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Additional Diagnoses (additional + diagnosis)
Selected AbstractsWalking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2009ARVE OPHEIM PT MSC Aim, To compare walking function, pain, and fatigue in adults with cerebral palsy (CP) 7 years after an initial survey. Method, A multidimensional questionnaire was mailed to 226 people with unilateral (hemiplegic) or bilateral (diplegic) spastic CP who had participated in a 1999 survey. People with additional diagnoses were excluded. Special emphasis was placed on participants with deterioration in walking. The questionnaire was the same as in 1999. Results, One hundred and forty-nine participants (76 males, 73 females; mean age 40y 5mo, SD 10y 7mo, range 24,76y) with a diagnosis of unilateral (n=81) or bilateral (n=68) spastic CP responded. Fifty-two per cent of all participants reported deterioration in walking function since debut of walking, compared with 39% 7 years previously. In participants with bilateral CP, 71% reported deteriorated walking, compared with 37% of participants with unilateral CP. Participants with deteriorated walking function had greater pain frequency, pain intensity, impact of pain on daily activities, and physical fatigue and reduced balance. The number of people reporting overall mobility problems was almost double compared with 7 years previously. Interpretation, The main finding was an increased prevalence of deteriorated walking, significantly associated with bilateral spastic CP, pain, fatigue, and reduced balance. Rehabilitation programmes addressing these areas are needed. [source] Nursing Diagnosis Extension and Classification: Ongoing PhaseINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Martha Craft-Rosenberg BACKGROUND The Nursing Diagnosis Extension and Classification Project (NDEC) has been active for almost a decade. The team began with the formation of a team of investigators at The University of Iowa College of Nursing. From 1994 until 2000 the research team consisted of 16 investigators who were experts in nursing care across the lifespan. They also represented expertise in both qualitative and quantitative research. The aims of the NDEC research are to evaluate and revise NANDA diagnoses, to validate the diagnoses using a clinical information system, and to develop candidate diagnoses. MAIN CONTENT POINTS Phase 1 of the NDEC research has yielded 116 refined and developed nursing diagnoses that have been submitted to NANDA. Of these, 65 have been approved and 54 appeared in Nursing Diagnoses: Definitions and Classification, 1999,2000 along with 39 NDEC products. In the 2000,2001 edition, 7 diagnoses refined by NDEC and 7 new diagnoses submitted by NDEC are included. As only about half the NDEC products have appeared in NANDA publications, the three-level review process (Diagnosis Review Committee, membership, and Board) has been discussed with the NANDA board. This request is currently being honored by the Diagnosis Review Committee; however, review by the membership and review by the NANDA board is just beginning to move in this direction. Phase 2, clinical validation of the NDEC work, is being conducted at a long-term care facility. It will also be conducted at a large teaching hospital. All the NDEC refinement and development work has been submitted for clinical validation. Currently validation is planned at the label level only. Phase 3 involves identification of candidate diagnoses. Many of the candidate diagnoses were developed during the concept analysis phase, when NDEC team members identified the need for additional diagnoses. Nurses in practice have submitted other candidate diagnoses. In total 195 candidate diagnoses have been identified and placed into a database. In order for the NDEC team to make decisions regarding priorities for diagnosis development, the diagnoses in the candidate database are compared to diagnoses in other classifications that have already been developed. Several classifications are used for comparison including the Omaha System and the Home Health Care Classification. A large table is used to compare candidate label to other labels. Candidate diagnosis included in other classifications will be given lower priority for development by NDEC. CONCLUSIONS The NDEC work plan includes work on diagnoses to be resubmitted to the NANDA Diagnosis Review Committee. It is hoped that the Web site for NLINKS will facilitate the work of diagnosis refinement and development. NDEC will continue to work with any investigator who is seeking assistance. The last part of the work plan is resource acquisition and recruitment of investigators to continue the refinement and development of diagnoses. [source] Treatment of obsessive-compulsive disorder in patients who have comorbid major depressionJOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2004Jonathan S. Abramowitz Many patients who have obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses such as mood, anxiety, and personality disorders. The presence of severe depression, and major depressive disorder per se, impedes response to treatment for OCD that uses the best available treatments. In this article, the comorbidity data in OCD are reviewed, then the relationship between depression and OCD treatment outcome is reviewed. Next, the derivation and implementation of a treatment program specifically for depressed OCD patients are illustrated with a case example. The article closes with a discussion of implications and directions gleaned from this single case study. © 2004 Wiley Periodicals, Inc. J Clin Psychol/In Session. [source] A multicentre study of the usefulness of liver biopsy in hepatitis CJOURNAL OF VIRAL HEPATITIS, Issue 4 2004V. G. Bain Summary., The role of liver biopsy in the assessment of chronic hepatitis C is generally accepted yet there is no prospective data available to quantify its contribution. A previous single centre pilot study suggested that the clinician could predict the amount of fibrosis and to a lesser extent, inflammation with moderate accuracy. The 2002 National Institute of Health Hepatitis C Consensus Conference recommended further study of the role of liver biopsy. Our objective was to compare a prediction of biopsy findings by expert clinicians using usually available clinical and laboratory data to actual biopsy results in order to determine whether biopsy is required routinely. This was a prospective observational study conducted at seven university centres in which the accuracy of clinician's predictions of the degree of inflammation and fibrosis were compared with the actual liver biopsy using an adaptation of a standard histological scoring system. We studied 81 adults with previously untreated chronic hepatitis C, raised serum transaminases and positive HCV-RNA in serum. Clinicians predicted the inflammatory grade in 44 of 80 cases (55%) and the fibrosis stage in 46 of 81 cases (57%). Nine of 17 cirrhotic cases were predicted (sensitivity 53%, specificity 56%). No unexpected additional diagnoses were made on the biopsies. Thus despite knowledge of the clinical and laboratory investigations of patients with hepatitis C, clinicians are unable to accurately predict the hepatic inflammatory grade and fibrotic stage. Liver biopsy is an essential investigation to accurately evaluate the grade and stage of liver disease patients with hepatitis C. [source] Interstate comparisons of public hospital outputs using DRGs: Are they fair?