to their training. The Mexican official norm NOM-157-SSA1-1996: Protection and radiological safety in the medical diagnosis with X-rays, indicates that the personnel must receive and accept the information, instructions and training related to the protection and radiological safety, in order to accomplish their work according to the requirements and obligations established in the outstanding procedures. Therefore it was designed an initial training course of instructors in the field of the radiological protection to train occupationally exposed professionals who work in the medical diagnosis establishments with X-rays. The didactic material was elaborated considering a period of training of 10 working days, 8.0 daily hours considering theoretical topics, as well as 11 practical. It is used a conventional radiology equipment, a ionization chamber of brand INOVISIOB model 451 P-DE-SI for increasing the radiation levels, and equipment Radical model 9015 with two ionization chambers of 150 cc and 150 cc respectively, as well as a calibrated plates game of aluminium type 110 and a phantom of acrylic as disperser. To date 73 persons have been trained, from which only 37% approved the initial training course. It has been seen that it is necessary to count on a previous training in the filed of the radiological protection to better profit from this training, since if students do not have good bases it is not possible for them to learn all the content in only 80 hours. To date it has been trained to 73 persons, of alone those which 37.0% approved the initial. (Author)

  3. Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center.

    Science.gov (United States)

    Metzl, Jonathan M; McClelland, Sara I; Bergner, Erin

    2016-06-01

    This paper discusses the role of gender role conformity in psychiatric determinants of well-being after of the depathologization of homosexuality from the DSM. In order to examine the heterosexualizing of sanity in U.S. psychiatric and popular cultures, we analyze archived psychiatrist-dictated patient charts from outpatient psychiatric clinics from a Midwestern medical center (n = 45). We highlight ways physicians deployed heteronormative gender expectations to describe and treat women's and men's depressive illness and implicitly construed troubled female-male relationships and sexual encounters as indices of psychopathology. We theorize how evolving connections between the heteronormal and the psychiatric normal performed some of the same regulatory functions, as did the DSM, coding particular gender performances and partner choices as mentally healthy while relegating others to the realm of disease. Only here, focusing on the mainstream instead of the marginalized kept the ideological work of these scripts hidden from view.

  4. Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center

    Science.gov (United States)

    Metzl, Jonathan M.; McClelland, Sara I.; Bergner, Erin

    2016-01-01

    This paper discusses the role of gender role conformity in psychiatric determinants of well-being after of the depathologization of homosexuality from the DSM. In order to examine the heterosexualizing of sanity in U.S. psychiatric and popular cultures, we analyze archived psychiatrist-dictated patient charts from outpatient psychiatric clinics from a Midwestern medical center (n = 45). We highlight ways physicians deployed heteronormative gender expectations to describe and treat women’s and men’s depressive illness and implicitly construed troubled female-male relationships and sexual encounters as indices of psychopathology. We theorize how evolving connections between the heteronormal and the psychiatric normal performed some of the same regulatory functions, as did the DSM, coding particular gender performances and partner choices as mentally healthy while relegating others to the realm of disease. Only here, focusing on the mainstream instead of the marginalized kept the ideological work of these scripts hidden from view. PMID:27354850

  5. Diagnosis of Late Stage, Early Onset, Small Fiber Polyneuropathy

    Science.gov (United States)

    2016-10-01

    polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain 2013; 154:2310-2316. 2. Oaklander AL and...Patient Data Registry SFPN Small-fiber polyneuropathy USAMRMC US Army Medical Research and Materiel Command VA Veterans Administration VSO Veterans’ Service Organization WRIISC War-Related Illness and Injury Study Center ...AWARD NUMBER: W81XWH-15-1-0683 TITLE: Diagnosis of Late-Stage, Early-Onset, Small-Fiber Polyneuropathy PRINCIPAL INVESTIGATOR: Anne

  6. [Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17].

    Science.gov (United States)

    Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys

    2015-08-01

    A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

  7. Impact of continuing medical education in cancer diagnosis on GP knowledge, attitude and readiness to investigate - a before-after study

    DEFF Research Database (Denmark)

    Toftegaard, Berit Skjødeberg; Bro, Flemming; Falborg, Alina Zalounina

    2016-01-01

    Dette studie undersøger, om en efteruddannelse i tidlig diagnostik af kræft har en effekt på alment praktiserende lægers viden om kræftdiagnostik, holdning til egen rolle i kræftudredning, henvisningsvillighed og vurdering af kræftrisiko. Studiet viste, at efteruddannelsen betød, at lægerne gener...

  8. Progression of Left Ventricular Dysfunction and Remodelling under Optimal Medical Therapy in CHF Patients: Role of Individual Genetic Background

    Directory of Open Access Journals (Sweden)

    Marzia Rigolli

    2011-01-01

    Full Text Available Background. Neurohormonal systems play an important role in chronic heart failure (CHF. Due to interindividual heterogeneity in the benefits of therapy, it may be hypothesized that polymorphisms of neurohormonal systems may affect left ventricular (LV remodelling and systolic function. We aimed to assess whether genetic background of maximally treated CHF patients predicts variations in LV systolic function and volumes. Methods and Results. We prospectively studied 131 CHF outpatients on optimal treatment for at least six months. Echocardiographic evaluations were performed at baseline and after 12 months. Genotype analysis for ACE I/D, β1adrenergic receptor (AR Arg389Gly, β2AR Arg16Gly, and β2AR Gln27Glu polymorphisms was performed. No differences in baseline characteristics were detected among subgroups. ACE II was a significant predictor of improvement of LV end-diastolic and end-systolic volume (=.003 and =.002, respectively but not of LV ejection fraction (LVEF; β1AR389 GlyGly was related to improvement of LVEF (=.02 and LV end-systolic volume (=.01. The predictive value of polymorphisms remained after adjustment for other clinically significant predictors (<.05 for all. Conclusions. ACE I/D and β1AR Arg389Gly polymorphisms are independent predictors of reverse remodeling and systolic function recovery in CHF patients under optimal treatment.

  9. Osteogenesis imperfecta: diagnosis and treatment.

    Science.gov (United States)

    Palomo, Telma; Vilaça, Tatiane; Lazaretti-Castro, Marise

    2017-12-01

    Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.

  10. Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

    Science.gov (United States)

    Morton, Laurel M; Phillips, Tania J

    2016-04-01

    Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Using computerised surface wound mapping to compare the potential medical effectiveness of Enhanced Protection Under Body Armour Combat Shirt collar designs.

    Science.gov (United States)

    Breeze, John; Allanson-Bailey, L C; Hunt, N C; Delaney, R; Hepper, A E; Lewis, E A

    2015-03-01

    Protecting the neck from explosively propelled fragments has traditionally been achieved through a collar attached to the ballistic vest. An Enhanced Protection Under Body Armour Combat Shirt (EP-UBACS) collar has been identified as an additional method of providing neck protection but limited evidence as to its potential medical effectiveness exists to justify its procurement. Entry wound locations and resultant medical outcomes were determined using Abbreviated Injury Scale (AIS) for all fragmentation neck wounds sustained by UK soldiers between 01 January 2010 and 31 December 2011. Data were prospectively entered into a novel computerised tool base and comparisons made between three EP-UBACS neck collar designs in terms of predicted reduction in AIS scores. All collars reduced AIS scores, with the greatest reduction provided by designs incorporating increased standoff from the neck and an additional semi-circle of ballistic material underneath the collar at the front and back. This technique confirms that reinforcing the neck collar of an EP-UBACS would be expected to reduce injury severity from neck wounds. However, without knowledge of entry wound locations for injuries to other body areas as well as the use of AIS scores without clinical or pathological verification its further use in the future may be limited. The ability to overlay any armour design onto a standardised human was potentially the most useful part of this tool and we would recommend developing this technique using underlying anatomical structures and not just the skin surface. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Under-diagnosis of mental disorder in people with intellectual disabilities: study of prevalence in population with different degrees of intellectual disability

    Directory of Open Access Journals (Sweden)

    Carlos PEÑA SALAZAR

    2018-03-01

    Full Text Available There are a few studies in the literature analyzing the prevalence of mental illness in people with intellectual disabilities (ID. This study explores the prevalence of mental disorders in adults without previous mental disorder and different degrees of ID. We assessed 142 individuals with varying degrees of ID and with unknown previous psychiatric disorder. We applied the diagnostic battery PAS-ADD based on criteria ICD-10 and DSM-IV TR to analyzed the prevalence of mental disorders in people with mild / moderate ID. We applied the Spanish version of the scale DASH-II to analyze the prevalence of mental disorders in people with severe and profound ID. We found a psychiatric disorder previously undiagnosed in 29.57% of our sample. In people with mild/ moderate ID the most common psychiatric disorder was depressive disorder (33.3%, but in people with severe and profound ID was the anxiety disorder. The most prevalent medical comorbidity was epilepsy (22.5% of the total sample and 39.2% in the population with severe / profound intellectual disabilities. Psychiatric disorders seem to be more common in the population with ID than in the general population, increasing their prevalence and medical comorbidity in severe and profound ID.

