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At least 577 records · Page 32Linked to original sources
PubMed1998

Day case hematuria diagnostic service: use of ultrasonography and flexible cystoscopy.

OBJECTIVES: To assess the efficacy of a day case diagnostic service employing ultrasonography and flexible cystoscopy in the evaluation of patients presenting with painless gross hematuria. METHODS: From July 1994 to June 1997 a prospective study was conducted for 312 consecutive patients presenting with painless gross hematuria. They were evaluated in a day case diagnostic service setting, where ultrasonography and flexible cystoscopy were performed together with other laboratory investigations. Intravenous urography was subsequently performed for possible additional diagnostic information. RESULTS: Eighty-one urinary malignancies were detected in 78 patients; 51 were carcinoma of the bladder, and the next most common was renal cell carcinoma (n = 15). Definitive diagnoses were made in 68 patients and an abnormality was noted in 9 other patients after the day case workup. The day case diagnostic workup has led to highly selective use of computed tomography scans with high diagnostic yield; intravenous urography only added important diagnostic information, not available from the earlier workup, in 9 patients. CONCLUSIONS: Day case diagnostic service is a feasible arrangement. By combining ultrasonography and flexible cystoscopy, most carcinomas were diagnosed and abnormalities detected. Such a service enhances rapid completion of diagnostic workup, and operations for surgical conditions can be scheduled more promptly.

Adolescent↗
PubMed2004

An illustration of how a self-report diagnostic screening scale could improve the internal validity of antidepressant efficacy trials.

BACKGROUND: During the past 20 years semi-structured diagnostic interviews have been the standard for diagnostic evaluations in research relying on reliable and valid psychiatric assessment and diagnosis; however, only a minority of antidepressant efficacy trials (AETs) employ these interviews. This might be important insofar as several studies have found that clinicians conducting unstructured clinical interviews underrecognize diagnostic comorbidity. Because of the financial incentives to recruit patients into AETs quickly, there is little incentive to vigorously determine the presence of comorbid conditions that should result in exclusion from the trial. In the present report we demonstrate how a self-report diagnostic screening scale could be used to identify systematic differences in diagnostic practice across settings, and how such a scale could be used to compare samples of patients who pass screening evaluations and are accepted into an AET. METHODS: Depressed patients completed the Psychiatric Diagnostic Screening Questionnaire (PDSQ), and were evaluated with either an unstructured clinical interview or with the Structured Clinical Interview for DSM-IV (SCID). RESULTS: The two samples were clinically comparable based on their scores on the self-administered PDSQ. Consistent with the greater thoroughness of the SCID, compared to unstructured diagnostic evaluations, more patients administered the SCID were diagnosed with comorbid conditions. After excluding patients with disorders that might be the basis for exclusion from an AET, the two samples then differed in their scores on the PDSQ. That is, more patients in the sample evaluated by an unstructured interview had 'occult' pathology than patients evaluated with the SCID. CONCLUSION: These findings demonstrate how systematic differences in diagnostic practice might be detected across sites when conducting AETs. LIMITATIONS: The study was conducted with patients in a single outpatient clinical practice rather than participants of a multi-site trial.

Adult↗
PubMed2000

Pediatric cardiac surgery after exclusively echocardiography-based diagnostic work-up.

This study was performed to evaluate the accuracy of exclusively non-invasive preoperative diagnostic work-up based on echocardiography and to assess the safety of cardiac surgery using this diagnostic approach in children with heart disease. During a 3. 5-year period, accuracy of preoperative (invasive and non-invasive) diagnostic work-up was prospectively tested by comparison with the intraoperative findings obtained by surgical inspection and transoesophageal echocardiography. Included were all consecutive 358 children undergoing cardiac surgery (except pulmonary artery bandings and ductus ligations) during the study period at our institution. Of the patients, 44% were operated on in infancy, 84% of procedures were on cardiopulmonary bypass. Echocardiography as the only preoperative imaging modality was used in 231 patients (65%), in the other children, a diagnostic catheter was done. Diagnostic errors occurred in 3.9% (n=5) of patients after diagnostic catheter and in 6.9% (n=16) of patients with echocardiography only. Major diagnostic errors (resulting in prolongation of cardiac bypass time) were observed at equal frequency in both groups (1.7% or four children in the echo-only group and 1.6% or two patients in the catheter group). In no case was the outcome affected by the previously unrecognized findings. It was shown that diagnostic cardiac catheterization could be avoided in a majority of pediatric patients prior to surgical palliation or correction of cardiac defects, without increasing the risk of complications or the overall outcome.

