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At least 1,027 records · Page 57Linked to original sources
PubMed2005

[Spanish scientific production in diagnostic and therapeutic research area of respiratory system in international journals from 1990 to 2002].

OBJECTIVE: The aim of this study were: to analyze the spanish production in diagnostic and therapeutics research area of respiratory system in international journals from 1990 to 2002. MATERIAL AND METHODS: Papers published in diagnostic and therapeutics area of respiratory system during this period of time were selected by the PUBMED system. We delimited the production with key words: respiratory system and the one that is used by the diagnostic and therapeutics research area. RESULTS: We obtain a total of 67 document published in international journals by spanish authors. The scientific production in the diagnostic and therapeutics area have stabilized in this 12 years period. The distribution of articles by the institutional affiliation and province of authors also showed a wide dispersion: Barcelona and Clinic and Provincial Hospital of Barcelona were responsible for 43.1% and 23.8% of all the production. Bronchoalveolar lavage and the use of telescopic catheter were the type of diagnostic and therapeutic procedure more productive. CONCLUSIONS: The scientific production in the diagnostic and therapeutics area of respiratory system have stabilized in this 12 years period, this evidence contrast with the high growth detected in respiratory system in general.

Biomedical Research↗
PubMedDate not supplied

Modified diagnostic criteria of drug-induced liver injury proposed by the international consensus meeting.

BACKGROUND/AIMS: The usefulness of the diagnostic criteria of the International Consensus Meeting (criteria A) has been previously reported. However, these criteria are not clinically adaptable in Japan where allergic reaction is one of the major etiologies of drug-induced liver injury and thus it was revised and reported in the Digestive Disease Week-Japan of 2002 as DDW-J criteria (criteria B). It remains controversial whether the revised criteria can exclude drugs not causing liver injury. METHODOLOGY: Two new diagnostic criteria (criteria C and D) were designed to supplement the DDW-J criteria. Usefulness and limitations of the four criteria were retrospectively examined using cases of drug-induced liver injury experienced in 8 hospitals. RESULTS: It was confirmed that the sensitivity of criteria B is excellent for diagnosis of drug-induced liver injury. However, diagnostic criteria B were found to be disadvantageous in relation to specificity, while diagnostic criteria D were disadvantageous in relation to sensitivity. Sensitivity of diagnostic criteria C was a little superior to that of diagnostic criteria A. CONCLUSIONS: On the basis, the significant sensitivity of criteria B was confirmed again, however, modification should be done for increasing specificity. Criteria C appear to be the best for their sensitivity and specificity.

Chemical and Drug Induced Liver Injury↗
PubMed2005

Evaluation of the diagnostic accuracy of the endoscopic ultrasonography results in the patients examined in a period of three years.

INTRODUCTION: Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE: The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS: First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC: Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION: Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.

Adult↗
PubMed2005

Patient acceptance of diagnostic laparoscopy.

PURPOSE: To assess patient acceptance of diagnostic conventional laparoscopy and minilaparoscopy under sedoanalgesia. MATERIALS AND METHODS: 120 consecutive patients undergoing diagnostic laparoscopy were enrolled prospectively in this study. Within the first week after diagnostic laparoscopy the patients were asked to answer a total of eight questions with regard to the acceptance of the procedure. RESULTS: The inconvenience of laparoscopy was assessed with a mean of 1.6 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). The discomfort in the two days following laparoscopy were graded with a mean of 2.1 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). There was no difference between conventional laparoscopy and minilaparoscopy. Only 10% of the patients described laparoscopy more inconvenient in comparison to diagnostic gastroscopy, whereas 29% of the patients assessed diagnostic gastroscopy more inconvenient. CONCLUSIONS: Diagnostic laparoscopy under sedoanalgesia is a very well tolerated procedure. There is no difference between conventional laparoscopy and minilaparoscopy.

Abdominal Pain↗
PubMed2006

[Diagnostic accuracy].

