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At least 1,171 records · Page 65Linked to original sources
PubMed2005

[The use of Meta-analysis in the evaluation on diagnostic tests].

OBJECTIVE: To introduce Meta-analysis in evaluating diagnostic tests. METHOD: Adjusted SROC method was used in assessing 7 diagnostic tests on fatty liver. RESULTS: The pooled sensitivity and specificity of type B ultrasonography were 0.89 [95% confidence interval (CI): 0.87-0.92] and 0.94 (95% CI: 0.92-0.96) respectively while the Q value was 0.90 by adjusted SROC method. The results indicated that the diagnostic value of type B ultrasonography were high, thus could be regarded as an effective method for fatty liver diagnosis. CONCLUSION: Meta-analysis on evaluating diagnostic tests could be used to assess the diagnostic test to increase the power of conclusion, and to improves its reliability.

Diagnostic Tests, Routine↗
PubMedDate not supplied

Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses.

BACKGROUND: Children presenting with symptoms of attention-deficit/hyperactivity disorder (ADHD) have become highly prevalent in primary care practice; however, advanced practice registered nurses (APRNs) diagnostic methods used to identify and diagnose this disorder are greatly understudied. AIM: This study aimed to identify APRNs recognition and diagnostic practices of children who were suspected of having an ADHD diagnosis. It also addressed APRNs comfort levels with treating and diagnosing ADHD, along with certain diagnostic methods and their perceived accuracy of these methods. METHODS: This nonexperimental exploratory research study used a self-administered questionnaire to gather information about diagnostic methods used by APRNs who diagnose children with ADHD, treat the disorder, or did both. RESULTS AND DISCUSSION: The questionnaires identified that the APRNs were following the American Academy of Pediatrics diagnostic guidelines for diagnosing ADHD in children more closely than other health care providers (pediatricians and family physicians). The results of this study also indicated that most APRNs were very comfortable to comfortable making an ADHD diagnosis (52.5%), and 64.4% reported the same level of comfort with treating ADHD. These findings indicate that the majority of APRNs surveyed who works with children are comfortable with diagnosing and treating ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

[Influence of computer tomography diagnostics on the treatment in state health care system].

The presented paper is a continuation of the widely debated topic on the role of radiation technologies, including computed tomography (CT), in municipal medicine, which has been earlier raised on the pages of the Vestnik. The main objective of the paper is that by using the results obtained from the use of CT in a near-Moscow health care facility that is typical of Russia's municipal health care service, the author attempted to provide evidence that it is necessary to extensively introduce this technique into the most mass link of Russian public health care--municipal medicine. As an evidence basis, the author analyzed changes occurring in the organization of a therapeutic-and-diagnostic process the municipal health care facility from a great variety of organ and system pathology that is particularly important from the practical point of view. The data obtained before and after introduction of CT into the municipal diagnostic algorithms on specific, the most critical clinical situations are compared. Moreover, objective analytical data are confirmed by a battery of brilliant diagnostic images. The author elucidates the readiness of municipal clinicians for virtually complete use of CT data for their purposes. By using several nosological entities, he shows the CT-induced transfer of some therapeutic procedures from the regional to municipal area of practice. In addition, arguments are advanced in favor of the thesis that some therapeutic technologies now in use are not up to world standards and municipal health care cannot be in compliance with civilized standards without its effective diagnostic support. Prominent in the paper is the description of changes in the continuity of diagnostic medicine at the municipal and regional levels after inclusion CT into the day-to-day activities of a municipal facility. It is concluded that the population needs for CT: one 24-slice unit per 50,000 dwellers of an area under service of a municipal facility.

Brain Ischemia↗
PubMed2006

Application of molecular diagnostic methods to penaeid shrimp diseases: advances of the past 10 years for control of viral diseases in farmed shrimp.

The most important diseases of farmed penaeid shrimp have infectious aetiologies. Among these are diseases with viral, rickettsial, bacterial, fungal and parasitic aetiologies. Diagnostic methods for these pathogens include the traditional methods of gross pathology, histopathology, classical microbiology, animal bioassay, antibody-based methods, and molecular methods using DNA probes and DNA amplification. While methods using clinical chemistry and tissue culture are standard methods in veterinary and human diagnostic laboratories, the former has not been routinely applied to the diagnosis of penaeid shrimp diseases and the latter has yet to be developed, despite considerable research and development efforts that have spanned the past 40 years. No continuous shrimp cell lines, or lines from other crustaceans, have been developed. Hence, when molecular methods began to be routinely applied to the diagnosis of infectious diseases in humans and domestic animals in the mid- to late 1980s, the technology was applied to the diagnosis of certain important diseases of penaeid shrimp for which only classical diagnostic methods were previously available. A DNA hybridization assay for the parvovirus IHHNV was the first molecular test developed for a shrimp disease. This was followed within a year by the first PCR test for MBV, an important baculovirus disease of shrimp. Today, shrimp disease diagnostic laboratories routinely use molecular tests for diagnostic and surveillance purposes for most of the important penaeid shrimp diseases.

