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Results for “diagnostic model”

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At least 325 records · Page 18Linked to original sources
PubMed2000

Heart graft monitoring by the ventricular evoked response.

Monitoring of the negative slew rate of the evoked T wave has been proposed as a noninvasive diagnostic tool to follow heart transplant recipients. The clinical contribution of this measurement on telemetrically recorded, paced unipolar ventricular electrograms was evaluated in the detection of grade 3 acute allograft rejection. Thirteen patients undergoing heart transplantation received a DDD pacemaker connected to two epimyocardial leads. Electrograms were recorded and digitized after each endomyocardial biopsy (EMB). The maximum slew rate of the descending slope of the repolarization phase (RSP) was extracted and normalized. A 20% downward shift of RSP from the reference value was considered abnormal. Results of signal processing were blinded during the first 6 months. Eleven patients completed the 6 months blinded period and two patients died. A total of 101 EMB were graded according to the International Society for Heart and Lung Transplantation classification. Grade 3 was assigned to 9 EMB. A significant difference was found between RSP values measured during grade 3 rejection episodes and other RSP values (P < 0.001). A diagnostic model consisting of a single threshold test confirmed the ability of RSP to predict significant signs of rejection on EMB (P < 0.0001). The sensitivity of RSP in detecting grade 3 rejections was 100%, specificity was 81%, negative predictive value 100%, and positive predictive value 35%. The use of RSP as a noninvasive monitoring tool to pose the indication for a biopsy would avoid 73% of EMB. Monitoring of transplanted hearts based on the analysis of the ventricular evoked response is promising and may markedly reduce the number of EMB.

Biopsy↗
PubMed1989

Epidemiology of anxiety disorders in Florence.

A structured interview designed to diagnose anxiety disorders according to DSM-III (plus infrequent panic attacks and generalized anxiety disorder using DSM-III-R criteria) was given to 1110 people registered with 6 general practitioners (GPs), whether they consulted the doctor or not. As each citizen in Italy has to be registered with a GP, the sample was representative of the population. The interviews were carried out by the GPs, who were also third- or fourth-year trainees in psychiatry. The lifetime prevalence and point prevalence were: 0.36% and 0.27% for agoraphobia; 0.90% and 0.72% for agoraphobia with panic; 1.35% and 0.27% for panic disorder; 0.63% and 0.45% for simple phobia; 0.49% and 45% for social phobia, 5.41% and 2.79% for generalized anxiety disorder; and 0.72% and 0.63% for obsessive-compulsive disorder. These figures are lower than those reported in other surveys; possible explanations may be the use of a hierarchical diagnostic model and the fact that diagnosticians were psychiatrists instead of lay interviewers as in most studies in the United States. On the whole, 62% of anxiety cases consult a GP, 50% consult a psychiatrist and 7% are hospitalized.

Adjustment Disorders↗
PubMed2006

Synthetic statistical approach reveals a high degree of richness of microbial eukaryotes in an anoxic water column.

Molecular surveys suggest that communities of microbial eukaryotes are remarkably rich, because even large clone libraries seem to capture only a minority of species. This provides a qualitative picture of protistan richness but does not measure its real extent either locally or globally. Statistical analysis can estimate a community's richness, but the specific methods used to date are not always well grounded in statistical theory. Here we study a large protistan molecular survey from an anoxic water column in the Cariaco Basin (Caribbean Sea). We group individual 18S rRNA gene sequences into operational taxonomic units (OTUs) using different cutoff values for sequence similarity (99 to 50%) and systematically apply parametric models and nonparametric estimators to the OTU frequency data to estimate the total protistan diversity. The parametric models provided statistically sound estimates of protistan richness, with biologically meaningful standard errors, maximal data usage, and extensive model diagnostics and were preferable to the available nonparametric tools. Our clone library exceeded 700 clones but still covered only a minority of species and less than half of the larger protistan clades. Our estimates of total protistan richness portray the target community as very rich at all OTU levels, with hundreds of different populations apparently co-occurring in the small (3-liter) volume of our sample, as well as dozens of clades of the highest taxonomic order. These estimates are among the first for microbial eukaryotes that are obtained using state-of-the-art statistical methods and can serve as benchmark numbers for the local diversity of protists.