  13. Assessment of Agreement between Clinical Diagnosis and Pathologic Report in the Soft Tissue Lesions of the Patients Referring to Pathology Department of Dental School, Tehran and Shahid Beheshti University of Medical Sciences During 2005-2008

    Directory of Open Access Journals (Sweden)

    S Ravaei

    2013-01-01

    Full Text Available Introduction: Agreement between clinical and pathologic diagnoses plays an important role in an appropriate treatment plan and it may also prevent serious side effects and problems in patients. This study was conducted to assess the agreement between clinical diagnoses and pathologic reports in soft tissue lesions of patients referring to pathology department of dental school, Tehran and shahid Beheshti university of medical sciences during 2005-2008. Methods: In this retrospective and descriptive study, 300 soft tissue lesions of patients referring to pathology department were selected by census sampling method and then were analyzed. The lesions were classified according to the criteria proposed by reference pathology textbooks and the data records regarding the patients age, gender and clinical and pathologic diagnoses were noted. Concordance between two diagnoses was determined by descriptive statistics. Results: In this study, pathologic findings were golden standard (definitive diagnoses. The results showed the concordance between two clinical and pathologic diagnoses were more than 0/7 except POF and pemphigus. Conclusion: The results showed that the surgeons of oral and maxillofacial surgery in dental departments of Tehran and shahid Beheshti university of medical science provided acceptable diagnoses regarding pathologic lesions during 2005-2008. However, even the slight differences between two diagnoses necessitate all patients to be evaluated clinically and paraclinically in order to propose an accurate scientific diagnosis and prevent the harmful outcomes of the disease. Furthermore most efforts must be done to make more agreements between clinical and pathological diagnoses.

  14. An Examination of the Roles of Medical Units in Support of Chemical, Biological, Radiological, or Nuclear Event (CBRN) under Joint Task Force Civil Support (JF-CS)

    Science.gov (United States)

    2012-05-16

    diabetes, obesity, pediatrics, geriatrics , obstetrics, are some of the areas that the military medical response forces are currently not capable of...equipment and maintenance thereof; combat stress control; and medical, dental, veterinary, laboratory, optometric, nutrition therapy, and medical...

  15. Radiological safety management in medical cyclotron facilities

    International Nuclear Information System (INIS)

    Senthilkumar, M.; Nagalakshmi, B.; Manisha, V.I.; Pushpangadan, K.D.; Agarwal, S.P.

    2005-01-01

    A new era of Nuclear Medicine diagnosis has started with Medical Cyclotron technology. Medical Cyclotron produces positron emitters, which can be used in molecular imaging of the organs. In Medical Cyclotron, particles such as protons, deuterons are accelerated and made to bombard with suitable target material to produce radioisotopes, which are positron emitters. The positron emitters are produced by the (p,α), (p,n) or (d,n) reaction. The neutron activation of the surrounding medium draws the major attention in radiation safety. The license for such medical cyclotron facilities is issued by Atomic Energy Regulatory Board in India on the basis of regulations drawn from Radiation Protection Rules 1971 promulgated by Govt. of India under Atomic Energy Act, 1962. In this paper, the following aspects i) the steps involved in cyclotron installation ii) Design, Operational specifications and other features of various medical cyclotrons iii) Regulatory requirements for a cyclotron installation have been discussed

  16. Medical handling of accidentally exposed individuals

    International Nuclear Information System (INIS)

    1988-01-01

    In 1978 the International Atomic Energy Agency issued a publication in the IAEA Safety Series entitled Manual on Early Medical Treatment of Possible Radiation Injury (Safety Series No. 47). The contents were directed to first aid and early medical treatment of workers who might be concerned in an accident involving exposure to radiation, whether external or internal. The present manual is the first of a set of three safety series publications dealing with assessment and treatment of overexposures which will constitute an articulated system of documents covering all aspects of diagnosis, prognosis and treatment of overexposures. This document establishes a set of general criteria and recommendations to aid specialists involved in the medical handling of overexposed persons. It deals with the medical management of individual patients or small groups of patients under close medical supervision. 14 refs, 7 figs, 7 tabs

  17. Fibromyalgia diagnosis: a review of the past, present and future.

    Science.gov (United States)

    Wang, Sheng-Min; Han, Changsu; Lee, Soo-Jung; Patkar, Ashwin A; Masand, Prakash S; Pae, Chi-Un

    2015-06-01

    Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.

  18. Physiotherapy as one column of an integrative and interdisciplinary medical approach--impact of the introduction of diagnosis related groups in Germany.

    Science.gov (United States)

    Romeyke, Tobias; Scheuer, Hans Christoph; Stummer, Harald

    2013-12-01

    To investigate the introduction of case tariff fee remuneration - as required by the current system - and its influence on patient satisfaction with the provision of physiotherapeutic treatment in an acute hospital aligned on a holistic, interdisciplinary therapeutic approach. Randomised controlled study with a total of 4598 patients were interviewed. No case tariff fee system was used during the years 2004 to 2006. The data were compared with the results of interviews that took place during 2007 and 2008 (use of DRGs). The results of this study are based on the largest survey performed to date of patient satisfaction with physiotherapeutic treatment in acute care focusing on a holistic interdisciplinary approach. In-patients being treated under DRG conditions were compared with a control group for whom the DRG system had not been applied. The target parameter of the study, which took more than five years, was the determination of patient satisfaction with the physiotherapeutic interventions. There were no significant differences between the two groups in respect of satisfaction with the physiotherapeutic treatments received. Regarding the outcome parameter encouragement to take more exercise, a significant change could be demonstrated under DRG conditions. Physiotherapeutic interventions play an important role in the provision of interdisciplinary care. In particular, the holistic perception of the patient, the interdisciplinary approach to complex diseases, and the requirements of the DRG system on the care provider can exert a positive influence on outcome quality. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Medical criminalistics.

    Science.gov (United States)

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.

  20. Has Medical Innovation Reduced Cancer Mortality?

    OpenAIRE

    Frank R. Lichtenberg

    2014-01-01

    I analyze the effects of four types of medical innovation and cancer incidence on US cancer mortality rates during the period 2000–2009, by estimating difference-in-differences models using longitudinal (annual) data on ∼60 cancer sites (breast, colon, etc.). The outcome measure used is not subject to lead-time bias. I control for mean age at diagnosis, the stage distribution of patients at time of diagnosis, and the sex and race of diagnosed patients. Under the assumption that there were no ...

  1. Medications (for IBS)

    Medline Plus

    Full Text Available ... of constipation. Laxatives should be used under the supervision of a physician. Read more about laxatives. Bulking ... medications intended for specific use under a doctor’s supervision. Read more about newer IBS medications. Summary The ...

  2. Enterococcus faecium and Enterococcus durans isolated from cheese: Survival in the presence of medications under simulated gastrointestinal conditions and adhesion properties.

    Science.gov (United States)

    Amaral, Daniel M F; Silva, Luana F; Casarotti, Sabrina N; Nascimento, Liane Caroline Sousa; Penna, Ana Lúcia B

    2017-02-01

    In this study, we evaluated the survival of Enterococcus faecium and Enterococcus durans, isolated from cheese, in the presence of medications and under simulated in vitro gastrointestinal conditions. The presence of genes encoding virulence factors, the susceptibility to antimicrobial agents, and adhesion properties were also assessed. Enterococcus faecium and E. durans both exhibited resistance to most of the tested medications but showed a large sensitivity to analgesics and antihypertensives; they also showed wide susceptibility to antimicrobial agents. Enterococcus durans SJRP29 had greater resistance to the presence of medications in comparison with the probiotic Lactobacillus acidophilus La-5. The strains, except for E. durans SJRP05, did not harbor virulence genes. Enterococcus durans SJRP14, SJRP17, and SJRP26 were sensitive to all tested antimicrobial agents. Enterococcus faecium was more stable during the simulation of gastrointestinal tract and showed greater viability. At the end of the assay, except for E. durans SJRP17, all strains showed high viability (>7 log cfu/mL). Enterococcus durans SJRP29 stood out from the other strains and was selected for further evaluation; it tolerated up to 3.0% NaCl at 30 and 37°C, besides having good adhesion properties (high values of auto-aggregation, co-aggregation, and hydrophobicity). Additionally, the microorganism did not show bile salt hydrolase activity or mucin degradation. These results encourage carrying out additional tests to evaluate the probiotic features by using in vitro dynamic models and in vivo tests before applying these strains to a food system. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  3. Preimplantation diagnosis.

