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Biomedical subjects

E Kessler

Publications and source records attributed to E Kessler.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Quality assurance in anatomic pathology: automated SNOMED coding.

This case study details the set-up and implementation of the PathNet autocoder (Cerner Corporation) in a busy anatomic pathology laboratory. After initial start-up, procedures were developed to improve the system's performance. Four classes of software coding errors were identified, and an index was developed to measure the number of cases between errors (CBE). Through modifications in the program, the CBE increased sharply by the end of the six-month study period. During the last three months of the study, the efficiency of case retrieval was tested by comparing manual and electronic methods on the same reference cases. This demonstrated significant time saving and removed the variability of manual coding. The technique employed in this study may assist other institutions seeking to implement such a coding system within their respective environments.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Michaelis-Gutmann bodies in a healing brain infarct.

A case of Michaelis-Gutmann bodies in a healing brain infarct is described. Morphologically this was consistent with cerebral malacoplakia. There are only 6 previously reported cases of cerebral malacoplakia, and only 1 of them was a consequence of postpartum stroke. The histologic and ultrastructural features of the malacoplakia lesion are reported and compared with the previously reported cases.

Aged↗
PubMedDate not supplied

Optimal interval for triple-lumen catheter changes: a decision analysis.

A survey of 53 university and community hospitals revealed that 73% of the institutions had no standard policy for the replacement of triple-lumen catheters (TLCs). Since the maintenance of a TLC in place for a prolonged period may lead to infectious complications, it appeared warranted that standards of management be developed. A decision-tree model was constructed for evaluating the optimal time for changing a TLC that would minimize infection. Cost estimates and health effects at three-, five-, and ten-day change intervals were considered for catheter insertion and complications resulting from such insertion. The results suggested that prophylactic catheter changes should occur no later than every five days, provided that there are no signs of infection. However, sensitivity analysis of several variables suggested that individual institutions should establish policy timing changes based upon careful interpretation of their own data. A model was developed to assist in determining the optimal time to change a TLC based upon such data.

Catheterization, Central Venous↗
PubMedDate not supplied

Sequential test selection in the analysis of abdominal pain.

Numerous decision-making tools exist to assist physicians in diagnosis management. However, the accuracy of available clinical information is often ambiguous or unknown and current analytical models do not explicitly incorporate judgementally defined information. A model encompassing both physician judgment and probability analysis was developed to accommodate such data. A problem requiring sequential diagnostic testing was structured utilizing the analytic hierarchy process (AHP). The case presented involved a patient complaining of upper abdominal pain who, after initial evaluation, did not need immediate surgery. Physicians were faced with identifying the optimal sequence of diagnostic testing. The criteria used for test selection included minimizing risk, patient discomfort, and cost of testing and maximizing diagnostic capability. Although at the onset the "best" test choice was unknown, the clinical picture indicated four test alternatives: upper gastrointestinal series (GI), abdominal ultrasonography (US), abdominal computed tomography (CT), and upper gastrointestinal endoscopy (END). Based upon the relative preferences of the criteria utilized, the AHP analysis indicated that upper GI series was the optimal first test. Given a negative test, posterior probabilities were calculated using Bayes' theorem, resulting in a new estimate of diagnostic capability. The AHP analysis was reiterated, identifying abdominal ultrasonography as the optimal second test. This analysis may be repeated as many times as necessary. Sensitivity analysis demonstrated that changing criteria preferences may alter the choice of tests and/or their sequence.

Abdominal Pain↗
PubMedDate not supplied

Treatment of early-stage breast cancer in the elderly: a health-outcome-based approach.