Animal Diseases↗
PubMed1991

Diminishing returns on the road to diagnostic certainty.

In the quest for diagnostic certainty, one can be led into a false sense of accomplishment by the results of sensitive, specific, and well-executed diagnostic tests that provide little or no diagnostic information. This is a consequence of the fact that as one approaches diagnostic certainty the useful information returned by diagnostic tests and observations approaches zero. This can be demonstrated by calculating the quantity of useful information provided by a test in a given clinical environment as one approaches certainty of diagnosis.

Cost-Benefit Analysis↗
PubMed1991

[Prospective study of community-acquired pneumonias seen in a general hospital. Diagnostic errors].

BACKGROUND: The patients with community acquired pneumonias seen in an emergency service of a basic general hospital during one year were evaluated to assess their etiological, clinical and radiological features, and also to investigate the initial and final diagnosis of the disease, its evolution and the parameters associated with each microbiological type. METHODS: A medical team investigated daily the clinical records. For etiologic diagnosis, blood cultures, serological studies, urine counterimmunoelectrophoresis (CIE) and, in individualized patients, pleural fluid culture, bronchoaspirate and bronchoalveolar lavage were performed. The discordance between the initial clinical and radiological diagnosis and the microbiological results, and also the initial and final diagnostic errors were analyzed. RESULTS: 311 cases of pneumonia (150 adults and 161 children) were diagnosed. 95 (30%) had microbiological confirmation. Streptococcus pneumoniae was the most commonly isolated organism. Serologic studies were the diagnostic method with the highest yield. Complications developed in 28% of the patients and the mortality rate was 2%. There was a relationship between mortality and a high respiratory rate on admission. The initial-final diagnostic discrepancy was 43% in atypical pneumonias and 40% in bacterial pneumonias. CONCLUSIONS: Clinical parameters permitting the differentiation between atypical and bacterial pneumonia were not found. The initial diagnostic error was 12%, consisting of false positives in all instances, and the final diagnostic error included 15% false positives and 10% false negatives. Underlying diseases have a influence on the evolution of pneumonia. The mean respiratory rate on admission should be measured as a prognostic indicator. In the present study, urine CIE was a poorly sensitive method.

Adolescent↗
PubMed1989

The sensitivity and specificity of clinical diagnostics during five decades. Toward an understanding of necessary fallibility.

Published studies encompassing more than 50,000 autopsies were assessed to determine the sensitivity and specificity of clinical diagnostics (the diagnostic process) in persons dying of 1 of 11 specific diseases during the period 1930 through 1977. The accuracy of clinical diagnostics, as reflected in these two determinations, appeared to improve over this period with respect to some of the diseases studied (rheumatic heart disease and leukemia), while for others it worsened (pulmonary tuberculosis, peritonitis, carcinoma of the lung, gastric carcinoma, and carcinoma of the liver and extrahepatic biliary tract) and for a significant number diagnostic accuracy seemed refractory to sustained change (pulmonary embolism, primary cirrhosis of the liver, gastric/peptic ulcer, and acute coronary thrombosis/myocardial infarction). The findings suggest a new way in which the autopsy can be used to monitor clinical diagnostics to identify possible sources of systematic weaknesses and provide data that can be used to approach the difficult subject of necessary fallibility.

Autopsy↗
PubMedDate not supplied

Diagnosis by the bit: a method for evaluating the diagnostic process.

The extent to which a diagnostic observation or test contributes to a diagnosis is usually represented by a conditional, or Bayesian, probability. According to information theory, the contribution of a diagnostic observation can also be measured in bits of information. This offers a representation of the Bayes rule which may be useful in comparing and evaluating diagnostic sequences, since the diagnostic contributions of the various tests, expressed as bits of information, are additive, providing a simple and graphic representation of the diagnostic process.

Bayes Theorem↗
PubMed1984

[Can therapeutic trials serve as a model for the evaluation of diagnostic methods?].