    Science.gov (United States)

    Delhanty, J D

    1994-12-01

    Research towards preimplantation diagnosis of genetic disease was initiated in the UK in the mid 1980s with the aim of helping those couples who would prefer selection to occur at this stage rather than during pregnancy. Following in vitro fertilisation, (IVF), biopsy and removal of 1 or 2 of the totipotent cells from the cleavage stage 3 day old embryo provides the material for molecular genetic diagnosis without interfering with development. Earliest applications were in the avoidance of X-linked disease by sexing embryos and selecting females for transfer to the mother. Initially, polymerase chain reaction (PCR) amplification of DNA from the biopsied blastomeres was performed using primers specific for sequences derived from the Y chromosome and this led to the birth of several normal girls. To reduce the risk of misdiagnosis due to amplification failure, PCR based methods for sexing the embryo now employ both X and Y specific sequences, but the preferred method is currently considered to be fluorescent in situ hybridisation (FISH) with fluorochrome labelled DNA probes to the embryonic nuclei that have been fixed and spread on slides. Dual FISH with probes from X and Y chromosomes allows unequivocal diagnosis of sex and determination of chromosome copy number, avoiding transfer of embryos with abnormal numbers of sex chromosomes, including those with only the maternal X that would be at 50% risk for the X-linked disease. The application of FISH for preimplantation diagnosis has also led to the realisation that chromosomal mosaicism is common at the cleavage stage of development, a finding that has important implications for diagnosis of both dominant single gene disorders and trisomies, as well as for our understanding of early human development. Cloning and sequencing of the relevant genes has enabled the development of methods for the diagnosis of certain recessive single gene disorders in cleavage stage embryos. PCR based methods have to be developed for each

  4. Safeguarding the Health of the NASA Astronaut Community: the Need for Expanded Medical Monitoring for Former NASA Astronauts Under the Astronaut Occupational Health Program

    Science.gov (United States)

    Rossi, Meredith; Lee, Lesley; Wear, Mary; Van Baalen, Mary; Rhodes, Bradley

    2016-01-01

    The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential latent health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging communities are necessary for astronauts to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography), as opposed to conditions resulting directly from the astronaut occupation; and increased breadth of monitoring services will improve the understanding of occupational health risks and longitudinal health of the astronaut community, past, present, and future. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding existing medical monitoring under the Astronaut Occupational Health program for former NASA astronauts.

  5. "For Their Own Good": A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) where Mental Illness Is the Sole Underlying Condition.

    Science.gov (United States)

    Dembo, Justine; Schuklenk, Udo; Reggler, Jonathan

    2018-01-01

    Canada is approaching its federal government's review of whether patients should be eligible for medical assistance in dying (MAID) where mental illness is the sole underlying medical condition, and when "natural death" is not "reasonably foreseeable". For those opposed, arguments involve the following themes: capacity, value of life, vulnerability, stigma, irremediability, and the role of physicians. It has also been suggested that those who are able-bodied should have to kill themselves, even though suicide may be painful, lonely, and violent. Opponents of MAID for severe, refractory suffering due to mental illness imply that it is acceptable to remove agency from such patients on paternalistic grounds. After years of efforts to destigmatise mental illness, these kinds of arguments effectively declare all patients with mental illness, regardless of capacity, unable to make considered choices for themselves. The current paper argues that decisions about capacity must be made on an individual-patient basis. Given the rightful importance granted to respect for patient autonomy in liberal democracies, the wholesale removal of agency advocated by opponents of a permissive MAID regime is difficult to reconcile with Canadian constitutional values.

  6. First Nations People: Addressing the Relationships between Under-Enrollment in Medical Education, STEM Education, and Health in the United States

    Directory of Open Access Journals (Sweden)

    Dharam Persaud-Sharma

    2018-02-01

    Full Text Available In the United States of America, an analysis of enrollment statistics to institutions of higher education, those pursuing Science, Technology, Engineering, and Mathematics (STEM fields, as well as those pursuing medical education show a paralleled ethnic stratification. Based upon such stratification, Native Americans consistently rank amongst the lowest demographic groups to enroll in and pursue higher education, STEM or medical education. A perturbed history of the First Nations people in the establishment of the United States of America laid the foundation for a multitude of factors contributing to current trends in health, living, and academic pursuits amongst First Nation’s people. This paper aims to explore the factors underlying the lack of Native American enrollment in higher education, careers in STEM and medicine. An investigation was conducted following a broad literature review relevant to the topic, and articles were critically appraised using the Search, Appraisal, Synthesis of Analysis (SALSA framework as well as the Standards for Reporting Qualitative Research (SRQR. Findings from such studies indicate that the Native American communities face a unique set of social circumstances rooted in a historical context, with several unmet basic needs of living required for integration, access, and pursuit of higher education.

  7. Relationship between communication manners of head nurses with job satisfaction of nurses under their supervision in educational hospitals of Isfahan University of Medical Sciences in 2006.

    Science.gov (United States)

    Dehaghani, Abdollah Rezaei; Hosseini, Habibollah; Tavakol, Khosrow; Bakhtiyari, Soheila

    2010-01-01

    Interpersonal communication is considered as an important and effective factor of job satisfaction and efficiency and has special significance in nursing career because of the face to face relationship with patients. This study aimed to determine the association between head nurses' interpersonal communication and job satisfaction of nurses under their supervision. The study was conducted in educational hospitals of Isfahan University of Medical Sciences in 2006. This was a descriptive and analytical study on 203 nursing personnel working in educational hospitals of Isfahan University of Medical Sciences in 2006. Data were collected using Job Descriptive Index (JDI) developed by Smith and Kendall and interpersonal communication was measured using a researcher-made questionnaire. Data were analyzed using SPSS software and Pearson's test and presented in tables and diagrams. The majority of the participants (148 subjects, 73%) believed that head nurses' interpersonal communication was excellent and in general Pearson's test showed a significant association between head nurses' interpersonal communication and their personnel's job satisfaction (p interpersonal communication of the head nurses and job satisfaction of their personnel, we can improve the job satisfaction of nursing personnel as well as patients' satisfactory and level of services by developing educational courses and workshops on importance and effectiveness of interpersonal communication for head nurses.

  8. Under-representation of developing countries in the research literature: ethical issues arising from a survey of five leading medical journals

    Directory of Open Access Journals (Sweden)

    Siribaddana Sisira

    2004-10-01

    Full Text Available Abstract Background It is widely acknowledged that there is a global divide on health care and health research known as the 10/90 divide. Methods A retrospective survey of articles published in the BMJ, Lancet, NEJM, Annals of Internal Medicine & JAMA in a calendar year to examine the contribution of the developing world to medical literature. We categorized countries into four regions: UK, USA, Other Euro-American countries (OEAC and (RoW. OEAC were European countries other than the UK but including Australia, New Zealand and Canada. RoW comprised all other countries. Results The average contribution of the RoW to the research literature in the five journals was 6.5%. In the two British journals 7.6% of the articles were from the RoW; in the three American journals 4.8% of articles were from RoW. The highest proportion of papers from the RoW was in the Lancet (12%. An analysis of the authorship of 151 articles from RoW showed that 104 (68.9% involved authorship with developed countries in Europe or North America. There were 15 original papers in these journals with data from RoW but without any authors from RoW. Conclusions There is a marked under-representation of countries in high-impact general medical journals. The ethical implications of this inequity and ways of reducing it are discussed.

  9. Corrosion performance of Cr3C2-NiCr+0.2%Zr coated super alloys under actual medical waste incinerator environment

    Science.gov (United States)

    Ahuja, Lalit; Mudgal, Deepa; Singh, Surendra; Prakash, Satya

    2018-03-01

    Incineration techniques are widely used to dispose of various types of waste which lead to formation of very corrosive environment. Such corrosive environment leads to the degradation of the alloys used in these areas. To obviate this problem, zirconium modified Cr3C2-(NiCr) coating powder has been deposited on three superalloys namely Superni 718, Superni 600 and Superco 605 using Detonation gun technique. Corrosion test was conducted in actual medical waste incinerator environment. The samples were hung inside the secondary chamber operated at 1050°C for 1000h under cyclic condition. Corrosion kinetics was monitored using the weight gain measurements and thickness loss. Corrosion products were characterized using scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction technique. It was observed that coating is found to be successful in impeding the corrosion problem in superalloys.

  10. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant

    OpenAIRE

    Matos, Lígia Neres; Guimarães, Tereza Cristina Felippe; Brandão, Marcos Antônio Gomes; Santoro, Deyse Conceição

    2012-01-01

    The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009....

  11. A novel de novo missense mutation in TP63 underlying germline mosaicism in AEC syndrome: implications for recurrence risk and prenatal diagnosis.