Adolescent↗
PubMed1993

Nonoperative management of blunt abdominal trauma: the role of sequential diagnostic peritoneal lavage, computed tomography, and angiography.

STUDY OBJECTIVE: To determine the usefulness of sequential nonoperative diagnostic studies in the evaluation and treatment of stable patients after blunt abdominal trauma. DESIGN AND SETTING: Retrospective review of a prospective treatment plan in a large urban Level I trauma center. PARTICIPANTS: Fifty-two patients deemed stable after initial evaluation following blunt abdominal trauma. INTERVENTIONS: Patients with a positive diagnostic peritoneal lavage for red blood cells underwent abdominal computed tomography (CT) scanning. If CT demonstrated a visceral injury, it was followed by diagnostic angiography. Attempts were made to treat on-going bleeding by transcatheter embolization. RESULTS: Fifteen patients had negative CT scans and were successfully observed. In the other 37 patients, CT identified 17 liver, 16 splenic, and eight kidney injuries; eight extra-peritoneal bleeds; and one mesenteric hematoma. Six of these patients were observed. Thirty underwent diagnostic angiograms. Twelve had no active bleeding, and all were observed successfully. Seventeen underwent successful embolization of the bleeding site(s). One had injuries not controllable by embolization and required exploration. Six patients required laparotomy later in their course, but none had intra-abdominal bleeding or a missed intestinal injury. Despite being performed after diagnostic peritoneal lavage, CT missed only two injuries. There was one main complication, delayed recognition of a diaphragmatic injury. Three patients died, two from multiple organ failure and one from a pulmonary embolus; none was believed to be related to this technique. With our algorithm, 45 patients (86%) were spared laparotomy. CONCLUSION: Diagnostic peritoneal lavage and CT are complementary when evaluating blunt abdominal trauma. Diagnostic peritoneal lavage is an effective screening tool. CT may be reserved for stable patients with a positive diagnostic peritoneal lavage to specify the organs injured. Bleeding often may be treated by embolization, limiting the rate of surgery.

Abdominal Injuries↗
PubMed1984

Basic points in and practical aspects of the application of diagnostic morphometry.

The number of applications of diagnostic morphometry is rapidly increasing. We have routinely used this technique for more than four years in our laboratory. Essential points in the application are: the type of lesions to which it is applied, multivariate analysis instead of single variate analysis and selection by a skilled pathologist of the relevant microscopical features. Such selective morphometry is useful in up to four percent of the total material entering an average pathology laboratory; in teaching laboratories the percentage may be considerably higher (e.g. 10-12%). Most of the applications are found in tumourpathology, but applications in non-tumor pathology are also promising. It is expected that diagnostic morphometry will become widely available and accepted in the next three to five years. Special symposia, diagnostic courses and organization of interested pathologists within the framework of the diagnostic morphometry workgroup of the European Society of Pathology is expected to be of help in this direction. Highly automatic, yet interactive, methods will become available within the next five to ten years. Further acceptance of these methods in most laboratories by 1990 is likely. A modular setup of quantitative microscopy equipment therefore is advisable. Turn-key, dedicated instruments for well-defined diagnostic problems are another (future) possibility. The diagnostic morphometry process as a product requires support and quality control. The pathologist is responsible for this and diagnostic morphometry should be seen as an integrated part of the diagnostic process.

Diagnosis↗
PubMed2002

Diagnostic accuracy of dermoscopy.

The accuracy of the dinical diagnosis of cutaneous melanoma with the unaided eye is only about 60%. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Our objectives were to review previous publications, to compare the accuracy of melanoma diagnosis with and without dermoscopy, and to assess the influence of study characteristics on the diagnostic accuracy. We searched for publications between 1987 and 2000 and identified 27 studies eligible for meta-analysis. The diagnostic accuracy for melanoma was significantly higher with dermoscopy than without this technique (log odds ratio 4.0 [95% CI 3.0 to 5.1] versus 2.7 [1.9 to 3.4]; an improvement of 49%, p = 0.001). The diagnostic accuracy of dermoscopy significantly depended on the degree of experience of the examiners. Dermoscopy by untrained or less experienced examiners was no better than clinical inspection without dermoscopy. The diagnostic performance of dermoscopy improved when the diagnosis was made by a group of examiners in consensus and diminished as the prevalence of melanoma increased. A comparison of various diagnostic algorithms for dermoscopy showed no significant differences in their diagnostic performance. A thorough appraisal of the study characteristics showed that most of the studies were potentially influenced by verification bias. In conclusion, dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners.

