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At least 919 records · Page 51Linked to original sources
PubMed2006

Strengths and Difficulties Questionnaire: research and clinical applications.

PURPOSE OF REVIEW: To critically discuss recent findings from studies using the Strengths and Difficulties Questionnaire, in relation to different research designs and clinical purposes. RECENT FINDINGS: A substantive body of research exists on the psychometric properties of the Strengths and Difficulties Questionnaire in different cultures. This body supports the validity and reliability of its versions for the parent, teacher and self-reporting purpose, despite some variation in cut-off scores. The Strengths and Difficulties Questionnaire is increasingly being used as a measure of child psychopathology in other types of research, that is, aetiological, longitudinal and service evaluation studies. Future studies need to address in more detail the Strengths and Difficulties Questionnaire diagnostic algorithms, added value score, impact and burden items and a preschool version. SUMMARY: The Strengths and Difficulties Questionnaire has been established as the most widely used instrument in child mental health research. It is easy to complete, is user friendly because of its positive attributes items, allows comparisons to be made between different populations and is sensitive to change.

Adolescent↗
PubMedDate not supplied

Diagnostic evaluation of patients with histiocytosis X.

The natural history of histiocytosis X was reviewed in 52 patients to identify the characteristics of patients with localized versus disseminated disease. Two categories of patients were identified. Older patients with solitary or multiple bone lesions constituted a low-risk group. This group had a high rate of development of new bone lesions (55% were asymptomatic) but an excellent prognosis. Patients with soft tissue involvement constituted a group at high risk for disease progression and organ dysfunction. These patients required a more extensive diagnostic workup and systemic treatment. A diagnostic algorithm is proposed to identify these two groups.

Adolescent↗
PubMed2005

Colorectal cancer: the role of PET/CT in recurrence.

Many imaging modalities and scanning techniques, such as contrast enhanced CT, MRI and FDG-PET, are available for assessment of recurrent colorectal carcinoma. In addition, integrated PET/CT is becoming increasingly available. Intuitively, a synergistic combination of scanning characteristics sounds promising. However, the exact clinical value has not yet been fully established. The role of PET/CT image fusion must be weighed carefully against other available modalities. In this review we evaluate the potential of combined PET/CT in recurrent colorectal carcinoma. When available, PET/CT currently appears the diagnostic tool of choice. In the near future, combined PET/MRI may further enhance the diagnostic algorithm.

Colorectal Neoplasms↗
PubMed2004

Combining FDI and AI approaches within causal-model-based diagnosis.

This paper presents a model-based diagnostic method designed in the context of process supervision. It has been inspired by both artificial intelligence and control theory. AI contributes tools for qualitative modeling, including causal modeling, whose aim is to split a complex process into elementary submodels. Control theory, within the framework of fault detection and isolation (FDI), provides numerical models for generating and testing residuals, and for taking into account inaccuracies in the model, unknown disturbances and noise. Consistency-based reasoning provides a logical foundation for diagnostic reasoning and clarifies fundamental assumptions, such as single fault and exoneration. The diagnostic method presented in the paper benefits from the advantages of all these approaches. Causal modeling enables the method to focus on sufficient relations for fault isolation, which avoids combinatorial explosion. Moreover, it allows the model to be modified easily without changing any aspect of the diagnostic algorithm. The numerical submodels that are used to detect inconsistency benefit from the precise quantitative analysis of the FDI approach. The FDI models are studied in order to link this method with DX component-oriented reasoning. The recursive on-line use of this algorithm is explained and the concept of local exoneration is introduced.

Algorithms↗
PubMedDate not supplied

Total mediastinal traverse with isolated internal mammary artery transection.

Transmediastinal gunshot wounds are infrequent but life-threatening injuries. The course of the projectile and the bullet track often is unpredictable. Prompt and specific diagnostic and therapeutic interventions are necessary to quickly identify and repair potentially life-threatening injuries to the heart, great vessels, and the aerodigestive tract. Multiple diagnostic algorithms exist for work-up of these injuries, and the therapeutic interventions are diverse and challenging. We describe a patient with total mediastinal traverse, who presented with right-sided hemopneumothorax. The work-up revealed surprisingly an isolated left internal mammary artery transection with a significant hemorrhage that mandated surgical intervention in left chest.

Adult↗
PubMed1981

Difficulties in assessing the adverse effects of drugs.

