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At least 1,639 records · Page 91Linked to original sources
PubMed1998

Dose reduction in a paediatric X-ray department following optimization of radiographic technique.

A survey of radiation doses to children from diagnostic radiography has been carried out in a dedicated paediatric X-ray room. Entrance surface dose (ESD) and dose-area product (DAP) per radiograph were simultaneously measured with thermoluminescent dosemeters (TLDs) and a DAP meter to provide mean dose values for separate age ranges. Results of ESD and DAP were lower than the mean values from other UK studies for all ages and radiographs, except for the infant pelvis AP radiograph. Comparison of ESD and radiographic technique with CEC quality criteria highlighted a need for reduction of dose to infants and implied an increase in tube filtration might overcome the limitations of the room's three-phase, 12-pulse generator, allowing higher tube potentials to be used on infants. Additional tube filtration of 3 mmA1 was installed following assessment of dose reduction and image quality with test objects and phantoms, and confirmation from the paediatric radiologist that clinical image quality was not-significantly altered. The tube potential was increased from 50 to 56 kVp for the infant pelvis AP radiograph. The resulting ESD and effective dose fell by 51% and 38%, respectively. The CEC quality criteria have proved useful as a benchmark against which technique in X-ray departments can be compared, and as such are a useful tool for optimizing radiographic technique and reducing patient dose.

Adolescent↗
PubMedDate not supplied

Multivariate hierarchical model for physical inactivity among public school children.

OBJECTIVE: To identify biological and sociodemographic factors associated with physical inactivity in public school children. METHODS: Parents of 2,519 children (49.3% of whom were girls), aged 7 to 10 years (mean = 7.6+/-0.9 years), from eight public schools in São Paulo, Brazil, completed a self-administered questionnaire. We used multiple correspondence analysis to identify groups of responses related to levels of physical activity and inactivity and to obtain an optimal scale. The cluster analysis identified groups of active and inactive children. The analysis of the receiver operator characteristic (ROC) curve, for the study of diagnostic properties of a simplified scale for physical inactivity derived from the optimal scale, revealed that a cutoff point of 3 had the best sensitivity and specificity, being therefore used as the outcome variable in the regression model. A multivariate hierarchical model was built, including distal and proximal categorical variables, with a p < 0.05. RESULTS: Physical inactivity was positively associated with biological factors such as being overweight, being older than 7.5 years, being a female, and having a good appetite, and with socioeconomic factors such as having garbage collected less than twice a week and having mothers who work outside the home. CONCLUSION: The results are consistent with published data about determinant factors of physical activity and inactivity among children, showing that questionnaires answered by parents and submitted to a sophisticated statistical analysis can be used in population-based studies involving children younger than 10 years old.

Child↗
PubMed2005

Influence of patient care provider on patient health outcomes in allergic rhinitis.

BACKGROUND: Diagnosing and managing the symptoms of allergic rhinitis are largely the responsibility of family physicians and allergists, but some patients choose self-management. However, few data are available to determine how the choice of care relates to measures of patient outcomes, such as the ability to perform activities, quality of life, and productivity. OBJECTIVE: To examine and compare patients' ability to perform activities, quality of life, productivity, and symptoms according to care provider: family physician, allergist, or self-management. METHODS: A questionnaire was developed and mailed to 2,065 patients enrolled in a 500,000-member managed care organization. Patients were identified by diagnostic codes for allergic rhinitis as determined from a retrospective examination of medical and prescription claims records between January 1, 2000, and December 31, 2000. RESULTS: Chi-squared Tests revealed statistically significant differences for symptoms, family history, testing, immunotherapy, and test value among patient care providers. Multivariate analysis of variance revealed statistically significant differences for activities, symptoms, and quality of life among patient care providers. Findings support the use of diagnostic testing to improve patient outcomes. Symptoms were statistically significantly associated with measures of productivity. CONCLUSIONS: Patient outcomes vary with respect to patient care group. It is imperative that patients suspected of having allergic rhinitis undergo appropriate evaluation and testing. Outcomes can be optimized if allergists and family physicians have access to appropriate diagnostic tools, such as skin testing and serologic tests for specific IgE antibodies.

Female↗
PubMed2003

[Acquisition and assessment of patient exposure in diagnostic radiology and nuclear medicine].

