[Optimization of the structure of diagnostic services of multi-disciplinary clinical hospitals].
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Diagnostic Services↗
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[Contralateral stapedial reflex in children, adults and high-frequency loss hearing impaired patients (author's transl)].
Contralateral stapedius reflexes were measured in 332 patients. Results were analysed and statistically checked with regard to amplitude, slope of reflex in the recovery phase and partial and total reflex area. The results seem to indicate that none of the measure parameters have any direct diagnostic value. Optimal results measuring contralateral stapedius reflex are to be expected at 1000 Hz.
Acoustic Impedance Tests↗
The role of prostate-specific antigen in the evaluation of benign prostatic hyperplasia.
This article reviews the role of prostate-specific antigen (PSA) in the evaluation of BPH. Efficacy of the PSA test in differentiating patients with BPH from patients with early, potentially curable prostate cancer is discussed. In addition, this complete overview provides a critical analysis of various concepts (PSA density, PSA velocity, age-specific reference ranges, and free versus complexed serum PSA), that are devised to optimize the diagnostic value of the serum PSA concentration in a population in which prostate cancer and BPH are almost equally prevalent. A clinical algorithm, useful to the practicing clinician for the early detection of prostate cancer in the BPH patient, is also proposed.
Diagnosis, Differential↗
Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet.
Lactose malabsorption may induce abdominal symptoms indistinguishable from those of the irritable bowel syndrome (IBS), however the exact relationship between the two conditions and the optimal differential diagnostic workup are still to be defined. We prospectively studied the prevalence of lactose malabsorption (by means of a hydrogen breath test) and the clinical effect of a long-term lactose-free diet in 230 consecutive patients with a suggested diagnosis of irritable bowel syndrome, no organic disease of the GI tract, and no history of milk intolerance. Lactose malabsorption was diagnosed in 157 patients (68.2%). In 48 (43.6%) of the 110 patients who complied with the diet symptoms subsided, in 43 they were somewhat reduced and in 17 they remained unchanged. Symptoms never fully subsided in lactose malabsorbers non-compliant with the diet or in normal lactose absorbers who adhered to a lactose-free regimen. Partial improvement was observed in 20% of these subjects. No relation was demonstrated between pre-trial symptoms and the outcome of the diet. The occurrence of symptoms during the lactose breath test strongly suggested a favorable response to diet, but did not help in predicting whether symptoms would subside or be reduced. Conversely, their absence during the test was not associated with an acceptable negative predictive value. The high prevalence of lactose malabsorption in the patients under study suggests that in Italy IBS and lactose malabsorption are frequently associated. A test for diagnosing lactose malabsorption should always be included in the diagnostic workup for IBS and a long-term lactose-free regimen recommended if the test is positive.
Adult↗
Porcelain jacket crowns: diagnostic try-ins for optimal aesthetics.
All-ceramic restorations have gained patient acceptance and are increasingly utilized in aesthetic appearance-related restorations. This case report describes the utilization of a leucite-reinforced porcelain to fabricate all-porcelain crowns for maxillary anterior restorations for functional and aesthetic improvement. This particular porcelain system was selected for its high tensile strength, fracture resistance, and excellent marginal adaptation. The new generation adhesive agents combined with highly filled resin luting cements allow the clinicians to create an integral unit between the restoration and the natural tooth. This bond provides high compressive strength and low microleakage. The preparation procedure, the fabrication of tooth-colored wax crowns, the wax try-in procedure, and the laboratory technique of all-porcelain crown fabrication are discussed in detail, using intraoral photographs of the case to illustrate each applicable procedure. The learning objective of this article is to share the knowledge of all-porcelain restoration principles and application and to provide a detailed description and illustration of each clinical procedure.
Aluminum Silicates↗
[A computed tomographic study of epilepsy in children: the primary diagnosis of a brain tumor].
There are presented experience of computer tomographic (CT) investigation of 435 children with different epileptic syndromes, which had been verified according to international Classification of Epilepsy and Epileptic Syndromes (New Delhi [correction of New-Daily], 1989). Tumors were diagnosed in 6 cases and were manifested as resistant epileptic fits. There was grounded the necessity of including of the neuroimaging methods in complex study of children with epilepsy for optimization of diagnostics, treatment and prognosing of the course of epilepsy. There were also formulated the practical recommendations concerning carrying out of CT investigations in children with prolonged resistant epileptic syndromes.
Adolescent↗
[Aspects of quality assurance in a rheumatology clinic. A contribution to the problem of length of stay and unnecessary admission].
