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At least 145 records · Page 8Linked to original sources
PubMed2003

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease.

Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.

Adult↗
PubMed1981

Ranking diagnostic protocols--a proposed process based on use of the nine-cell diagnostic decision matrix.

A process for ranking competing diagnostic protocols for a specific disease is presented. The process incorporates the basic principles of medical decision making, and provides for the consideration of equivocal test results as well as results for patients who have ill-defined or incompletely defined disease. It provides a means for developing an a priori optimization process prior to ranking competing diagnostic algorithms. Methods for transferring ranking information among populations with widely differing disease prevalences are given.

Clinical Laboratory Techniques↗
PubMed2004

A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.

BACKGROUND: Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE: To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. PARTICIPANTS AND METHODS: Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students' estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. RESULTS: The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. CONCLUSION: A carefully designed, but traditionally administered, short course could not improve the students' abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the "rule-in conscious paradigm."

Adult↗
PubMed1985

Dose-response assessments of Kathon biocide (I). Diagnostic use and diagnostic threshold patch testing with sensitized humans.

Nearly all effective, commercially available preservatives possess skin sensitization potential. This manuscript describes a program of diagnostic patch and practical use testing of consumer products that contained Kathon CG, a relatively new biocide. A series of threshold diagnostic patch tests demonstrated that the minimal elicitation concentration in occluded patch testing of allergic subjects considerably exceeded the concentrations of the biocide typically present in normal diluted use of the test products. Use testing further confirmed a threshold exposure for eliciting allergic reactions. It showed that even subjects who have delayed contact hypersensitivity to Kathon CG used rinse-off personal care products preserved with this agent without experiencing elicitation of these allergies.

Dermatitis, Contact↗
PubMed1994

Reliability of diagnostic reporting for children aged 6-11 years: a test-retest study of the Diagnostic Interview Schedule for Children-Revised.

OBJECTIVE: This study examined the reliability of symptom reporting by community children of elementary school age and their parents on a version of the Diagnostic Interview Schedule for Children-Revised (DISC-R). METHOD: A sample of 109 children aged 6-11 years from an ongoing epidemiologic study were recruited for retest DISC-R interviews after completion of the study protocol. Retest interviews took place 7-18 days after the first interview and were conducted by interviewers who had no prior information about the subjects. Test-retest reliability for five common childhood psychiatric diagnoses was evaluated with the kappa statistic; the intraclass correlation coefficient was used to evaluate test-retest reliability of symptom scales. RESULTS: The reliability of the parents' reports on the DISC-R was good to excellent for attention deficit hyperactivity disorder and separation anxiety disorder; it was fair for overanxious disorder, oppositional defiant disorder, and conduct disorder. The children reported many fewer symptoms than the parents except for separation anxiety disorder; reliability was fair for separation anxiety disorder and poor for attention deficit hyperactivity disorder. The children were particularly unreliable in reporting about time factors, such as duration and onset of symptoms. When symptoms were considered without duration and onset, children's reports reached fair reliability for separation anxiety disorder, overanxious disorder, and attention deficit hyperactivity disorder but remained poor for oppositional defiant disorder. CONCLUSIONS: The results suggest that highly structured diagnostic interviews such as the DISC-R may not be appropriate for use with younger children of elementary school age in community-based studies.

Adolescent↗
PubMed1999

Consequences of the new diagnostic criteria for diabetes in older men and women. DECODE Study (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe).