Anaerobiosis↗
PubMedDate not supplied

Ethics and comprehensive diagnosis.

This paper briefly reviews basic concepts of ethics, including its meanings and dimensions and its relationship to culture. It then examines the ethical bases of medicine and psychiatry. Of particular relevance here is the connection between ethics as concern for totality and the fundamentals of health and healing. Next, the ethical bases and implications of clinical diagnosis are considered. Finally, the paper outlines the features of a comprehensive diagnostic model and explicates how ethics is linked to the integrative nature of comprehensive diagnosis and its therapeutic purpose.

Ethics, Medical↗
PubMed2005

Positive health: conceptual place, dimensions and implications.

Positive health combines with pathology or illness to yield a broader concept of health, etymologically anchored on the concept of wholeness and enshrined in WHO's constitution. The most recognized aspects of positive health include functioning/resilience, resources/supports and quality of life. Systematic assessments of positive health are being incorporated into comprehensive diagnostic models that by attending to the totality of the person who consults may enhance effectiveness and ethics in diagnosis and care. Health, a precious human concern, constitutes a wide-ranging condition and experience. However, pathology, one of its important domains, has tended to monopolize attention when professionals discuss health and carry out health care. This short paper examines the concept of positive health, as opposed to ill-health, as well as some of its aspects or dimensions and its implications for comprehensive diagnosis and care.

Attitude to Health↗
PubMedDate not supplied

Use of grade-based norms versus age-based norms in psychoeducational assessment for a college population.

Considerable discussion has occurred about the most appropriate methods for diagnosing learning disabilities (LD) in postsecondary students. Two of the many areas of controversy that have emerged include the appropriate diagnostic criteria to use and the appropriate referent group. A review of previous court cases demonstrates that the issue of whether to compare an individual to the general population or to a smaller referent population has not been adequately clarified. Furthermore, few empirical studies have examined the impact of choosing different referent groups on the likelihood that one will be diagnosed with LD. Therefore, this correlational study described the levels of agreement between three diagnostic models of LD, using both age- and grade-based norms to represent two referent groups for each of the three models. The sample included 155 postsecondary students referred for testing due to academic difficulties. The findings indicated that in two of the three models tested, comparing individuals to their grade-matched peers (i.e., using grade-based norms) resulted in more LD diagnoses than comparing individuals to their age-matched peers (i.e., age-based norms).

Adolescent↗
PubMedDate not supplied

Escaping the cave to dream new dreams: a normative vision for learning disabilities.

This essay is predicated on two beliefs: (a) that special educators must critically examine the dominant view of reality undergirding the field of learning disabilities to see the false images built into it, and (b) we must seek a new, empowering vision of the purposes of education as we move into the twenty-first century. The purpose of the article is to analyze how the dominant image of reality in the field of learning disabilities is derived from the diagnostic model, and to propose an alternative, normative conception of education that emphasizes the importance of caring, social relatedness, and community participation.

Education, Special↗
PubMed2001

Postintubation phonatory insufficiency: an elusive diagnosis.

OBJECTIVE: To describe postintubation phonatory insufficiency, a routinely overlooked complication of prolonged intubation. This entity results from an erosive injury with permanent divots of the medial surfaces of the arytenoid cartilages and/or scarring of the anterior cricoarytenoid joint capsule so that during phonation there is incomplete adduction and a glottic gap remains. SETTING: Tertiary care center. STUDY DESIGN/RESULTS: We present a retrospective review of the findings of 138 patients evaluated for chronic intubation injuries in our voice laboratory using a diagnostic model composed of pertinent history, elicited vocal capabilities and limitations, and an intense fiberoptic laryngeal examination directed at revealing the suspected injuries. CONCLUSION/SIGNIFICANCE: In many patients, the diagnosis of postintubation phonatory insufficiency was made years after the intubation injury occurred and after numerous nondiagnostic examinations elsewhere. Mechanisms of intubation injury are reviewed, and prevention and treatment of the condition are discussed.