In a rheumatological hospital, quality assurance has many aspects. Diagnostic as well as classification criteria are essential; however, they should not be regarded as a strait-jacket. The very important radiological diagnostics require optimal technology. All x-ray-pictures should only be interpreted by experienced rheumatologists. Also of importance is the documentation of all relevant data, sometimes for decades, especially the kind of drugs, their effectiveness and side effects and the assessment of activity, stage, progression and functional ability. Very important is also a close communication with other medical disciplines. Nursing in rheumatology is mostly underestimated quantitatively and qualitatively as well; it cannot be compared with nursing in other patients. Physical and occupational therapy are indispensable parts of treatment of in-patients; under certain conditions, they may have priority in comparison to other treatments. For chronobiological reasons, physical therapy has a definite time requirement. A duration of 3 weeks is necessary to get therapeutically desired adaptation processes. Thus, the duration of stay in rheumatological departments must be longer than in other disciplines. An actual questionnaire, which has been sent to 50 rheumatological departments, asked the question, which reasons and indications will make future in-patient treatment necessary. As main reason, the comprehensive treatment options and induction of a special pharmacotherapy have been mentioned. Also an element of quality assurance in a rheumatological hospital is warmheartedness and humanity.
Arthritis, Rheumatoid↗
[Prostatic and bladder cancer--possibilities and limitations of diagnostic imaging].
An optimal detection and subsequent documentation of tumour development with imaging methods is achieved with transrectal sonography combined with biopsy. In bladder carcinoma the penetration through the cystic wall and infiltration into adjacent organs and the lymph nodes is detected by computed tomography or better by magnetic resonance tomography.
Diagnostic Imaging↗
[Liver metastases: diagnostic value of blood tests, scintiscanning, and laparoscopy (author's transl)].
In 90 patients with known extra-hepatic malignancy the liver was examined for metastases. The diagnostic value of clinical information, blood examinations, 99mTc scintiscan, and laparoscopy for the diagnosis of the liver metastases was evaluated. Clinical data (age, sex, time since onset of symptoms and localisation of primary tumor) are of no diagnostic value. The most reliable blood tests are alkaline phosphatase (AP) and GOT. The probability of liver metastastases rises with increasingly abnormal values of AP and GOT. However, the probability is not much greater in cases with highly abnormal values than in cases with only moderate elevation of AP and GOT. Diagnostic accuracy of AP is optimal by using a cutoff point of 76 U/l (sensitivity 79%, specificity 64%). Bilirubin, prothrombin time, haemoglobin and blood sedimentation rate are of very little value. Combinations of AP with these blood tests does not improve diagnostic accuracy. Therefore, it is not useful to determine more blood tests than AP alone. Informed reading of liver scans has a specificity of 75% and a sensitivity of 91%. Blind reading of scans has a sensitivity of 94% and a specificity of 95%. This diagnostic accuracy cannot be improved by additional blood tests. Laparscopy has a sensitivity of 85% and a specificity of 95%. Scanning and laparoscopy are complementary methods. When optimal diagnostic accuracy is required both methods should be used.
Adult↗
[The role of non-invasive diagnostics of pulmonary embolism in the optimization of treatment].
177 patients with pulmonary embolism (PE) were examined to study the information value of transthoracal echoCG in early diagnostics of the disease, the possibility of noninvasive evaluation of its severity, and possibility of determining indications for thrombolytic therapy (TLT) on basis of such evaluation. The results show that the sensitivity of such a sign as elevation of pulmonary artery pressure (PAP) by 30 mmHg, is 95%, provided that the patient does not have severe or moderate concomitant diseases cousing PAP elevation (postinfarction cardiosclerosis, chronic obstructive lung disease, valvular diseases etc.). The specificity of this sign, vs the control group, was 5%. Thus, elevation of PAP in patients with clinical manifestations of PE and without concomitant pathology, is a highly informative symptom of acute PE. The sensitivity of the parameter of right ventricular (RV) dilatation was 85%, of paradoxial ventricular septum motion--54%. In patients with PE of various degree of severity and concomitant diseases, high sensitivity of the above-listed sonographic signs of RVoverload goes together with their low specificity, which is not higher than 25%. This does not allow evaluating the degree of embolism and determining indications for TLT in these patients on basis of echoCG data. The authors of the article have developed an algorithm of diagnostic and therapeutic measures in patients with suspected PE.
Echocardiography, Doppler↗
Identification of optimal classification functions for biological sample and state discrimination from metabolic profiling data.