The regular annual monitoring of patient exposure in radiation diagnostics, as performed by the Federal Office for Radiation Protection (BfS), plays an important role in evaluating the awareness of radiological quality and safety in Germany and the risk-benefit optimization for patients. For the reporting year 1997, X-ray diagnostics resulted in a mean effective dose of 2 +/- 0.5 mSv per head of population. The underlying frequency of medical X-ray examinations was approximately 136 million, i.e., 1.7 examinations annually per head of population. In terms of nuclear medicine diagnostics, the patients exposure amounted to approximately 0.15 mSv effective dose per head of population. In this case, the number of examinations amounted to approximately 4 million, corresponding to a frequency of approximately 0.05 examinations annually per head of population. The paper discusses factors influencing the calculation of exposure, as well as the lack of an internationally accepted protocol to evaluate patient exposure.

Environmental Exposure↗
PubMed1994

Asthma in ambulatory care: use of objective diagnostic criteria.

Asthma, a disease of reversible airway hyperactivity, is responsible for 6.5 million visits to ambulatory care offices each year. In spite of treatment advances, asthma-related deaths have increased 31% from 1980 to 1987. The severity of asthma is often determined solely by history and physical examination, which can result in either overestimation or underestimation of disease severity. To optimize management, objective quantitative criteria should be added to the diagnostic evaluation. The use of peak flow meters provides physicians with easily obtainable objective measurements to augment their diagnostic armamentarium in the treatment of asthma.

Ambulatory Care↗
PubMed2005

Partial-thickness rotator cuff tears.

Partial-thickness tears of the rotator cuff have been diagnosed with increased frequency because of a heightened awareness of the condition by clinicians and improved diagnostic methods. Research into the causes, natural history, and optimal treatment of this condition lags behind that of full-thickness tears. However, despite the limitations in the existing literature, there has emerged a consensus among shoulder experts that partial-thickness rotator cuff tears should be aggressively treated in the active athlete because of the unfavorable natural history of these lesions and success of accepted surgical algorithms. This review will provide an overview of the theories regarding the origins of partial-thickness rotator cuff tears, discuss the relative accuracy of accepted diagnostic techniques, and summarize the indications and methods of operative repair with an emphasis on the results of various treatment approaches.

Age Factors↗
PubMed2004

Is there a role for antibody testing in the diagnosis of invasive candidiasis?

During the last decades, the use of antibody tests for the diagnosis of invasive mycoses has declined as a consequence of the general belief that they are insensitive and non-specific. However, there is a clear evidence that antibodies can be detected in highly immunodeficient patients (such as bone marrow transplant recipients), and that those antibodies are useful for the diagnosis. Antibody tests are currently in use as diagnostic tools for some primary mycoses, such as the endemic mycoses, aspergilloma, allergic bronchopulmonary aspergilosis and sporothrichosis. For invasive candidiasis, diagnostic methods must differentiate Candida colonization of mucous membranes or superficial infection from tissue invasion by this microorganism. Substantial progress has been made in diagnosis of invasive candidiasis with the development of a variety of methods for the detection of antibodies and antigens. However, no single test has found widespread clinical use and there is a consensus that diagnosis based on a single specimen lacks sensitivity. It is necessary to test sequential samples taken while the patient is at greatest risk for developing invasive candidiasis to optimize the diagnosis. Results obtained from a panel of diagnostic tests in association with clinical aspects will likely be the most useful strategy for early diagnosis and therapy.

Antibodies, Fungal↗
PubMedDate not supplied

Tailored helical CT evaluation of acute abdomen.

Helical computed tomography (CT) allows rapid, cost-effective evaluation of patients with acute abdominal pain. Tailoring the examination to the working clinical diagnosis by optimizing constituent factors (eg, timing of acquisition, contrast material used, means and rate of contrast material administration, collimation, pitch) can markedly improve diagnostic accuracy. Rapid (>/=3 mL/sec) intravenous injection of contrast material is required for optimal assessment of acute pancreatitis, ischemic bowel, aortic aneurysm, and aortic dissection. Narrow collimation and small reconstruction intervals can help detect calculi in the biliary system and genitourinary tract. Tailored helical CT in patients with acute pyelonephritis usually involves several acquisitions through the kidneys during various phases of renal enhancement. In patients with suspected renal infarction, CT protocol must include an acquisition during the corticomedullary phase. Helical CT with 5-mm collimation through the lower abdomen and pelvis is used to evaluate patients with suspected diverticulitis. Use of both oral and intravenous contrast material can help localize small bowel perforation and characterize related complications. Tailored helical CT for assessment of abdominal hemorrhage consists of initial unenhanced CT followed by optional contrast material-enhanced CT. Clear communication between the radiologist, the patient, and the referring physician is essential for narrowing the differential diagnosis into a working diagnosis prior to helical CT.