1 In recent years the phenomenon of the adverse drug reaction (ADR) has become a focus of increased attention and research, and we have become aware of the clinical complexity of the phenomenon and some of the difficulties inherent in assessing adverse effects. Evidence for such difficulties includes the discrepancies in figures for ADR incidence in epidemiological studies, the non-specificity and suggestibility of ADR symptoms, and the substantial disagreements, even among experts, in the diagnosis of ADRs. 3 An observed clinical manifestation heavily depends on the clinical setting and on the intent of the clinician, and the large number of factors that many confound the link between a given manifestation and an administered drug. A diagnostic algorithm, or branched logic decision format, has recently been developed. It comprises six axes of decision strategy and provides standardized, operational rules for rating the probability of an ADR.

Diagnosis↗
PubMed2005

Update on the diagnosis and management of pulmonary embolism.

Pulmonary embolism (PE) is a common and often fatal disease. In the US, an estimated 40-53 people per 100,000 are diagnosed with PE annually and approximately 60,000 die from the disease. Diagnosis is difficult because symptoms are non-specific; however, a quick and accurate diagnosis is critical because, with appropriate therapy, the risk of recurrent (and potentially fatal) PE can be greatly reduced. Recent publication of prediction rules and improved non-invasive diagnostic tools have simplified diagnostic algorithms for PE. The efficacy of the standard treatment for PE, initial administration of continuous i.v. unfractionated heparin overlapped with long-term oral anticoagulation, is well established. However, newer treatment options such as low-molecular-weight heparins and the pentasaccharides may offer similar efficacy with improved convenience.

Algorithms↗
PubMed2005

The use of a fixed high sensitivity to evaluate five D-dimer assays' ability to rule out deep venous thrombosis: a novel approach.

Suspected deep venous thrombosis (DVT) is difficult to refute without complex diagnostic algorithms and expensive testing. We analysed five D-dimer assays' utility for exclusion of suspected DVT during a prospective clinical cohort trial, choosing a highly sensitive cut-off value at which to compare the assays. Assays were performed on 436 consecutive patients who were referred with symptoms that suggested a first episode of DVT. Venous thromboembolism (VTE) was defined as positive findings on comprehensive duplex ultrasonography or any episode, or complication of VTE detected during 3 months of clinical follow-up. All five assays were performed in 377 patients. At a highly sensitive cut-off value, all five assays reliably excluded DVT in the study population. While the choice of a highly sensitive cut-off value reduced the specificity of all the assays, the change in specificity differed between tests. Our findings suggest that a second-generation D-dimer assay could be used as a stand-alone test to rule out suspected DVT when a highly sensitive cut-off value is chosen. These findings should be subjected to a prospective management study, as a small reduction in sensitivity from our findings could result in a clinically relevant decrease in negative predictive value.

Adult↗
PubMed2004

Copper hypersensitivity: dermatologic aspects.

Reports of immune reactions of both the immediate and delayed types due to cutaneous or systemic exposure to copper have been reviewed, in the endeavor to draw a comprehensive profile of the immunogenic potential of that metal and its compounds. The metal's immunotoxic potential is also briefly reviewed. In principle, as noted for other transition metals, the electropositive copper ion is potentially immunogenic due to its ability to diffuse through biological membranes to form complexes in contact with tissue protein. Based on predictive guinea pig test and the local lymph node assay (LLNA), copper has a low sensitization potential. Reports of immune reactions to copper include immunologic contact urticaria (ICU), allergic contact dermatitis (ACD), systemic allergic reactions (SAR) and contact stomatitis (STO), but considering the widespread use of copper IUDs and the importance of copper in coinage, items of personal adornment and industry, unambiguous reports of sensitization to the metal are extremely rare, and even fewer are the cases, which appear clinically relevant. Reports of immune reactions to copper mainly describe systemic exposure from intrauterine devices and prosthetic materials in dentistry, implicitly excluding induction of the hypersensitivity from contact with the skin as a risk factor. We provide a diagnostic algorithm that might clarify the frequency of copper hypersensitivity.

Copper↗
PubMedDate not supplied

Classification of feline intraocular neoplasms based on morphology, histochemical staining, and immunohistochemical labeling.

