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Diagnostic reasoning

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https://www.readbyqxmd.com/read/28445954/a-clinically-feasible-multiplex-proteomic-immunoassay-as-a-novel-functional-diagnostic-for-pancreatic-ductal-adenocarcinoma
#1
Kian-Huat Lim, Emma Langley, Feng Gao, Jingqin Luo, Lin Li, Gary Meyer, Phillip Kim, Sharat Singh, Vladamir M Kushnir, Dayna S Early, Daniel K Mullady, Steven A Edmundowicz, Sachin Wani, Faris M Murad, Dengfeng Cao, Riad R Azar, Andrea Wang-Gillam
To date, targeted therapy for pancreatic ductal adenocarcinoma (PDAC) remains largely unsuccessful in the clinic. Current genomics-based technologies are unable to reflect the quantitative, dynamic signaling changes in the tumor, and require larger tumor samples that are difficult to obtain in PDAC patients. Therefore, a highly sensitive functional tool that can reliably and comprehensively inform intra-tumoral signaling events is direly needed to guide treatment decision. We tested the utility of a highly sensitive proteomics-based functional diagnostic platform, Collaborative Enzyme Enhanced Reactive-immunoassay (CEERTM), on fine-needle aspiration (FNA) samples obtained from 102 patients with radiographically-evident pancreatic tumors...
April 11, 2017: Oncotarget
https://www.readbyqxmd.com/read/28444634/watching-diagnoses-develop-eye-movements-reveal-symptom-processing-during-diagnostic-reasoning
#2
Agnes Scholz, Josef F Krems, Georg Jahn
Finding a probable explanation for observed symptoms is a highly complex task that draws on information retrieval from memory. Recent research suggests that observed symptoms are interpreted in a way that maximizes coherence for a single likely explanation. This becomes particularly clear if symptom sequences support more than one explanation. However, there are no existing process data available that allow coherence maximization to be traced in ambiguous diagnostic situations, where critical information has to be retrieved from memory...
April 25, 2017: Psychonomic Bulletin & Review
https://www.readbyqxmd.com/read/28442330/symptomatic-carotid-artery-disease-revascularization
#3
REVIEW
Piero Montorsi, Stefano Galli, Paolo M Ravagnani, Marco Roffi
Patients with symptomatic carotid artery disease should be managed by a multidisciplinary team including neurologists, vascular surgeons and interventionalists. Duplex ultrasound is the most widely used diagnostic modality to assess carotid disease, followed by additional imaging tests (CT- or MR-angiography) to confirm the severity of the stenosis, detect brain lesions, and assess intracranial circulation as well as the supra-aortic anatomy. Although overall randomized trial results favored (CEA) over carotid artery stenting (CAS) in symptomatic patients, this was likely related to the insufficient expertise of the endovascular specialists in several of the trials...
April 22, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28441603/assessment-of-wastewater-treatment-facility-compliance-with-decreasing-ammonia-discharge-limits-using-a-regression-tree-model
#4
Bihu Suchetana, Balaji Rajagopalan, JoAnn Silverstein
A regression tree-based diagnostic approach is developed to evaluate factors affecting US wastewater treatment plant compliance with ammonia discharge permit limits using Discharge Monthly Report (DMR) data from a sample of 106 municipal treatment plants for the period of 2004-2008. Predictor variables used to fit the regression tree are selected using random forests, and consist of the previous month's effluent ammonia, influent flow rates and plant capacity utilization. The tree models are first used to evaluate compliance with existing ammonia discharge standards at each facility and then applied assuming more stringent discharge limits, under consideration in many states...
April 22, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28440858/treatment-with-disease-modifying-drugs-for-people-with-a-first-clinical-attack-suggestive-of-multiple-sclerosis
#5
REVIEW
Graziella Filippini, Cinzia Del Giovane, Marinella Clerico, Omid Beiki, Miriam Mattoscio, Federico Piazza, Sten Fredrikson, Irene Tramacere, Antonio Scalfari, Georgia Salanti
BACKGROUND: The treatment of multiple sclerosis has changed over the last 20 years. The advent of disease-modifying drugs in the mid-1990s heralded a period of rapid progress in the understanding and management of multiple sclerosis. With the support of magnetic resonance imaging early diagnosis is possible, enabling treatment initiation at the time of the first clinical attack. As most of the disease-modifying drugs are associated with adverse events, patients and clinicians need to weigh the benefit and safety of the various early treatment options before taking informed decisions...
April 25, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28440538/massive-nasal-polyposis-in-a-patient-with-newly-diagnosed-cystic-fibrosis
#6
Małgorzata Olszowiec-Chlebna, Krzysztof Trzciński, Iwona Stelmach
INTRODUCTION: Cystic fibrosis (CF) - is the most common fatal autosomal recessive disease in Caucasians. A number of reports have described patients who do not meet diagnostic criteria for cystic fibrosis. Atypical or nonclassic CF is characterised by normal or borderline sweat test, pancreatic sufficiency and a monosymptomatic phenotype. For these reasons clinicians should remain alert to the possibility of the occurrence of CF. CASE REPORT: We described a case presentation of massive nasal polyposis and recurrent sinusitis leading to the diagnosis ofcystic fibrosis in a 11-year-old male...
