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PubMedDate not supplied

[Algorithm for prediction of reconvalescent salmonellosis carriage].

Of total of 181 patients with Salmonella infection were examined by clinical and laboratory methods. As many as 124 indices characterizing biological properties of Salmonellae, a large intestine microbiocenosis status, systemic and local immunity, were investigated as well. Among these indices, the most revealing signs were defined to prognosticate the reconvalescent carrier state. Conclusion was made on the prevalence of immune mechanisms in the development of reconvalescent salmonella carriage and on the important role of the ability of a causative agent to inactivate the factors of host innate immunity in this process. Diagnostic prognosis algorithm for Salmonella bacterial carriage was worked out. Clinical testing confirmed its effectiveness.

Adolescent↗
PubMed2006

Comparing the effects of sampling designs on the diagnostic accuracy of eight promising screening algorithms for pediatric bipolar disorder.

BACKGROUND: Past studies have used markedly different inclusion and exclusion criteria to form samples used to evaluate diagnostic tests, making it difficult to compare results across studies. The present investigation compared eight screening algorithms in the same sample but under two different design strategies. METHODS: The DSM-IV diagnoses were based on a semi-structured diagnostic interview (KSADS) with the parent and youth sequentially. Raters were blind to index test scores. Participants were 216 youths with bipolar spectrum diagnoses and 284 youths with other Axis I diagnoses or no diagnosis. T-tests evaluated whether areas under the curve (AUC) from receiver operating characteristic analyses differed under the two design conditions. RESULTS: All of the instruments discriminated bipolar cases better when inclusion and exclusion criteria duplicated those used in phenomenological research studies selecting narrow phenotypic cases (AUCs ranging from .90 to .81). The measures performed less well when more heterogeneous clinical presentations were included [AUCs ranging from .86 to .69, t(8) = 4.99, p = 001]. CONCLUSIONS: Results indicate that checklists perform less well discriminating pediatric bipolar disorder under conditions that more closely resemble clinical practice. Test users must consider whether the sampling strategies and participant characteristics used to evaluate tests match the characteristics of their own patients.

Adolescent↗
PubMed2005

The effects of gray scale image processing on digital mammography interpretation performance.

RATIONALE AND OBJECTIVES: To determine the effects of three image-processing algorithms on diagnostic accuracy of digital mammography in comparison with conventional screen-film mammography. MATERIALS AND METHODS: A total of 201 cases consisting of nonprocessed soft copy versions of the digital mammograms acquired from GE, Fischer, and Trex digital mammography systems (1997-1999) and conventional screen-film mammograms of the same patients were interpreted by nine radiologists. The raw digital data were processed with each of three different image-processing algorithms creating three presentations-manufacturer's default (applied and laser printed to film by each of the manufacturers), MUSICA, and PLAHE-were presented in soft copy display. There were three radiologists per presentation. RESULTS: Area under the receiver operating characteristic curve for GE digital mass cases was worse than screen-film for all digital presentations. The area under the receiver operating characteristic for Trex digital mass cases was better, but only with images processed with the manufacturer's default algorithm. Sensitivity for GE digital mass cases was worse than screen film for all digital presentations. Specificity for Fischer digital calcifications cases was worse than screen film for images processed in default and PLAHE algorithms. Specificity for Trex digital calcifications cases was worse than screen film for images processed with MUSICA. CONCLUSION: Specific image-processing algorithms may be necessary for optimal presentation for interpretation based on machine and lesion type.

Algorithms↗
PubMed1998

The use of diagnostic imaging to assess spinal arthrodesis.

Despite advances in surgical techniques and internal fixation devices, pseudarthrosis remains a significant factor in the clinical failure of attempted fusions in the cervical, thoracic, and lumbar spine. This article reviews the use of diagnostic imaging in the assessment of spinal fusion, with a focus on the accuracy of different imaging modalities based on surgical exploration. A cost-effective strategy for the radiographic follow-up of patients after spinal fusion surgery also is presented.

Algorithms↗
PubMed2003

Diagnostic approaches to suspected deep vein thrombosis and pulmonary embolism.