Clinical decision making while making a diagnosis is based on pre-test probability evaluation, a decision whether further tests are needed, and post-test probability evaluation based on test results. The add value of the test is the increase in probability, which depends on its diagnostic accuracy. Some measures of diagnostic accuracy are sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, area under the curve, Youden index, and diagnostic odds ratio. ROC curve is the most efficient way of graphic description of the relationship between sensitivity and specificity. Diagnostic accuracy of a test is evaluated in a cross-sectional study on a group of individuals subjected simultaneously to the index test and the gold standard. All parameters of diagnostic accuracy are very sensitive to the study design, therefore it is of utmost importance to perform and write a study to adhere to the proposed STARD standards. This lecture gives an insight into the basics of biostatistical terminology from the field of diagnostic accuracy.

Biometry↗
PubMed2006

A web-based test of residents' skills in diagnostic radiology.

PURPOSE: To develop an objective, Web-based tool for evaluating residents' knowledge of diagnostic radiology. METHODS: We developed and tested a Web-based evaluation tool (the Diagnostic Radiology Skills Test) that consists of 3 tests, one in each of 3 domains of diagnostic radiology: chest, gastrointestinal, and musculoskeletal imaging. Each test comprises 30 cases representing a range of difficulty in the domain, including normal states, normal variants, typical cases of common diagnoses, and cases with more subtle findings. Cases are presented with a long menu of domain-specific possible diagnoses (response options), each coded for diagnostic appropriateness. Our subjects were 21 residents in postgraduate year (PGY) 2 to 5 and 11 experts in diagnostic radiology. Subjects accessed the tool via a Web site on our Web server. Residents' test results were compared for reliability and validity across domain, case, and training level. In addition, results were correlated with commonly used established and objective evaluation tools. RESULTS: The tool demonstrated consistent monotonic improvement in performance with training level. It showed acceptable reliability in discriminating between residents at different performance levels, both within and across training levels (r= 0.53 within level and 0.69 across levels). Test results also had concurrent validity against the American College of Radiology In-Training Examination, a widely accepted objective assessment tool (r = 0.65, P < 0.01), and 2 Objective Structured Clinical Examinations (OSCEs) focusing on diagnostic skills (r= 0.78 and r= 0.69, P < 0.01, respectively). CONCLUSIONS: Our study demonstrates the feasibility of a Web-based, standardized, objective assessment method for evaluating residents' performance.

Clinical Competence↗
PubMedDate not supplied

[Diagnostic scintigraphy and effectiveness of 131I radioiodine therapy in differentiated thyroid carcinoma (DTC)].

INTRODUCTION: Since the effect of pre-therapeutic scintigraphy on the outcome of DTC treatment is debated, we evaluated factors affecting the effectiveness of (131)I therapy with respect to the delay between diagnostic scintigraphy and the application of radioiodine. MATERIAL AND METHODS: In the studied group of 60 patients with DTC, mean age 54.6 +/- 13.0 years, four weeks prior to the planned diagnostics, L-thyroxine was withdrawn and the following tests performed: (131)I (4 MBq) uptake above the neck, thyroid volume by USG, TSH and hTg level. Wholebody scintigraphy (37 MBq) was performed. The time between this diagnostic scintigraphy and application of (131)I (3657 MBq) was calculated. Based on whole-body 131I scintigraphy (74 MBq) performed 1 year after radioiodine treatment, the patients were divided into: group I - 42 patients with no tracer accumulation, and group II--18 patients who continued to accumulate (131)I in the neck. RESULTS: The differences between the median values of (131)I uptake and of thyroid volumes, and between the TSH and hTg median values in the two groups of patients were found not to be statistically significant. The average times between diagnostic scintigraphy and (131)I treatment in group I and II (9.4 vs. 8.3 weeks, respectively) were not significantly different either. CONCLUSION: Despite the different effectiveness of supplementary (131)I treatment, patients in group I and group II showed no statistically significant differences in the studied parameters. It appears that the diagnostic (131)I activity of 37 MBq and the time between diagnostic scintigraphy and application of (131)I did not have any effect on the results of the treatment in our group of patients.