OBJECTIVE: To evaluate the prevalence of diabetes and the risk of death in older European men and women aged between 60 and 79 years at baseline using the new American Diabetes Association diagnostic criteria for diabetes. RESEARCH DESIGN AND METHODS: The analysis involved existing population-based European studies from the DECODE Study Group (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) and involved baseline measures of fasting and 2-h glucose concentrations after a 75-g oral glucose tolerance test (OGTT) and follow-up to determine deaths. This analysis included 4,032 men and 2,207 women who were not previously known to have diabetes and 383 men and 319 women who had established diabetes. RESULTS: More than half of the diabetic subjects had already been diagnosed, one sixth had a fasting hyperglycemia > or = 7.8 mmol/l (140 mg/dl), one-sixth had a fasting glucose level of 7.0-7.8 mmol/l (126-140 mg/dl), and one-sixth had an isolated postchallenge hyperglycemia (fasting glucose < 7.0 mmol/l and 2-h glucose > or = 11.1 mmol/l [200 g/dl]). Compared with non-diabetic subjects, the hazard ratios for death in diabetic subjects were close to 2 and did not differ significantly according to the method of diagnosis of diabetes, age-group, or sex. CONCLUSIONS: One-third of the older diabetic subjects who were undiagnosed at baseline had isolated postchallenge hyperglycemia. OGTT screening of the subjects with impaired fasting glucose (6.1-6.9 mmol/l) would reduce this fraction by half. The group with isolated postchallenge hyperglycemia had an elevated risk of mortality similar to that of other diabetic subjects.

Age Factors↗
PubMed1998

The principle of diagnostic method and diagnostic imaging for infectious diseases.

Rapid progress of diagnostic examination or technique for infectious diseases has been observed in recent several years. Diagnostic imaging also developed remarkably through introductions of new technology, and made the diagnosis of infectious diseases much more easier than before. However, the most important point is the perfect collection of patients' or disease information and their appropriate evaluation by medical doctors to make full use of the latest technology. This fundamental ability of medical doctors is indispensable for rapid and certain diagnosis of infectious diseases.

Adult↗
PubMedDate not supplied

Breast ultrasonography: diagnostic efficacy of a computer-aided diagnostic system using fuzzy inference.

We have developed a computer-aided diagnostic (CAD) system using fuzzy inference for breast sonography and have evaluated the performance of the system. Our CAD system is not an automated image processing method, but requires the observer's subjective "scoring." Seven radiologists interpreted 54 breast mass lesions (24 malignant, 30 benign). Six criteria (shape, border, halo, internal echoes, posterior echoes, and edge shadows) were scored using a five-point rating scale. The output was described as a real number from 0.0 to 1.0. For cancer diagnosis, the sensitivity of the radiologists, a six-criteria CAD version, and a four-criteria version (excluding posterior echoes and edge shadows) were 63.1%, 82.1%, and 78.0%, respectively. Specificity was 71.0%, 42.9%, and 51.0%, respectively, while accuracy was 67.5%, 60.3%, and 63.0%, respectively. No significant differences in the areas under ROC curve (Az) were found between the observers and CAD system. Several cases assessed as false-negative by observers were correctly diagnosed by the CAD system, and diagnostic efficacy could be improved, especially among novice sonographers. Although the system's high false-positive rate needs to be reduced, it will assist radiologists in generating a level of suspicion for malignancy.

Algorithms↗
PubMed2001

[Diagnostics in clinically occult, radiologically suspect breast lesions more often surgery than needle diagnostics with image monitoring].

OBJECTIVE: To inventory the diagnostic methods used in patients with clinically occult, radiologically suspect breast lesions. DESIGN: Enquiry. METHOD: The departments of radiology of all Dutch hospitals were sent a list in January 2000 containing questions concerning the number of thread localizations in 1999 and the use of cytological or histological needle diagnostics with image monitoring prior to surgical intervention in clinically occult, radiologically suspect breast lesions. Of the 120 questionnaires mailed, 74 (62%) were completed and returned by clinics throughout the country. RESULTS: Fifty-one of the 74 hospitals (69%) had prior to operation carried out histological or cytological examinations and in these 51 hospitals this was done in 1743 of the 2857 lesions (61%): fine-needle aspiration cytology was performed in 1046 (/1743 = 60%; /4140 lesions in all 74 hospitals = 25%) and/or histological needle biopsy in 784 (45%; /4140 = 19%). CONCLUSION: In less than half of all non-palpable breast abnormalities non-surgical methods of diagnosis are used, histological needle biopsy less often than fine needle aspiration cytology.

Biopsy↗
PubMed2004

The diagnostic utility of human papillomavirus-testing in combination with immunohistochemistry in advanced gynaecologic pelvic tumours: a new diagnostic approach.