2017: Advances in Respiratory Medicine
https://www.readbyqxmd.com/read/28440098/early-diagnosis-of-amyotrophic-lateral-sclerosis-mimic-syndromes-pros-and-cons-of-current-clinical-diagnostic-criteria
#7
Elena Cortés-Vicente, Jesús Pradas, Juan Marín-Lahoz, Noemi De Luna, Jordi Clarimón, Janina Turon-Sans, Ellen Gelpí, Jordi Díaz-Manera, Isabel Illa, Ricard Rojas-Garcia
OBJECTIVE: To describe the frequency and clinical characteristics of patients referred to a tertiary neuromuscular clinic as having amyotrophic lateral sclerosis (ALS) but who were re-diagnosed as having an ALS mimic syndrome, and to identify the reasons that led to the revision of the diagnosis. METHODS: We reviewed the final diagnosis of all patients prospectively registered in the Sant Pau-MND register from 1 January 2004 to 31 December 2015. A detailed clinical evaluation and a clinically-guided electrophysiological study were performed at first evaluation...
April 25, 2017: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
https://www.readbyqxmd.com/read/28439469/migratory-orientation-in-a-narrow-avian-hybrid-zone
#8
David P L Toews, Kira E Delmore, Matthew M Osmond, Philip D Taylor, Darren E Irwin
BACKGROUND: Zones of contact between closely related taxa with divergent migratory routes, termed migratory divides, have been suggested as areas where hybrid offspring may have intermediate and inferior migratory routes, resulting in low fitness of hybrids and thereby promoting speciation. In the Rocky Mountains of Canada there is a narrow hybrid zone between Audubon's and myrtle warblers that is likely maintained by selection against hybrids. Band recoveries and isotopic studies indicate that this hybrid zone broadly corresponds to the location of a possible migratory divide, with Audubon's warblers migrating south-southwest and myrtle warblers migrating southeast...
2017: PeerJ
https://www.readbyqxmd.com/read/28438399/type-2-myocardial-infarction-due-to-supply-demand-mismatch
#9
REVIEW
Nino Mihatov, James L Januzzi, Hanna K Gaggin
The best-accepted definition of myocardial infarction (MI) is provided by statements from the Universal Definition of MI Global Task force. This article, now in its third iteration, defines MI as myocardial cell death due to prolonged myocardial ischemia. It further delineates an increasingly incident subclassification of MI known as type 2 MI (T2MI). T2MI identifies instances of myocardial necrosis in which an imbalance between myocardial oxygen supply and/or demand occurs for reasons other than atherosclerotic plaque disruption...
March 11, 2017: Trends in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28438085/the-feline-blood-film
#10
John W Harvey
Practical relevance: Many veterinary practices have invested in quality automated hematology instruments for use in-house. However, regardless of the specific choice of analyzer, there are important hematology findings that can only be determined by microscopic examination of stained blood films. For this reason, and also for the purpose of quality control for the analyzer, a quick blood film review should be performed alongside every automated complete blood count. Even those practices that submit their blood samples to outside diagnostic laboratories for evaluation, still require the capability to examine stained blood films in emergency situations...
May 2017: Journal of Feline Medicine and Surgery
https://www.readbyqxmd.com/read/28436930/a-framework-for-ethical-decision-making-in-the-rehabilitation-of-patients-with-anosognosia
#11
Anna Rita Egbert
Currently, the number of patients diagnosed with impaired self-awareness of their own deficits after brain injury-anosognosia-is increasing. One reason is a growing understanding of this multifaceted phenomenon. Another is the development and accessibility of alternative measurements that allow more detailed diagnoses. Anosognosia can adversely affect successful rehabilitation, as often patients lack confidence in the need for treatment. Planning such treatment can become a complex process full of ethical dilemmas...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436390/biomarkers-for-early-diagnosis-of%C3%A2-alzheimer-s-disease-in-the-oldest-old-yes-or-no
#12
Lucia Paolacci, David Giannandrea, Patrizia Mecocci, Lucilla Parnetti
In recent years, many efforts have been spent to identify sensitive biomarkers able to improve the accuracy of Alzheimer's disease (AD) diagnosis. Two different workgroups (NIA-AA and IWG) included cerebrospinal fluid (CSF) and neuroimaging findings in their sets of criteria in order to improve diagnostic accuracy as well as early diagnosis. The number of subjects with cognitive impairment increases with aging but the oldest old (≥85 years of age), the fastest growing age group, is still the most unknown from a biological point of view...
April 15, 2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28435659/an-investigative-framework-to-facilitate-epidemiological-thinking-during-herd-problem-solving
#13
Simon J More, Michael L Doherty, Luke O'Grady
Veterinary clinicians and students commonly use diagnostic approaches appropriate for individual cases when conducting herd problem-solving. However, these approaches can be problematic, in part because they make limited use of epidemiological principles and methods, which has clear application during the investigation of herd problems. In this paper, we provide an overview of diagnostic approaches that are used when investigating individual animal cases, and the challenges faced when these approaches are directly translated from the individual to the herd...