MOTIVATIONS: Classification of biological samples for diagnostic purposes is a difficult task because of the many decisions involved on the number, type and functional manipulations of the input variables. This study presents a generally applicable strategy for systematic formulation of optimal diagnostic indexes. To this end, we develop a novel set of computational tools by integrating regression optimization, stepwise variable selection and cross-validation algorithms. RESULTS: The proposed discrimination methodology was applied to plasma and tissue (liver) metabolic profiling data describing the time progression of liver dysfunction in a rat model of acute hepatic failure generated by d-galactosamine (GalN) injection. From the plasma data, our methodology identified seven (out of a total of 23) metabolites, and the corresponding transform functions, as the best inputs to the optimal diagnostic index. This index showed better time resolution and increased noise robustness compared with an existing metabolic index, Fischer's BCAA/AAA molar ratio, as well as indexes generated using other commonly used discriminant analysis tools. Comparison of plasma and liver indexes found two consensus metabolites, lactate and glucose, which implicate glycolysis and/or gluconeogenesis in mediating the metabolic effects of GalN.
Algorithms↗
Field evaluation of malaria rapid diagnostic tests for the diagnosis of P. falciparum and non-P. falciparum infections.
The objective of this study was to evaluate various malaria rapid diagnostic tests as a tool in the detection of P. falciparum and non-P. falciparum infections in field conditions. Four field surveys were conducted in malaria-endemic areas of Palawan and Davao del Norte, Philippines to validate the various rapid diagnostic tests, namely Diamed OptiMAL 48 (DiaMed AG, Switzerland), ParaHIT f (Span Diagnostics, India), Orchid OptiMAL, and Paracheck Pf (both from Orchid Biomedical Systems, India). The results of the various rapid diagnostic tests were compared to those of microscopy. Sensitivity, specificity and detection rates according to the level of parasitemia were used as parameters to describe the performance of the various rapid diagnostic tests in the field. Practical and operational assessments were also done. The results of the study show that the sensitivity and detection rates were generally lower than previously reported, with sensitivities ranging from 4.8% to 20.6%, except for Diamed OptiMAL 48, which had sensitivities of 78.8% to 96.8%, and detection rates of 50.0% to 96.8%. The rest had detection rates ranging from 0.0% to 50.0%. All the specificities ranged from 18.2% to 100.0%. Improper conditions at the time of manufacturing, storage, transport, and utilization may affect the validity of the results. Rapid diagnostic tests for malaria provide practical means of detecting malarial infections, especially in endemic areas. However, issues regarding variability in performance must to be addressed before they can be used as mainstream diagnostic tools.
Algorithms↗
Assessing case definitions in the absence of a diagnostic gold standard.
Optimal case definition is important in epidemiological research, but can be problematic when no satisfactory gold standard is available. In particular, difficulties arise where the pathology underlying a disorder is unknown or cannot be reliably diagnosed. This problem can be overcome if diagnoses are viewed not necessarily as labels for disease processes, but more generally as a useful method for classifying people for the purpose of preventing or managing illness. With this perspective, the value of a case definition lies in its practical utility in distinguishing groups of people whose illnesses share the same causes or determinants of outcome (including response to treatment). A corollary is that the best-case definition for a disorder may vary according to the purpose for which it is being applied.
Diagnosis↗
[Possibilities of colposcopy in the diagnostics of cervical Chlamydia-mycoplasmatic infections (population prospective study)].
Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.
Adolescent↗
Diagnostic primer sets for microsatellite instability optimized for a minimal amount of damaged DNA from colorectal tissue samples.
BACKGROUND: The diagnosis of microsatellite instability from a minimal amount of highly damaged DNA, extracted from formalin-fixed, paraffin-embedded tissue by the microdissection method, is difficult. Therefore, optimized primer sets were newly designed for substitution of documented ones. METHODS: DNA was extracted from 15 archival colorectal carcinomas and used as templates for polymerase chain reaction. Nine standard microsatellite markers (BAT-25, BAT-26, BAT-40, D18S69, D2S123, D5S346, D10S197, D17S250, and D18S58) were selected for diagnosis of microsatellite instability in colorectal carcinomas. All polymerase chain reaction conditions for primer sets were unified to save experimental time. RESULTS: The primer sets for the latter five markers documented in the literature were redesigned because of poor efficiency for damaged DNA. As a result, the number of DNA samples, sufficiently amplified at all markers, improved from 0% to 93%. CONCLUSIONS: Diagnostic primer sets for microsatellite instability, optimized for a minimal amount of damaged DNA from colorectal tissue samples, were established.
Colorectal Neoplasms↗
Diagnostic imaging in Canada.
