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At least 523 records · Page 29Linked to original sources
PubMed1984

Diagnostic peritoneal lavage in blunt trauma patients with coagulopathy.

Coagulopathies such as dilutional coagulopathy secondary to massive crystalloid and/or blood resuscitation, and disseminated intravascular coagulation secondary to head injury, complicate the care of severely traumatized patients. The accuracy of diagnostic peritoneal lavage has not been appraised in patients with coagulopathy. During a 3-year period, 847 patients underwent diagnostic peritoneal lavage using the direct visualization, open method. Exploratory laparotomy was performed on 298 patients for a positive diagnostic peritoneal lavage. All patients had coagulation studies prior to diagnostic peritoneal lavage. Twenty-eight patients (9.4%) with a mean injury severity score of 45, had coagulopathy prior to diagnostic peritoneal lavage. Only 2% (6/298) of the diagnostic peritoneal lavages were falsely positive despite the presence of pelvic fractures in 24.5% (73/298) of the patients. The incidence of falsely positive diagnostic peritoneal lavage was similar (P = .5) for patients with coagulopathy (3.6%, 1/28) as compared to patients without coagulopathy (1.8%, 5/272). Following blunt trauma, clinical indications for diagnostic peritoneal lavage do not mandate coagulation screening because diagnostic peritoneal lavage is reliable in patients with preexisting coagulopathy.

Abdominal Injuries↗
PubMed1984

Morphometry in pathology: another look at diagnostic histopathology.

Histopathology is crucial for diagnostic and therapeutic decisions in many disease states. The created classifications, however, have not always allowed explicit recognition of diagnostic categories. So, considerable intra- and interobserver variations are possible under diagnostic circumstances. Better reproducibility can be reached by applying other than traditional methods. These include morphometry as well as special stains, electron microscopy and immunohistochemistry. Morphometry is basic in that in detects structural and morphological aberrations in samples prepared by other methods and without doubt brings the element of accuracy to support the diagnostic decision. Morphometric approach includes item classification and grading, point counting and intersection counting methods, and the use of various semiautomatic or automatic instruments. In statistical morphometry morphometrical parameters are collected from several disease cases. Such data reinforced with prognostic follow-ups are the basis for disease classification. Diagnostic morphometry, on the other hand, tries to study the sample of one individual and give relevant data for diagnostic decisions. Morphometric methods allow estimation of the limits of possible performance in histopathology, estimation of human performance in the diagnostic process and estimation of the influence of interfering human factors. Diagnostic decisions as well as decisions linked with therapy are basically probabilistic. Also the data collected by diagnostic morphometry should be linked with probabilistic estimates of the prognostic relevance of the findings. Education of histopathology should be developed to meet these demands, both at elementary medical level and at postgraduate medical level. Education of morphometry can be incorporated into the medical curricula as shown by the experience at the University of Kuopio where aspects of morphometry are taught during histopathology course and special postgraduate courses have been arranged.

Diagnosis↗
PubMed2001

Diagnostics and a qualitative model.

First generation expert systems were using shallow knowledge based on heuristic information to solve a diagnostic problem. This approach has many disadvantages, which can be avoided by using deep knowledge. Diagnostic reasoning based on deep knowledge is called model-based diagnostics. Recently, the use of qualitative modeling in relation to deep knowledge in expert systems has become increasingly important. The main purpose of our contribution is to present the model-based diagnostic approach at a formal level. The originality of the presented formalization is the concept of the diagnostic space, the characterization of the minimal diagnoses, and the measurement. The formalization serves as the theoretical background to prove our view to the design of qualitative system models and to establish the diagnostic architecture called DISY. The qualitative system model in our diagnostic approach needs not to be specially adopted for use in the diagnostic domain. The only requirement is that it must simulate the system behavior expressed by normal or abnormal functioning of its components. Proposed DISY architecture is not complex and simply takes into an account the previous diagnostic result to obtain a new one from the additional observation-measurement (medical tests or examinations) of the system.

Decision Support Techniques↗
PubMed1997

A diagnostic support system in general practice: is it feasible?