Adenocarcinoma, Follicular↗
PubMed1991

Diagnostic and prognostic utility of phospholipase A activity in patients with acute pancreatitis: comparison with amylase and lipase.

We compared the diagnostic and prognostic utility of phospholipase A (PLA; EC 3.1.1.4) for acute pancreatitis with that of amylase and lipase by analysis of sera from 151 consecutive patients presenting with abdominal pain in whom assays of serum amylase and (or) lipase had been ordered. We determined the diagnostic accuracy for both the initial and the peak enzyme activities. Maximal diagnostic accuracy obtained for the initial activities of amylase, lipase, and PLA was 0.83, 0.83, and 0.76 at cutoff values of 650, 650, and 41 U/L, respectively. Use of peak enzyme activities showed maximal diagnostic accuracy of 0.85, 0.86, and 0.73 at cutoff values of 650, 1050, and 42 U/L, respectively. Receiver-operator characteristic curve analysis revealed the diagnostic performance of amylase and lipase to be similar, whereas that of PLA was almost random and not incremental. As with amylase and lipase, PLA activities in sera showed no relation to patients' survival; three patients who died after an attack of acute pancreatitis failed to demonstrate the dramatic increases in PLA activity previously described. We conclude that assessing the severity of acute pancreatitis by using enzyme activities still remains problematical. Measurements of amylase or lipase activities provide similar diagnostic discrimination when appropriate cutoff values are used and remain the methods of choice for diagnosis of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

[SCAN system--semi-structured interview based on diagnostic criteria].

This paper presents the main features of contemporary diagnostic systems which are implemented into the SCAN--modern and semi-structured diagnostic interview. The concepts of further development of the classifications, rationale for operationalized diagnostic criteria and for the divisional approach to mental diagnoses will be in focus. The structure and components of SCAN ver. 2.1 (WHO), i.e. Present State Examination--10th edition, Item Group Checklist, Clinical History Schedule, Glossary of Definitions and computer software with the diagnostic algorithm: I-Shell, as well as rules for a reliable use of diagnostic rating scales, will be discussed within the scope of this paper. The materials and training sets necessary for the learning of proper use of the SCAN, especially training sets for SCAN Training Centers and the Reference Manual--a form of guidebook for SCAN shall be introduced. Finally the paper will present evidence that SCAN is an instrument feasible in different cultural settings. Reliability and validity data of SCAN will also be dealt with indicating that SCAN could be widely used in research studies as well as in everyday clinical practice facilitating more detailed diagnostic approach to a patient.

Diagnosis, Differential↗
PubMedDate not supplied

[Study of compatibility of psychiatric diagnoses with ICD-10 diagnostic criteria using the SCAN questionnaire].

AIM: Authors aimed at testing whether psychiatrists in their diagnostic process obeyed strict ICD-10 diagnostic criteria. Diagnoses made by psychiatrists at discharge were compared with those of SCAN ver.2.1 on admission. METHODS: Diagnoses obtained by SCAN I-Shell program were compared with clinical diagnoses obtained by psychiatrists in the psychiatric wards according to ICD-10 criteria on 3 levels: diagnostic group (Fc), diagnostic class (Fcc), and diagnostic category (Fcc.c). Validity assessment was obtained with Cohen's Kappa coefficient, sensitivity, specificity and Yule's Y coefficient. RESULTS: On the diagnostic group level, Cohen's kappa was 0.14-0.65, Yule's Y 0.57-0.71. Sensitivity 0.69-0.95 and specificity 0.41-0.94. In psychotic disorders group F2 kappa was 0.65, Yule's Y 0.71, sensitivity 0.69, specificity 0.94. In affective disorders group F3 kappa was 0.31, Yule's Y 0.57, sensitivity 0.95, specificity 0.41. In neurotic disorders group F4 kappa was low 0.14, Yule's Y 0.62, sensitivity 0.95, specificity 0.50. CONCLUSIONS: The study showed a higher level of agreement between SCAN and clinical diagnoses in the group of psychotic disorders with exception of schizoaffective disorders, and lower agreement rates in the group of affective and neurotic disorders where the number of SCAN diagnoses outweighed that of the clinical ones. It could be the result of systematic faults in the coding of diagnoses.