    Science.gov (United States)

    Barbaro, Vanessa; Nardiello, Paola; Castaldo, Giuseppe; Willoughby, Colin E; Ferrari, Stefano; Ponzin, Diego; Amato, Felice; Bonifazi, Ernesto; Parekh, Mohit; Calistri, Arianna; Parolin, Cristina; Di Iorio, Enzo

    2012-08-01

    Ankyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome is a rare autosomal dominant ectodermal dysplasia syndrome. It is caused by heterozygous mutations in TP63, encoding a transcriptional factor of the p53 family. Mutations in TP63, mainly missense in exons 13 and 14 encoding the sterile alpha motif (SAM) and the transactivation inhibitory (TI) domains, account for 99% of mutations in individuals with AEC syndrome. Of these, ≥70% are de novo mutations, present in the affected patient, but not in parents nor in healthy siblings. However, when a mutation appears de novo, it is not possible to differentiate between a sporadic mutation, or germline mosaicism in the parents. In this latter case, there is a risk of having additional affected offspring. We describe two sisters with AEC syndrome, whose parents were unaffected. Both patients carried the heterozygous c.1568T>C substitution in exon 13 of TP63, resulting in a p.L523P change in the SAM domain of the protein. Analyses of DNA from parental blood cells, seminal fluid (from the father) and maternal cells (buccal, vaginal, and cervical) did not reveal the mutation, suggesting that the mosaicism may involve a very low percentage of cells (very low grade somatic mosaicism) or, more likely, maternal gonadal mosaicism. Mosaicism must be considered for the assessment of recurrence risk during genetic counseling in AEC syndrome, and pre-implantation/prenatal genetic diagnosis should be offered to all couples, even when the mutation is apparently de novo. Copyright © 2012 Wiley Periodicals, Inc.

  12. Clinical diagnosis versus autopsy diagnosis in head trauma

    Directory of Open Access Journals (Sweden)

    Velnic Andreea-Alexandra

    2017-12-01

    Full Text Available The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1 to total discordance (C4 and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis- missing injuries in the autopsy reports and C3 (partial discordance in favor of the necroptic diagnosis- missing injuries in the medical files. Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral

  13. Differential diagnosis of Jakob-Creutzfeldt disease

    OpenAIRE

    Paterson, RW; Torres-Chae, CC; Kuo, AL; Ando, T; Nguyen, EA; Wong, K; DeArmond, SJ; Haman, A; Garcia, P; Johnson, DY; Miller, BL; Geschwind, MD

    2012-01-01

    Objectives: To identify the misdiagnoses of patients with sporadic Jakob-Creutzfeldt disease (sCJD) during the course of their disease and determine which medical specialties saw patients with sCJD prior to the correct diagnosis being made and at what point in the disease course a correct diagnosis was made. Design: Retrospective medical record review. Setting: A specialty referral center of a tertiary academic medical center. Participants: One hundred sixty-three serial patients over a 5.5-y...

  14. Medical Issues: Breathing

    Science.gov (United States)

    ... after diagnosis. Helpful Links Aaron's Tracheostomy webpage Acute Respiratory Illness Care Guidelines A Young Man's Voice (Experience with a Tracheostomy) Books on Medical Information and Life with SMA Chest Physiotherapy in SMA Cough Assist Machine Health Facts Cure ...

  15. Dystonia Medical Research Foundation

    Science.gov (United States)

    ... the DMRF Find An Event Donate Donate Online Membership Find an Event Donor Bill of Rights About Dystonia Symptoms & Diagnosis Forms of Dystonia Genetics Glossary Treatment Find a Doctor Oral Medications Botulinum Neurotoxin Neurosurgery ...

  16. SARS - Diagnosis

    Indian Academy of Sciences (India)

    SARS - Diagnosis. Mainly by exclusion of known causes of atypical pneumonia; * X ray Chest; * PCR on body fluids- primers defined by WHO centres available from website.-ve result does not exclude SARS. * Sequencing of amplicons; * Viral Cultures – demanding; * Antibody tests.

  17. Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache.

    Science.gov (United States)

    Wanasuntronwong, Aree; Jansri, Ukkrit; Srikiatkhachorn, Anan

    2017-01-03

    Patients with medication-overuse headache suffer not only from chronic headache, but often from psychiatric comorbidities, such as anxiety and depression. The mechanisms underlying these comorbidities are unclear, but the amygdala is likely to be involved in their pathogenesis. To investigate the mechanisms underlying the comorbidities we used elevated plus maze and open field tests to assess anxiety-like behavior in rats chronically treated with analgesics. We measured the electrical properties of neurons in the amygdala, and examined the cortical spreading depression (CSD)-evoked expression of Fos in the trigeminal nucleus caudalis (TNC) and amygdala of rats chronically treated with analgesics. CSD, an analog of aura, evokes Fos expression in the TNC of rodents suggesting trigeminal nociception, considered to be a model of migraine. Increased anxiety-like behavior was seen both in elevated plus maze and open field tests in a model of medication overuse produced in male rats by chronic treatment with aspirin or acetaminophen. The time spent in the open arms of the maze by aspirin- or acetaminophen-treated rats (53 ± 36.1 and 37 ± 29.5 s, respectively) was significantly shorter than that spent by saline-treated vehicle control rats (138 ± 22.6 s, P amygdala as indicated by their more negative threshold for action potential generation (-54.6 ± 5.01 mV for aspirin-treated, -55.2 ± 0.97 mV for acetaminophen-treated, and -31.50 ± 5.34 mV for saline-treated rats, P amygdala [18 ± 10.2 Fos-immunoreactive (IR) neurons per slide in the amygdala of rats treated with aspirin, 11 ± 5.4 IR neurons per slide in rats treated with acetaminophen, and 4 ± 3.7 IR neurons per slide in saline-treated control rats, P amygdala, which could underlie the anxiety seen in patients with medication-overuse headache.

  18. Dermatomyositis: Diagnosis

    Science.gov (United States)

    ... for MDA Blog Donate Search MDA.org Close Dermatomyositis Share print email share facebook twitter google plus ... As with other muscle diseases, a doctor diagnoses dermatomyositis by considering an individual’s history, family medical history ...

  19. differential diagnosis

    African Journals Online (AJOL)

    Pervasive developmental disorders. Disruptive behaviour disorder. (conduct and oppositional defiant disorders). Learning disabilities. Childhood psychosis. Medical disorders. Chronic diseases such as congenital heart disease, asthma, chronic renal failure, fetal-alcohol syndrome, thyroid diseases and other endocrine.

  20. Globalization and Equitable Use of Natural Resources in the Contemporary World: A Diagnosis Under the Bias of The Principle of Intergenerational Equity

    Directory of Open Access Journals (Sweden)

    Luís Marcelo Mendes

    2016-10-01

    Full Text Available Article  conduct  an  assessment  of  globalization  has  unleashed  the  commodification/depredation of natural resources in local/global scale to meet the interests of the market and the performance of the principle of intergenerational equity to try to curb this phenomenon. The research makes use of the deductive method, and uses dialectical contributions in order to implement a more accurate analysis of the phenomenon. At first, time will address under as globalization changes in consumption patterns of individuals in local/global level. Finally, it will take shape-the role of the principle of intergenerational equity by the legal system to try to curb ecological degradation.

  1. Comportamiento de las crisis hipertensivas en un centro médico de diagnóstico integral Behavior of the hypertensive crisis present in patients from an integral diagnosis medical center

    Directory of Open Access Journals (Sweden)

    Vladimir Curbelo Serrano

    2009-09-01

    Full Text Available Se realizó un estudio descriptivo y retrospectivo, con el objetivo de describir el comportamiento de las crisis hipertensivas en el Cuerpo de Guardia del Centro Médico de Diagnóstico Integral "Carvajal", del municipio del mismo nombre, en el estado de Trujillo, Venezuela, en el período de enero a junio de 2007. Se trabajó con un universo de 104 pacientes diagnosticados con crisis hipertensivas que acudieron al cuerpo de guardia en el período mencionado. Para la recogida de los datos se utilizaron las hojas de cargo y las microhistorias. Se emplearon frecuencias absolutas y relativas (porcentaje para resumir la información, y tablas para su presentación. Se obtuvo un predominio del sexo masculino, el grupo de edades de 50-59 años y una mayor frecuencia de las urgencias hipertensivas. Los accidentes vasculares encefálicos y el síndrome coronario agudo, así como la hipertrofia del ventrículo izquierdo y la elevación del segmento ST dentro de las alteraciones electrocardiográficas, fueron las de mayor significación.A descriptive and retrospective study was carried out to describe the behavior of hypertensive crises in Emergency Room of "Carvajal" Integral Diagnosis Medical Center from this municipality in Trujillo state, Venezuela from January to June, 2007. Universe included 104 patients diagnosed with hypertensive crises seen in emergency room during above period. For data collection charge records and micro-medical records were used as well as absolute end relative frequencies (percentage to summarize the information and tables for its presentation. There was a male predominance, 50-59 years age group, and a great frequency of hypertensive urgencies. Encephalic vascular accidents (strokes and the acute coronary syndrome, as well as left ventricle atrophy and rise of ST-segment within the electrocardiographic alterations, were the more significant.