Abdomen, Acute↗
PubMedDate not supplied

Severe oligohydramnios with intact membranes: an indication for diagnostic amnioinfusion.

OBJECTIVE: To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. METHODS: Patients referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualization of routinely imaged structures before and after the infusion procedure. RESULTS: The overall rate of adequate visualization of fetal structures improved from 50.98 to 76.79% (p < 0.0001). In fetuses having preinfusion-identified obstructive uropathy, there was improvement in identification of associated anomalies from 11.8 to 31.3%. CONCLUSIONS: Several authors have suggested that diagnostic amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios. We have quantified the improvement in the rate of optimal visualization of fetal structures which likely translates, in experienced hands, into this observed improved diagnostic precision. Of particular importance is the improvement in appreciation of associated anomalies in cases of obstructive uropathy in which such findings may determine whether or not invasive fetal therapy is indicated.

Abnormalities, Multiple↗
PubMed2026

Molecular Landscape and Advanced Diagnostic Technologies for BRAF Mutations in Cancer: From Quantitative PCR and ddPCR to CRISPR-Based Platforms.

BRAF mutations are key oncogenic alterations across multiple malignancies, including melanoma, thyroid carcinoma, colorectal cancer, non-small cell lung cancer, glioma, and hairy cell leukemia. The most prevalent variant, BRAF-V600E, induces constitutive activation of the MAPK signaling pathway, promoting tumor progression and influencing therapeutic responsiveness. Accurate detection of BRAF alterations is therefore essential for molecular classification, prognostic assessment, treatment selection, and resistance surveillance. This review summarizes the molecular heterogeneity of BRAF mutations and critically evaluates current diagnostic methodologies. Conventional approaches such as allele-specific PCR and Sanger sequencing are compared with advanced quantitative platforms, including high-resolution melting analysis, droplet digital PCR, and next-generation sequencing, with emphasis on analytical sensitivity, mutation coverage, and clinical applicability. Emerging technologies such as CRISPR-based assays, rolling circle amplification systems, and nanoparticle-based biosensors and point-of-care diagnostic platforms are also discussed for their potential to enhance ultra-sensitive detection, particularly in liquid biopsy settings. These emerging tools are highlighted for their potential to enable ultra-sensitive, rapid, and decentralized mutation detection, particularly in liquid biopsy settings. Key challenges, including intratumoral heterogeneity, low allele-frequency variants, FFPE-associated artifacts, and clonal evolution under therapeutic pressure, are examined within a translational framework. In addition, we examine critical barriers to clinical implementation, including standardization, cost, and global accessibility of molecular diagnostics, and outline potential solutions through scalable technologies and decentralized testing strategies. We propose that optimal BRAF testing requires a mutation subclass-informed and clinically integrated strategy combining comprehensive baseline profiling with longitudinal molecular monitoring. Future diagnostic paradigms will likely integrate multi-omics data and artificial intelligence (AI)-assisted interpretation to refine precision oncology implementation. Looking forward, we propose that optimal BRAF testing will require integration of multi-omics profiling with AI-assisted interpretation, enabling automated variant classification, real-time clinical decision support, and improved prediction of therapeutic response and resistance.

Humans↗
PubMed2002

Evaluation of two modified cardiac troponin I enzyme immunoassays.