Female↗
PubMed1987

A case of mistaken identity: a fourth ventricular tumor presenting as school phobia in a 12 year old boy.

A 12 year old boy was diagnosed as having overanxious disorder of childhood and school phobia. He was later found to be suffering from the effects of a cerebral tumor. Surgical removal of the tumor led to alleviation of the anxiety. The authors utilize this case to illustrate some aspects of differential diagnosis in child psychiatry. In particular, they point out the necessity of comprehensive physical examination in child psychiatry impatient units. The danger of attributing physical symptoms to functional illness purely in the absence of positive physical findings is noted. The importance of utilizing a biopsychosocial diagnostic model in child psychiatry is stressed.

Cerebral Ventricle Neoplasms↗
PubMed1995

Interpersonal disorder in schizoid and avoidant personality disorders: an attachment perspective.

OBJECTIVE: To investigate the characteristics related to avoidant attachment of 13 schizoid/avoidant psychiatric outpatients and 20 nonschizoid/avoidant psychiatric outpatients. METHOD: Three scales ("maintains distance in relationships", "high priority on self-sufficiency" and "attachment relationship is a threat to security") differentiated schizoid and avoidant personality disordered patients from other personality disordered patients. RESULTS: The results are discussed in terms of the attachment and DSM diagnostic models of avoidant styles in relationships. CONCLUSION: The 2 groups of schizoid and avoidant personality disordered patients were not significantly different on the desire for close affectional bonds scale.

Adult↗
PubMed2025

FOSB is a key factor in the genetic link between inflammatory bowel disease and acute myocardial infarction: multiple bioinformatics analyses and validation.

BACKGROUND: Inflammatory Bowel Disease (IBD), which includes Crohn's disease and ulcerative colitis, is associated with an increased risk of Acute Myocardial Infarction (AMI). The genetic mechanisms underlying this link are not well understood. METHODS: We downloaded IBD and AMI-related microarray datasets from the NCBI Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified and analyzed using enrichment analysis and Weighted Gene Co-expression Network Analysis (WGCNA). Machine learning techniques, including LASSO, random forest, and Boruta, were employed to screen for hub genes. These genes were validated through qRT-PCR and Western blotting. Single-cell sequencing was used to confirm findings. Additionally, potential therapeutic targets were identified using the Connectivity Map (CMap) database. RESULTS: Five key hub genes-THBD, FOSB, ADGPR3, IL1R2, and PLAUR-were identified as significantly involved in both IBD and AMI pathogenesis. A diagnostic model for AMI constructed using these hub genes demonstrated high predictive accuracy. Single-cell sequencing analysis and several potential drugs targeting these hub genes were identified, offering new therapeutic avenues. CONCLUSION: This study highlights the crucial role of FOSB and other hub genes in the comorbidity of IBD and AMI. The findings provide novel insights for early diagnosis and potential therapeutic strategies, emphasizing the importance of further investigation into these genetic links.

Humans↗
PubMedDate not supplied

Nursing at a specialist diagnostic clinic for multiple sclerosis.

People with multiple sclerosis (MS) need support, information, education and guidance in order to adapt effectively to the impact of the disease (Sheridan, 1997). The care received at the time of diagnosis is central to this adaptation process as the information given and received may impact on the person with MS for the rest of his/her life. In order to achieve effective coping strategies, the person with MS needs to develop a collaborative relationship with the team of healthcare professionals. At the National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), the MS team believes that the foundations of this relationship should be cemented at the diagnostic stage. This article describes a diagnostic model that facilitates accurate timely diagnosis of MS and the role of the MS nurse in providing expert clinical assessment, guidance, support and education in order to help the patient adjust to the disease.