  2. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant.

    Science.gov (United States)

    Matos, Lígia Neres; Guimarães, Tereza Cristina Felippe; Brandão, Marcos Antônio Gomes; Santoro, Deyse Conceição

    2012-01-01

    The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009. The results showed that 71.1% of the patients had decreased cardiac output (measured by cardiac index). The majority of the NANDA-International defining characteristics for DCO were more frequent in individuals with reduced cardiac index levels. The study emphasizes the odds ratio (OR) for increased Systemic Vascular Resistance of OR=4.533, of the third heart sound with OR=3.429 and the reduced ejection fraction with OR=2.850. By obtaining the predictive values for the defining characteristics the study identifies them as diagnostic indicators of decreased cardiac output.

  3. Transformation of medical grade silicone rubber under Nd:YAG and excimer laser irradiation: First step towards a new miniaturized nerve electrode fabrication process

    Science.gov (United States)

    Dupas-Bruzek, C.; Robbe, O.; Addad, A.; Turrell, S.; Derozier, D.

    2009-08-01

    Medical grade silicone rubber, poly-dimethylsiloxane (PDMS) is a widely used biomaterial. Like for many polymers, its surface can be modified in order to change one or several of its properties which further allow this surface to be functionalized. Laser-induced surface modification of PDMS under ambient conditions is an easy and powerful method for the surface modification of PDMS without altering its bulk properties. In particular, we profit from both UV laser inducing surface modification and of UV laser micromachining to develop a first part of a new process aiming at increasing the number of contacts and tracks within the same electrode surface to improve the nerve selectivity of implantable self sizing spiral cuff electrodes. The second and last part of the process is to further immerse the engraved electrode in an autocatalytic Pt bath leading in a selective Pt metallization of the laser irradiated tracks and contacts and thus to a functionalized PDMS surface. In the present work, we describe the different physical and chemical transformations of a medical grade PDMS as a function of the UV laser and of the irradiation conditions used. We show that the ablation depths, chemical composition, structure and morphology vary with (i) the laser wavelength (using an excimer laser at 248 nm and a frequency-quadrupled Nd:YAG laser at 266 nm), (ii) the conditions of irradiation and (iii) the pulse duration. These different modified properties are expected to have a strong influence on the nucleation and growth rates of platinum which govern the adhesion and the thickness of the Pt layer on the electrodes and thus the DC resistance of tracks.

  4. Transformation of medical grade silicone rubber under Nd:YAG and excimer laser irradiation: First step towards a new miniaturized nerve electrode fabrication process

    Energy Technology Data Exchange (ETDEWEB)

    Dupas-Bruzek, C., E-mail: catherine.dupas@univ-lille1.fr [Universite des Sciences et Technologies de Lille (USTL), 59655 Villeneuve d' Ascq (France); Laboratoire de Physique des Lasers, Atomes et Molecules (PhLAM), UMR CNRS 8523, Centre d' Etudes et de Recherches Lasers et Applications (CERLA), FR CNRS 2416 (France); Robbe, O. [Universite des Sciences et Technologies de Lille (USTL), 59655 Villeneuve d' Ascq (France); Laboratoire de Spectroscopie Infrarouge et Raman (LASIR), UMR CNRS 8516, Centre d' Etudes et de Recherches Lasers et Applications (CERLA), FR CNRS 2416 (France); Addad, A. [Universite des Sciences et Technologies de Lille (USTL), 59655 Villeneuve d' Ascq (France); Laboratoire de Structures et Proprietes de l' Etat Solide (LSPES), UMR CNRS 8008 (France); Turrell, S. [Universite des Sciences et Technologies de Lille (USTL), 59655 Villeneuve d' Ascq (France); Laboratoire de Spectroscopie Infrarouge et Raman (LASIR), UMR CNRS 8516, Centre d' Etudes et de Recherches Lasers et Applications (CERLA), FR CNRS 2416 (France); Derozier, D. [Universite des Sciences et Technologies de Lille (USTL), 59655 Villeneuve d' Ascq (France); Laboratoire de Physique des Lasers, Atomes et Molecules (PhLAM), UMR CNRS 8523, Centre d' Etudes et de Recherches Lasers et Applications (CERLA), FR CNRS 2416 (France)

    2009-08-15

    Medical grade silicone rubber, poly-dimethylsiloxane (PDMS) is a widely used biomaterial. Like for many polymers, its surface can be modified in order to change one or several of its properties which further allow this surface to be functionalized. Laser-induced surface modification of PDMS under ambient conditions is an easy and powerful method for the surface modification of PDMS without altering its bulk properties. In particular, we profit from both UV laser inducing surface modification and of UV laser micromachining to develop a first part of a new process aiming at increasing the number of contacts and tracks within the same electrode surface to improve the nerve selectivity of implantable self sizing spiral cuff electrodes. The second and last part of the process is to further immerse the engraved electrode in an autocatalytic Pt bath leading in a selective Pt metallization of the laser irradiated tracks and contacts and thus to a functionalized PDMS surface. In the present work, we describe the different physical and chemical transformations of a medical grade PDMS as a function of the UV laser and of the irradiation conditions used. We show that the ablation depths, chemical composition, structure and morphology vary with (i) the laser wavelength (using an excimer laser at 248 nm and a frequency-quadrupled Nd:YAG laser at 266 nm), (ii) the conditions of irradiation and (iii) the pulse duration. These different modified properties are expected to have a strong influence on the nucleation and growth rates of platinum which govern the adhesion and the thickness of the Pt layer on the electrodes and thus the DC resistance of tracks.

  5. Achieving diagnosis by consensus

    LENUS (Irish Health Repository)

    Kane, Bridget

    2009-08-01

    This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

  6. Goal-oriented incentive payment in CUDAM institution and variation in medical visit indicators in children under one and pregnant women

    Directory of Open Access Journals (Sweden)

    Marcelo Morales

    2011-11-01

    Full Text Available ntroduction: The establishment of National Integrated Health System in Uruguay from 2007 led to changes in the financing of the Collective Health Care Institutions (IAMC. They charge the National Health Fund (FONASA for their partners from social security (SS a health fee consists of: a A risk-adjusted capita (94%b A component for compliance with performance (6%, depending on the fulfillment of three goals of care. Goal 1 is a component of the child under 1 year and a component of the pregnant woman. For both components were established institutional baseline (July 2007-September 2008 in the control patients in both age groups. This motif COMPLIANCE quarterly reports with a fee of $48/user FONASA/month for average baseline compliment. Las for children and pregnant women were monitored for IAMC CUDAM 64% and 59% respectively.This institution has 42,000 users, 95% derived from SS, featuring 45 births, 585 children <1 year and 405 pregnant women tested monthly.Objectives: Evaluate two years (July-September 2010:a The mean percentages of compliance for children and pregnant CUDAM with medical controlb Relationship between income through the FONASA insitucional for goal 1 and children and pregnant women in medical management during the quarter.Methods: a retrospective study of children and pregnant women with medical control CUDAM. In turn, each target has 6 indicators (N: children, F: females. Child: N1 and N2: derivation and acquisition of the newborn, N3: controls as a guideline, N4: current vaccination, N5: ultrasound hip and pregnant, N6: accreditation in good feeding practices for infants and young children and pregnant women. Pregnant woman: M1 controls as a guideline, M2: leaf perinatal information system, M3: HIV and VDRL performed, M4: uptake in 1 st quarter, M5 and M6: dental checkup during pregnancy and postpartum.Results: The mean percentages of compliance for children and pregnant women increased to 92% (164 additional children and 88

  7. Diretrizes da Associação Médica Brasileira para o diagnóstico e diagnóstico diferencial do transtorno de ansiedade social Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder

    Directory of Open Access Journals (Sweden)

    Marcos Hortes N. Chagas

    2010-12-01

    presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed, Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending". RESULTS: We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION: The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.

  8. Medical Imaging: A Review

    Science.gov (United States)

    Ganguly, Debashis; Chakraborty, Srabonti; Balitanas, Maricel; Kim, Tai-Hoon

    The rapid progress of medical science and the invention of various medicines have benefited mankind and the whole civilization. Modern science also has been doing wonders in the surgical field. But, the proper and correct diagnosis of diseases is the primary necessity before the treatment. The more sophisticate the bio-instruments are, better diagnosis will be possible. The medical images plays an important role in clinical diagnosis and therapy of doctor and teaching and researching etc. Medical imaging is often thought of as a way to represent anatomical structures of the body with the help of X-ray computed tomography and magnetic resonance imaging. But often it is more useful for physiologic function rather than anatomy. With the growth of computer and image technology medical imaging has greatly influenced medical field. As the quality of medical imaging affects diagnosis the medical image processing has become a hotspot and the clinical applications wanting to store and retrieve images for future purpose needs some convenient process to store those images in details. This paper is a tutorial review of the medical image processing and repository techniques appeared in the literature.