In Ontario, between 1993 and 2003, the annual number of MRI scans performed increased by more than 600 percent (Iron et al. 2003), and the number of CT scans increased threefold (Tu et al. 2005). Despite these massive increases, the Fraser Institute reported a median wait of five weeks for CT and thirteen weeks for MRI scanning in 2004 (Esmail and Walker 2004), and Canadians are increasingly concerned about the length of time they wait for diagnostic imaging. Because of this, politicians have made decreasing wait times for diagnostic imaging one of their top priorities (Health Canada 2004). This raises several interesting questions. Have the indications for CT and MRI really expanded that rapidly, or was there just a huge pent-up demand because Canada had fallen so far behind in acquiring modern imaging machines? Are physicians relying more on diagnostic imaging technologies and less on clinical skills? Are an increasing number of patients undergoing scans when there is a small likelihood that the results will change their management or improve their outcomes? Supporters of the view that Canada needs to expand its diagnostic imaging capacity point to the fact that we rank well behind many developed countries in terms of the number of diagnostic imaging machines per population (Canadian Institute for Health Information 2003: 33), and that improvements in imaging quality have expanded the indication for imaging. Supporters of the view that there is an increased and inappropriate reliance on technology over clinical skill point to the findings of a recent American study showing that the regions that spent the most on healthcare did not have better outcomes than the regions that spent less--indeed, the trend was toward poorer outcomes in the highest-spending regions (Fisher et al. 2003a, 2003b). One of the greatest differences between the highest- and lowest-spending regions was their expenditure on a variety of diagnostic tests, suggesting that more testing did not lead to better outcomes on a population basis. It may in fact have led to iatrogenic illnesses because of the workup of false positive results, and diverted attention away from simple interventions that have been shown to be effective (Fisher et al. 2003a). The truth is likely a combination of many factors. Some patients with clear indications for diagnostic imaging undoubtedly wait too long for their tests in Canada. At the same time, a number of patients undergo tests whose results have a very small likelihood of changing their management, which itself contributes to the access problem. Unfortunately there are no evidence-based benchmarks for the appropriate rate of diagnostic testing that can be used to determine the optimal supply of diagnostic machines and radiological personnel. In this article we discuss the reasons it has been so difficult to determine the optimal imaging capacity needed for a population, describe some factors that are "inappropriately" increasing the rate of imaging and suggest some solutions. Although many of our examples deal with CT and MRI scanning, our remarks apply more broadly to many other diagnostic tests.
Attitude of Health Personnel↗
Combined pelvic sonography and serum beta hCG, versus laparoscopy for the diagnosis of stable patient suspected of ectopic pregnancy.
The role of sonography in stable patients suspected of ectopic pregnancy is to establish the diagnosis using positive, suggestive or negative signs. Establishing whether or not intrauterine gestation is present is crucial, as is the detection of any extrauterine abnormality. Sonography may be normal in ectopic pregnancy or when it is not abnormal findings are frequently nonspecific. Therefore, the sonographic results must be correlated and integrated with the clinical history and findings as well as with other diagnostic procedures. The combination of ultrasound scanning with beta hCG was found highly contributory to the determination of the existence of an ectopic pregnancy. Understanding the objectives and limitations of each diagnostic test involved is essential for logical and optimal sequences of diagnostic procedures to be employed in patient management. During a twenty-month period, 138 patients were examined due to clinical suspicion of "sub-acute" ectopic pregnancy. Sixty-one patients were managed according to a non-invasive protocol composed of: a) ultrasound scanning alone and b) ultrasound scanning combined with serum beta subunit hCG. Ultrasonograms for ectopic pregnancy diagnosis were coded: positive (fluid in cul-de-sac or extrauterine sac); suggestive empty uterus, adnexal mass and pseudo-gestational sac) and negative (intrauterine gestational sac and normal pelvis). Surgical procedure was carried out immediately on nine patients with positive signs; all of them had ectopics. Suggestive signs were found in twenty-two patients. beta subunit hCG was determined prior to interventive procedure; ectopic pregnancy was revealed in eighteen of them. Among thirty patients with negative signs, only two patients (7% of this sub-group or 3.5% of the general group) had ectopics.(ABSTRACT TRUNCATED AT 250 WORDS)
Chorionic Gonadotropin↗
[Risk level correction when choosing treatment and diagnostics surgical tactics for surgical patients in grave condition].
The study on risk level reduction in specialized surgical clinics with the use of mathematical modeling for optimization medical-diagnostics tactics has been conducted by the author. 215 patients have been observed. The carried out analysis reflects FR of surgical operations as follows: general condition of the patients, severity of surgical pathology, complexity of surgical aggression. The modeling is designed using computer data processing and the system of Cartesian. Number risk assessment enabled to analyze surgical operation outcomes and optimize treatment-and-diagnostics tactics, reduce in number of operated patients in grave condition.
Critical Illness↗