Many health care professionals think that diagnostic technologies must be assessed as treatments are and that controlled diagnostic trials must be organized for evaluation of diagnostic tests. There are many differences between these two types of trials relating with: unfeasibility of blind judgments, biases due to requesting of diagnostic tests in addition to technologies to be compared, number of patients required for a sufficiently powerful statistical analysis, diverging interest of the various clinical teams involved into the assessment. A different approach using simulation methods and decision trees appears more appropriate in the evaluation of diagnostic technics.

Clinical Trials as Topic↗
PubMed1995

[Small bowel injuries in blunt abdominal trauma--a diagnostic problem!].

AIMS: Injuries of the small bowel following a blunt abdominal trauma are rare (incidence 6%). The diagnosis is difficult and therefore often missed. The aim of this paper is to acquire an useful diagnostic sequence of our own results in comparison to the literature. METHODS: The diagnostic procedures and the time of the final diagnosis of 13 patients with this rare injury have been retrospectively analysed. RESULTS: Two of these 13 patients died in the emergency room. Five of the remaining 11 patients had signs of peritonitis at the first examination. These were confirmed by findings either in peritoneal lavage (3), ultrasound (1) or X-ray (1). Patients without signs of peritonitis revealed no pathological signs at the first examination with these diagnostic tools. Correct diagnosis was achieved on 7/11 patients within 24 hours. The diagnosis of small bowel injury was confirmed by the rest of the patients (n = 4) after an average of 11 days after trauma. DISCUSSION/CONCLUSION: Initial assessment with diagnostic tools as ultrasound, peritoneal lavage or X-ray is poor. Therefore repetitive controls (Nowadays by ultrasound) are indicated. The CT is a valuable tool to detect an organ lesion in hemodynamic stable patients with positive proof of liquid in the ultrasound. Today the value of the diagnostic laparoscopy is not established. It should be considered that a local ischemia due to the blunt trauma can cause a delayed perforation.

Abdomen↗
PubMed1995

[What to choose? On the rational use of diagnostic imaging in pediatrics].

Dynamic development and progress in diagnostic imaging imply the rational use of diagnostic methods and their clinical applications. The choice of diagnostic techniques, especially in pediatrics, is still of fundamental importance. Proper indications for diagnostics may reduce the invasiveness of diagnostic procedures.

Diagnostic Imaging↗
PubMed1995

[Quality assurance in diagnostic radiology].

Quality assessment is increasingly important in medicine in general as well as in diagnostic imaging. Quality in medicine includes state-of-the-art procedures, patient satisfaction, economic aspects, safety, and access to adequate care for the entire population. In order to measure quality more specifically in diagnostic imaging, several levels of efficacy have been defined. These include technical efficacy, diagnostic accuracy, diagnostic-thinking efficacy, therapeutic efficacy, outcome efficacy, and societal efficacy. Major factors in improving quality in diagnostic imaging include the expanded access to and use of databases, progress in continuing education, and increased research activities.

Diagnostic Imaging↗
PubMed1994

The Routine Antenatal Diagnostic Imaging with Ultrasound Study: another perspective.

The Routine Antenatal Diagnostic Imaging With Ultrasound Study (RADIUS) has reported that the adoption of routine screening in the United States would add considerably to health care costs, but stated that a potential benefit may be identification of fetal anomalies. To determine whether the cost per detected malformed fetus using data from the RADIUS study is cost-effective, a comparison is made with the California maternal serum alpha-fetoprotein (MSAFP) screening program. When screening ultrasound is performed by individuals who have a diagnostic rate similar to that reported for tertiary centers that participated in the RADIUS study (6.8 per 1000), the cost for identifying a malformed fetus is $10,805 less ($200 per ultrasound examination) than the cost using MSAFP screening ($40,338; $53 per test). However, when the screening examination is performed by individuals whose diagnostic rate is similar to that reported for non-tertiary centers (1.7 per 1000) that participated in the RADIUS study, the cost for identifying a malformed fetus ($115,575) is $75,237 higher than MSAFP screening. Using data from the RADIUS study, a proposal is suggested by which physicians are reimbursed for second-trimester ultrasound based upon their diagnostic skills. This approach maintains the cost per detected malformed fetus at less than $30,000, decreases the current cost of diagnostic ultrasound to third-party payers, and allows second-trimester ultrasound to be offered as a cost-effective screening test for low-risk patients for identification of malformed fetuses.

Congenital Abnormalities↗
PubMed1996

Functional diagnostic work-up in patients with irritable bowel syndrome.