One of the major challenges for manufacturers of troponin immunoassays is to optimize the low-end of the assays because diagnostic and therapeutic interventions are based on decreasing cutpoints. Recently published consensus documents of the European Society of Cardiology and the American College of Cardiology recommended the 99th percentile of a reference control group as cut-off for increased troponin I levels and suggested that imprecision at the 99th percentile for each assay should be < or = 10%. In this study, we have evaluated two newly modified cardiac troponin I (cTnI) enzyme immunoassays (Dimension cTnI assay, Dade Behring, Germany and AIA-PACK cTnI 2nd-Gen, Eurogenetics Tosoh, Belgium). With both assays all measured cTnI values in plasma and serum samples of apparently healthy volunteers were within the reference ranges given by the manufacturers. Intra-assay coefficients of variation of cTnI concentrations above the 99th percentile (given by the manufacturers) were below 17% and decreased with increasing cTnI concentrations. In most samples, the AIA-PACK cTnI assay yielded higher results; however, a close correlation between both assays was observed. Both tests exhibit acceptable overall performance, but (especially the Dimension cTnI assay) do not yet meet the above-mentioned precision in the low-end assay range. These data emphasize the need for cTnI assay standardization and for further optimization at clinical decision levels.

Adult↗
PubMed1995

Difference analysis of antifibrin images in the detection of deep venous thrombosis.

UNLABELLED: This study was designed to test the hypothesis that the detection of non-blood-pool localization due to deep venous thrombosis uptake can be enhanced by computer processing. METHODS: Immediate blood-pool and 90-min delay images from 25 patient studies obtained with 99mTc T2G1s antifibrin were paired into 125 image sets (5/pt, including A, P knees, A, P calves and A thighs). After spatially aligning the image pairs, the blood-pool activity obtained from the immediate image was removed from the delayed image to produce a "clot only" image. Unprocessed data (UnP) and computer processed images (CmP) were presented to novice readers as part of a receiver operator characteristic (ROC) comparison study. The image interpreters were asked to provide independent diagnostic assessment at 250 limb sites using both datasets. Image intensity and color scale mappings were freely adjustable. Three readers were presented with images adjusted with optimal image contrast as judged by an observer with knowledge of the correct response. RESULTS: The area under the ROC curve (Az), a measure of the method's accuracy, for these readers was 88.5% (UnP) and 88.8% (CmP) (p = ns). Four readers whose images were not optimized showed Az of 79.1% (UnP) and 90.7% (CmP) (p < 0.05). Average diagnostic decision time for all readers, per limb site, was 18.2 +/- 7.8 sec, m +/- s.e.m., (UnP) and 7.6 +/- 4.6 sec (CmP). CONCLUSION: Novice reader accuracy is improved with computer processed images when image intensity and contrast factors are important. Computer processing can provide "clot" images that minimize nonspecific blood background activity and allow greater interpreter decision speed/confidence.

Algorithms↗
PubMed1998

Approximation algorithms for a genetic diagnostics problem.

We define and study a combinatorial problem called WEIGHTED DIAGNOSTIC COVER (WDC) that models the use of a laboratory technique called genotyping in the diagnosis of an important class of chromosomal aberrations. An optimal solution to WDC would enable us to define a genetic assay that maximizes the diagnostic power for a specified cost of laboratory work. We develop approximation algorithms for WDC by making use of the well-known problem SET COVER for which the greedy heuristic has been extensively studied. We prove worst-case performance bounds on the greedy heuristic for WDC and for another heuristic we call directional greedy. We implemented both heuristics. We also implemented a local search heuristic that takes the solutions obtained by greedy and dir-greedy and applies swaps until they are locally optimal. We report their performance on a real data set that is representative of the options that a clinical geneticist faces for the real diagnostic problem. Many open problems related to WDC remain, both of theoretical interest and practical importance.

Algorithms↗
PubMedDate not supplied

[Current concept of diagnostic procedure in Alzheimer's disease: an evidence based approach].

The aim of this article is to provide evidence-based recommendations for early diagnosis of Alzheimer's disease (AD) and hereby to give clinician the guidelines for optimal detection of patients with AD. Our intention is also to unify diagnostic schemes in accordance with our objective and specific possibilities. Basic diagnostic procedures primaruly are anamnesis and clinical examination with rational usage of neuroimaging, electrophysiological and laboratory procedures. Using these guidelines in medical practice in Croatia would be a solid basis for future epidemiological and clinical multicenter studies.

Alzheimer Disease↗
PubMed2004

[Imaging methods in liver diseases].