A medical diagnostic decision support system (DDSS) has been developed for and tested in general practice. Two major issues have been addressed: diagnostic support and usefulness. The diagnostic support pertains to the ability of the system to generate diagnostic hypotheses from a set of patient data. The usefulness is approached by creating a computer system which can be used simultaneously with the doctor-patient consultation. The support function operates by matching symptoms from the patient data base with symptom configurations contained in the knowledge base. The support is presented as a list of diagnostic hypotheses ranked by degree of concordance. A user-friendly interface has been constructed with a comprehensive set of clinical terms within which the doctor can locate a desired symptom and store it with a single keystroke. With another keystroke the doctor can check the stored data and ask for support at any moment during the process. The overall purpose is to invite the doctor to rethink and re-examine his steps and to reconsider possible alternatives in the light of the presented diagnostic information. In our view it has to be the doctor who makes the final judgement. A test with the system in general practice revealed good performance of the system and an astonishing proficiency of the participating doctors in its use during the consultation. Twenty doctors solved five patient cases, entering 2000 clinical items within acceptable limits of consultation time. In 96% of the cases the correct diagnosis appeared in the differential diagnosis list. The doctors' diagnostic accuracy was 43%. The use of standardised terminology as an option for further development is discussed. The role of the doctor in computer-aided diagnostics remains open to debate. A computer-aided diagnostic support system in general practice appears to be feasible.

Adult↗
PubMed2001

Transvitreal fine needle aspiration biopsy: the influence of intraocular lesion size on diagnostic biopsy result.

PURPOSE: To determine the efficacy of transvitreal biopsy in the diagnosis of suspected intraocular malignancy and simulating conditions. METHODS: We performed a retrospective study of the case notes from patients who underwent pars plana transvitreal biopsy from July 1986 to October 1999. We studied the relationship between lesion thickness as measured by A-scan ocular ultrasound and the incidence of a successful diagnostic biopsy. We assessed the diagnostic accuracy by comparing the biopsy result with the histological examination of any subsequently enucleation specimens and noted the incidence and severity of complications attributable to the biopsy. RESULTS: A total of 83 biopsies were performed for choroidal masses. There was insufficient material for cytological examination in 10 cases, and sufficient material in 73 cases (an overall diagnostic report rate was 88%). There was a strong correlation (p = 0.0004, Mann-Whitney U-test) between a diagnostic biopsy result and the thickness of the lesion on A-scan ultrasound: a biopsy was diagnostic in only 40% (4 of 10) of choroidal lesions less than 1.99 mm thick, whereas biopsies taken from lesions between 2.00 and 4.00 mm thick were diagnostic in 90% of cases (27 of 30). In thicker lesions of 4 mm or more the cell aspirate was sufficient to make a diagnosis in 98% (42 of 43). Following diagnostic biopsy 27 patients had their tumours resected, and the histology results following enucleation confirmed the cytological diagnosis of malignancy in 96% of these cases (26 of 27). CONCLUSION: Transvitreal biopsy is a highly accurate diagnostic procedure with a low complication rate. It is a reliable diagnostic tool in suspicious choroidal lesions greater than 2 mm thick.

Biopsy, Needle↗
PubMed1999

Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast-enhancement in patients with localized prostate cancer: mapping studies with biopsy specimens.

BACKGROUND: New diagnostic criteria for dynamic magnetic resonance (MR) imaging in prostate cancer are presented. The diagnostic usefulness of endorectal MR imaging with dynamic contrast-enhancement in localized prostate cancer and the validity of these criteria were evaluated. METHODS: Eighteen untreated patients who were suspected of localized prostate cancer were included in the study. They received endorectal dynamic MR imaging before systematic sextant needle biopsy. First. a mapping study with the findings of MR images and histopathology of biopsy specimens was performed in eight patients out of 18 to compare the difference in T2-weighted images with the endorectal coil and the body coil in the same individuals. Second, another mapping study was performed in all 18 patients by analyzing the findings of endorectal dynamic MR images. For the diagnosis of prostate cancer in MR imaging, we offered diagnostic criteria from our experience in addition to those in plain T2-weighted images from the literature. RESULTS: The overall diagnostic rates of endorectal dynamic MR imaging were 88.9% in accuracy, 100% in sensitivity, and 81.8% in specificity. In the comparison of the endorectal and body coils in T2-weighted images in eight patients, there was no difference in the diagnostic rates except for one more histopathologic false positive portion in endorectal MR imaging. In the second mapping study in 18 patients, the diagnostic rates were 92.6% in accuracy, 88.9% in sensitivity and 93.3% in specificity. Endorectal dynamic imaging raised the diagnostic sensitivity from 77.8 to 88.9%. CONCLUSION: The data demonstrated the validity of this diagnostic criteria and the diagnostic usefulness of endorectal dynamic MR imaging in localized prostate cancer.