The first aim of the study was to find a cause of symptoms in patients suffering from "irritable bowel syndrome" using diagnostic tests aimed at functional disorders of lower gut. A second aim was to test, whether the presence of irritable bowel syndrome (or, synonymously, absence of classic organic disease) can be predicted by specific symptoms. 134 consecutive patients (50 +/- 16 SD years, range 17 to 88, 94 women) presenting in our gastroenterological outpatient department with abdominal pain and altered bowel habits were included. A conventional diagnostic work-up aimed at classic organic diseases and, if negative, a functional diagnostic work-up aimed at gastrointestinal malfunction such as dietary fibre trial, functional proctoscopy, defecography, colonic transit of radiopaque markers, anorectal manometry, and lactose tolerance test were done. A classic organic disease was found in only 15 of 134 patients by conventional diagnostic tests. Functional diagnostic work-up yielded a diagnosis in 70 of the remaining 119 patients that else would have been labeled to suffer from IBS (25 slow transit constipation, 20 disordered defecation, nine low fibre intake, and nine lactose intolerance among them). When symptoms were evaluated with a standardized questionnaire, "constipation" and the "necessity of straining to open bowels" were very specific for functional bowel disorder (92% and 100%), but sensitivity of both symptoms was only about 60%. The so-called "Manning criteria" had a very low prevalence in our sample and so were not discriminatory. Since in more than half of the patients with "irritable bowel syndrome" a specific diagnosis can be reached, functional tests should be considered in such patients. The symptom "constipation" in patients with lower gut complaints predicted a functional disorder rather than a classic organic disease with a high specificity.

Adolescent↗
PubMed1997

Analysis of correlated ROC areas in diagnostic testing.

This paper focuses on methods of analysis of areas under receiver operating characteristic (ROC) curves. Analysis of ROC areas should incorporate the correlation structure of repeated measurements taken on the same set of cases and the paucity of measurements per treatment resulting from an effective summarization of cases into a few area measures of diagnostic accuracy. The repeated nature of ROC data has been taken into consideration in the analysis methods previously suggested by Swets and Pickett (1982, Evaluation of Diagnostic Systems: Methods from Signal Detection Theory), Hanley and McNeil (1983, Radiology 148, 839-843), and DeLong, DeLong, and Clarke-Pearson (1988, Biometrics 44, 837-845). DeLong et al.'s procedure is extended to a Wald test for general situations of diagnostic testing. The method of analyzing jackknife pseudovalues by treating them as data is extremely useful when the number of area measures to be tested is quite small. The Wald test based on covariances of multivariate multisample U-statistics is compared with two approaches of analyzing pseudovalues, the univariate mixed-model analysis of variance (ANOVA) for repeated measurements and the three-way factorial ANOVA. Monte Carlo simulations demonstrate that the three tests give good approximation to the nominal size at the 5% levels for large sample sizes, but the paired t-test using ROC areas as data lacks the power of the other three tests and Hanley and McNeil's method is inappropriate for testing diagnostic accuracies. The Wald statistic performs better than the ANOVAs of pseudovalues. Jackknifing schemes of multiple deletion where different structures of normal and diseased distributions are accounted for appear to perform slightly better than simple multiple-deletion schemes but no appreciable power difference is apparent, and deletion of too many cases at a time may sacrifice power. These methods have important applications in diagnostic testing in ROC studies of radiology and of medicine in general.

Analysis of Variance↗
PubMed1998

Amended reports in surgical pathology and implications for diagnostic error detection and avoidance: a College of American Pathologists Q-probes study of 1,667,547 accessioned cases in 359 laboratories.

OBJECTIVES: To evaluate amended report rates relative to surveillance methods and to identify surveillance methods or other practice parameters that lower amended report rates. DESIGN: Participants in the 1996 Q-Probes quality improvement program of the College of American Pathologists were asked to prospectively document amended surgical pathology reports for a period of 5 months or until 50 amended reports were recorded. The methods of error detection were also recorded and laboratory and institutional policies surveyed. Four types of amended reports were investigated: those issued to correct patient identification errors, to revise originally issued final diagnoses, to revise preliminary written diagnoses, and to revise other reported diagnostic information that was significant with respect to patient management or prognosis. PARTICIPANTS: Three hundred fifty-nine laboratories, 96% from the United States. RESULTS: A total of 3147 amended reports in all four categories from a survey of 1,667,547 surgical pathology specimens accessioned during the study period were issued by the participants. The aggregate mean rate of amended reports was 1.9 per 1000 cases (median, 1.5 per 1000 cases). Of these, 19.2% were issued to correct patient identification errors, 38.7% to change the originally issued final diagnosis, 15.6% to change a preliminary written diagnosis, and 26.5% to change clinically significant information other than the diagnosis. Most frequently, a request from a clinician to review a case (20.5%) precipitated the error detection. Although not statistically significant, a higher amended report rate (1.6 per 1000) for all error types was associated with routine diagnostic slide review that was performed after completion of the surgical pathology report. This is compared to rates for institutions that had routine diagnostic slide review of cases prior to finalization of pathology reports (1.2 per 1000) and institutions that had no routine diagnostic slide review (1.4 per 100). Slide review of cases prior to completion of reports lowered the rate of amended reports issued for two types of amended reports: those in which the originally issued final diagnosis was changed and those in which information other than the diagnosis was changed for patient management or prognostic significance. Other laboratory practice variables examined were not found to be associated with the amended report rate. CONCLUSIONS: There is an association between lower amended report rates and diagnostic slide review of cases prior to completion of the pathology report. The level of case review and type of case mix that is necessary for optimal quality assurance needs further investigation.