The objectives of this study were to evaluate morphologic, histochemical, and immunohistochemical characteristics of well-differentiated and anaplastic intraocular neoplasms of cats, and to develop a diagnostic algorithm for, and investigate the association of ruptured lenses with these neoplasms. Seventy-five feline globes with intraocular neoplasms were stained with hematoxylin and eosin and examined by light microscopy. Morphologic diagnoses included 33 intraocular sarcomas, 17 diffuse iris melanomas, 15 lymphosarcomas, three ciliary adenomas, one metastatic carcinoma, and six undifferentiated intraocular neoplasms. Sections of these globes were then stained with periodic acid Schiff (PAS), and immunohistochemical (IHC) labels for various cellular markers. Histochemical staining and IHC labeling confirmed cellular differentiation in 73/75 neoplasms but was discordant with morphologic diagnoses in 8/75. These included four neoplasms morphologically diagnosed as lymphosarcomas but which expressed differentiation antigens consistent with melanoma (n = 3) or ciliary adenocarcinoma (n = 1), and four tumors morphologically diagnosed as intraocular sarcomas that expressed differentiation antigens for melanoma (n = 2), metastatic carcinoma (n = 1), or remained undifferentiated (n = 1). Immunohistochemical labeling suggested a diagnosis in 5/6 morphologically undifferentiated neoplasms including one intraocular sarcoma, two diffuse iridal melanomas, and two ciliary adenocarcinomas. Based upon morphologic, histochemical, and IHC characterization, ruptured lens capsules were detected in 28/30 intraocular sarcomas, 3/24 diffuse iris melanomas and 1/11 lymphosarcomas, but not in ciliary epithelial neoplasms, metastatic carcinomas, or undifferentiated intraocular neoplasms. An algorithm is provided that facilitates stain and IHC label selection for differentiating anaplastic intraocular feline neoplasms.

Adenoma↗
PubMed2005

Acrokeratosis paraneoplastica: Bazex syndrome.

Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 64-year-old patient that was diagnosed with squamous cell lung carcinoma after being evaluated for lesions compatible with paraneoplastic acrokeratosis. With a high frequency Bazex syndrome is the earliest marker of an underlying subclinical neoplasm. An early suspicion is of the outmost importance in order to perform a prompt diagnosis of an underlying malignancy. We propose a diagnostic algorithm upon suspicion of acrokeratosis paraneoplastica and review the pathogenesis of this entity.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

The diagnosis and management of renovascular disease: a primary care perspective. Part I. Making the diagnosis.

Renovascular disease is a complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerotic disease. It usually presents in one of three forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. This complexity often makes diagnostic and management decisions difficult. This review will be presented in two parts. In Part I, the authors will discuss when to consider and how to go about making the diagnosis. In Part II (in a future issue of The JCH), the authors discuss the management of renovascular disease. The clinical index of suspicion remains paramount in setting the diagnostic strategy. Although it is subject to certain limitations, conventional contrast angiography is usually considered the gold standard in confirming the diagnosis. In addition, there are a number of available noninvasive tests that can aid in decision making. These tests can be divided into those that detect the anatomic presence of a stenosis and those that identify the functional consequences of the renal artery obstruction. No one study is appropriate for every patient. A diagnostic algorithm is proposed at the conclusion of this review.

Algorithms↗
PubMedDate not supplied

Is it constrictive pericarditis or restrictive cardiomyopathy? A systematic approach.

In this case review, the authors propose a fluent diagnostic algorithm for the consideration and therapeutic approach to either constrictive pericarditis or restrictive cardiomyopathy. Additionally, while focusing on the differential diagnosis of these clinically vexing entities, the authors outline the therapeutic expectations from surgical pericardiectomy in constrictive pericarditis.

Adult↗
PubMed2006

Diagnosis and characteristics of syncope in older patients referred to geriatric departments.

OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross-sectional observational study. SETTING: In-hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty-two patients (aged>or=65, mean+/-standard deviation=79+/-7, range 65-98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope-like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65-74, n=71; aged>or=75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.

Age Factors↗
PubMed2005

Management of suspected pulmonary embolism (PE) by D-dimer and multi-slice computed tomography in outpatients: an outcome study.