Aged↗
PubMed1976

Empirical validation of diagnostic similarities from a structural perspective.

In an effort to establish definitive patterns of patient variables for the diagnostic categories used by psychiatry, this study investigated the similarity between diagnostic classes as perceived by psychiatrists when evaluating patients from their own caseloads. A grid method was used to evaluate the diagnostic process. Thirteen psychiatrists rated their own patients on the constructs generated from their own personal dimensions. An overall analysis of the data demonstrated that patients within a diagnostic category were seen as more similar to one another than were patients from different diagnostic categories. Similarities between diagnostic classes showed that neurotic/situational maladjustment, personality disorder/alcoholic, and psychotic/alcoholic were the most similar pairs of unlike diagnoses. Examination of the process of diagnosis showed the functional similarity between some diagnostic classes. Specific areas of diagnostic similarity were present in a system that produced overall diagnostic clarity. Implications for the use of the grid method in psychiatric training were discussed.

Alcoholism↗
PubMed2003

Diagnostic delay and prognosis in invasive bladder cancer.

OBJECTIVES: To study diagnostic delay in invasive bladder cancer in a population-based material with long-term follow-up, and to evaluate whether delay in diagnosis affects the risk of bladder cancer death. MATERIAL AND METHODS: In a previous study, 177 patients with invasive bladder cancer (T1-T4) diagnosed in 1988 were investigated with regard to diagnostic delay. A review of all available clinical records was performed. In the present study, causes of death for these patients were registered over a 12-year follow-up period, and the impact of diagnostic delay on bladder cancer death was studied by means of survival analysis. RESULTS: The median diagnostic delay in the material was 144 days. When the patients were stratified into groups with diagnostic delays of 0-3, 3-6, 6-12 and >12 months, those with T1 tumours in the two groups with a diagnostic delay of <6 months showed a trend towards a decreased risk of bladder cancer death. In contrast, in patients with muscle-invasive disease, a significantly increased risk of bladder cancer death was noted for those with a diagnostic delay of <6 months. CONCLUSION: A trend towards better prognosis was found for patients with T1 tumours with a shorter diagnostic delay. The poor prognosis of patients with muscle-invasive disease and a short diagnostic delay suggests aggressive behaviour of the tumour and may explain the worse prognosis in these patients.

Age Distribution↗
PubMed2004

Computed-tomography-guided percutaneous core needle biopsies of suspected malignant lymphomas: impact of biopsy, lesion, and patient parameters on diagnostic yield.

PURPOSE: To investigate the diagnostic yield of core needle biopsy in patients with malignant lymphoma. MATERIAL AND METHODS: Computed-tomography-guided core needle biopsies in patients with malignant lymphoma performed in the period 1996 to 2001 were evaluated retrospectively. A biopsy was considered as "fully diagnostic" if a histological diagnosis, including the histologic subtype in the event of malignant lymphoma, was achieved and the clinical course and CT follow-up of at least 6 months confirmed the biopsy results. A biopsy was regarded as "partly diagnostic" if histological work-up defined malignant lymphoma but not the histological subtype, and if histological diagnosis bore therapeutic relevance. Diagnostic yield was correlated with features such as size of specimen, location and depth of the target lesion, and experience of the investigator. RESULTS: 45 biopsies were performed in 40 patients. With respect to definite histopathological diagnosis, 31 biopsies (68.9%) were diagnostic and 14 (31.1%) non-diagnostic. In 4 cases (8.8%), biopsies yielded partly diagnostic results, since therapy could be scheduled after biopsy without final sub-classification. Statistical analysis of biopsy parameters revealed that sample sizes were significantly larger in the diagnostic group. CONCLUSION: CT-guided biopsy can be considered as an alternative for lymphoma diagnosis and should be the first interventional procedure. The most important parameter for diagnostic success is the size of the specimen.

Biopsy, Needle↗
PubMed1998

Statewide study of diagnostic agreement in breast pathology.

