Home About us Contact
|
Home About us Contact | ||
|
|
||
Diagnostic Outcome (diagnostic + outcome)
Selected AbstractsProcedure-related pain among adult patients with hematologic malignanciesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009Y. LIDÉN Background: Cancer patients undergo numerous invasive diagnostic procedures. However, there are only sparse data on the characteristics and determinants for procedure-related pain among adult cancer patients. Methods: In this prospective study, we evaluated the characteristics and determinants of procedure-related pain in 235 consecutive hematologic patients (M/F:126/109; median age 62 years, range 20,89 years) undergoing a bone marrow aspiration/biopsy (BMA) under local anesthesia. Questionnaires were used to assess patients before-, 10 min and 1,7 days post BMA. Using logistic regression models, we calculated odds ratios (ORs) and 95% confidence intervals (CIs). Results: 165/235 (70%) patients reported pain during BMA; 92 (56%), 53 (32%) and 5 (3%) of these indicated moderate [visual analogue scale (VAS),30 mm], severe (VAS>54 mm) and worst possible pain (VAS=100 mm), respectively. On multivariate analyses, pre-existing pain (OR=2.60 95% CI 1.26,5.36), anxiety about the diagnostic outcome of BMA (OR=3.17 95% CI 1.54,6.52), anxiety about needle-insertion (OR=2.49 95% CI 1.22,5.10) and low employment status (sick-leave/unemployed) (OR=3.14 95% CI 1.31,7.55) were independently associated with an increased risk of pain during BMA. At follow-up 10 min after BMA, 40/235 (17%) patients reported pain. At 1, 3, 6 and 7 days post BMA, pain was present in 137 (64%), 90 (42%), 43 (20%) and 25 (12%) patients, respectively. Conclusions: We found that 3/4 of hematologic patients who underwent BMA reported procedural pain; one third of these patients indicated severe pain. Pre-existing pain, anxiety about the diagnostic outcome of BMA or needle-insertion, and low employment status were independent risk factors. [source] Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studiesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009R. SWEIS Summary Background, Standard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown. Aim, To examine the tolerability and diagnostic outcome of catheter-free pH-monitoring technique in patients who failed standard monitoring. Methods, Patients referred for C-pH and catheter-free pH monitoring completed a tolerability questionnaire. Acid exposure in the distal oesophagus and symptom index (SI) were reviewed. Results, Over 4 years, 883/1751 (50%) of patients with typical reflux symptoms referred for C-pH were diagnosed with gastro-oesophageal reflux disease (GERD) based on a pathological percentage time acid exposure (%time pH <4);134 (8%) patients failed C-pH and, of these, 129 successfully completed 2-day catheter-free pH monitoring. Ninety-eight (76%) of these patients had a pathological percentage pH <4 on either day compared with 49/102 (49%) of contemporaneous C-pH patients (P < 0.01). There was no difference in SI for heartburn (35% vs. 42%; P = 0.49). The questionnaire demonstrated a preference for catheter-free pH monitoring (96%) with less restriction in activities of daily living, naso-pharyngeal discomfort, dysphagia and chest pain. Conclusions Tolerance and satisfaction with catheter-free pH monitoring are high in patients who had previously failed C-pH; catheter-free pH monitoring assists the definitive diagnosis of GERD in this group. [source] Engineering a chemical implementation device and an imaging device for detecting chemiluminescence with a PolaroidÔ high-speed detector film: application to influenza diagnostics with the ZstatFlu®-II testLUMINESCENCE: THE JOURNAL OF BIOLOGICAL AND CHEMICAL LUMINESCENCE, Issue 2 2003Komandoor E. Achyuthan Abstract We describe the engineering and product development of the chemiluminescent ZstatFlu®-II Test kit for influenza diagnostics. The reaction vessel is a chemical implementation device with a polystyrene bottom chamber and a polypropylene top chamber that screw together. The patient's specimen is dispersed in a proprietary diluent and mixed inside the bottom chamber with the influenza viral neuraminidase-specific substrate, 1,2-dioxetane-4,7-dimethoxy-Neu5Ac. Neuraminidase catalysis releases the dioxetane. The top chamber contains 40% NaOH and is sealed at the top with an ABS plastic plug-crush pin assembly. The top chamber floor is 85% thinner at the centre, forming a frangible flap. An automated imaging device serves as an incubator for the chemical implementation devices and also facilitates the piercing of the flap by the crush pin. This action results in NaOH flushing into the bottom chamber, initiating chemiluminescence. The imaging device also exposes the PolaroidÔ high-speed detector film to chemiluminescence. At the end of exposure, the film is automatically processed and ejected. Chemiluminescence from an influenza virus-positive specimen produces a ,+'-shaped white image, archiving the diagnostic outcome. The modular ZstatFlu®-II test kit components are easily adaptable for the chemiluminescent detection of a wide range of analytes. Copyright © 2003 John Wiley & Sons, Ltd. [source] Does imprint cytology of brain tumours improve intraoperative diagnoses?ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2003T. Brommeland Objectives , To evaluate the diagnostic accuracy using frozen sections only and a combination of imprint cytology and frozen sections. Material and methods , After introduction of imprint cytology as a supplement to frozen sections in 1999, 153 patients with brain tumours underwent stereotactic or open surgery. An equal number of cases prior to 1999 were chosen for comparison. Intraoperative diagnoses were compared with final diagnoses based on paraffin sections of the same tissue samples. The number of delayed intraoperative diagnoses was noted in each patient group. Results , The combined use of the two techniques improved intraoperative diagnostic accuracy from 87 to 91% while the delayed intraoperative diagnoses were significantly reduced from 30 to 8. The choice of surgical procedure did not affect the outcome of the pathological investigations. Conclusion , A combination of frozen sections and imprints significantly reduced the number of delayed intraoperative diagnoses. Intraoperative diagnostic accuracy was improved, although not to a statistically significant level. Choice of surgical procedure did not affect the diagnostic outcome. [source] Factorial validity, reliability of assessments and prevalence of ADHD behavioural symptoms in day and residential treatment centres for children with behavioural problemsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2002E.M. Scholte Abstract This study uses the attention deficit/hyperactivity disorder (ADHD) symptom ratings of professional care workers to estimate the prevalence of ADHD symptoms among children in day treatment centres (N = 162) and residential treatment centres (N = 195) in Holland. Although further research is needed, the study supports the suggestion that such ratings can add to reliable diagnostic outcomes when assessing the behavioural symptoms of ADHD in children in the centres. It is estimated that nearly a fifth of the children in such centres exhibit the symptoms of ADHD in the judgement of professional care workers. Model testing using confirmatory factor analysis favours a dimensional behavioural model that comprises all the three constitutional symptom dimensions of ADHD (inattention, hyperactivity and impulsivity) instead of the two-factor model as used in the DSM-IV (inattention and hyperactivity/impulsivity). However, the differences of fit between both models were only small and the hyperactivity and impulsivity factors were highly correlated. This suggests that, in practice, a two-factor model can also be appropriate. The issue of whether a two-factor or a three-factor model is more appropriate thus remains unsolved in this study. Copyright © 2002 Whurr Publishers Ltd. [source] Associations of ALDH2 and ADH1B Genotypes With Alcohol-Related Phenotypes in Asian Young AdultsALCOHOLISM, Issue 5 2009Christian S. Hendershot Background:, Associations of ALDH2 and ADH1B genotypes with alcohol use have been evaluated largely using case,control studies, which typically focus on adult samples and dichotomous diagnostic outcomes. Relatively fewer studies have evaluated ALDH2 and ADH1B in relation to continuous drinking outcomes or at different developmental stages. This study examined additive and interactive effects of ALDH2 and ADH1B genotypes on drinking behavior in a mixed-gender sample of Asian young adults, focusing on continuous phenotypes (e.g., heavy episodic and hazardous drinking, alcohol sensitivity, drinking consequences) whose expression is expected to precede the onset of alcohol use disorders. Methods:, The sample included 182 Chinese- and Korean-American young adults ages 18 years and older (mean age = 20 years). Effects of ALDH2, ADH1B and ethnicity were estimated using generalized linear modeling. Results:, The ALDH2*2 allele predicted lower reported rates of alcohol use and drinking consequences as well as greater reported sensitivity to alcohol. There were significant ethnic group differences in drinking outcomes, such that Korean ethnicity predicted higher drinking rates and lower alcohol sensitivity. ADH1B status was not significantly related to drinking outcomes. Conclusions:, Ethnicity and ALDH2 status, but not ADH1B status, consistently explained significant variance in alcohol consumption in this relatively young sample. Results extend previous work by showing an association of ALDH2 genotype with drinking consequences. Findings are discussed in the context of possible developmental and population differences in the influence of ALDH2 and ADH1B variations on alcohol-related phenotypes. [source] Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal painALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009K. THAKKAR Summary Background, Abdominal pain is the most common indication for oesophagogastroduodenoscopy (OGD) in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. Aim, To examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and to describe the endoscopic and histological findings in patients undergoing OGD for abdominal pain of unclear aetiology. Methods, We performed a retrospective cross-sectional cohort study in children under 18 years of age who had OGD for the primary indication of abdominal pain, at Texas Children's Hospital and Children's Hospital of The King's Daughters from 1 January 2002 to 30 June 2005. Results, Overall, OGD was diagnostic in 454 (38.1%) of the 1191 procedures, including reflux oesophagitis (23%, n = 271), Helicobacter pylori infections (5%, n = 55), peptic ulcers (3%, n = 32), eosinophilic oesophagitis (2%, n = 25), celiac disease (1%, n = 9) and Crohn's disease (0.5%, n = 7). Male gender, older age, elevated C-reactive protein and vomiting were associated with increased diagnostic yield. Conclusions, Our findings suggest that OGD is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%. The majority of alarm symptoms and routine laboratory tests are not significantly associated with diagnostic yield. [source] | ||||||||||