Humans↗
PubMed2006

Diagnosis of colorectal cancer using Raman spectroscopy of laser-trapped single living epithelial cells.

A single-cell diagnostic technique for epithelial cancers is developed by utilizing laser trapping and Raman spectroscopy to differentiate cancerous and normal epithelial cells. Single-cell suspensions were prepared from surgically removed human colorectal tissues following standard primary culture protocols and examined in a near-infrared laser-trapping Raman spectroscopy system, where living epithelial cells were investigated one by one. A diagnostic model was built on the spectral data obtained from 8 patients and validated by the data from 2 new patients. Our technique has potential applications from epithelial cancer diagnosis to the study of cell dynamics of carcinogenesis.

Adenocarcinoma↗
PubMed2002

Evaluation of models.

Evaluation of models describing computer based technology is crucial for further evolution of medical progress. In this project, the research sites of the Sonderforschungsbereich 414 "Computer and sensor aided surgery" were linked for evaluation purposes. Topics of flow, morphology, function, and robotics in the field of cardiac and oromaxillofacial surgery are addressed. Key methods are animal models, phantoms, image processing and clinical studies in the setting of exactly defined circumstances. As an example, 3D evaluation of myocardial edema is presented. Heterogeneity of 3D distribution of induced myocardial edema was validated. Temporal dynamics of edema is described as an example. Based on such models, diagnostic and operation relevant planning data are offered to cardiac surgeons.

Animals↗
PubMed2001

Anticonvulsants in the treatment of mood disorders: assessing current and future roles.

Anticonvulsants are frequently used in the treatment of affective illnesses, especially for patients refractory to or intolerant of other treatments. The differential therapeutic roles of anticonvulsants, however, remain largely undetermined. The author reviews the available efficacy data for carbamazepine, oxcarbazepine, valproate, lamotrigine, gabapentin and topiramate. Valproate is efficacious in the monotherapy of acute manic presentations but confirmatory evidence of the efficacy of valproate in long-term maintenance has been elusive. Valproate and possibly carbamazepine, may provide a therapeutic advantage over lithium in non-classic bipolar conditions such as mixed mood states and rapid cycling conditions. Lamotrigine is unique among the anticonvulsants in its monotherapy efficacy for bipolar I depression. Emerging data also suggest a role for lamotrigine in the adjunctive treatment of depressive mixed states and rapid cycling conditions in the absence of prominent manic symptoms. Controlled trials have found gabapentin ineffective for acute mania and refractory bipolar conditions. The role of gabapentin in the treatment of other aspects of affective illness remains uncertain. Definitive statements regarding the differential psychotropic use of topiramate and oxcarbazepine are not possible, though active investigation is underway to better characterise the utility of topiramate. The author suggests that current diagnostic models utilised in controlled trials may limit identification of differential therapeutic benefits. Caution is advised in generalising from the ability or inability of an agent to demonstrate antimanic activity. Future studies of newer anticonvulsants should include dimensional perspectives and soft bipolar presentations, as the greatest contribution of the newer anticonvulsants may be in treatment of mood conditions other than acute mania.

Anticonvulsants↗
PubMed2006

Psychiatric morbidity in children with medically unexplained chronic pain: diagnosis from the pediatrician's perspective.