BACKGROUND: This study assessed the degree of diagnostic agreement among community-based general pathologists reading slides of representative breast tissue specimens and tested whether diagnostic variability is associated with type of breast specimen (e.g., core needle or excisional biopsy) or slide quality. METHODS: Twenty-six of the 44 eligible pathologists working at community-based pathology practices in New Hampshire participated. Each pathologist evaluated slides of breast tissue obtained from 30 case subjects randomly selected from a statewide breast pathology database. The diagnostic categories used were benign, benign with atypia, noninvasive malignant, and invasive malignant. The levels of agreement (i.e., kappa coefficients) for the diagnoses were assessed. RESULTS: Agreement was high among pathologists for assignment of diagnostic category (kappa coefficient = 0.71) and was nearly perfect for their selection of benign versus malignant categories (kappa coefficient = 0.95). There was less agreement for the categories of noninvasive malignant and benign with atypia (kappa coefficients of 0.59 and 0.22, respectively). There was no apparent relationship between levels of diagnostic agreement and specimen type or perceived slide quality. CONCLUSIONS: Diagnostic agreement for breast tissue specimens is high overall among community-based pathologists, but clinically relevant disagreements may occur in the assessment of noninvasive malignant diagnoses. The establishment of reread policies for certain diagnostic categories may reduce the possibility that diagnostic misclassification will lead to overtreatment or undertreatment. The high degree of diagnostic reproducibility for invasive cancerous lesions of the breast suggests that it is unnecessary for a central review of these lesions in national cancer trials.

Adult↗
PubMed2004

Clinical implications of the differences between diagnostic 123I and post-therapy 131I scans.

BACKGROUND: 123I has been promoted for diagnostic imaging as a means of avoiding 'stunning'. It has also been suggested that the more favourable physical characteristics and consequent enhanced imaging resolution provided by 123I offers a more accurate diagnostic assessment of the extent of disease prior to therapy. This study evaluated pairs of diagnostic 123I and post-therapy 131I scans for differences in patterns of radioiodine uptake. METHODS: Thirty-eight patients (31 women and seven men) with a history of differentiated thyroid cancer underwent 41 diagnostic 123I studies. 131I therapy was administered to 29 patients as soon as possible after positive diagnostic findings were confirmed (with one patient being treated twice during the study period, making 30 treatments). Post-treatment scans were obtained an average of 5.8 days after therapy. RESULTS: Qualitative comparison of diagnostic 123I and post-therapy 131I scans revealed a decrease in the extent of post-treatment uptake in four of the 30 treatments (13%). Seven patients (23%) demonstrated increased uptake on their post-therapy 131I scan. CONCLUSIONS: Because the physical characteristics of 123I make it inconceivable that it could cause stunning, the decrease in post-treatment uptake seen in 13% of patients from this series increases the likelihood that this pattern is due to factors other than stunning, such as differential rates of radioiodine turnover. In addition, the increase in extent of post-therapy uptake seen in 23% of patients suggests that diagnostic imaging with 123I is vulnerable to the same pre-therapy staging inaccuracies as is low-dose diagnostic imaging with 131I. Further work is needed to determine whether larger diagnostic doses of 123I might mitigate this problem.

Adolescent↗
PubMed2003

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

OBJECTIVE: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. DESIGN: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. MEASUREMENTS: A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. RESULTS: Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman rho 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). CONCLUSION: The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Artificial Intelligence↗
PubMed2005

Case-control and two-gate designs in diagnostic accuracy studies.

BACKGROUND: In some diagnostic accuracy studies, the test results of a series of patients with an established diagnosis are compared with those of a control group. Such case-control designs are intuitively appealing, but they have also been criticized for leading to inflated estimates of accuracy. METHODS: We discuss similarities and differences between diagnostic and etiologic case-control studies, as well as the mechanisms that can lead to variation in estimates of diagnostic accuracy in studies with separate sampling schemes ("gates") for diseased (cases) and nondiseased individuals (controls). RESULTS: Diagnostic accuracy studies are cross-sectional and descriptive in nature. Etiologic case-control studies aim to quantify the effect of potential causal exposures on disease occurrence, which inherently involves a time window between exposure and disease occurrence. Researchers and readers should be aware of spectrum effects in diagnostic case-control studies as a result of the restricted sampling of cases and/or controls, which can lead to changes in estimates of diagnostic accuracy. These spectrum effects may be advantageous in the early investigation of a new diagnostic test, but for an overall evaluation of the clinical performance of a test, case-control studies should closely mimic cross-sectional diagnostic studies. CONCLUSIONS: As the accuracy of a test is likely to vary across subgroups of patients, researchers and clinicians might carefully consider the potential for spectrum effects in all designs and analyses, particularly in diagnostic accuracy studies with differential sampling schemes for diseased (cases) and nondiseased individuals (controls).

Case-Control Studies↗
PubMed1983

Physician attitudes toward the competence of general diagnostic radiologists: survey and implications.