Gynaecologic pelvic tumours comprise a range of histological entities that are highly variable with respect to their clinical behaviour. The distinction of these tumours can be extremely difficult. Accurate identification of the primary tumour site has significant impact on the treatment strategy and prognosis. In this study we investigated the diagnostic and clinical utility of HPV (Human Papillomavirus)-testing in combination with selected immunohistochemical markers in advanced pelvic tumours of unknown primary origin. Specimens of eight patients who presented with advanced gynaecologic pelvic tumour of unknown primary origin, 10 unequivocal cervical carcinomas with 10 corresponding metastases and 10 unequivocal endometrial carcinomas with 4 corresponding metastases were studied. All cases were analysed for HPV-infection by PCR. The expression of CEA, vimentin (VIM), estrogen receptor (ER) and progesterone receptor (PR) was studied by immunohistochemistry. HPV-DNA was exclusively detected in cervical carcinomas and their corresponding metastases but in none of the endometrial carcinomas (Fisher's exact test p<0.001). Endometrial carcinomas and their metastases were generally positive for ER (86%), PR (93%) and VIM (100%) but rarely positive for CEA (14%) and HPV (0%). Most cervical carcinomas and their corresponding metastases were positive for CEA (79%) and HPV (89%). They rarely expressed ER (5%), PR (5%) and VIM (10%). Among the eight patients with unknown primary tumour four patients were diagnosed with a cervical carcinoma and four with an endometrial carcinoma. In one case we could exclude an ovarian carcinoma. Immunohistochemical analysis of selected markers in combination with HPV-testing is simple and inexpensive. The detection of HPV-DNA seems to provide the most compelling evidence for the primary tumour site, when immunohistochemical analysis is less definitive. The proposed diagnostic approach is helpful in the identification and management of pelvic tumours of unknown primary origin.

Aged↗
PubMed2005

[Diagnostic criteria and diagnostic considerations for hypertension in the elderly].

Hypertension in the elderly consists mostly of essential hypertension, and its pathophysiology differs in many ways from that of essential hypertension in the young or middle-aged. No special diagnostic criteria for hypertension in the elderly were stated in ESH/ESC JNC 7 guidelines, that is, the criteria is systolic pressure of 140 mmHg and greater or diastolic pressure of 90mmHg and greater as in general adults. As the diagnostic considerations for hypertension in the elderly, we should pay much attention to medical history taking, measurement of blood pressure, discrepancy on auscultation, pseudohypertension, fluctuation of blood pressure, and diagnosis of secondary hypertension.

Aged↗
PubMed1991

A statistical method for the comparison of a discrete diagnostic test with several continuous diagnostic tests.

In this paper we study a statistic that is suitable for comparing a discrete diagnostic marker to one or more continuous diagnostic markers. Test procedures and confidence intervals are based on asymptotic normality. The statistic is applicable for correlated data in which all the markers are obtained for each subject. The statistic was studied for use in comparing two markers for rectal bleeding. Examples for this application and two more general applications are presented.

Analysis of Variance↗
PubMed1992

Diagnostic peritoneal lavage: integration with clinical information to improve diagnostic performance.

Management of abdominal trauma requires both the detection of injuries sustained and an ability to distinguish patients who require operative repair from those who do not. In this prospective study of 200 patients receiving diagnostic peritoneal lavage (DPL) following blunt trauma, relationships among DPL result, clinical features (information from initial patient assessment), and laparotomy outcome were investigated. The DPL result alone predicted requirement for laparotomy with an accuracy of 93%, a specificity of 96%, a sensitivity of 85%, a positive predictive value (PV-Positive) of 87%, and a negative predictive value (PV-Negative) of 95%. Combining clinical features with the DPL result reduced the number of unnecessary laparotomies (increased PV-Positive and specificity), but increased the number of missed necessary laparotomies (decreased PV-Negative and sensitivity). The best diagnostic performance was found by combining the DPL result with circulatory status, which, in this series of patients, predicted necessary laparotomy with an accuracy of 95%, a specificity of 99%, a sensitivity of 81%, a PV-Positive of 98%, and a PV-Negative of 94%.