Dermatology↗
PubMed1989

Diagnostic grammar and assessment: translating criteria into questions.

There has been concern about whether standardized psychiatric interviews make valid diagnoses. Agreements between the Diagnostic Interview Schedule (DIS), as an example of a standardized interview, with independent assessments by a clinician are reasonably high in most studies, but the clinical assessment is itself of uncertain validity. Using predictive ability is an alternative way of judging validity. Data are presented to show that the DIS is almost as good at prediction as a clinician's assessment, but here too there are problems. Because prediction is probabilistic (i.e. the same disorder can have multiple outcomes, and different disorders can share outcomes), it is not possible to say how good prediction has to be to demonstrate perfect validity. Across varied methods of validity assessment, some disorders are regularly found more validly diagnosed than others, suggesting that part of the source of invalidity lies in the diagnostic grammar of the systems whose criteria standardized interviews evaluate. Sources of invalidity inherent in the content and structure of a variety of diagnoses in DSM-III and its heir, DSM-III-R, are reviewed and illustrated, in part with results from the Epidemiological Catchment Area study. The relationship between diagnostic criteria and standardized interviews is symbiotic. While attempts to adhere closely to existing diagnostic criteria contribute to the diagnostic accuracy of standardized interviews, the exercise of translating official diagnostic criteria into standardized questions highlights problems in the system's diagnostic grammar, enabling standardized interviews to contribute to improvements in diagnostic nosology.

Humans↗
PubMed2003

Reflux symptoms in general practice: diagnostic evaluation of the Carlsson-Dent gastro-oesophageal reflux disease questionnaire.

BACKGROUND: Amongst primary care patients with dyspeptic symptoms, those with reflux-like symptoms or gastro-oesophageal reflux disease are expected to benefit most from empirical proton pump inhibitor therapy. Recognition of this patient group, however, is difficult. The Carlsson-Dent gastro-oesophageal reflux disease questionnaire was developed to justify the selection of primary care patients for empirical proton pump inhibitor treatment. AIM: To evaluate the diagnostic test characteristics of the Carlsson-Dent questionnaire in a primary care population. METHODS: A prospective, open-label, multi-centre diagnostic prevalence study was conducted amongst primary care adults with reflux symptoms. All patients completed the questionnaire and underwent gastroscopy. If no abnormalities were found, the patients were prescribed 2 weeks of treatment with omeprazole (20 mg daily). Receiver operating characteristic curve analysis was used to determine the overall discriminative value of the questionnaire. Diagnostic test characteristics of both the cut-off score (total diagnostic score) in the questionnaire and the physician's provisional classification were measured using oesophagitis and omeprazole treatment success as the reference tests. RESULTS: Of the 536 patients included, 515 underwent endoscopy. No abnormalities were found in 286 (55%). Omeprazole treatment success occurred more frequently in patients with a total diagnostic score of > 7 and oesophagitis II-IV in patients with a total diagnostic score of > 9. The diagnostic test characteristics of the questionnaire were comparable with those of the physician's provisional classification. The area under the receiver operating characteristic curve did not exceed 0.65. Kappa values for observer agreement with the gold standard were far below 0.4. CONCLUSION: The diagnostic performance of this version of the Carlsson-Dent questionnaire was poor. It equalled the physician's clinical judgement and therefore its value for clinical use is limited.

Adolescent↗
PubMed2002

Critical care cardiovascular nurse expert and novice diagnostic cue utilization.

