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Diagnostic Data (diagnostic + data)
Selected AbstractsSystematic review of methods to diagnose infection in foot ulcers in diabetesDIABETIC MEDICINE, Issue 4 2006S. O'Meara Abstract Aim, To undertake a systematic review of the diagnostic performance of clinical examination, sample acquisition and sample analysis in infected foot ulcers in diabetes. Methods, Nineteen electronic databases plus other sources were searched. To be included, studies had to fulfil the following criteria: (i) compare a method of clinical assessment, sample collection or sample analysis with a reference standard; (ii) recruit diabetic individuals with foot ulcers; (ii) present 2 × 2 diagnostic data. Studies were critically appraised using a 12-item checklist. Results Three eligible studies were identified, one each on clinical examination, sample collection and sample analysis. For all three, study groups were heterogeneous with respect to wound type and a small proportion of participants had foot ulcers due to diabetes. No studies identified an optimum reference standard. Other methodological problems included non-blind interpretation of tests and the time lag between index and reference tests. Individual signs or symptoms of infection did not prove to be useful tests when assessed against punch biopsy as the reference standard. The wound swab did not perform well when assessed against tissue biopsy. Semiquantitative analysis of wound swab might be a useful alternative to quantitative analysis. The limitations of these findings and their impact on recommendations from relevant clinical guidelines are discussed. Conclusion, Given the importance of this topic, it is surprising that only three eligible studies were identified. It was not possible to describe the optimal methods of diagnosing infection in diabetic patients with foot ulceration from the evidence identified in this systematic review. Diabet. Med. 23, 341,347 (2006) [source] Comparison of costs and utilization among buprenorphine and methadone patientsADDICTION, Issue 6 2009Paul G. Barnett ABSTRACT Aims Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. Design Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. Findings VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11 597 for buprenorphine and $14 921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547,0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. Conclusion Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients. [source] An examination of the overlap between genetic and environmental risk factors for intentional weight loss and overeatingINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 6 2009Tracey D. Wade PhD Abstract Objective: To further our understanding of how intentional weight loss (IWL) and overeating are related, we examined the shared genetic and environmental variance between lifetime IWL and overeating. Method: Interview data were available for 1,976 female twins (both members of 439 and 264 pairs of monozygotic and dizygotic twins, respectively), mean age = 40.61, SD = 4.72. We used lifetime diagnostic data for eating disorders obtained from a semistructured psychiatric telephone interview, examined in a bivariate twin analysis. Both lifetime behaviors were measured on a 3-point scale, where absence of IWL or overeating formed one anchor on the scale and lifetime anorexia nervosa (AN) and bulimia nervosa (BN) formed the opposite anchors, respectively. Results: In line with previous findings, a higher body mass index was significantly associated with the lifetime presence of IWL and/or overeating (odds ratio = 1.13, 95% confidence interval (CI): 1.08,1.19). The best fitting twin model contained additive genetic and nonshared environmental influence influencing both IWL and overeating, with correlations between these influences of 0.61 (95% CI: 0.35,0.92) and 0.24 (95% CI: 0.07,0.42), respectively. Discussion: About 37% of genetic risk factors were considered to overlap between IWL and overeating, and with only 6% of overlap between environmental risk factors. Thus, considerable independence of risk factors was indicated. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009 [source] Multilevel investigation of variation in HoNOS ratings by mental health professionals: a naturalistic study of consecutive referralsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2004R. Ecob Episodes of mental healthcare in specialist psychiatric services often begin with the assessment of clinical and psychosocial needs of patients by healthcare professionals. Particularly for patients with complex needs or severe problems, ratings of clinical and social functioning at the start of each episode of care may serve as a baseline against which subsequent measures can be compared. Currently, little is known about service variations in such assessments on referrals from primary care. We set out to quantify variability in initial assessments performed by healthcare professionals in three CMHTs in Bristol (UK) using the Health of the Nation Outcome Scales (HoNOS). We tested the hypothesis that variations in HoNOS total and sub-scale scores are related to referral source (general practices), healthcare assessor (in CMHTs) and the assessor's professional group. Statistical analysis was performed using multilevel variance components models with cross-classified random effects. We found that variation due to assessor substantially exceeded that due to referral source (general practices). Furthermore, patient variance differed by assessor profession for the HoNOS , Impairment scores. Assessor variance differed by assessor profession for the HoNOS , Social scores. As HoNOS total and subscale scores show much larger variation by assessor than by referral source, investigations of HoNOS scores must take assessors into account. Services should implement and evaluate interdisciplinary training to improve consistency in use of rating thresholds; such initiatives could be evaluated using these extensions of multilevel models. Future research should aim to integrate routine diagnostic data with continuous outcomes to address selection effects (of patients to assessors) better. Copyright © 2004 Whurr Publishers Ltd. [source] C3 and C4 hypocomplementemia and associated diseases in ArabiansINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2005Emad A. KOSHAK Abstract Background:, Hypocomplementemia, which is a state of decrease in the complement (C) proteins in the serum, is