Imaging methods in liver diseases. The author reviews the diagnostic imaging procedures applied most commonly in liver disease in this day and age- with special attention to ultrasound imaging. She describes the possibilities, performance and disadvantages of the imaging procedures. She makes a recommendation for a generally applicable optimal investigative sequence.

Angiography↗
PubMed1988

Using the microbiology laboratory in the diagnosis of pneumonia.

Pneumonia/influenza is one of the top ten leading causes of mortality in the United States each year. The identification of the etiologic agent responsible for lower respiratory tract infection plays an important role in the proper management of this clinical problem. The specimens submitted for evaluation are obtained in diverse ways and include expectorated sputum, material from transtracheal and bronchoscopic procedures, pleural fluid and lung aspirates, and biopsy of actual lung tissue. Processing of material can include stained smears, aerobic and anaerobic cultures, and special processing techniques for fungal, viral, Pneumocystis carinii, Legionella, mycobacterial, and mycoplasma identification. Modifications of smear preparation techniques and application of the new DNA probe technology are providing the opportunity for rapid microbiologic testing of clinical specimens with increased sensitivity and specificity, often obviating the need for invasive diagnostic procedures. Laboratory methodology is continually undergoing technological change, and optimal care of the patient with pneumonia requires close cooperation between the attending physician and the clinical laboratory.

Bacteriological Techniques↗
PubMed2000

Comparison of low-dose dobutamine ventriculography with low-dose dobutamine echocardiography for predicting regional improvement in left ventricular function after coronary artery bypass grafting.

The demonstration of a contractile reserve during low-dose dobutamine echocardiography (LDDE) identifies viable myocardium and predicts recovery of left ventricular (LV) function after myocardial revascularization in patients with chronic coronary artery disease. However, a technically difficult transthoracic visualization may limit the use of LDDE, thus requiring an alternative diagnostic procedure. The present study compares LDDE with low-dose dobutamine ventriculography (LDDV) in predicting an improvement in regional LV function after surgical revascularization. We studied 18 patients with coronary artery disease and LV dysfunction who were to undergo coronary artery bypass grafting. Preoperatively, all patients were evaluated for the presence of viable myocardium using LDDE and LDDV. Follow-up echocardiography at rest and left ventriculography were performed 4 months after successful revascularization to assess recovery of LV function. The sensitivity and specificity of LDDE to identify dysfunctional segments capable of recovering function were 63% and 71%, respectively, with a diagnostic accuracy of 68%. The sensitivity, specificity, and diagnostic accuracy of LDDE improved to 81%, 72%, and 76% when patients with optimal transthoracic evaluation were selected, whereas they were 30%, 77%, and 57%, respectively, in those who underwent suboptimal evaluation. The sensitivity, specificity, and diagnostic accuracy of LDDV were 66%, 75%, and 71%, respectively, with no difference in subgroups of patients. This study demonstrates that LDDV can be considered a useful technique for identifying the presence of myocardial viability and may provide an advantage over LDDE in patients with suboptimal echocardiographic visualization.

Aged↗
PubMed1990

[Methods of optimizing and objective criteria for evaluating the efficacy of chemo-surgical treatment of malignant epithelial tumors of the ovaries].

In a group of 811 patients with epithelial malignancies of the ovaries, the diagnostic and therapeutic procedures used were either standard or they involved elements of optimization based on certain objective criteria. The reliability of diagnosis and treatment efficacy in the two subgroups were compared. Stage I-II tumors made up 37.1% of neoplasms diagnosed at regular check-ups and 16.9% of those identified in controls. Duration of relapse-free period was 45.0 and 11.8 months whereas five-year survival rate--42.9% and 20.5%, respectively. Clinically inapparent recurrence was cytologically detected in 29.5% of "actively" followed patients. Additional estrogen and progestin therapy assured an increase in recurrence-free period from 13.5 to 20.6 months in patients with stage III-IV tumors (9.1 and 9.5 months in controls). The efficacy of single-agent and combination chemotherapy in stage III-IV cancer was nearly the same. Adjuvant postoperative chemotherapy administered during the first 2.5-3 years of remission resulted in a 2.2--fold decrease in recurrence rate and a 21.4% rise in five-year survival rate in patients with stage Ia and Ib cancer.

Adenocarcinoma↗