AIM: Critical care cardiovascular (CCCV) nursing diagnostic expertise was the focus of this research. The purpose of the study was to compare diagnostic cue utilization between expert and novice CCCV nurses. BACKGROUND: Knowledge related to objective measures of clinical nursing diagnostic expertise would enhance effective and efficient recognition, utilization, and reward of clinical expertise. METHODS: Five CCCV written simulations served as instruments in the study. Diagnostic content areas included left ventricular dysfunction, cardiac tamponade, sepsis, right ventricular failure, and hypovolemia related to internal abdominal haemorrhage. The sample was composed of 23 expert and 23 novice nurses. After reading each simulation, subjects were asked to verbally recall the simulation, give an impression of the predominant problem or diagnosis, and give a diagnostic explanation. Verbal recalls were audio-taped for protocol analysis. Diagnostic accuracy and cue utilization were determined through comparisons of subjects' recalled diagnoses and cues with results from an expert panel review consensus. The major variable was the mean recalled proportion of highly relevant cues to total cues (HRC/TC) on accurately diagnosed simulations. Chi-square analysis revealed that diagnostic accuracy was greater with experts than with novices. Differences between and among simulations, expertise, accuracy and the mean proportion of highly relevant cues to total cues were examined with a 4 x 2 x 2 factorial analysis of variance. RESULTS: When considering all accurately diagnosed simulations, experts had a higher HRC/TC than novices. The major limitations were the use of low fidelity written simulations and virgin verbal protocol methods. CONCLUSION: The findings generally support the idea that the development of diagnostic expertise is associated with the ability to focus on highly relevant cues.

Adult↗
PubMed2003

Allele-specific primers for diagnostic PCR authentication of Dendrobium officinale.

Based on rDNA ITS sequences of D. officinale and the other 37 species of Dendrobium, a pair of allele-specific diagnostic primers, TP-JB01S and TP-JB01X, were designed to authenticate D. officinale from the other species. Before the diagnostic PCR, the primer pair, P1 and P2, for amplifying the whole ITS region was used to validate template DNA and to obtain the appropriate template DNA for the diagnostic PCR. Diagnostic PCRs were performed using the diagnostic primers with the total DNAs of the original plants as a template. When the annealing temperature was raised to 66 degrees C, only the template DNA of D. officinale could be amplified whereas the diagnostic PCRs of the other Dendrobium species were all negative. The diagnostic PCRs have been repeated many times and have played an important role in authenticating the stems of D. officinale in China. Compared with the authentication method by sequencing DNA fragments, the allele-specific diagnostic PCR is not only simpler and time-saving but also practical and effective.

Alleles↗
PubMed2000

Structured interview and uniform assessment improves diagnostic reliability.

OBJECTIVE: To compare a Childhood Uniform Assessment Package (CUAP), including a computerized structured diagnosis, with routine assessment and treatment in public mental health settings. DATA SOURCES/STUDY SETTINGS: Data was collected prospectively on 250 children and adolescents in both public mental health inpatient and outpatient settings in a large metropolitan area and a rural area. STUDY DESIGN: Subjects were randomized to either routine assessment and treatment as usual (ATU) or ATU plus an additional "gold standard" assessment battery Childhood Uniform Assessment Package (CUAP). Outcome measures were taken at admission (baseline), discharge, and again 6 months later. METHODS: The study was conducted at a State Hospital (CUAP, n = 75; ATU, n = 75) and a Community Mental Health center (CUAP, n = 50; ATU, n = 50). The "gold standard" diagnostic process was established at the Children's Medical Center-Dallas. Research focused on a comparison of the CUAP diagnostic process to the existing diagnostic process (ATU) and the service delivery system of an inpatient and outpatient public sector clinical treatment setting. PRINCIPAL FINDINGS: A bachelor's level individual can be trained to administer a highly reliable diagnostic battery to meet a "gold standard," suggesting a possible cost-effective way to assist in diagnostic evaluations. Higher reliability was found between this standardized assessment package (CUAP) and inpatient physicians than for outpatient physicians. The highest interrater reliabilities were found for attention deficit and substance abuse disorders, less so for the other behavior disorders. The use of CUAP results in more reliable diagnoses in public settings than those provided by typical clinical staff by identifying mood and anxiety disorders (disorders with the lowest reliability) with better reliability. The addition of "gold standard" diagnostic assessments (CUAP) did not appear to affect length of stay, number of medication changes, use of seclusion or restraints, and other behavioral interventions in the inpatient setting. Outpatient follow-up services did not differ for CUAP versus ATU either. CONCLUSIONS: A standard uniform assessment package that includes a structured diagnostic instrument can improve overall diagnostic reliability but may not have a significant overall impact in clinical treatment strategies or outcomes without additional intervention to assure proper use of the information. A well-trained bachelor's level assistant can administer such a battery.

Adolescent↗
PubMed1995

Diagnostic video-assisted thoracoscopic procedures.