  9. X-ray equipment in medical diagnosis

    International Nuclear Information System (INIS)

    This document sets out requirements for the safe use of radiation emitting devices. Included in this code are sections for the specific guidance of the radiologist, the physician, the operator, and the health physicist

  10. Interactive tele-radiological segmentation systems for treatment and diagnosis.

    Science.gov (United States)

    Zimeras, S; Gortzis, L G

    2012-01-01

    Telehealth is the exchange of health information and the provision of health care services through electronic information and communications technology, where participants are separated by geographic, time, social and cultural barriers. The shift of telemedicine from desktop platforms to wireless and mobile technologies is likely to have a significant impact on healthcare in the future. It is therefore crucial to develop a general information exchange e-medical system to enables its users to perform online and offline medical consultations through diagnosis. During the medical diagnosis, image analysis techniques combined with doctor's opinions could be useful for final medical decisions. Quantitative analysis of digital images requires detection and segmentation of the borders of the object of interest. In medical images, segmentation has traditionally been done by human experts. Even with the aid of image processing software (computer-assisted segmentation tools), manual segmentation of 2D and 3D CT images is tedious, time-consuming, and thus impractical, especially in cases where a large number of objects must be specified. Substantial computational and storage requirements become especially acute when object orientation and scale have to be considered. Therefore automated or semi-automated segmentation techniques are essential if these software applications are ever to gain widespread clinical use. The main purpose of this work is to analyze segmentation techniques for the definition of anatomical structures under telemedical systems.

  11. Interactive Tele-Radiological Segmentation Systems for Treatment and Diagnosis

    Directory of Open Access Journals (Sweden)

    S. Zimeras

    2012-01-01

    Full Text Available Telehealth is the exchange of health information and the provision of health care services through electronic information and communications technology, where participants are separated by geographic, time, social and cultural barriers. The shift of telemedicine from desktop platforms to wireless and mobile technologies is likely to have a significant impact on healthcare in the future. It is therefore crucial to develop a general information exchange e-medical system to enables its users to perform online and offline medical consultations through diagnosis. During the medical diagnosis, image analysis techniques combined with doctor’s opinions could be useful for final medical decisions. Quantitative analysis of digital images requires detection and segmentation of the borders of the object of interest. In medical images, segmentation has traditionally been done by human experts. Even with the aid of image processing software (computer-assisted segmentation tools, manual segmentation of 2D and 3D CT images is tedious, time-consuming, and thus impractical, especially in cases where a large number of objects must be specified. Substantial computational and storage requirements become especially acute when object orientation and scale have to be considered. Therefore automated or semi-automated segmentation techniques are essential if these software applications are ever to gain widespread clinical use. The main purpose of this work is to analyze segmentation techniques for the definition of anatomical structures under telemedical systems.

  12. Differences in medical schools' regional retention of physicians by school type and year of establishment: effect of new schools built under government policy.

    Science.gov (United States)

    Kamitani, Satoru; Nakamura, Fumiaki; Itoh, Mitsuko; Sugiyama, Takehiro; Toyokawa, Satoshi; Kobayashi, Yasuki

    2015-12-30

    Physician maldistribution is an ongoing concern globally. The extent of medical schools retaining graduates within their geographical areas has rarely been explored in Japan or in other countries. This study aimed to investigate whether the proportion of medical school graduates practicing in the vicinity of medical school (retention rate) differs by the year of the school's establishment and by the school's funding source. This cross-sectional study used a set of databases on medical institutions and personnel. We analyzed a sample of 168,594 clinically active physicians practicing in institutions as of May 2014, who passed the National Medical Practitioners Examination between 1985 and 2013. We assessed the retention rate and the schools' establishment period and funding source (pre-1970/post-1970, private/public), using a hierarchical regression model with random intercept unique to each medical school. We used the following factors as covariates: gender, physicians' length of professional experience, and the geographical features of the medical schools. The retention rate was widely distributed from 16.2 to 81.5 % (median: 48.4 %). Physicians who graduated from post-1970 medical schools were less likely to practice in the prefecture of their medical school location, relative to those who graduated from pre-1970 medical schools (adjusted odds ratio: 0.75; 95 % confidence interval: 0.62-0.90). Physicians who graduated from private medical schools were also less likely to practice in the prefecture of their medical school location, relative to those who graduated from public medical schools (adjusted odds ratio: 0.63; 95 % confidence interval: 0.51-0.77). In addition, the ability to retain graduates varied by school according to the school's characteristics. There was a considerable difference between medical schools in retaining graduates locally. The study results may have significant implications for government policy to alleviate maldistribution of physicians

  13. Conhecimento dos métodos para diagnóstico do câncer de mama entre estudantes de medicina Knowledge regarding breast cancer diagnosis among medical students

    Directory of Open Access Journals (Sweden)

    Nilceana Maya Aires

    1999-04-01

    understanding of the students in the fifth year of medical school, who had already attended the Gynecology course. Methods: Through questionnaires given to 348 individuals, from the first to the fifth year, out of a total population of 550 students, the authors searched for information with regard to basic knowledge on the diagnosis of breast cancer. Of the 348 questionnaires, 55 (16% were given to fifth-year students, who had already attended the Gynecology course. Furthermore, 43% of the students were women, 62% had medical doctors in their immediate family, and 17% had a family history of breast cancer. Results: in regard to the knowledge of diagnostic methods, 84% of the students were aware of the most frequent sign of breast cancer, 34% knew which was the best screening method, 49% knew when to refer asymptomatic women to mammography, 37% knew the recommended interval between mammography for women above the age of 50, and 24% knew when to associate ultrasound to mammography for the detection of breast cancer. The fifth-year students provided correct answers at a significantly higher rate, when compared to the others. Concerning gender, the only difference regarded the fact that women showed a better knowledge as to the best time for self-examination and when to recommend ultrasound associated with mammography. The presence of medical doctors in the family and a history of family members with breast cancer did not have any influence on the answers. Conclusion: The lack of information in regard to the diagnosis of breast cancer is very high, even among medical students. Nevertheless, the rate of information increases significantly after students are taught Gynecology, which is only offered during the fifth year of the medical school.

  14. Diagnosis and pathology of endocrine diseases

    International Nuclear Information System (INIS)

    Shriver, B.D.

    1988-01-01

    This book contains 22 papers under the headings of Diagnosis and Pathology of endocrine diseases. Topics covered include: Laboratory tests in the diagnosis and management of thyroid disorders, Pathology of thyroid diseases, Diagnosis of adrenourtical disease, Radiologic techniques in evaluating endocrine disorders; and the Pituitary and adrenal glands

  15. Diagnosis and pathology of endocrine diseases

    Energy Technology Data Exchange (ETDEWEB)

    Shriver, B.D.

    1988-01-01

    This book contains 22 papers under the headings of Diagnosis and Pathology of endocrine diseases. Topics covered include: Laboratory tests in the diagnosis and management of thyroid disorders, Pathology of thyroid diseases, Diagnosis of adrenourtical disease, Radiologic techniques in evaluating endocrine disorders; and the Pituitary and adrenal glands.

  16. DISCUSSING NURSING DIAGNOSIS APPLIED BY NURSING STUDENTS

    OpenAIRE

    K. M. H. Cavalcante; M. L. Botelho; P. P. Cavalcanti; F. M. P. Garcia

    2016-01-01

    Aimed to identify and discuss nursing diagnosis present in 50 Case Studies developed by students of graduation nursing of Federal University of Mato Grosso - Campus of Sinop, in a unit of clinical medical. Documentary research that addressed quantitatively the nursing diagnosis proposed using the Taxonomy II of NANDA-I (2009-2011). It was documented 82 different diagnosis, and covered all the 13 domains. The involvement of all the domains and the large variability of diagnoses identified sug...

  17. Burnout: a fashionable diagnosis.

    Science.gov (United States)

    Kaschka, Wolfgang P; Korczak, Dieter; Broich, Karl

    2011-11-01

    "Burnout syndrome" is now a common reason for medical excuses from work, and thus an important topic in health-related economics. Much research is still needed, however, to establish the scientific basis for this entity, the criteria by which it might be diagnosed and classified, and how it should be treated. A systematic review of this topic, previously published as an HTA report, is presented here together with a selective overview of pertinent literature. There currently exists neither an officially accepted definition nor a valid instrument for the differential diagnosis of burnout syndrome. Its manifestations are generally considered to lie along three dimensions: emotional exhaustion, depersonalization, and reduced performance ability and/or motivation. Most of the available studies on its epidemiology and differential diagnosis provide no more than a low level of evidence for their conclusions. There have been no controlled trials of treatments for burnout. High-quality controlled studies on burnout syndrome are lacking. A standardized and internationally accepted diagnostic instrument with a validated rating scale should be developed. There is also a need for epidemiological and health-economic studies on the prevalence, incidence, and cost of burnout. The etiology and pathogenesis of burnout should be studied with special regard to the possible role of neurobiological factors. Treatments for it should be studied systematically so that their effects can be judged at a high level of evidence. In view of the current lack of knowledge about what is called "burnout," the term should not be used as a medical diagnosis or as a basis for decisions regarding disability or other socioeconomic matters.