OBJECTIVES: A prospective outcome study designed to evaluate a simple strategy for the management of outpatients with suspected pulmonary embolism (PE), based on clinical probability, D-dimer, and multi-slice computed tomography (MSCT). METHODS: A cohort of 432 consecutive patients admitted to the emergency department with suspected PE was managed by sequential non-invasive testing. Patients in whom PE was ruled out were not given anticoagulants, but were followed-up for 3 months. RESULTS: Normal D-dimer and low-intermediate clinical probability ruled out PE in 103 patients [24% (95% CI 20-28)]. Seventeen patients had normal D-dimer, but high clinical probability and proceeded to MSCT. All patients proved negative for PE. A total of 329 (76%) patients underwent MSCT examination. Pulmonary embolism was diagnosed in 93 patients [21.5% (95% CI 18-26)] and was ruled out by negative MSCT in 221 patients [51% (95% CI 46-56)]. MSCT scans were determined as inconclusive in 15 (4.5%) patients. No patient developed objectively verified venous thromboembolism (VTE) during the 3-month follow-up period. However, the cause of death was adjudicated as possibly related to PE in two patients, resulting in an overall 3-month VTE risk of 0.6% (95% CI 0-2.2%). The diagnostic algorithm yielded a definite diagnosis in 96.5% of the patients. CONCLUSIONS: This simple and non-invasive strategy combining clinical probability, D-dimer, and MSCT for the management of outpatients with suspected PE appears to be safe and effective.

Algorithms↗
PubMed1998

Is the atrial high rate episode diagnostic feature reliable in detecting paroxysmal episodes of atrial tachyarrhythmias?

The atrial high rate episode diagnostic in the Thera pacemaker reports frequency, duration, and date/time of atrial tachyarrhythmias according to programmed criteria. The aim of the study was to validate the atrial high rate episode diagnostic feature. Episodes of atrial fibrillation recorded by Holter monitoring were compared to episodes detected by the pacemaker. Forty five ambulatory (Holter) recordings were used for evaluation. Thirty of 45 ambulatory (Holter) recordings showed sinus rhythm. On 4 of these 30 ambulatory (Holter) recordings, the Thera detected 12 episodes of atrial tachyarrhythmias as false-positives (sinus rhythm was detected as atrial tachyarrhythmia). The main reason was far-field R and T was oversensing. On 15 of 45 ambulatory (Holter) recordings, 125 episodes of atrial tachyarrhythmias were recorded. Ninety-three of these events also were detected by the pacemaker, while for 32 events the Thera reported sinus rhythm. The main reason was that the episodes were of too short duration. Therefore, the Thera (programmed with detection rate 160 beats/min, detection beats 40, termination beats 10) was unable to detect atrial tachycardias. Software simulation of the diagnostic algorithm under several programming settings using the digitized Holter files demonstrated highly reliable detection of atrial tachyarrhythmias (sensitivity 98%, specificity 100%) when programmed as follows: detection rate 220 beats/min, detection beats 10, termination beats 20. It can be concluded that Thera's high rate episode monitor is a reliable tool for detection of atrial tachyarrhythmias, if programmed as recommended.

Aged↗
PubMed2003

Spiral CT for pulmonary embolism: the paradigm has shifted.

Computed tomography (CT) is rapidly becoming the first-line modality for imaging pulmonary embolism (PE). However, limitations for the accurate diagnosis of small peripheral emboli have prevented the unanimous embrace of CT as the new standard of reference for imaging PE, although the actual significance of isolated peripheral emboli is uncertain. At the same time, the high negative predictive value of CT pulmonary angiography for excluding clinically significant PE has been established. The introduction of multidetector-row spiral CT has greatly improved visualization of peripheral pulmonary arteries and detection of small emboli. Previous concerns regarding the use of spiral CT for the accurate diagnosis of peripheral pulmonary emboli should thus be overcome. Multidetector-row spiral CT has become a widely available and cost-effective technology and appears to have surpassed other imaging modalities for the accurate detection of central and peripheral PE. In this review, the authors assess the current role of spiral CT in the diagnostic algorithm of PE.

Contrast Media↗
PubMed2004

The diagnostic evaluation of deep vein thrombosis.

Due to the morbidity and mortality associated with either untreated disease or inappropriate anticoagulant therapy, accurate diagnosis of venous thromboembolism is essential. As venography, the current gold standard test for deep vein thrombosis (DVT), is both invasive and costly, noninvasive diagnostic strategies for diagnosing DVT have been developed. Noninvasive tests often have to be combined to either raise the post-test probability of disease to a level justifying treatment or lower it to a level at which withholding treatment is warranted. Diagnostic algorithms involving clinical assessment, venous ultrasonography, and D-dimer testing have been validated in management trials of patients with DVT. The optimal strategy at individual institutions is dependent on local expertise and cost. Magnetic resonance venography has the potential to be used as a stand-alone test for DVT but requires further evaluation.

Decision Trees↗