OBJECTIVE: The authors evaluated the effectiveness and the limitations of video-assisted diagnostic thoracoscopy. SUMMARY BACKGROUND DATA: The initial successes achieved with the use of video-assisted diagnostic thoracoscopic techniques has lead to an enthusiastic propagation of its use by thoracic surgeons as well as by some pulmonologists. However, detailed analyses of the diagnostic yield and potential limitations of this technique in relation to the roentgenographic and pathologic presentations of the patients are necessary to ensure its safe and effective application. METHODS: From July 1991 to December 1993, 102 diagnostic video-assisted thoracoscopic procedures were performed. All patients received other preoperative diagnostic workups without a definitive diagnosis. The initial roentgenographic presentations of these patients included 42 pulmonary nodules, 23 interstitial processes, 11 parenchymal infiltrates, 6 pleural effusions, 10 mediastinal tumors, and 10 mediastinal lymphadenopathies. If the procedure was completed without minithoracotomy or extension of any port site, then it was defined as an exclusive thoracoscopic biopsy (ETB); if the procedure was completed with the assistance of minithoracotomy (4-6 cm), then it was defined as a supplementary thoracoscopic biopsy (STB). RESULTS: Ninety-two of the pathology reports (90.2%) were interpreted as conclusive. Of these, 35 tumors were malignant and 67 benign. Ten pathology reports were inconclusive and on initial roentgenography had presented as pulmonary infiltrates (4 cases), pulmonary nodule (2), pleural effusion (2), interstitial process (1), and mediastinal lymphadenopathy (1). Seventy-six procedures (74.5%) were completed thoracoscopically and were classified as ETB. The remaining 26 procedures (25.5%) were completed with minithoracotomy and were classified as STB. The underlying diseases in the STB group were carcinoma (8 cases), Hodgkin's lymphoma (3), sarcoidosis (3), tuberculosis (2), interstitial pneumonitis (2), organizing pneumonia (2), mesothelioma (1), and miscellaneous disease (5). The reasons given for minithoracotomy were diffuse intrapleural adhesion (10 cases), technical inexperience (8), inability to localize the lesion (5), problems with anesthesia (1), poor patient tolerance (1), and unknown (1). Four patients (3.9%) experienced complications and three (2.9%) died while in the hospital. CONCLUSIONS: Diagnostic thoracoscopy provides high diagnostic yield with very low risk. However, 25.5% of the procedures require minithoracotomy to obtain adequate tissue for definitive diagnosis. This finding supports the assertion that diagnostic thoracoscopy should be performed only by experienced thoracic surgeons who can extend the procedure when indicated.

Adolescent↗
PubMed2005

The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.

PURPOSE: To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning. METHOD: In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning. RESULTS: Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately. CONCLUSION: The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Clinical Competence↗
PubMed1996

Multiyear diagnostic information from prior hospitalization as a risk-adjuster for capitation payments.

As part of a move toward a more market-oriented health-care system, major changes have been implemented in the Dutch social health insurance system. The competing sickness funds now receive risk-adjusted capitation payments, currently based on the age-sex distribution of the insurance portfolios. These very crude health indicators do not reflect expected costs accurately. The authors examine whether the incorporation of inpatient diagnostic information over a multiyear period can increase the accuracy of the capitation model. Using a panel data set (n approximately 50,000) comprising annual costs and diagnostic information for 5 successive years, the authors compare demographic and diagnostic models in their ability to predict future health care costs. The predictive accuracy of an age-sex-based capitation formula improves substantially when diagnostic information from an individual's prior hospitalizations is used as an additional risk-adjuster. The longer the period over which diagnostic information is available, the better is the predictive accuracy. The expected loss in 1992 for insured persons with the highest costs in 1988 decreases from 88% (demographic model) to 62% (1-year diagnostic model) and to 43% (3-year diagnostic model). The use of diagnostic information from prior hospitalizations is a promising option for improving the capitation formulae. The authors' results are relevant not only for situations where competing insurers are capitated, as in the Netherlands, but also when providers (United Kingdom) or health maintenance organizations (United States) are capitated.

Adult↗
PubMed2006

The potential impact of enhanced diagnostic techniques for tuberculosis driven by HIV: a mathematical model.