  18. Anticonvulsant medications attenuate amphetamine-induced deficits in behavioral inhibition but not decision making under risk on a rat gambling task.

    Science.gov (United States)

    Tremblay, Melanie; Winstanley, Catharine A

    2016-11-01

    Impulsivity is a major component of mania in bipolar disorder (BD), and patients also show impairments in decision-making involving risk on the Iowa Gambling Task (IGT). Similar deficits are observed in some patients with temporal lobe epilepsy (TLE), and incidence of problem gambling is higher in both these populations. Anticonvulsant drugs are widely used in the treatment of epilepsy, but also as mood stabilizers and prophylaxis for the management of BD. Unfortunately, little is still known about the precise mechanisms of action underlying their efficacy, and the specific behavioral aspect targeted by these drugs. This project explored the effect of the three anticonvulsant drugs currently also used as mood stabilizers- carbamazepine, valproate and lamotrigine on aspects of decision-making using a rat analogue of the IGT, the rat Gambling Task (rGT). In this task, rats choose between four distinct, probabilistic reinforcement schedules. Sugar pellet profits are maximized by adopting a conservative strategy, avoiding tempting high-risk, high-reward options. Effects of the anticonvulsant agents were assessed on baseline performance and also in conjunction with amphetamine administration, in order to approximate a "mania-like" state. Carbamazepine appeared to slow processing speed, decreasing premature responses and increasing choice latency, whereas valproate and lamotrigine had no effect. When administered prior to amphetamine, lamotrigine was the only drug that failed to attenuate the pro-impulsive effect of the psychostimulant. Further studies looking at chronic administration of anticonvulsants may help us understand the impact of this medication class on decision-making and impulsivity in healthy rats and disease models. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Necrotizing fasciitis: an urgent diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Paz Maya, Silvia; Dualde Beltran, Delfina [Hospital Clinico Universitario de Valencia, Valencia (Spain); Lemercier, Pierre; Leiva-Salinas, Carlos [Hospital Politecnico y Universitario La Fe, Valencia (Spain)

    2014-05-15

    Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests - e.g., the ''finger test'' or biopsy - and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. (orig.)

  20. Radioisotopes and medical imaging in Sri Lanka

    International Nuclear Information System (INIS)

    Jayasinghe, J.M.A.C.

    1993-01-01

    The article deals with the use of X-rays and magnetic resonance imaging in medical diagnosis in its introduction. Then it elaborates on the facilities in the field of medical imaging for diagnosis, in Sri Lanka. The use of Technetium-99m in diagnostic medicine as well as the future of medical imaging in Sri Lanka is also dealt with

  1. Fuzzy diagnosis

    International Nuclear Information System (INIS)

    Watanabe, K.

    1990-01-01

    Studies have been made on fuzzy diagnosis using inverse problem solutions of the fuzzy relational equation of ao R=b, where a is the failure vector, R the fuzzy relation matrix and b the sympton vector. Four phases of analyses were carried out in this study. First, fault tree analysis was undertaken to investigate what kind of causes produce fall of water level in a steam drum of ATR (Advanced Thermal Reactor), which is heavy-water-moderated boiling-water-cooled pressure-tube-type reactor. Next, simulation for 100 seconds was executed to determine how plant parameters respond to an occurrence of a transient induced by the cause. Third, the simulation data was analysed utilizing an autoregressive model. From this analysis, a total of 36 coherency functions up to 0.5 Hz in each transient were computed among nine important and detectable plant parameters, that is neutron flux, flow rate of coolant, steam and feed water, water level in the steam drum, pressure and opening area of control valve in a steam pipe, feed water temperature and electrical power. Last, the inverse problem of the fuzzy relational equation was solved. Relation matrices were adjusted from 0.00 to 1.00, after nine membership functions following the Gussian distribution for the symptom vector were estimated from correlation values of the coherency functions

  2. Redefining "Medical Care."

    Science.gov (United States)

    Roth, Lauren R

    President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments

  3. DNA Sensors for Malaria Diagnosis

    DEFF Research Database (Denmark)

    Hede, Marianne Smedegaard; Fjelstrup, Søren; Knudsen, Birgitta R.

    2015-01-01

    In the field of malaria diagnosis much effort is put into the development of faster and easier alternatives to the gold standard, blood smear microscopy. Nucleic acid amplification based techniques pose some of the most promising upcoming diagnostic tools due to their potential for high sensitivi......, robustness and user-friendliness. In the current review, we will discuss some of the different DNA-based sensor systems under development for the diagnosis of malaria....

  4. Radioimmunoassays for tumor diagnosis

    International Nuclear Information System (INIS)

    Dressler, J.

    1983-01-01

    Aside from imaging techniques several (radio-)immunological analyses are used for tumor diagnosis. Oncofetal antigens, for instance the carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), have become the most important substances for many malignancies. However, nearly all of the so-called tumor markers are not suitable for early diagnosis or screening either because of low sensitivity or low tumor specifity. On the other hand follow-up measurements give a very sensitive index of the success of treatment and may indicate tumor progression when other signs are still not present. In some carcinomas and under some clinical circumstances tumorspecific markers are available and mandatory for detection and/or staging: AFP in hepatoma, acid phosphatase in metastasizing carcinoma of the prostate and serum thyreoglobulin in differentiated thyroid cancer. (orig.) [de

  5. Necrotizing fasciitis: strategies for diagnosis and management.

    Science.gov (United States)

    Taviloglu, Korhan; Yanar, Hakan

    2007-08-07

    Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  6. Necrotizing fasciitis: strategies for diagnosis and management

    Directory of Open Access Journals (Sweden)

    Yanar Hakan

    2007-08-01

    Full Text Available Abstract Necrotizing fasciitis (NF is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  7. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment

    Science.gov (United States)

    Torres, Patrick A.; Helmstetter, John A.; Kaye, Adam M.; Kaye, Alan David

    2015-01-01

    Background Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. Methods This review focuses on the epidemiology, pathophysiology, causes, presentation, diagnosis, complications, management, and anesthetic considerations related to rhabdomyolysis. Results Any form of muscle damage––and by extension any entity that causes muscle damage––can initiate rhabdomyolysis. One of the most important treatment goals when rhabdomyolysis is suspected is avoiding acute kidney injury. Conclusion All clinicians should be aware of common causes, diagnosis, and treatment options. PMID:25829882

  8. A novel method for the purification of DNA by capturing nucleic acid and magnesium complexes on non-woven fabric filters under alkaline conditions for the gene diagnosis of tuberculosis by loop-mediated isothermal amplification (LAMP).

    Science.gov (United States)

    Fukasawa, Tadashi; Oda, Naozumi; Wada, Yasunao; Tamaru, Aki; Fukushima, Yukari; Nakajima, Chie; Suzuki, Yasuhiko

    2010-07-01

    A novel method for purifying DNA from clinical samples based on the complex formation of DNA and magnesium ion (Mg(2+)) was developed for the detection of Mycobacterium tuberculosis. The formation of a DNA-Mg(2+) complex under alkaline conditions was observed by analyzing electrophoretic mobility reduction of DNA on agarose gel. The DNA-Mg(2+) complex increases the efficacy of DNA recovery from the sample solution on polyethylene terephthalate non-woven fabric (PNWF) filters. Among the various divalent metal cations, only Mg(2+) was associated with this effect. The applicability of DNA recovered on the PNWF filter was examined for the gene amplification method; loop-mediated isothermal amplification (LAMP). DNA on the PNWF filter could be used for the amplification of specific DNA fragments without elution from the filter. Using this method, DNA was directly purified from M. tuberculosis spiked sputum and examined by LAMP assay, showing a high sensitivity in comparison to the commercially available DNA extraction kit. These results indicated that the method developed in this study is useful for rapid gene diagnosis of tuberculosis.