The present paper aims at reviewing our present knowledge on the diagnosis of deep vein thrombosis and pulmonary embolism with a particular emphasis on clinically suspected outpatients. The various contemporary diagnostic tools (including clinical probability assessment, fibrin D-Dimer measurement, venous compression ultrasonography, ventilation/perfusion lung scintigraphy, helical CT scan, and echocardiography) are presented and rational sequential strategies are discussed in their various aspects, including validation in outcome studies, and cost-effectiveness analyses.

Algorithms↗
PubMed1997

[Is there a renaissance of conservative therapy in plastic penile induration?].

The management of Peyronies's disease should include an exact pretherapeutic staging. Diagnostic methods like ultrasound imaging, X-ray using "mammography technique" and magnetic resonance imaging are modalities of choice. The good results of new conservative therapy options have to be evaluated in randomized multicentric studies. Surgical therapy shows good results in patients with calcified plaques.

Algorithms↗
PubMed2003

Diagnostic decision rule for support in clinical assessment of the need for surgical intervention in horses with acute abdominal pain.

A prospective survey of horses with colic referred to a university hospital was undertaken to elaborate on a simple clinical decision support system capable of predicting whether or not horses require surgical intervention. Cases were classified as requiring surgical intervention or not on the basis of intraoperative findings or necropsy reports. Logistic regression analysis was applied to identify predictors with the strongest association with treatment needed. The classification and regression tree (CART) methodology was used to combine the variables in a simple classification system. The performance of the elaborated algorithms, as diagnostic instruments, was recorded as test sensitivity and specificity. The CART method generated 5 different classification trees with a similar basic structure consisting of: degree of pain, peritoneal fluid colour, and rectal temperature. The tree, constructed at a prevalence of 15% surgical cases, appeared to be the best proposal made by CART. In this classification tree, further discrimination of cases was obtained by including the findings of rectal examination and packed cell volume. When regarded as a test system, the sensitivity and specificity was 52% and 95%, respectively, corresponding to positive and negative predictive values of 68% and 91%. The variables examined in the present study did not provide a safe clinical decision rule. The classification tree constructed at 15% surgical cases was considered feasible, the proportion of horses incorrectly predicted to be without need of immediate surgery (false negatives) was small, whereas the proportion of horses incorrectly predicted to be in need of immediate surgery (false positives) was large. Some of the false positive horses were amenable to surgical treatment, although these cases did not conform to the strict definition of a surgical case. A less rigorous definition of a surgical case than that used in the present study would lower the percentage of false positives.

Abdomen, Acute↗
PubMed2006

Pediatric inflammatory bowel disease.

Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents. The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies, and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn's disease and ulcerative colitis. Once diagnosed, the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population. Surgical management is usually indicated for failure of medical management, complication, or malignancy. Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented. The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease.

Adolescent↗
PubMed2000

Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children.

The aim of this study was to select children with pathological lesions of the intra-articular structures from children with identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment is justified only in acute cases.

Adolescent↗
PubMed2006

Characteristics of nosologically informative data sets that address key diagnostic issues facing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) and International Classification of Diseases, eleventh edition (ICD-11) substance use disorders workgroups.

AIMS: Over the past two decades, many nosological issues have been addressed by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) substance use disorders workgroups. Even with those efforts, there are key issues that have not been resolved and must be revisited, or addressed de novo, by the workgroups. These lingering points are broad, due to the array of substances classified under the diagnostic umbrella of substance use disorders. They include substantive issues ranging from dimensional approaches, similar criteria for each substance, cut-points and thresholds, distinct abuse and dependence classifications, new criteria and drugs, to less substantive ones, such as the adjectives used to describe the severity of the behaviors. RESULTS: This paper describes the characteristics of the data sets that will be needed to resolve the key nosological issues. Ten points are described: (1) data must be true to nomenclature under study; (2) flexible regarding rearrangements of scoring algorithms; (3-4) able to assess substances individually and retain former versions of the criteria; (5) not rely on shortened versions; (6) utilize samples that are generalizable; (7) make diagnoses with transparent algorithms; (8) combine mixed methods for corroborating data; (9) utilize assessments that collect reliable and valid diagnoses and criteria; and (10) stretch the limits by allowing for new discoveries. CONCLUSIONS: This paper describes each of these and gives examples of the limitations and strengths of data for the purpose of defining a useful, unified concept of addictive behaviors.