frequently encountered in a wide range of diseases. Objective:, To explore the diversity of C3 and C4 hypocomplementemia and associated diseases in patients seen at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Methods:, Serum samples send to the clinical immunology laboratory with requests for the measurements of C3 and C4 tests by nephelometry were studied. Files of patients with C3 and/or C4 hypocomplementemia were reviewed for demographic and diagnostic data. Results:, Out of 270 complement tests, C3 and/or C4 hypocomplementemia was found in 196 different tests (72.6%), and only 175 tests were studied. Their ages ranged between 1 week and 81 years (mean 26 ± 17 SD), and female sex was predominant in 143 tests (81.3%). Hypocomplementemia was detected as follows: C3 in 64 tests (23.7%) with sole C3 in 3 tests only (1.5%); C4 in 193 samples (71.5%) with sole C4 in 132 tests (67.3%); and combined C3 with C4 hypocomplementemia in 61 tests (22.6%). Cross-tabulation revealed that 95% of C3 hypocomplementemia were significantly associated with C4 hypocomplementemia (P < 0.001). Conversely, only 31% of C4 hypocomplementemia were significantly associated with C3 hypocomplementemia (P < 0.001). SLE was the predominant disease associated with hypocomplementemia in 104 tests (53.1%), followed by kidney diseases in 20 tests (10.2%) and chronic liver disease in eight tests (4.1%). Conclusion:, C4 hypocomplementemia was a common laboratory verdict in patients at KAUH. Of interest, most of C3 hypocomplementemia tests were associated with C4 hypocomplementemia and lone C3 hypocomplementemia is rare. The diagnosis of systemic lupus erythematosus was the predominant disease associated with hypocomplementemia. Supplementary awareness of immunopathological mechanisms leading to involvement of complement proteins in many diseases is essential to enhance its clinical utility. [source] Individualized Selection of Pacing Algorithms for the Prevention of Recurrent Atrial Fibrillation: Results from the VIP RegistryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006THORSTEN LEWALTER Objectives: The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden. Background: There are few data identifying which patients might benefit most from which preventive pacing algorithms. Methods: Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker therapy, were enrolled. They received pacemakers with AF diagnostics and four preventive algorithms (Selection and PreventAF series, Vitatron). A 3-month Diagnostic Phase with conventional pacing identified a Substrate Group (>70% of AF episodes with <2 premature atrial contractions [PACs] before AF onset) and a Trigger Group (,70% of AF episodes with <2 PACs before AF onset). This was followed by a 3-month Therapeutic Phase where in the Trigger Group algorithms were enabled aimed at avoiding or preventing a PAC and in the Substrate Group continuous atrial overdrive pacing was enabled. Results: One hundred and twenty-six patients were evaluated. In the Trigger Group (n = 73), there was a statistically significant 28% improvement in AF burden (median AF burden: 2.06 hours/day, Diagnostic Phase vs 1.49 hours/day, Therapy Phase; P = 0.03304 signed-rank test), and reduced PAC activity. There was no significant improvement in AF burden in the Substrate Group (median AF burden: 1.82 hours/day, Diagnostic Phase vs 2.38 hours/day, Therapy Phase; P = 0.12095 signed-rank test), and little change in PAC activity. Conclusions: We identified a subgroup of patients for whom the selection of appropriate pacing algorithms, based on individual diagnostic data, translated into a reduced AF burden. Trigger AF patients were more likely responders to preventive pacing algorithms as a result of PAC suppression. [source] Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our PatientsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2002BERND NOWAK NOWAK, B.: Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our Patients. Stored electrograms (EGMs), well-known diagnostic tools in implantable cardioverter defibrillators, have now been incorporated in pacemakers as well, thereby increasing their diagnostic capabilities. The clinician can detect and diagnose patient arrhythmias with EGMs and directly validate diagnostic data stored by the devices. The appropriateness of detection algorithms can also be judged. Initial experiences with pacemaker EGMs reveals their potential to detect and diagnose sensing or detection algorithm problems. These so-called "false-positive" EGMs help to optimize pacemaker programming. Date and time stamp can correlate an event to patient symptoms. Recent advances, like onset recordings and marker annotation, have further increased the effectiveness of stored EGMs. The use of patient-triggered magnet-stored EGMs facilitates diagnostic workups in symptomatic pacemaker patients and reveals nondevice related symptoms in a considerable number of cases. Stored EGMs in pacemakers will soon be a standard diagnostic tool that can illustrate what is really going on in our patients. [source] Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unitACTA NEUROLOGICA SCANDINAVICA, Issue 3 2010F. Boesebeck Boesebeck F, Freermann S, Kellinghaus C, Evers S. Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unit. Acta Neurol Scand: 122: 189,195. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective,,, The etiological misinterpretation of paroxysmal neurological symptoms frequently causes a delayed treatment or an inappropriate utilization of ICU-capacities. Methods,,, In this study, the data of 208 patients admitted to a neurological ICU because of acute transient neurological deficits, loss of consciousness or unclear motor phenomena were retrospectively analyzed. The initial emergency room diagnosis was compared to the final diagnosis and the rate of misdiagnosis was related to the patients' history and diagnostic data. Results,,, In 13.9%, the emergency room diagnosis of epileptic seizures turned out to be incorrect, whereas in 15.6%, the final diagnosis of epileptic seizures was missed in the emergency room. Factors that were significantly correlated to missing the seizure diagnosis were (i) no prior history of epilepsy, (ii) old age, (iii) multi-morbidity, (iv) pathologic CT-scans demonstrating cerebrovascular lesions, (v) seizure description by non-professionals, (vi) predominantly negative seizure phenomena (aphasia, loss of consciousness, paresis), (vii) lack of tongue-bite lesions. [source] | ||||||||||