Responses to a questionnaire were obtained from 1,539 physicians in 15 medical specialties to measure their attitudes toward general diagnostic radiologists in regard to their medical knowledge and professional competence as consultants. The data were evaluated in terms of the demographic profile of the respondents. Among the detailed results obtained, it was determined that only 8.1% of all physicians believe general diagnostic radiologists are poorly informed about disease processes, but 25% believe that these radiologists need more subspecialty training to be valuable as consultants to them. Physicians who do their own radiographic/sonographic examinations believe general diagnostic radiologists to be unimportant twice as often as do physicians who refer their patients to radiologists (28.2% vs. 14.5%). Most physicians (78%) believe that diagnostic radiologists perform unique functions in hospitals, while only 38% believe this to be true in the office setting. Consistent with this is that physicians practicing primarily in hospitals believe diagnostic radiologists need more training than do the primarily office-based physicians (29.6% vs. 16.8%). Of the specialists surveyed, orthopedic surgeons, neurosurgeons, cardiologists, and neurologists consistently had the lowest opinion of general diagnostic radiologists as consultants. In each of these specialties, less than 30% believed that general diagnostic radiologists are indispensable in the hospital setting. Also, younger (less than 45 years) physicians feel less dependent on general diagnostic radiologists than do older physicians. For example, twice as many younger physicians (17.3% vs. 7.9%) believe that diagnostic radiologists perform few or no unique functions which they cannot do themselves.

Ambulatory Care↗
PubMed2001

Medical audit of diagnostic mammography examinations: comparison with screening outcomes obtained concurrently.

OBJECTIVE: We performed a medical audit of our diagnostic mammography practice and compared clinical outcomes with those of screening mammography examinations performed concurrently. MATERIALS AND METHODS: We analyzed 46,857 consecutive mammography examinations (10,007 diagnostic, 36,850 screening) from 1997 to 2000, including data on demographics, image interpretation, and biopsy (including size, nodal status, and cancer stage). RESULTS: The mean age at diagnostic mammography was 55.8 years (mean age at screening mammogram, 59.1 years; p < 0.0001). Among patients who underwent diagnostic examinations, 14.7% had a strong or very strong family history of breast cancer (screening, 11.6%; p < 0.0001). Examination findings were interpreted as abnormal in 14.4% (screening, 5.2%; p < 0.0001). Biopsy was performed in 11.9% (screening, 1.4%; p < 0.0001). Forty-six percent of the biopsies were positive for malignancy (screening, 38%; p < 0.0001). The cancer detection rate was 55 per 1000 (screening, 5/1000; p < 0.0001). Of cancers found, 74.4% were stage 0 or I (screening, 89.3%; p < 0.0001), average size was 18.0 mm (screening, 12.9 mm; p < 0.0001), and axillary nodes were positive for malignancy in 19.9% of invasive cancers (screening, 6.3; p < 0.0001). Differences between diagnostic and screening outcomes were attributable predominantly to the subgroup of diagnostic examinations performed for evaluation of palpable masses. CONCLUSION: Medical auditing of diagnostic mammography examinations yields substantially different results compared with those of screening examinations, including different patient demographics; higher number of positive biopsies; higher cancer detection rates; and larger, more advanced-stage cancers. Diagnostic and screening data should be segregated during auditing, or if this is not possible, analysis of combined results should be based on known differences between diagnostic and screening outcomes.

Breast Neoplasms↗
PubMed1999

Diagnostic uncertainty expressed in prostate needle biopsies. A College of American Pathologists Q-probes Study of 15,753 prostate needle biopsies in 332 institutions.