PURPOSE: To evaluate the post-lumpectomy treatment of a nonpalpable, stage I, T1b tumor, mammographically detected, in a 74-year-old woman without comorbidities. METHODS: A Markov process, through 120 monthly cycles, was used to model patient progression through a treatment program, employing literature data and a health-outcome utility. Treatments considered were: observation; radiation totaling 5,000 cGy over six weeks; tamoxifen, 20 mg/day, for five years; simple mastectomy; and radiation therapy plus tamoxifen. Health states included absence of disease (NED), loco-regional recurrence, distant metastasis, age-sex-race (ASR)-adjusted death, cancer mortality, treatment complications, and post-mastectomy death. Transition probabilities were established from the literature. Health-state utilities were determined from the responses of health care professionals to a basic reference gamble. RESULTS: Quality-adjusted life years (QALYs) were determined to be 8.19 for radiation plus tamoxifen, decreasing to 8.04 for mastectomy, a difference of only a 0.15 years (1.8 months). Sensitivity analysis, however, showed relative stability in the ranking among treatment options. CONCLUSION: Although the model showed little difference between QALYs with the treatments, the combination of radiation and tamoxifen provides the optimal therapy for this case.

Aged↗
PubMedDate not supplied

Analysis of three decision-making methods: a breast cancer patient as a model.

PURPOSE: To compare three decision making techniques using a common clinical problem. METHODS: Two recently developed methods, the analytic hierarchy process (AHP) and the analytic network process (ANP), were compared with a Markov process in the evaluation of the optimal post-lumpectomy treatment strategy for an elderly woman with a mammographically detected, nonpalpable early-stage breast cancer. The following treatment alternatives were considered: observation, radiation, tamoxifen, combination radiation and tamoxifen, and simple mastectomy. All three decision methods incorporated patient preferences. RESULTS: The models agreed on the ranking of the preferred treatment, radiation and tamoxifen, but there were variations in the rankings of the other treatment choices. Individual differences between the three models were uncovered. The Markov process provided estimates of quality-adjusted life expectancy and distribution of health events. Both AHP and ANP required less development time than the Markov process. CONCLUSION: All three methods may be useful tools to the clinician in analyzing complex medical problems. The Markov is the most labor-intensive method but provides detailed results, whereas the AHP and the ANP give only rank orders of the alternatives. The most important considerations in choosing between these methods are time to project completion and the detail of information sought.

Antineoplastic Agents↗
PubMedDate not supplied

The potential value of the demonstration of thyroglobulin by immunoperoxidase techniques in fine needle aspiration cytology.

The peroxidase-antiperoxidase method for the demonstration of thyroglobulin was performed on 30 fine needle aspiration smears. All of the benign thyroid lesions plus the papillary and follicular carcinomas of the thyroid were positive for thyroglobulin. Two cases of metastatic thyroid carcinoma in lymph nodes were also positive. Medullary carcinoma of the thyroid and ten control smears from various other tissues were negative. This proves the sensitivity and the specificity of the method, which may be used in routine cytology and may add to the accuracy of diagnosing metastatic tumors suspected of being of thyroid origin. The intranuclear cytoplasmic vacuoles in papillary carcinoma of the thyroid were negative for thyroglobulin. This unexpected finding is demonstrated, and a possible explanation is offered.

Adenocarcinoma↗
PubMedDate not supplied

Salivary duct carcinoma of the parotid gland. Cytologic and histopathologic study.

Ductal carcinoma is an uncommon tumor of the salivary glands. Histopathologically, it is characterized by the presence of intraductal and infiltrative neoplastic components, morphologically resembling mammary carcinoma. A case of ductal carcinoma of the parotid gland, in which preoperative fine needle aspiration biopsy was performed, is presented. Cytologic examination of the aspirate revealed naked nuclei featuring anisokaryosis, chromatin clumps and clear vacuolar zones.

Biopsy, Needle↗
PubMedDate not supplied

Cytodiagnosis of a spindle-cell tumor of the breast using antisera to epithelial membrane antigen.

A case of an unusual breast tumor is described in which the smear from a fine needle aspiration (FNA) biopsy caused difficulty in differentiating between a spindle-cell carcinoma and a sarcoma. The problem was resolved by the immunoperoxidase demonstration of epithelial membrane antigen (EMA) in the cells, thus enabling a definitive diagnosis of spindle-cell carcinoma to be made. This case further demonstrates the utility of demonstrating EMA in FNA specimens to distinguish between epithelial and nonepithelial neoplasms.

Aged↗