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Diagnostic Subgroups (diagnostic + subgroup)
Selected AbstractsValidation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup , disc derangement with reductionJOURNAL OF ORAL REHABILITATION, Issue 12 2002R. Emshoff summary, 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) internal derangement type (ID)-I as compared with the magnetic resonance imaging (MRI) ,gold standard'. The study comprised 168 TMJs in 84 patients, who were assigned a clinical TMJ-related diagnosis of ID-I (disc displacement with reduction) in at least one TMJ. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of the disc,condyle relationship. For the CDC/TMD interpretations, the positive predictive value (PPV) of ID-I for disc displacement with reduction (DDR) was 44%, and for the presence of an ID 69%. The overall diagnostic agreement for ID-I was 47·6% with a corresponding K -value of 0·05. Most of the disagreement was the result of the false-positive interpretations of ID-I, and false-negative interpretations of an ,absence of ID'. The results suggest CDC/TMD for ID-I to be insufficient reliable for determination of ID and/or DDR. Patients assigned a clinical TMJ-related diagnosis of ID-I may need to be supplemented by evidence from MRI to determine the functional ,disc,condyle relationship'. [source] An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulationNEUROGASTROENTEROLOGY & MOTILITY, Issue 4 2006N. Abidi Abstract, Gastric electrical stimulation (GES) is effective to improve symptoms of nausea and vomiting in most patients, but very little is known about the effect of varying stimulation parameters. We analysed stimulation parameters in a pilot study of 22 patients (12 idiopathic, four diabetic and four postsurgical) with drug-refractory gastroparesis who did not respond optimally to initial settings. Patients underwent high-frequency/lowenergy GES using identical initial stimulation parameters: 5 mA of current, 330 ,s pulse width, 14 Hz for 0.1 s on and 5.0 s off. Due to lack on optimal response, 22 patients underwent alteration of an algorithm using stimulation parameters. At follow-up (mean of 4.3 years) a dose,response relationship for charge, power and energy were compared with baseline for the whole group and for each diagnostic subgroup by anovadata are reported as mean ± SE. Based on the mean of individual dose,response curves, differences in data are charge, current per pulse and energy per pulse were noted for the whole group at follow up vs baseline. The subgroup of patients with postsurgical gastroparesis required the most energy using the algorithm. In conclusion, an algorithmic approach to identify optimal stimulation parameters in GES for individual patients is associated with symptom improvement. Also, certain subgroups appear to have different energy parameters. Based on this preliminary data, the use of an algorithm for some patients with GES is feasible and may have potential for clinical application. A randomized-controlled trial of different stimulation parameters for GES seems warranted. [source] The Cannabis Use Problems Identification Test (CUPIT): development, reliability, concurrent and predictive validity among adolescents and adultsADDICTION, Issue 4 2010Jan Bashford ABSTRACT Aims To describe the empirical construction and initial validation of the Cannabis Use Problems Identification Test (CUPIT), a brief self-report screening instrument for detection of currently and potentially problematic cannabis use. Design In a three-phase prospective design an item pool of candidate questions was generated from a literature review and extensive expert consultation. The CUPIT internal structure, cross-sectional and longitudinal psychometric properties were then systematically tested among heterogeneous past-year users. Participants Volunteer participants were 212 high-risk adolescents (n = 138) and adults (n = 74) aged 13,61 years from multiple community settings. Measurements The comprehensive assessment battery included several established measures of cannabis-related pathology for CUPIT validation, with DSM-IV/ICD-10 diagnoses of cannabis use disorders as criterion standard. Findings Sixteen items loading highly on two subscales derived from principal components analysis exhibited good to excellent test,retest (0.89,0.99) and internal consistency reliability (0.92, 0.83), and highly significant ability to discriminate diagnostic subgroups along the severity continuum (non-problematic, risky, problematic use). Twelve months later, baseline CUPIT scores demonstrated highly significant longitudinal predictive utility for respondents' follow-up diagnostic group membership. Receiver operating characteristic (ROC) analysis identified a CUPIT score of 12 to be the optimal cut-point for maximizing sensitivity for both currently diagnosable cannabis use disorder and those at risk of meeting diagnostic criteria in the following 12 months. Conclusions The CUPIT is a brief cannabis screener that is reliable, valid and acceptable for use across diverse community settings and consumers of all ages. The CUPIT has clear potential to assist with achievement of public health goals to reduce cannabis-related harms in the community. [source] Emergency nurse practitioner care and emergency department patient flow: Case,control studyEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2006Julie Considine Abstract Objective:, The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods:, A case,control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results:, There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion:, Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes. [source] Effect of weight-regulating practices on potassium level in patients with anorexia or bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2004Dr. Katrin Imbierowicz Abstract Objective The authors evaluated retrospectively data from 397 patients with anorexia (AN) and bulimia nervosa(BN). Method Patients were divided into six pre-defined and symptom-related subgroups and their hypokalemia frequencies compared. The correlation between potassium level and disease-related patterns was assessed. Results The two purging type AN groups were at greatest risk of hypokalemia. Vomiting frequency, body mass index (BMI) and laxative dosage had an effect on potassium levels within the overall group but only accounted for 19% of the variance of potassium level. Effects could not be proved for fasting, sport and disease duration. Discussion Patients with anorexia or bulimia nervosa are very heterogeneous due to the considerable range of potential weight-regulating measures. Taking this heterogeneity into consideration by dividing patients into diagnostic subgroups and considering their symptomatology thus considerably aids the estimation of hypokalemia risk when treating eating disorders. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Is it possible to identify early predictors of the future cost of chronic arthritis?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2009The VErA project Abstract This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self-questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003,) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was ,4700 per patient. The costs attributable to the RA and UA sub-groups were ,5928 and ,2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub-group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness's subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition's impact on healthcare budgets. [source] Factors associated with suicidal behaviors in a large French sample of inpatients with eating disordersINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 7 2007Valérie J. Fedorowicz MDCM Abstract Objective: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. Method: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. Results: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. Conclusion: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] The Remarkably High Prevalence of Epilepsy and Seizure History in Fetal Alcohol Spectrum DisordersALCOHOLISM, Issue 6 2010Stephanie H. Bell Background:, Fetal alcohol spectrum disorder (FASD) is the umbrella term that describes the range of adverse developmental outcomes that may occur in the offspring of mothers who drink alcohol during pregnancy. FASD is associated with several comorbidities including epilepsy. The objective of the study was to evaluate the prevalence of epilepsy or a history of seizures in subjects with FASD and the contribution of relevant risk factors. Methods:, A retrospective chart review was conducted on all active charts (N = 1063) at two FASD clinics. After exclusion of subjects without a confirmed diagnosis, a total of 425 subjects between the ages of 2,49 were included in the analysis. The relationships between FASD diagnosis and other risk factors for co-occurrence of epilepsy or a seizure disorder (e.g., extent of exposure to alcohol and other drugs, type of birth, and trauma) were examined using chi-square and multivariate multinomial logistic regression. Results:, Twenty-five (5.9%) individuals in the study population had a confirmed diagnosis of epilepsy, and 50 (11.8%) had at least one documented seizure episode, yielding an overall prevalence of 17.7% in this population. Importantly, a history of epilepsy or seizures was not different across the three diagnostic subgroups. In those subjects with available maternal drinking histories, first trimester exposure or drinking throughout all three trimesters were the predominant forms of fetal exposure. None of the other risk factors were associated with a greater prevalence of epilepsy or seizures. Conclusions:, There is a remarkably high prevalence of epilepsy/seizures in the FASD population. [source] | |||||||||||||