Adult↗
PubMedDate not supplied

Diagnostic imaging of lung cancer after heart transplantation.

AIMS AND BACKGROUND: In heart transplant recipients pulmonary neoplasms are among the most frequent solid tumors; they have a rapid and aggressive course, and therefore require an early diagnosis. We describe the role that diagnostic imaging plays in different diagnostic moments of this disease. METHODS: We evaluated the incidence and diagnosis of lung cancer in patients who underwent heart transplants at our institution. Taking into account the few different diagnostic imaging techniques (chest X-ray, high-resolution computed tomography [CT], staging CT and CT-guided biopsy) used in standard surveillance protocols or indicated by clinical symptoms, we evaluated their diagnostic accuracy, their efficacy in tumor staging, and their impact on the therapeutic choices. RESULTS: Seventeen neoplasms in a total of 712 patients were diagnosed (2.4%). In 16 of these 17 cases chest X-ray (routinely performed as follow-up in 11 cases, indicated by symptoms in 5 cases) was diagnostic. In another 11 cases chest X-ray was false positive. The diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of chest X-ray was 98%, 91%, 98%, 50%, and 99%, respectively. Total-body CT correctly staged the tumors and provided information as to whether surgery was indicated or not (stage II or advanced). CONCLUSIONS: Chest X-ray is still the surveillance radiological technique in heart transplant recipients. Considering its low specificity and sensitivity, we propose high-resolution CT imaging during follow-up to identify pulmonary lesions as soon as possible and enable a differential diagnosis with parenchymal inflammation. The use of CT-guided fine-needle biopsy and culture examinations permits to differentiate neoplastic from inflammatory parenchymal opacities. Use of CT in cancer staging is effective for subsequent treatment choices.

Biopsy↗
PubMed2006

[Pulmonary mycobacteriosis--the diagnostic challenge. The authors' experience].

UNLABELLED: The diagnosis of NTM-related pulmonary disease is based on clinical symptoms, radiological features and several positive cultures of one and the same NTM species from samples obtained from the respiratory tract. Short hospitalization usually does not enable sufficient diagnostic procedures to meet the diagnostic criteria, and this may lead to the reduction of diagnostic sensitivity. The aim of the study was to draw attention to NTM-related pulmonary disease, to share the authors' experience in the diagnosing of pulmonary mycobacteriosis and to indicate the possibilities of improving the diagnostic accuracy in this disease. A group of 31 patients with sputum, bronchial washing and/or bronchoalveolar lavage fluid (BALF) NTM-positive cultures was selected from a cohort of 245 patients evaluated for tuberculous and nontuberculous mycobacterial diseases (total number of 1277 specimens were invastigated). In two of them NTM related pulmonary disease was diagnosed (caused by M. kansasii and M. avium) at the course of initial evaluation. In the remaining 29 patients the microbiological data did not allow to establish the diagnosis of mycobacterial lung disease mainly due to a small number of samples from the respiratory tract. From this group 13 patients were reevaluated within 3 - 6 months from the initial investigation. This allowed to identify two new cases of mycobacteriosis (M. kansasii and M. avium). Thus among 31 patients with NTM positive cultures from respiratory tract specimens 4 patients (4/31, 12,9%) met the diagnostic criteria for mycobacterial disaease. CONCLUSION: Microbiological analysis of an adequate number of samples in symptomatic patients with radiological features suggestive for NTM-related pulmonary disease increses the diagnostic sensitivity in pulmonary mycobacteriosis. Identification of the species in positive cultures is of great importance.

Bronchoalveolar Lavage Fluid↗
PubMed1991

[Diagnostic yield in rhino-sinusal inflammatory pathology: comparison of projective radiology, CT and MR].