OBJECTIVE: To determine the rate of diagnostic uncertainty in rendering diagnoses on prostate needle biopsies and to examine pathology practice variables that influence that rate. DESIGN: Anatomic pathology departments participating in the College of American Pathologists Q-Probes laboratory quality improvement program retrospectively reviewed their last 50 consecutive prostate needle biopsy diagnoses. For each diagnosis, participants provided information concerning patients' prostate-specific antigen levels; number, locations, and laterality of biopsy specimens; number of tissue levels examined; performance of high-molecular-weight cytokeratin immunoperoxidase staining; and acquisition of consultations from general pathologists or experts in prostate pathology. Characteristics of pathology practices included yearly surgical and prostate needle biopsy caseloads, number of pathologists rendering biopsy diagnoses, use of standard descriptive checklists, access to patients' prostate-specific antigen and digital rectal examination results, percentages of prostate needle biopsies routinely submitted for internal consultations, and presence of departmental experts in prostate pathology. SETTING AND PARTICIPANTS: Three hundred thirty-two public and private institutions located in the United States (n = 318), Canada (n = 6), Australia (n = 5), United Kingdom (n = 2), and Guam (n = 1). MAIN OUTCOME MEASURE: The rate of diagnostic uncertainty in prostate needle biopsy diagnoses. RESULTS: Participants submitted diagnoses on a total of 15 753 prostate needle biopsy cases, of which 33.4% were adenocarcinoma; 55.5% were benign; 3.9% were carcinoma in situ, prostatic intraepithelial neoplasia, or both; and 7.1% were diagnostically uncertain. The median rate of diagnostic uncertainty was 6%, ranging from 0 at the 10th percentile to 14% at the 90th percentile of all participating laboratories. Performing high-molecular-weight cytokeratin immunoperoxidase staining resolved diagnostic uncertainty in 68% of cases in which it was performed, and obtaining intradepartmental and extradepartmental consultations resolved diagnostic uncertainty in 70% to 87% of cases for which they were obtained. Knowledge of patients' prostate-specific antigen results and examining multiple biopsy cores had marginal effects on the rate of uncertainty. Thoroughness of prostate gland sampling and examination of multiple tissue block levels were not associated with the aggregate rate of diagnostic uncertainty. We found no particular pathology departmental practices or institutional demographic characteristics associated with institutional rates of diagnostic uncertainty. CONCLUSIONS: Use of high-molecular-weight cytokeratin immunoperoxidase staining and obtaining intradepartmental and extradepartmental consultations may be effective in reducing diagnostic uncertainty in prostate biopsies.

Adenocarcinoma↗
PubMed1999

Improving diagnostic accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein (CRP)

BACKGROUND: Sore throat or pharyngitis is an extremely prevalent condition in primary care. There is a diagnostic dilemma in differentiating bacterial and non-bacterial infections for adequate use of antibiotics. Standard diagnostic procedures take too long for an immediate decision. AIM: To evaluate, if near patient C-reactive protein measurement in the general practice surgery improves diagnostic accuracy. METHOD: One hundred and seventy-nine consecutive patients with sore throat, from 15 general practitioners (GPs) in southern Germany (phase 1) and 161 consecutive patients from 14 GPs (phase 2), were examined physically and a throat-swab was taken and white blood-cell count (WBC) and CRP-measurement were performed. In phase 1, CRP was measured centrally to assess the method's diagnostic value and the adequate threshold. In the second phase, near patient CRP was measured and CRP values were used to make a diagnosis. RESULTS: Using relative operating characteristics (ROC) analysis, the diagnostic value of CRP measurement was much better than WBC count (area under curve = 0.85 versus 0.68). All diagnostic parameters improved when using the near patient CRP measurement. Sensitivity went up from 0.61 (95% confidence interval = 0.45-0.75) to 0.78 (0.61-0.90), specificity went up from 0.73 (0.65-0.81) to 0.82 (0.73-0.88). Positive and negative predictive value improved significantly as well. Diagnostic accuracy went up from 70.1% to 81.0%. Out of 1000 theoretical patients with sore throat, 109 more will be treated correctly when using CRP measurement as a diagnostic tool. CONCLUSIONS: Use of near patient CRP measurement can improve diagnostic accuracy in the differentiation of bacterial and non-bacterial pharyngitis in primary care, and potentially results in a more adequate use of antibiotics.

Adolescent↗
PubMed1975

The use of structural diagnostics in recognition.

The suggestion of Krueger (1973) and other that wholistic processes underlie certain perceptual judgments is taken up in this paper. It is argued that properties such as bilateral symmetry can have a "diagnostic" significance for visual matching tasks. Diagnosticity means that if the property is present the appropriate response to a stimulus could theoretically be determined without any other analysis of the stimulus. Experiments 1 and 2 indicate that symmetry is exploited as a diagnostic property for the simultaneous same-different judgment. Displays that show the diagnostic form produce short reaction times. These experiments also show that the diagnosticity effect can be demonstrated independent of potentially confounding factors such as simplicity or redundancy. Experiments 3, 4, and 5 discount further confounding factors and also show that other properties, notably parallelism and colinearity of stimulus elements, can also be exploited as diagnostic in the simultaneous matching task. Diagnostics can have a structural or relational form. Diagnostic features are viewed as two-place structural predicates. Whether these diagnostics always have the same underlying form or not, the need for some representation of structure is a prerequisite for understanding even these simple recognition phenomena.

Association↗