Diagnostic Errors↗
PubMed1999

Risk of venous thrombosis with use of current low-dose oral contraceptives is not explained by diagnostic suspicion and referral bias.

BACKGROUND: The magnitude of the relative risk of venous thrombosis caused by low-dose oral contraceptive use is still debated because previous studies might have been affected by diagnostic suspicion and referral bias. METHODS: We conducted a case-control study in which the effect of diagnostic suspicion and referral bias was excluded. The study was performed in 2 diagnostic centers to which patients with clinically suspected deep vein thrombosis of the leg were referred. History of oral contraceptive use was obtained before objective testing for thrombosis. Young females with an objective diagnosis of deep vein thrombosis were considered case patients, and those who were referred with the same clinical suspicion but who had no thrombosis served as control subjects. Participants were seen between September 1, 1982, and October 18, 1995: 185 consecutive patients and 591 controls aged 15 to 49 years with a first episode of venous thrombosis and without malignant neoplasms, pregnancy, or known inherited clotting defects. RESULTS: The overall odds ratio for oral contraceptive use was 3.2 (95% confidence interval [CI], 2.3-4.5); after adjustment for age, family history of venous thrombosis, calendar time, and center, the odds ratio was 3.9 (95% CI, 2.6-5.7). In the idiopathic group (120 patients and 413 controls, excluding recent surgery, trauma, or immobilization), the odds ratio for oral contraceptive use was 3.8 (95% CI, 2.5-5.9); after adjustment, the odds ratio was 5.0 (95% CI, 3.1-8.2). CONCLUSIONS: In this study, in which patients and controls were subj ect to the same referral and diagnostic procedures, we found similar relative risk estimates for oral contraceptive use as in previous studies. We conclude that diagnostic suspicion and referral bias did not play an important role in previous studies and that the risk of venous thrombosis with use of current brands of oral contraceptives still exists.

Adolescent↗
PubMed2000

Sensitivity of diagnostic and localization tests for pheochromocytoma in clinical practice.

BACKGROUND: Although pheochromocytomas are believed to account for fewer than 0.3% of all cases of hypertension, aggressive diagnostic and surgical intervention is recommended whenever a pheochromocytoma is suspected because uncontrolled catecholamine release from the tumors can lead to catastrophic consequences. Many biochemical diagnostic and imaging localization tests exist for detecting pheochromocytomas. We sought to evaluate the sensitivity of these tests used over a 35-year period at a single institution. METHODS: Thirty-five patients with complete medical records who had pathologically confirmed pheochromocytomas between 1962 and 1997 at the University of Chicago Hospitals were identified. Sensitivity and 95% confidence intervals were calculated for 12 laboratory diagnostic tests and 5 imaging studies. RESULTS: The most sensitive laboratory diagnostic tests in our study were plasma total catecholamines (95%) and urine total metanephrines (100%). Testing for urine vanillylmandelic acid, while less expensive and easier to perform than many other tests, had a slightly lower sensitivity (89%). The most sensitive imaging tests in the study were magnetic resonance imaging (100%) and iodine I-131 metaiodobenzylguanidine scintigraphy (100%). The more often used computed tomography had only 88% sensitivity. Localization was safely and successfully performed on two pregnant patients using magnetic resonance imaging and ultrasound. CONCLUSIONS: By properly choosing from the wide array of laboratory diagnostic and imaging tests, pheochromocytomas can be identified and localized with nearly 100% sensitivity. These tests should be performed in any patient for whom the diagnosis of pheochromocytoma is being considered.

Adrenal Gland Neoplasms↗