  9. Experiencia metacompleja para la construcción de un modelo de diagnóstico médico por estudiantes Metacomplex experience for the construction of a model of medical diagnosis by students

    Directory of Open Access Journals (Sweden)

    Juan M. Muñoz-Cano

    2012-06-01

    Full Text Available Introducción. Se desarrolló este trabajo en base a proyectos para elaborar una estrategia de diagnóstico, con eje en 'diarrea', causa importante de morbilidad y mortalidad en México, pues la educación médica orientada a las asignaturas desde el paradigma de la 'transmisión' no forma la competencia. Sujetos y métodos. Se trabajó con 16 estudiantes de medicina de una universidad del sureste de México y se estructuró en base al modelo de experiencia metacompleja 'El diálogo nos hace escribir nueva teoría'. El producto fue la elaboración de un proceso diagnóstico para identificar el mecanismo del síntoma y las causas de mayor probabilidad. Los avances se retroalimentaron de acuerdo con una matriz de evaluación y la acreditación se obtuvo al cumplir el 80% de los criterios de la matriz. Resultados. La mitad de los estudiantes terminaron la experiencia. Aprendieron a identificar patrones de conducta sin utilidad para el diagnóstico y a evaluar la relevancia de los contenidos de los textos escolares y la necesidad de buscar información en bibliotecas virtuales. Tras construir sus conceptos, que se evidenciaron mediante diagramas de flujo y cuadros comparativos, pudieron manejar guías clínicas y revisiones sistemáticas, así como las normas oficiales mexicanas. Conclusión. Mediante el proceso de la construcción del cuerpo metacomplejo, los estudiantes ponderaron de manera positiva su papel activo y pudieron desarrollar un pensamiento crítico.Introduction. The aim of this study based on projects was develop a strategy for diagnosis. Axis was 'diarrhea', a major cause of morbidity and mortality in Mexico, because medical education from 'transmission' paradigm can't construct the competence. Subjects and methods. We worked with 16 medicine students at a university in southern Mexico and development was based on the model of metacomplex experience 'Dialogue makes us write new theory'. The obtained product was a diagnostic process

  10. Order of the 29. of January 2010 approving the decision n. 2009-DC-0146 made on the 16. of July 2010 by the Nuclear Safety Authority (ASN), modified by the decision n. 2009-DC-0162 of the 20. of October 2009, defining the list electric equipment generating X rays which are hold or used for purposes of biomedical research or medical, dental, forensics or veterinary diagnosis and submitted to a declaration regime on the account of the first paragraph of the article R. 1333-19 of the Public Health code and abrogating the 23 April 1969 order related to equipment and installations using ionizing radiations on medical purposes

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    This legal document indicates the list of equipment which must now be declared to the ASN (the French Nuclear Safety Authority), specifies that any use of these equipment in conditions other than normal requires an authorization on the account of an article of the Public Health Code. A list of equipment is given which are used in medical and forensics radio-diagnosis, in biomedical research, in dental and veterinary radio-diagnosis

  11. Technologies for Medical Sciences

    CERN Document Server

    Tavares, João; Barbosa, Marcos; Slade, AP

    2012-01-01

    This book presents novel and advanced technologies for medical sciences in order to solidify knowledge in the related fields and define their key stakeholders.   The fifteen papers included in this book were written by invited experts of international stature and address important technologies for medical sciences, including: computational modeling and simulation, image processing and analysis, medical imaging, human motion and posture, tissue engineering, design and development medical devices, and mechanic biology. Different applications are treated in such diverse fields as biomechanical studies, prosthesis and orthosis, medical diagnosis, sport, and virtual reality.   This book is of interest to researchers, students and manufacturers from  a wide range of disciplines related to bioengineering, biomechanics, computational mechanics, computational vision, human motion, mathematics, medical devices, medical image, medicine and physics.

  12. Neutron spectrum measurement in a medical Cyclotron

    International Nuclear Information System (INIS)

    Sathian, V.; Phadnis, U.V.; Sharma, D.N.; Deepa, S.; Soni, P.S.

    2008-01-01

    Radio nuclides are being used in diagnostic purpose as well as therapeutic purpose under medical category for early detection of malignancies. The diagnosis using radio nuclides are playing very important role. PET scan is a miles stone in medical history. These scan is done using a positron emitter 18 F. This radio nuclide is produced by the reaction 18 O(p, n) 18 F in Medical cyclotron of Radiation Medicine center (RMC), India. The neutron production is an unwanted by product. These neutrons will make lot of radiation protection problem as neutron itself and also these neutrons will produce induced activity in the different elements of cyclotron shielding material as well as the wall materials in long run. So the accurate neutron dose measurement is very important and this depends on the accurate neutron spectrum. The unfolding of neutron spectrum and measurement of neutron dose in cyclotron of RMC using activation foil technique is presented in this paper. (author)

  13. Ileocecal endometriosis: diagnosis and management.

    Science.gov (United States)

    López Carrasco, Ana; Hernández Gutiérrez, Alicia; Hidalgo Gutiérrez, Paula A; Rodríguez González, Roberto; Marijuán Martín, José L; Zapardiel, Ignacio; de Santiago García, Javier

    2017-04-01

    Ileocecal endometriosis is rare. Symptoms range from no symptoms, cramps, vomiting, to acute intestinal obstruction. Our objective was to review our cases, clarify, and resume its most appropriate management focusing on the factors to determine diagnosis. This is a retrospective study by revision of medical charts of all ileal endometriosis cases of our unit from 2006 to 2014. Seven cases were found; three (43%) had previous endometriosis laparoscopic diagnosis, four (57%) had partial bowel obstruction episodes, three (43%) had chronic pelvic pain, and one developed acute intestinal obstruction in postoperative ileostomy closure. In three (43%), the diagnosis was made with magnetic resonance imaging (MRI) and double contrast barium enema, in one (14%) only with MRI, and the other three (43%) during surgery. All patients underwent resection of the ileum and evolved favorably. Variability in symptoms hinders diagnosis. The gold standard for diagnosis is MRI, but clinical suspicion optimizes imaging test diagnosis. Segmental resection should be indicated in the majority of the cases. Copyright © 2017. Published by Elsevier B.V.

  14. Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration.

    Science.gov (United States)

    Liddle, Jennifer; Roddy, Edward; Mallen, Christian D; Hider, Samantha L; Prinjha, Suman; Ziebland, Sue; Richardson, Jane C

    2015-09-14

    To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Tuberculosis diagnosis support analysis for precarious health information systems.

    Science.gov (United States)

    Orjuela-Cañón, Alvaro David; Camargo Mendoza, Jorge Eliécer; Awad García, Carlos Enrique; Vergara Vela, Erika Paola

    2018-04-01

    Pulmonary tuberculosis is a world emergency for the World Health Organization. Techniques and new diagnosis tools are important to battle this bacterial infection. There have been many advances in all those fields, but in developing countries such as Colombia, where the resources and infrastructure are limited, new fast and less expensive strategies are increasingly needed. Artificial neural networks are computational intelligence techniques that can be used in this kind of problems and offer additional support in the tuberculosis diagnosis process, providing a tool to medical staff to make decisions about management of subjects under suspicious of tuberculosis. A database extracted from 105 subjects with precarious information of people under suspect of pulmonary tuberculosis was used in this study. Data extracted from sex, age, diabetes, homeless, AIDS status and a variable with clinical knowledge from the medical personnel were used. Models based on artificial neural networks were used, exploring supervised learning to detect the disease. Unsupervised learning was used to create three risk groups based on available information. Obtained results are comparable with traditional techniques for detection of tuberculosis, showing advantages such as fast and low implementation costs. Sensitivity of 97% and specificity of 71% where achieved. Used techniques allowed to obtain valuable information that can be useful for physicians who treat the disease in decision making processes, especially under limited infrastructure and data. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. MRI diagnosis for prostate cancer

    International Nuclear Information System (INIS)

    Tamada, Tsutomu; Nagai, Kiyohisa; Imai, Shigeki; Kajihara, Yasumasa; Jo, Yoshimasa; Tanaka, Hiroyoshi; Fukunaga, Masao; Matsuki, Takakazu

    1998-01-01

    Recently, in Japan, both the Westernization of life styles and the advent of an aged-society have led to an increase in the incidence of prostate cancer. In making a localizing diagnosis of prostate cancer, magnetic resonance imaging (MRI), which has excellent contrast resolution, and transrectal ultrasonography, are used clinically, and their usefulness is being established. MRI is employed in the diagnosis of prostate cancer to detect tumors, and to determine the stage of such tumors. For the visualization of prostate cancer by MRI, T2-weighted axial images are used exclusively. After becoming familiar with normal prostate images, it is important to evaluate the localization of a tumor, and the invasion of the capsule and seminal vesicles. Future applications of new techniques for MRI will undoubtedly be found. In this paper, the present state of MRI diagnosis of prostate cancer at Kawasaki Medical School Hospital will be reviewed. (author)

  17. Vaginitis: Diagnosis and Treatment.

    Science.gov (United States)

    Paladine, Heather L; Desai, Urmi A

    2018-03-01

    Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. Treatment of noninfectious vaginitis should be directed at the underlying cause. Atrophic vaginitis is treated with hormonal and nonhormonal therapies. Inflammatory vaginitis may improve with

  18. Delay in an Eating Disorder Diagnosis: The Reason Was a "Shox".

    Science.gov (United States)

    Reed, Sara; Curran, Kelly A; Middleman, Amy B

    2018-04-01

    Patients' underlying medical conditions might affect the presentation and progression of an eating disorder. We describe a patient with an undiagnosed, rare, genetic skeletal dysplasia with effects