Algorithms↗
PubMedDate not supplied

Problem-oriented prefetching for an integrated clinical imaging workstation.

Prefetching methods have traditionally been used to restore archived images from picture archiving and communication systems to diagnostic imaging workstations prior to anticipated need, facilitating timely comparison of historical studies and patient management. The authors describe a problem-oriented prefetching scheme, detailing 1) a mechanism supporting selection of patients for prefetching via characterizations of clinical problems, using multiple data sources (picture archiving and communication systems, hospital information systems, and radiology information systems), classifying patients into cohorts on the basis of their medical conditions (e.g., lung cancer); and 2) prefetching of multimedia data (imaging, laboratory, and medical reports) from clinical databases to enable the viewing of an integrated patient record. Preliminary evaluation of the prefetching algorithm using classic information retrieval measures showed that the system had high recall (100 percent), correctly identifying and retrieving data for all patients belonging to a target cohort, but low precision (50 percent). A key finding during testing was that the recall of the system was increased through the use of multiple data sources (compared with one data source), because of better patient descriptors. Medical problems and patient cohorts were more specifically defined by combining information from heterogeneous databases.

Algorithms↗
PubMed2005

Effective dose as a limiting quantity for the evaluation of primary barriers for diagnostic x-ray facilities.

The National Council on Radiation Protection in Report 147 of NCRP has recommended that shielding design limit for diagnostic x-ray facilities must be consistent with the guidance specified in Report 116 of NCRP. In the latter report, it is specified that the limit of exposure must be in terms of effective dose received annually. New mathematical models that are different from those in Report 49 of NCRP are reported in the recently published Report 147 of NCRP, and the design limit is specified as kerma value. In this work, to provide a means of compliance with the recommendation in Report 116 of NCRP, the effective dose that is classified as the limiting quantity in Report 57 of ICRU has been incorporated into shielding algorithms for diagnostic x-ray facilities. Also, shielding models are presented using exposure, kerma-in-air, kerma-in-tissue and ambient dose equivalent as limiting quantities. A computer program, XSHIELD, was written in FORTRAN language to execute these models. With design limits set at 1 mSv y and 0.25 mSv y (as specified in Report 116 of NCRP) and using sample distribution of workload, age of patient, field sizes at image receptor, and types of projection, computations of shielding requirements were carried out for rooms designated adult and pediatric chest rooms. For same values of respective workload and design limit, the use of exposure, kerma-in-air, kerma-in-tissue, and ambient dose equivalent as limiting quantity produces thicker barriers than the use of effective dose. By the use of effective dose as limiting quantity, the shielding requirement for the same workload is independent of size of the individual to be shielded. However, irradiating the individual who is to be shielded in posterior-anterior projection requires a thicker barrier than when irradiation is in lateral projection.

Adolescent↗
PubMed1998

[Aortoiliac graft infection as a diagnostic and treatment problem].