2017: Irish Veterinary Journal
https://www.readbyqxmd.com/read/28435489/gender-differences-in-cdc-guideline-compliance-for-stis-in-emergency-departments
#14
Bryan G Kane, Alexander W D Guillaume, Elizabeth M Evans, Terrence E Goyke, Jessica K Eygnor, Lauren Semler, Stephen W Dusza, Marna Rayl Greenberg
INTRODUCTION: Sexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers. METHODS: We performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28429366/analysis-of-transcriptional-activities-of-angiogenic-biomarkers-during-intrauterine-complications-leading-to-preterm-birth
#15
M Rabajdová, R Dudič, P Urban, V Dudičová, P Urdzík, M Mareková
OBJECTIVE: Pre-eclampsia, growth retardation and preterm delivery are the most common reasons leading to increased maternal and perinatal mortality. The increased expression of hypoxia induced factors, such as HIF-1, triggers the overexpression of anti-angiogenic genes. The aim of this study was to determine the transcriptional activity of individual pro- and anti-angiogenic markers (VEGF, HIF-1, sEng, Flt-1, PlGF-1) in maternal blood samples from patients with spontaneous preterm labor, preterm labor in combination with pre-eclampsia and fetal growth restriction in comparison with physiologically terminated pregnancies...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28428732/access-to-information-and-counselling-older-cancer-patients-self-report-a-cross-sectional-survey
#16
Kristin Vassbotn Guldhav, Randi Jepsen, Siri Ytrehus, Ellen Karine Grov
BACKGROUND: An increasingly older population, improved diagnostics and treatment increase the number of older cancer survivors, thus more than 60% of those affected by cancer are over the age of 65. Symptom relief and the prevention of functional impairment are important tasks for home care nursing, considering that patients can live a long time with their cancer disease and related side effects. The aim of this study was to investigate the extent to which cancer patients over the age of 65 reported access to information and counselling from home care nursing services, including those offered by the cancer coordinator...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28425889/soap-methodology-in-general-practice-family-medicine-teaching-in-practical-context
#17
Luiz Miguel Santiago, Isabel Neto
INTRODUCTION: Medical records in General Practice/Family Medicine are an essential information support on the health status of the patient and a communication document between health professionals. The development of competencies in General Practice/Family Medicine during pre-graduation must include the ability to make adequate medical records in practical context. As of 2012, medicine students at the University of Beira Interior have been performing visits using the Subjective, Objective, Assessment and Plan - SOAP methodology, with a performance evaluation of the visit, with the aim to check on which Subjective, Objective, Assessment and Plan - SOAP aspects students reveal the most difficulties in order to define improvement techniques and to correlate patient grade with tutor evaluation...
December 30, 2016: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28425112/beyond-guidelines-discretionary-practice-in-face-to-face-triage-nursing
#18
Lars E F Johannessen
This article draws on ethnographic data from a Norwegian emergency primary care clinic (EPCC) to explore nurses' discretionary application of guidelines. Specifically, it analyses nurses' discretionary use of the Manchester Triage System (MTS) when performing face-to-face triage, that is, assessing the urgency of patients' complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning...
April 20, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28425083/restless-legs-syndrome-willis-ekbom-disease-prevalence-in-beta-thalassemia-patients
#19
Euthimia Dimitriadou, Christoforos D Giannaki, Maria Tsekoura, Ioannis Stefanidis, Georgios M Hadjigeorgiou, Eleftherios Lavdas, Christina Karatzaferi, Giorgos K Sakkas
PURPOSE: Both beta thalassemia and restless legs syndrome (RLS) patients share some common pathophysiological characteristics related to iron handling. In the present study, the aim was to explore the prevalence of RLS as well as to explore potential association between the syndrome and various quality of life-related parameters in a sample of beta thalassemia patients. METHODS: One hundred fourteen (age 40 ± 11 yr, 59 M/55F) beta thalassemia patients participated in this cross-sectional descriptive study...
April 19, 2017: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/28424090/targeted-endomyocardial-biopsy-guided-by-real-time-cardiovascular-magnetic-resonance
#20
Christina Unterberg-Buchwald, Christian Oliver Ritter, Verena Reupke, Robin Niklas Wilke, Christine Stadelmann, Michael Steinmetz, Andreas Schuster, Gerd Hasenfuß, Joachim Lotz, Martin Uecker
BACKGROUND: Endomyocardial biopsies (EMB) are an important diagnostic tool for myocarditis and other infiltrative cardiac diseases. Routinely, biopsies are obtained under fluoroscopic guidance with a substantial radiation burden. Despite procedural success, there is a large sampling error caused by missing the affected myocardium. Therefore, multiple (>6) biopsies are taken in the clinical setting. In cardiovascular magnetic resonance (CMR), late gadolinium enhancement (LGE) depicts areas of affected myocardium in myocarditis or in other infiltrative cardiomyopathies...
April 19, 2017: Journal of Cardiovascular Magnetic Resonance
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