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Appropriate Diagnosis (appropriate + diagnosis)
Selected AbstractsA Computerized Nursing Process Support System in BrazilINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Maria da Graça Oliveira Crossetti BACKGROUND Hospital de Clinicas de Porto Alegre introduced the nursing process model as the basis for nursing practice at the hospital more than 20 years ago. A computerized nursing order system based on nursing diagnoses was introduced. The strategies used in the development of the system included establishment of Nursing Diagnosis Work Groups in 1998; systematic analysis of nursing processes based on the work of existing studies, the NANDA taxonomy in 1999; development and implementation of a data collection instrument to analyze the nursing diagnosis process; training of all nursing staff during 1999,2000; meetings between analysts and nursing staff to articulate the nursing process needs the system would be required to support; pilot implementation of the computerized nursing process system in the ICU in February 2000; and hospital-wide implementation in December 2000. The system supports nursing diagnoses and orders. It was developed in-house by the information systems group at the hospital and is implemented as an Oracle database accessed in client server mode over a Windows NT-based Ethernet network. The system is part of the hospital's larger clinical information management system. MAIN CONTENT POINTS The patient care module includes medical orders and nursing orders. On entering the nursing orders module, the user selects a patient and the system presents a list all current orders completed and pending. These orders can be examined, updated, and reprinted, and new daily nursing orders can also be input at this time. The "new order" screen provides the user with any previous orders to ensure consistency in nursing care. New nursing orders are prepared based on the patient history, physical exam, and daily evaluations. Required interventions are identified based on changes in the patient's "basic human needs." This process can be realized through two distinct paths through the nursing care module: one associated with diagnoses and the other with signs and symptoms. A nurse with more clinical experience and knowledge of diagnostic reasoning will opt to develop orders based on diagnoses. After the diagnosis and associated etiology is input, the system generates a list of possible interventions for selection. The duration and frequency of the intervention can then be specified and the order individualized to a patient's particular needs. Less experienced nurses and students will develop nursing orders based on a patient's signs and symptoms. The system generates a list of diagnoses, etiology, and associated basic human needs in response to the signs and symptoms input. The nurse selects the appropriate diagnoses and etiology and the system generates the list of nursing intervention options. Nurses following either path are required to confirm their orders. They then have the option of developing other orders for the same patient until all that patient's basic human needs have been addressed. The orders can be printed but also remain in the system for nursing staff to implement. CONCLUSIONS The application of systematic, evidence-based methods in nursing care results in improved quality of service that conforms to individual patients' basic human needs. [source] Biopsy Strategies for Endoscopic Surveillance of Pre-malignant Gastric LesionsHELICOBACTER, Issue 4 2010Annemarie C. De Vries Abstract Background:, Endoscopic surveillance of pre-malignant gastric lesions may add to gastric cancer prevention. However, the appropriate biopsy regimen for optimal detection of the most advanced lesions remains to be determined. Therefore, we evaluated the yield of endoscopic surveillance by standardized and targeted biopsy protocols. Materials and Methods:, In a prospective, multi-center study, patients with intestinal metaplasia (IM) or dysplasia (DYS) underwent a surveillance gastroscopy. Both targeted biopsies from macroscopic lesions and 12 non-targeted biopsies according to a standardized protocol (antrum, angulus, corpus, cardia) were obtained. Appropriate biopsy locations and the yield of targeted versus non-targeted biopsies were evaluated. Results:, In total, 112 patients with IM (n = 101), or low-grade (n = 5) and high-grade DYS (n = 6) were included. Diagnosis at surveillance endoscopy was atrophic gastritis (AG) in one, IM in 77, low-grade DYS in two, high-grade DYS in three, and gastric cancer in one patient. The angulus (40%), antrum (35%) and lesser curvature of the corpus (33%) showed the highest prevalence of pre-malignant conditions. Non-targeted biopsies from the lesser curvature had a significantly higher yield as compared to the greater curvature of the corpus in diagnosing AG and IM (p = .05 and p = .03). Patients with extensive intragastric IM, which was also present at the cardia were at high risk of a concurrent diagnosis of dysplasia or gastric cancer. High-grade DYS was detected in targeted biopsies only. Conclusions:, At surveillance endoscopies, both targeted and non-targeted biopsies are required for an appropriate diagnosis of (pre-)malignant gastric lesions. Non-targeted biopsies should be obtained in particular from the antrum, angulus and lesser curvature of the corpus. [source] Enlarging pigmented patches on the handINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2003Matthew Muellenhoff DO This case illustrates the clinical and pathological features of Tinea mgra. Awareness of the characteristic features of this cutaneous infection, especially in areas where the organism is endemic, can ultimately lead clinicians to the appropriate diagnosis. If Tinea nigra should be considered in the differential diagnosis of palmoplantar pigmentation, potassium hydroxide (KOH) preparation may facilitate the diagnosis. [source] Epidemiology of Anemia in the Elderly: Information on Diagnostic EvaluationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3s 2003Lodovico Balducci MD A rise in the aging population has been predicted, and, as a result, it is expected that the incidence of age-related health conditions will also increase. Although common in the elderly, anemia is often mild and asymptomatic and rarely requires hospitalization. However, untreated anemia can be detrimental, because it is associated with increased mortality, poor health, fatigue, and functional dependence and can lead to cardiovascular and neurological complications. Several factors have been suggested to cause anemia in this population, for example, blood loss or chronic disease. In some cases, the cause is unknown. It has been suggested that this is a result of the presence of comorbid conditions that can mask the symptoms of anemia. Therefore, appropriate diagnosis and management strategies of anemia in the elderly need to be identified, particularly because anemia may indicate the presence of other serious diseases. [source] Pemphigoid vegetans: a case report and review of the literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 12 2008Jinah Kim Pemphigoid vegetans is an exceptionally rare intertriginous variant of bullous pemphigoid characterized by vegetative and purulent lesions present in the groin, axillae, thighs, hands, eyelids and perioral regions. The clinical, histopathological and immunofluorescent profile of a new case of pemphigoid vegetans in a 79-year-old man is reported. Our patient had papillomatous plaques with pustules in the bilateral inguinal folds, which clinically resembled pemphigus vegetans. Also suggesting pemphigus vegetans, an initial skin biopsy showed eosinophilic spongiosis, while a second biopsy showed histological and immunological features diagnostic of pemphigoid. Because only a few cases of pemphigoid vegetans have been reported in the literature, clinical and morphological data are scant. Most reported cases were successfully treated with topical antibiotics or steroids; therefore, appropriate diagnosis of this rare lesion will assist management. [source] INFLUENCE OF MEASUREMENT TECHNIQUE, TEST FOOD, TEETH AND MUSCLE FORCE INTERACTIONS IN MASTICATORY PERFORMANCEJOURNAL OF TEXTURE STUDIES, Issue 1 2007FLÁVIA RIQUETO GAMBARELI ABSTRACT The role of texture and flavors in mastication is evident, but it is difficult to understand the interactions among food properties, oral physiology and perception. Mastication results from rhythmic mandibular movements. The teeth and masticatory muscles together form the mechanism whereby the food particles are fragmented. Masticatory performance and efficiency are defined as the capacity to reduce natural or artificial test materials during mastication, or by counting the number of strokes required to reduce food, respectively. Foods eaten for nourishment are very different from the industrial test materials used to quantify masticatory performance, thus, divergences could arise if the chewable material can or cannot be swallowed. This study presents a synopsis of masticatory performance methods, which is also related to muscle force, number of teeth and test chewing substance diversity. PRACTICAL APPLICATIONS The attributes of food, such as appearance, flavor and texture, as well as its interaction with saliva, number of teeth and conditions of the biomechanical system, influence the chewing process. In addition, reflex control and cognition can influence food perception and breakdown in the mouth. Food acceptability and choice depend on sensory properties of the food, which are perceived during chewing and swallowing. Masticatory performance and maximal occlusal force measurement may provide essential information that could lead to an appropriate diagnosis as regards masticatory function. Masticatory efficiency and performance can be measured to determine the individual's capacity to comminute a natural or a chewable test material. A material with uniform properties that can be reliably reproduced is essential to provide an ideal test bolus for the scientific study of masticatory effectiveness. [source] Can't stop dancing: Could it be St. Vitus' dance?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2008Corrie Rogness RN Abstract Purpose: To inform providers of one of the rare but significant consequences that result from not diagnosing and treating streptococcal pharyngitis: Sydenham's chorea (St. Vitus' dance). Data sources: Current Internet sources including review articles, informational articles, online medical textbooks, and professional organization Web sites. Conclusion: It is vital that each case of streptococcal pharyngitis be treated with appropriate antibiotic therapy. Doing so will help prevent the sequelae associated with streptococcal infections, such as acute rheumatic fever (ARF) and Sydenham's chorea. Implications for practice: Streptococcal pharyngitis is a common illness that has the potential to cause very serious consequences. The consequences may be life altering, such as suffering permanent heart damage. With appropriate diagnosis and treatment with antibiotics, the sequelae of ARF and Sydenham's chorea can be prevented. [source] The Treatment of Acute Adrenocortical Insufficiency in the DogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2001DACVECC, DACVIM, Michael Schaer DVM Summary Acute hypoadrenocorticism in the dog is a true medical emergency that requires a prompt and accurate diagnosis and appropriate treatment in order to provide for the most optimal outcome. Because the signs of adrenal insufficiency mimic those caused by other more common clinical conditions such as renal failure, intoxications, and various gastrointestinal disorders, it behooves the emergency clinician to always include this condition in the list of differential diagnoses. This paper will review the main elements of this hypoendocrinopathy in order to provide the emergency clinician with the essentials that will be required for appropriate diagnosis and treatment. J Vet emerg Crit Care 2001; 11(1):7,14 [source] Low-grade periductal stromal sarcoma of the breast with myxoid features: ImmunohistochemistryPATHOLOGY INTERNATIONAL, Issue 8 2009Davor Tomas A 52-year-old woman was admitted with a painful right breast tumor measuring more than 20 cm in largest diameter, which ulcerated the overlying skin. The lesion had appeared 4 years previously but the patient hesitated to seek medical care due to ,fear of cancer'. Microscopically, the tumor was composed of spindle cells that formed cuffs around multiple open tubules and ducts set in an abundant, myxoid stroma. The spindle cells had significant atypia with nuclear pleomorphism, occasional cytoplasmic vacuolation and moderate mitotic activity. The ducts and lobules surrounded by the proliferating tumor cells had minimal distortion, with a pericanalicular growth pattern devoid of the phyllodes pattern. The tumor had a multinodular growth pattern with coalesced and individual tumor nodules, the latter being found mostly at the periphery of the lesion. On immunohistochemistry the tumor cells were positive for smooth muscle actin, CD34, and vimentin, and focally positive for CD10. A diagnosis of low-grade periductal stromal sarcoma (PDSS) with myxoid features was established. PDSS is a distinct low-grade breast sarcoma, the appropriate diagnosis of which requires extensive tumor sampling and additional broad immunohistochemistry. PDSS should not be confused with other spindle cell breast tumors because they require different treatment. [source] General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 2 2006A major cause of concern for a developing country Abstract The prevalence of diabetes in Pakistan is one of the highest reported worldwide. Proper education of patients regarding strategies to prevent complications of diabetes is an essential component of good management of diabetes. We conducted this study to determine the approach of general practitioners towards the management of diabetes. We carried out a cross-sectional survey of 100 randomly selected GPs from urban cities of Pakistan. A rigorously developed questionnaire was administered and contained questions on (1) diagnostic criteria, (2) health education, and management of a patient by non-pharmacological and (3) pharmacological treatment, and (4) appropriate referral of the patients to specialists. In total, 100 GPs were approached, and all consented to enrol; 70% were male. The average number of patients seen at each clinic was 30 patients per day. Only 38% of the GPs used the correct level of fasting blood glucose (,126mg/dl) as the cut-off for diagnosing diabetes. The majority of GPs did not adequately educate their patients. Only 65% of the GPs interviewed gave advice about exercise, 38% about weight reduction, 26% about foot care, 26% about the complications, 9% about insulin use, 20% about hypoglycaemic events, and 23% about smoking cessation. It was concluded that GPs in Pakistan under-diagnose and under-educate patients with diabetes. Our findings highlight the need for appropriate diagnosis and management of diabetes, and prevention of its complications. Copyright © 2006 John Wiley & Sons, Ltd. [source] Lateral Thyrotomy for Excision of Laryngeal ParagangliomasTHE LARYNGOSCOPE, Issue 1 2006Seth M. Brown MD Abstract Laryngeal paragangliomas, although rare, are lesions that warrant appropriate diagnosis and treatment secondary to their location and high risk of bleeding when violated. This article describes a method to workup patients with solid submucosal lesions of the larynx to diagnose a paraganglioma without a biopsy. When recognized preoperatively, a lateral approach to removal can be performed, decreasing the risk of significant bleeding and the need for tracheotomy or permanent laryngostoma. This article also adds two more cases to the reported literature of 75. [source] Management of neuro-ophthalmology cases in childrenACTA OPHTHALMOLOGICA, Issue 2009S MILAZZO Neuro-ophthalmological conditions in children must be analyzed carefully and some emergencies must be recognized. Clinical and practical cases are illustrated. On that basis the most important aspects of the field of neuro-ophthalmology are covered succinctly but sufficiently to enable the practitioner to determine an appropriate diagnosis and course of treatment. Rare and unusual diseases are included but those that are especially critical to the patient's vision or general health and life. Some specific clinical signs and symptoms need to be carefully evaluated as papilledema, papillary abnormalities, ptosis, diplopia or ocular motility abnormalities. Each clinical case deals with a symptom that leads the patient to seek medical attention or a sign that is demonstrated on physical examination. The proper diagnosis is frequently made with the imaging but must be repeated if necessary. Specific techniques in children are described including oculomotor and electrical testing, tomodensitometry and magnetic resonance imaging. Different treatment as medical surgical and neurosurgical are discussed. The physician evaluating neuro-ophtalmic patients needs to have a broad background of medical information. So the patient's workup is properly managed and therapeutic orientations can be done. [source] Diagnosis and treatment of low-renin hypertensionCLINICAL ENDOCRINOLOGY, Issue 3 2007Paolo Mulatero Summary Plasma renin levels can be used to classify hypertension. A significant proportion of hypertensive individuals display a low-renin profile and thus low-renin hypertension (LRH) requires appropriate diagnosis and treatment. LRH includes essential, secondary and genetic forms, the most common of which are low-renin essential hypertension and primary aldosteronism. Several studies have investigated the relationship between PRA status and clinical response to different antihypertensive therapies. The present review will discuss the differential diagnosis of LRH subtypes and the most appropriate treatment options based on the pathophysiological background of this condition. [source] | ||||||||||