UNLABELLED: Aortoiliac graft infection occurs in 2-6% of patients with such prosthesis. This condition is seldom properly diagnosed by conventional radiographic methods, leading to high morbidity and mortality. Clinically, the diagnosis of aortic graft infection is difficult because patients may have a variety of nondescript clinical complaints. The diagnosis of graft infection when associated with minimal or absent clinical signs of low-grade infection is uncertain, but is critically important to avoid frequently catastrophic complications such as sepsis, gastrointestinal hemorrhage, and suture line disruption. AIM OF THE STUDY: identification of bacterial flora present in aortoiliac graft infection; the presentation of my own experience in the detection of aortoiliac graft infection with special description of isotopic study with WBC labeled 99mTc HM-PAO and estimation of the usefulness of this test in comparison with computed tomography, ultrasonography, fistulography and angiography; evaluation of the usefulness of various treatment methods; establishing principles (algorithm) of diagnostic and therapeutic procedures in the case of the suspicion of aortoiliac graft infection. As many as 1190 patients with implanted aortoiliac graft in 1986-1996 at the General and Vascular Surgery Clinic in Szczecin were studied (Tab. 2). Thirty-one patients in the study had deep aortoiliac graft infection (Tab. 3), while 9 patients had, in addition, prosthetic-enteric fistulae and 1 had arterio-enteric secondary fistulae. The group of 31 patients with deep graft infection, that is 2.6% of all patients (1190), had aortoiliac graft implanted at the mentioned time period (Tab. 4, 5). Test results for detection of graft infection have been analysed (Tab. 17). The results of isotopic investigation (Tab. 16), computed tomography (Tab. 11), ultrasonography (Tab. 13), fistulography (Tab. 14) and angiography (Tab. 15) were compared with intraoperative state or in a case of exclusion of infection, with results of follow up. Results of various paths of treatment were estimated (Tab. 18). Based on performed cultures most common bacterial flora from infected grafts, was identified (Tab. 9, 10). The sensitivity of the isotopic study with labeled white blood cells in detection of graft infection was 88%, specificity was 97%, accuracy 93%, positive predictive value 96%. Other useful diagnostic procedures in detection of aortic graft infection are: computed tomography with an accuracy of 75%, endoscopic investigation useful in detection of arterio-enteric fistulae with an accuracy of 50% and ultrasonography with an accuracy of 35.5% (Tab. 17). The choice of the best treatment is still controversial. In my material total excision of infected graft and extraanatomic revascularization were burdened with 50% mortality rate. Among patients treated less radically the mortality rate was considerably lower. In a group of patients with the excision of the infected graft only, the mortality rate was 9% but the amputation rate was 36.4% and in a group of patients with excision of infected graft and reconstruction in situ, the mortality rate was 25% (Tab. 18). Taking into consideration our results, less aggressive methods of aortic graft infection treatment such as the excision of the infected part of the prosthesis with or without in situ revascularization if only possible should be recommended. Most common in bacterial cultures from infected aortoiliac grafts with prosthetic-enteric fistulae were Escherichia coli found (Tab. 10). In infections without fistula various types of Staphylococcus aureus were identified (Tab. 9). CONCLUSIONS: 1. In cases of aortoiliac graft infection the most common cultured bacteria are found to be Staphylococcus aureus. If there is additional prosthetic-enteric fistula Escherichia coli is the most common cultured bacteria. 2. In a case there was suspicion of aortoiliac graft infection, proper diagnostic procedures are most important for effective ma

Adult↗
PubMed2003

Development of an evidence-based algorithm for the management of ovarian cancer.

OBJECTIVE: To describe the management of ovarian cancer to be undertaken by a gynaecologist and to describe the highest level of primary research evidence supporting it. DESIGN: Use of regional guidelines and semi-structured interviews with gynaecological oncologists to devise a flow-chart algorithm for management. Use of an algorithm to identify the key research questions and to define search strategies for primary research, which was assessed using pre-defined criteria for validity. MAIN OUTCOME MEASURES: Highest level of evidence for each research question based on the design of the valid studies. RESULTS: Prospective cohort studies (level II-2A) support the algorithm's diagnostic procedures. The evidence for accurate staging is derived from case series data (level II-2B). Preserving the uterus in young women wishing to maintain fertility is supported by prospective cohort studies (level II-2A) and by case series data (level IV) for women with germ cell tumours. Prospective cohort studies (level II-2A) support surgical management with hysterectomy, bilateral oophorectomy and debulking. The evidence for chemotherapy comes from randomised controlled trials (level I), except for germ cell tumours where the evidence was from case series data (level IV). CONCLUSIONS: The management of ovarian cancer and the level of evidence supporting it can be described using a flow-chart algorithm. Evaluations of whether this presentation helps consultants follow guidelines are required.