OBJECTIVE: To explore the potential impact of enhanced tuberculosis (TB) diagnostic techniques as a TB control strategy in an adult population with high HIV prevalence. DESIGN: A compartmental difference-equation model of TB/HIV was developed using parameter estimates from the literature. METHODS: The impact of five TB control interventions (rapid molecular testing, mycobacterial culture, community-wide and HIV-targeted active case finding, and highly active antiretroviral therapy) on TB incidence, prevalence, and mortality was modeled in a steady-state population with an HIV prevalence of 17% and annual TB incidence of 409 per 100 000. Sensitivity analyses assessed the influence of each model parameter on the interventions' mortality impact. RESULTS: Enhanced diagnostic techniques (rapid molecular testing or culture) are each projected to reduce TB prevalence and mortality by 20% or more, an impact similar to that of active case-finding in 33% of the general community and greater than the effect achievable by case-finding or antiretroviral treatment efforts in HIV-positive patients alone. The projected impact of enhanced diagnostics on TB incidence (< 10% reduction) is smaller. The impact of TB diagnostics is sensitive to the quality of existing diagnostic standards and the level of access to diagnostic services, but is robust across a wide range of population parameters including HIV and TB incidence. CONCLUSIONS: Enhanced TB diagnostic techniques may have substantial impact on TB morbidity and mortality in HIV-endemic regions. As TB rates continue to increase in these areas, enhanced diagnostic techniques merit further consideration as TB control strategies.

AIDS-Related Opportunistic Infections↗
PubMed2004

Diagnostic methods for insect sting allergy.

PURPOSE OF REVIEW: This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity. RECENT FINDINGS: The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued. SUMMARY: This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.

Animals↗
PubMed2003

Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures.

PURPOSE: To analyze variables affecting diagnostic accuracy of computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: A retrospective analysis of factors affecting diagnostic accuracy of CT-guided percutaneous coaxial cutting needle lung biopsy was performed in 631 consecutive procedures with confirmed final diagnoses. Benign and malignant needle biopsy results were cross-examined with correct and incorrect final outcomes to determine diagnostic accuracy. Factors affecting diagnostic accuracy were determined by multivariate logistic regression analysis of variables thought to affect diagnostic accuracy. A P value less than 0.05 was interpreted as statistically significant. RESULTS: The overall diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions was 95% (95% CI: 92.7%-96.2%). Sensitivity was 93%, specificity 98%, negative predictive value 6%, positive predictive value 99%, false-positive rate 0.7%, and false-negative rate 15%. The factors affecting diagnostic accuracy were final diagnoses (benign, 86%; malignant, 99%; chi(2) test, P < 0.001) and lesion size (lesions <1.5 cm, 84%; lesions 1.5-5.0 cm, 96%; lesions >5 cm, 93%; chi(2) test, P = 0.06). CONCLUSION: Benign lung lesions, lung lesions smaller than 1.5 cm (which pose technical difficulty), and lung lesions larger than 5 cm (which are associated with a higher necrosis rate) affect diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

Biopsy, Needle↗
PubMed2004

The diagnostic value of skin prick testing in children with food allergy.

The diagnostic accuracy of the skin prick test (SPT) in food allergy is controversial. We have developed diagnostic cut-off levels for SPT in children with allergy to cow milk, egg and peanut. Based on 555 open food challenges in 467 children (median age 3.0 yr) we defined food-specific SPT weal diameters that were '100% diagnostic' for allergy to cow milk (>or=8 mm), egg (>or=7 mm) and peanut (>or=8 mm). In children < 2 yr of age, the corresponding weal diameters were >or=6 mm, >or=5 mm and >or=4 mm, respectively. These SPT cut-off levels were prospectively validated in 90 consecutive children <or=2 yr with challenge-proven food allergy. In young infants under 6 months of age who have not previously been exposed to a particular food item, the SPT were often negative or below the diagnostic cut-off but reached the diagnostic cut-off at the time of challenge in the second year of life. We assessed the diagnostic agreement between food-specific immunoglobulin E (IgE) antibody levels and SPT in a cohort of 820 infants and children under 2 yr of age (median age 13.1 months) with suspected allergy to cow milk, egg or peanut. When applying published 95%-positive predictive CAP values, the diagnostic accuracy of SPT and IgE antibody levels was similar for cow milk, but SPT was more sensitive in diagnosing allergy to egg (p < 0.0001) and peanut (p < 0.0001). Further studies are required to define age-specific diagnostic IgE antibody and SPT cut-off levels use in infants under 2 yr of age with suspected food allergies.

Age Factors↗