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2005Michael Coory Objective: To assess whether there is variation among Australian States in the reporting and coding of important and relevant secondary diagnoses in public hospital data. Such variation is a potentially important problem because it may invalidate interstate (and other) comparisons of hospital outputs based on Diagnosis Related Groups (DRGs). Methods: Our outcome measure was the percentage of separations in the lowest-resource split for adjacent DRGs. To reduce potential bias due to interstate differences in the complexity of cases treated in public hospitals, we directly standardised by adjacent-DRG and analysed two subgroups of adjacent-DRGs where there is less discretion about the threshold for admission: obstetrics and major medical conditions. Results: There was important interstate variation in the percentage of separations in the lowest-resource split. The statistically significant differences represent a large number of medical records that might have been documented or coded differently if the separation had occurred in another State. For example, if Queensland had the same standardised percentage as South Australia, then an extra 10,100 separations in Queensland would have been allocated to a DRG with a higher cost weight. Conclusions: The task of perfecting a national database is never complete and it makes sense to super impose a permanent cycle of monitoring, followed by more detailed audits. The methods used in this paper could be routinely used to screen administrative hospital data to identify where detailed audits with feedback might be implemented with best effect. Unless interstate variation in the reporting and coding of important additional diagnoses is reduced, measuring public hospital outputs using DRGs will be of limited value at a national level. [source] Behaviour guidance in dental treatment of patients with autism spectrum disorderINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2009CHEEN Y. LOO Background., Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder , not otherwise specified (PDD-NOS) and Asperger syndrome. Aims., To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. Design., The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. Results., Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. Conclusions., Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified. [source] Unenhanced helical computed tomography in the evaluation of acute flank painINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2003NAZIM ALI AHMAD Abstract Objectives: The purpose of this study was to determine the value of unenhanced helical computed tomography (UHCT) in the diagnosis of acute flank pain at our institution. Methods: Two hundred and thirty-three consecutive UHCT examinations, performed for suspected renal/ureteral colic between July 2000 and August 2001 were reviewed, along with pertinent medical records. Results: Ureteral calculi were identified in 148 (64%) examinations, evidence of recent passage of calculi was found in 10 (4%) and no calculi were found in 75 (32%). Thirty-two of the conservatively managed patients were excluded for inadequate follow-up. In the remaining 201 patients, sensitivity of UHCT in diagnosing calculi was 99% and specificity was 98%, while the positive predictive value was 99% and negative positive predictive value was 98%. Overall, an alternative or additional diagnosis was established in 28 (12%) patients. Upon diagnosis of ureterolithiasis on UHCT, none of the patients required additional imaging studies for confirmation. Conclusion: UHCT is a highly sensitive imaging modality for the detection of urinary tract calculi and obstruction. [source] Imported Malaria in Children: A Comparative Study Between Recent Immigrants and Immigrant Travelers (VFRs)JOURNAL OF TRAVEL MEDICINE, Issue 4 2010Juan Arnáez MD Background. In Europe, imported malarial cases occur in returning travelers and immigrants mostly from African countries. There have been an increasing number of cases in the past years in Spain. Methods. An analysis of all cases of malaria who attended at the Hospital of Mostoles in the Southwest of Madrid from 1995 to 2007 was performed. Clinical, epidemiological, laboratory, and parasitological findings were analyzed and compared between immigrants coming from endemic countries (recent immigrants) and children who traveled to endemic areas to visit friends and relatives (VFRs). Results. Sixty cases of imported malaria were detected. Most of the cases (59 of 60) were acquired in sub-Saharan Africa. The most common species was Plasmodium falciparum (43 of 60). Microscopic examination was positive in 95%, and the polymerase chain reaction (PCR) for Plasmodium achieved additional diagnosis in seven cases. Fourteen cases were VFRs; none of them used appropriate malaria chemoprophylaxis. Fever and thrombocytopenia were significantly more common among VFRs. They also had significantly higher parasite density. Twelve cases were asymptomatic at the time of diagnosis; all of them were recent immigrants. Conclusions. VFRs account for a significant number of childhood malarial cases. These patients had not taken malaria chemoprophylaxis and malarial cases were more severe. VFR children are a high-risk group, and pretravel advice should underline the risk for malaria. Recent immigrants can be asymptomatic and parasitemias are lower. Therefore, a high index of suspicion is necessary, and PCR for Plasmodium should be performed in case of negative thick smears. [source] Treatment of Social Phobia: Potential Mediators and ModeratorsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2000Stefan G. Hofmann Although the efficacy of numerous psychosocial interventions for social phobia has been clearly demonstrated, little is known about the mediators and moderators of treatment change. Three potential mediators here are discussed that are derived from prominent psychological theories: negative cognitive appraisal (estimated social costs), perceived self-efficacy (perceived social skills), and perceived emotional control. Furthermore, the generalized subtype of social phobia and the additional diagnosis of avoidant personality disorder are considered as potential treatment moderators. [source] | |||||||||||||