Adolescent↗
PubMed2005

[The treatment of clinically silent breast lesions].

Analysis of a diagnostic procedure leading to the clinical diagnosis and treatment of nonpalpable lesions in breast was presented in the paper. 668 women with breast lesions were treated in our department between 1995 and 2001. Nonpalpable lesions were detected in 68 women. The following diagnostic-treatment algorithm was used: case history and physical examination, radiological examination, hooked wire localisation under mammography or USG, breast surgical biopsy, intra-operative histological examination, further procedures according to morphological changes found in patients. Mammography was performed in 68 patients. Stereotactic needle biopsy under mammography was done in 61 patients (DXRBL-18-9 needle was used). The lesions were localized under USG in 7 patients. Surgical biopsy and X-Ray examination of the removed specimen was performed in 68 patients. Intra-operative histological examination revealed benign lesions in 54 women whereas malignant lesions were found in 14 women. Post-operative complications were present in 8 patients. Nonpalpable breast lesions require individual, planned diagnostic treatment. Stereotactic needle biopsy not only allows definitive surgical removal of malignant lesions within margins of normal breast tissue but also gives a good cosmetic effect. Complex diagnostics together with standardized procedure ensure the highest rate of correct diagnosis and lower the risk of diagnostic failures.

Adult↗
PubMed2005

[Intracranial meningiomas--criteria for selection of the optimum therapeutic modality].

The authors present their own proposal for a standard diagnostic procedure algorithm in intracranial meningiomas, which they used in their prospective, non-randomized longitudinal study in a group of 30 subjects within a year. The following four criteria were assessed in each patient: age, physical condition according the ASA classification, location of the meningioma on the MRI (superficial, the scull base) and the growth invasivity using selective DSA (ACI+ACE) and MRI (the vascularization type, the oedema index and the change in the oedema signal intensity in 3.5 hours). The criteria helped to establish the optimum therapeutic procedure for each patient: embolisation without a follow-up surgery (2 subjects), observation (2 subjects), pre-operative embolisation (5 subjects) and surgery without preceeding embolisation (21 subjects). This study did not assess the intracranial meningiomas treatment outcome. It highlights significance of the diagnostic procedures standardization in order to establish their optimum therapeutic modality.

Adult↗
PubMedDate not supplied

[Algorithms and computation methods of diagnostic coefficients in dynamic scintigraphy of skeleton and skeletal muscles].

The paper is concerned with a program for data processing of dynamic scintigraphy of the skeleton and skeletal muscles using 99mTc-sodium 1-hydroxy-ethane-1, 1-diphosphonate. Employing gamma-chamber computer the program enables rapid and precise computation of the coefficient of RP elimination from the blood and the coefficients of RP accumulation by the bones and muscle tissue. Based on those coefficients one can make diagnosis and follow the time-course of pathological changes occurring in the skeleton during endocrine diseases.

Algorithms↗
PubMed1989

Impact of postprocessing on the detection of simulated pulmonary nodules with digital radiography.

The authors compared the impact of five postprocessing algorithms on diagnostic performance in the detection of simulated pulmonary nodules on storage phosphor-based digital chest radiographs. Tissue equivalent paraffin nodules (0.5-2.5 cm diameter) were randomly positioned over the chest of a normal volunteer. Receiver operating characteristics (ROC) analysis of a total of 2500 observations by five readers indicated that the default unenhanced image having the appearance of a conventional chest radiograph (ROC area = 0.87 +/- 0.05) was as good as an image with moderate enhancement of medium frequencies (ROC area = 0.85 +/- 0.03), an image with reversed gray scale polarity (ROC area = 0.84 +/- 0.02), an image with reversed gray scale and moderate enhancement of medium frequencies (ROC area = 0.87 +/- 0.03), and an image with a linear rather than a sigmoid gradation curve and incorporating moderate enhancement of medium frequencies (ROC area = 0.87 +/- 0.03). The authors conclude that the specific algorithms they tested had no effect on the detection of pulmonary nodules.

Algorithms↗