Abbreviated Injury Scale↗
PubMed1991

[The Composite International Diagnostic Interview (CIDI): an epidemiologic instrument suitable for using in conjunction with different diagnostic systems in different cultures].

The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version in Puerto Rico. The field test was being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and general people in different cultures and providing data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will reliably allow investigators to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

Cross-Cultural Comparison↗
PubMed1990

[The diagnostic value of a meningococcal-B erythrocyte diagnostic agent based on the group-specific polysaccharide].

In this work the diagnostic value of group B meningococcal erythrocyte diagnosticum was determined. 585 blood serum samples taken from adult donors were studied: 220 samples from practically healthy persons and 365 samples from 144 patients with meningococcal infection and purulent bacterial meningitis of nonmeningococcal etiology. Group B meningococcal erythrocyte diagnosticum was found to possess serological activity and to reveal the growth of specific antibodies in the sera of patients with meningococcal infection, serologically confirmed by the isolation of group B meningococcal culture, in 100% of cases on weeks 2-3 of the disease. Diagnostic characteristics--specificity and sensitivity--for group B erythrocyte diagnosticum were, respectively, 90.2% and 63.5%. The study revealed that antibodies to several group-specific meningococcal polysaccharides in blood sera can be simultaneously determined in the passive hemagglutination test with a set of erythrocyte diagnostica, which should be taken into consideration in the clinical interpretation of serological results.

Adult↗
PubMed1989

[Diagnostic value of a diagnostic strip for determining urinary amylase].

The semiquantitative determination of amylase in urine with a stick-method has produced controversial results as to its diagnostical significance. In our study we compared the result of the Rapignost-test with the simultaneously measures activity of enzymes (total amylase, pancreatic isoamylase in serum and urine and lipase) in 323 samples of serum and urine taken from 32 patients affected with acute pancreatitis. On the 1st day of hospitalization Rapignost was positive in only 17 out of 32 cases. Both sensitivity and specificity of the test depended of the values referred to. Near range limits and in cases with slight or average increase of the enzymes, the correspondence of Rapignost results were unsatisfactory. We found a good correspondence in cases with normal low and excessively high values of the enzymes. On the whole, Rapignost showed the best correspondence with the pancreas isoamylase in urine. The result of Rapignost was also positive in 5 out of 15 cases with extrapancreatic increased urinary amylase, which confirms its lack of organ specificity. From case to case, the -, and + + test results of Rapignost did not lead to any conclusions as to the absolute values of the enzymes in serum and urine. Our results show that Rapignost does not offer enough safety either to confirm or to exclude an acute pancreatitis, and especially it should not be used as a screening test in emergency diagnostics. The determination of the enzyme, in particular in serum, can not be eluded.

Adult↗
PubMedDate not supplied

[Diagnostic criteria for psychiatric research: RDC (Research Diagnostic Criteria). French translation and adaptation by M. Ansseau].

This article represents the French translation of the Research Diagnostic Criteria, a set of operational criteria for 24 psychiatric disorders developed by researchers at the New York State Psychiatric Institute and Columbia University (New York) to permit the selection of homogeneous samples of patients presenting with a defined psychiatric illness. The Research Diagnostic Criteria are especially focussed on depressive disorders, defining the major depressive disorder, which comprises 10 non exclusive subtypes. These criteria currently represent the most widely used nosologic system for clinical research in psychiatry, allowing for comparison of results and facilitation of replication by different research teams.

Affective Disorders, Psychotic↗
PubMed1985

[Evaluation of the diagnostic power of 3 methods for assaying free T4. Results in the diagnostic strategy of hyperthyroidism].

The free thyroxin (FT4) tests of Amersham, Clinical Assay and Corning Medical were evaluated in 240 patients who were suspected of hyperthyroidism. The diagnostic performances of the Corning method were of less value while those of the other methods were equivalent to that obtained with the free thyroxin index for an average cost reduced. Furthermore our results show that T3 determination is better than T4 determination in patients who remained doubtful after FT4. However the development of ultra-short methods of measurement of total thyroid hormone blood levels using fluorescence polarization could lead to reconsider the diagnostic strategy of hyperthyroidism.

Evaluation Studies as Topic↗