CONTEXT: There is very little general evidence to support the clinical management, particularly diagnosis, of medically unexplained chronic pain (UCP) in children. OBJECTIVE: We sought to assess in children with UCP if clinical characteristics held important by general pediatricians help to accurately diagnose psychiatric morbidity and, alternatively, if the same can be achieved using dedicated questionnaires. METHODS: We used a cross-sectional diagnostic study in a pediatric outpatient clinic of a university hospital. Our participants were 134 patients, aged 8 to 18 years, who were referred for UCP. Performed were (1) diagnostic test reflecting the pediatricians' choice of clinical characteristics and (2) selected questionnaires. Classification was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, by a child psychiatrist using the Diagnostic Interview Schedule for Children-Parent Version IV and the Semi-structured Clinical Interview for Children and Adolescents. Results were analyzed by logistic regression. RESULTS: Psychiatric morbidity was present in 80 of the children. A minority had a medical explanation for the pain (15% definite, 17% probable). The clinical diagnostic model included age, social-problem indicators, family structure, parental somatization, and school problems. In the quintile of children in whom this model predicted the highest risk, 93% indeed had psychiatric morbidity at reference testing. In the quintile with the lowest predicted risk, indeed only 27% had psychiatric morbidity. The Dutch Personality Inventory for Youth and the Child Behavior Checklist matched the pediatricians' choice of clinical characteristics. In the quintile of children with the highest predicted risk based on these questionnaires, 89% had psychiatric morbidity. In the quintile with the lowest predicted risk, only 15% had psychiatric morbidity. CONCLUSIONS: A pediatrician-chosen set of clinical characteristics of children with UCP proves useful in diagnosing psychiatric morbidity. Using selected questionnaire screening yields similar results.

Adolescent↗
PubMed2000

[Diagnosis of cerebellum-pontine angle tumors using artificial intelligence techniques].

We are concerned in this paper with learning classification procedures from known cases. More precisely, we provide a diagnostic model that discriminate between cerebellum-pontine angle (CPA) tumors and otorhinolaryngological (ENT) disorders. Usually, in order to distinguish between CPA tumors and ENT disorders one must perform clinical-neurological examination together with expensive radiological imagery (CT and MRI). The proposed model was obtained through artificial intelligence methods and presented a good accuracy level (88.4%) when tested against new cases, considering only clinical examination without radiological imagery results.

Artificial Intelligence↗
PubMed2007

A randomized, double-blind, placebo-controlled study to determine the safety and efficacy of cultured and expanded autologous fibroblast injections for the treatment of interdental papillary insufficiency associated with the papilla priming procedure.

BACKGROUND: The aim of this study was to assess the efficacy and safety of using autologous fibroblast injections following a minimally invasive papilla priming procedure to augment open interproximal spaces. METHODS: Twenty-one patients with open interproximal spaces were enrolled in this study, with 20 patients retained to study completion. Two primary sites were selected and randomized to receive autologous fibroblast injections or placebo injections beginning 1 week following the papilla priming procedure; two additional injections were performed 7 to 14 days following the initial injections. Up to seven additional sites could be treated per patient, and the analyses were conducted for the primary and secondary sites. The primary efficacy parameter was the percentage change in papillary height of the primary treatment areas from baseline to the 4-month visit, as measured by a periodontal probe from the base of the contact area to the tip of the interproximal papilla. Digital image analysis and diagnostic models were used to confirm clinical measurements. A visual analog scale (VAS) was used by the examiner and subject to assess the defect change from baseline to 2, 3, and 4 months. Tissue texture also was assessed by the examiner. RESULTS: The primary efficacy analysis failed to show a significant treatment effect at 4 months, but the treatment areas showed a statistically significant mean percentage increase from baseline in papillary height (P = 0.0067; signed-rank test) at 2 months. The difference between test and placebo sites in papillary height at 2 months approached statistical significance (P = 0.0730), suggesting that the test treatment was superior to the placebo treatment. The examiner and subject VASs were statistically significantly different from baseline for both treatment groups, and the VAS was superior for the test sites over the placebo. Based on safety data, the test treatment was deemed safe. CONCLUSIONS: This early-phase study using cell transplantation of autologous cultured and expanded fibroblasts following a papilla priming procedure suggests that the treatment is safe and may be efficacious for treating papillary insufficiency, especially in the early phases (2 months) of healing. The analysis of the investigator and subject VAS assessments indicates that the test treatment was superior to the placebo treatment. The finite measurement required to detect a change creates a problem that needs to be addressed in future studies.

Adult↗