In everyday practice, the radiologist is concerned with the diagnosis of inflammatory conditions of the nose and paranasal sinuses. This paper was aimed at evaluating and comparing the diagnostic efficacy of the main diagnostic imaging procedures currently available. Fifty-six patients were studied: 25 with computed radiography (CR) and CT, 21 with CR and MRI (0.22 T resistive magnet), and 10 with CR, CT, and MRI. From the diagnostic point of view, the conventional-like CR image was assumed as analog to the conventional radiographic (RX) one on the basis of previous personal experience. The following elements were separately considered for RX, CR, CT, and MRI: anatomical structure identificability, spatial resolution, dosimetry, time consumption, diagnostic results, and economics. A global performance index was calculated (RX less than 1; CR = 1; MRI ranging 1.2-2.2; CT = 7.3). CR was superior to RX, from both a diagnostic and a dosimetric point of view, but buying the equipment is nowadays expensive. CT and MRI were superior to both RX and CR in the diagnosis of inflammatory conditions of the nose and paranasal sinuses. When an inflammatory condition is unquestionable, MRI is more accurate than CT, but the latter (thanks to its optimal documentation of both bony walls and soft tissues) is superior to MRI in the differential diagnosis of a generic disease of the nose and paranasal sinuses--that is, when the inflammatory nature is questionable. MRI limitations were poor visualization of bone walls, high cost, and poor access. Thus, CT emerged as the technique of choice, thanks to its diagnostic results, easy access and low cost, with a negligible radiation dose to patients.

Adult↗
PubMedDate not supplied

[Radiculopathy and the organization of health services: applicability verification of a technic for analyzing time factors in diagnostic procedures].

The PERT is a SPR (Reticular Programation System) based on statistic-mathematic models. Since some years they are applied to productive processes to increase the efficiency and effectiveness. They all have a same base structure which is the net that is composed by the logical succession of the event and the activity which has the part of the project. Determining the minimum time (to), the maximum one (tp) and the more frequent time (tm) of each activity and applying the statistic method PERT, one gets the probable duration (te) of every activity and the critical path of the net is placed in evidence. This is formed by the chain of those activities whose duration determines the total duration of the project. The Authors have desired to verify the applicability of SPR even to the "medical industry" and, more precisely, to the diagnostic process for the verification of radiculoneuropathy. Such pathology affects a large part of the active population. The diagnostic process in this case comprises besides an accurate neurological and clinical examination of the patient, also the x-ray exam, the electromyography, the Computed Tomography (CT) and the Magnetic Resonance Imaging (MR) exam. These last two investigations gives an increase of diagnostic accuracy. With the collaboration of the physicians of the diagnostic Service, the Authors have measured in every step of the diagnostic procedure the waiting time of 48 patients with low back pain. Applying the PERT method, it has been possible to put in evidence in the net the critical activities. They are such that their duration time determines the probable duration of the whole diagnostic process. Such duration in this case it corresponds to 91 days with a standard deviation of 33 days. The delay of any critical activity causes a lealy of the whole route. This delay influences negatively on the patient's health. Besides it determines an economic damage to the system because a relation cost/time exists. The systems of reticular programmation have as objective not only the one of improving the programmation and the control of the processes, but also the attainment of an optimum cost/time ratio, varying in a way that the total cost of the realization of the process is minimum. They represent a useful criterion to direct Quality Assurance (Q.A) in the local political sanitary context, within the bounds of organization of technical - scientific quality. An accurate application of the Q.A. should modify besides the duration of the critical activities.

Adult↗
PubMedDate not supplied

Usefulness of bile cytology in the diagnostic management of patients with biliary tract obstruction.

Eighteen patients with evidence of biliary tract obstruction had a total of 29 satisfactory bile samples submitted for diagnostic cytology during a two-year period. These 29 specimens were reviewed in order to determine if bile cytology is useful in the diagnostic management of patients with obstructive biliary tract disease. Twenty-one of the bile specimens were from patients with malignant biliary stricture, and eight were from patients with benign biliary obstruction. Bile cytology was positive for carcinoma in eight samples from patients with malignant stricture and was inconclusive for malignancy in two. There were no false positives. The diagnostic specificity of bile cytology was 100%, the diagnostic sensitivity was 48%, and the diagnostic accuracy was 62%. When carefully collected and promptly processed, bile proved an excellent specimen for cytologic evaluation and was a valuable adjunct to other diagnostic procedures for the detection of carcinoma causing biliary tract obstruction.

Adenoma, Bile Duct↗
PubMed1986

A framework for clinical evaluation of diagnostic technologies.

Most new diagnostic technologies have not been adequately assessed to determine whether their application improves health. Comprehensive evaluation of diagnostic technologies includes establishing technologic capability and determining the range of possible uses, diagnostic accuracy, impact on the health care provider, therapeutic impact and impact on patient outcome. Guidelines to determine whether each of these criteria have been met adequately are presented. Diagnostic technologies should be disseminated only if they are less expensive, produce fewer untoward effects and are at least as accurate as existing methods, if they eliminate the need for other investigations without loss of accuracy, or if they lead to institution of effective therapy. Establishing patient benefit often requires a randomized controlled trial in which patients receive the new test or an alternative diagnostic strategy. Other study designs are logistically less difficult but may not provide accurate assessment of benefit. Rigorous assessment of diagnostic technologies is needed for efficient use of health care resources.

Clinical Trials as Topic↗
PubMed1987

Comparison of Ca++ uptake and spontaneous Ca++ release from sarcoplasmic reticulum vesicles isolated from muscle of malignant hyperthermia diagnostic patients.

Inward Ca++ transport and spontaneous Ca++ release activities were compared among sarcoplasmic reticulum (SR) membrane fractions isolated from human skeletal muscle in patients undergoing malignant hyperthermia (MH) diagnostic contracture testing. Two different membrane fractions were isolated, a heavy (8-12,000 X g) and light (12-48,000 X g) fraction, from each diagnostic subject. The rates of inward Ca++ transport were faster in light SR compared to heavy SR, but no statistically significant difference was observed among MH diagnostic groups. Spontaneous Ca++ release occurred at optimum Ca++ preload in all SR fractions and this preload did not differ among MH diagnostic groups. Optimal Ca++ preload for rate of spontaneously released Ca++ was greater in light SR compared to heavy SR. Similarly, rate of Ca++ release was faster in light SR than in heavy SR, but no difference in rate of spontaneously released Ca++ was observed among MH diagnostic groups. Amount of Ca++ released did not differ among SR fractions and it did not differ among diagnostic groups. In contrast to previous studies showing a defect in Ca++-induced Ca++ release, the mechanisms related to spontaneous Ca++ release and to oxalate-facilitated inward Ca++ transport, as measured in this study, appear to be normal in SR from human MH skeletal muscle.

Calcium↗
PubMed1987

The diagnostic value of the medical history. Perceptions of internal medicine physicians.

We investigated the perceptions of 71 internal medicine faculty and residents regarding the diagnostic value of the medical history and other attitudes toward the medical interview. Physicians perceive the medical history as having much higher value in diagnosis than either the physical examination or laboratory/radiography information (mean scores, 5.76, 2.41, and 2.49, respectively). The perceptions of the importance of the physician-patient relationship were significantly correlated with the diagnostic value of the history. There was also a strong relationship between the perceived value of the history and preferences for more skilled interviewing responses, as measured by the Helping Relationship Inventory. Contrary to expectations, the perceptions of residents toward the diagnostic value of the patient's history increased significantly over the course of training (5.00 to 6.00). We conclude that despite the increasing emphasis on diagnostic technology, internal medicine residents and faculty continue to view the patient's history as the preeminent source of diagnostic information. Physician attitudes toward the physician-patient relationship and toward the medical interview may contribute to the diagnostic value of the history.

Attitude of Health Personnel↗