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Diagnostic reasoning

Francois Maissan, Jan Pool, Eric Stutterheim, Harriet Wittink, Raymond Ostelo
BACKGROUND: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. OBJECTIVE: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present...
June 2, 2018: Musculoskeletal Science & Practice
P A van Rijn, J Boonstra, H G P van Gennip
Since February 1st 2011, rinderpest (RP) has been officially declared eradicated worldwide. National authorities have been requested to destroy all their RP related materials. Nonetheless, their national reference laboratories performing real time reverse transcription polymerase chain reaction assays (PCR diagnostics) need RP positive control samples, since some countries still prefer to maintain diagnostic capability for RP for several reasons. In the future, a similar situation will arise for peste des petits ruminants (PPR) as the ambition has been expressed to eradicate PPR...
June 12, 2018: Journal of Virological Methods
Carsten W Israel
Transient loss of consciousness represents one of the most frequent reasons for patients to present in the emergency room. Already at the very beginning, the diagnostic work-up is faced with fundamental questions: (1) Was it really a loss of consciousness? (2) Which department (neurology, cardiology, or others) should check the patient? (3) Is an in-hospital diagnostic work-up required? These questions can be answered from a meticulous patient history which needs to be adjusted to the individual case but also has to systematically go through a list of questions...
June 2018: Herzschrittmachertherapie & Elektrophysiologie
Jose L Diaz-Gomez, Ami A Grek, Carla P Venegas-Borsellino, Andreea C Chirila, Angela M Builes, Robert A Ratzlaff
OBJECTIVE: To describe a focused transthoracic echocardiography (FoTE) curriculum for advanced practice providers (APPs) for echocardiography-driven diagnosis of shock in critically ill patients. METHODS: Twelve APPs in 4 intensive care units at an academic medical center received didactic sessions on FoTE, including 1-on-1 proctorship with a registered cardiac sonographer. For a period of 6 months the trainees performed individual studies, then they performed FoTE examinations on critically ill patients; their diagnoses were compared with those of experienced intensivists for the same patients...
June 11, 2018: Heart & Lung: the Journal of Critical Care
Carlo Lombardo, Sara Iacopi, Francesca Menonna, Niccolò Napoli, Emanuele Kauffmann, Juri Bernardini, Andrea Cacciato Insilla, Piero Boraschi, Francescamaria Donati, Carla Cappelli, Daniela Campani, Davide Caramella, Ugo Boggi
BACKGROUND/OBJECTIVES: Despite diagnostic refinements, pancreatic resection (PR) is eventually performed in some patients with asymptomatic serous cystadenoma (A-SCA). The aim of this study was to define incidence and reasons of PR in A-SCA. METHODS: A retrospective analysis of a prospectively maintained database was performed for all the patients referred for pancreatic cystic lesions (PCL) between January 2005 and March 2016. RESULTS: Overall, there were 1488 patients with PCL, including 1271 (85...
June 8, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
L Raposo Rodríguez, D J Tovar Salazar, N Fernández García, L Pastor Hernández, Ó Fernández Guinea
OBJECTIVE: To describe and illustrate the key findings on structural magnetic resonance imaging (MRI) in the most common dementias of neurodegenerative origin: Alzheimer's disease, vascular dementia, dementia with Lewy bodies, variants of frontotemporal dementia, progressive supranuclear palsy, variants of multiple system atrophy, Parkinson dementia, and corticobasal degeneration. CONCLUSION: Today the role of MRI is no longer limited to ruling out underlying causes of cognitive deterioration...
June 11, 2018: Radiología
J Baldi, D Attala, A Scotto di Uccio, V Laquintana, R Biagini, C Zoccali
INTRODUCTION: Core biopsy is today recognized as the gold standard for the diagnosis of bone lesions; unfortunately, when the bone is too solid it can be very difficult to penetrate it; in case of failure, open biopsy is indicated but it is associated with greater contamination and complications. A possible solution is to connect a common orthopedic drill to the core biopsy needle. The aim of the presenting study was to present a technique useful for performing biopsies in case of very strong bone lesions and to evaluate the adequacy and quality of the obtained specimen...
June 9, 2018: Injury
Ammar AlLugami, Kerstin von Pückler, Marlene Sickinger
In male small ruminants, voiding disturbances are not uncommon. A precise knowledge of the underlying disease is essential for prognostic evaluation as well as for a decision concerning the therapeutic approach. Common reasons for voiding disturbances in the male small ruminant are obstructive urolithiasis, traumata of the penis or inflammatory processes within the urethra or urinary bladder. The diagnostic method of choice - in addition to clinical examination - is diagnostic imaging. Because radiology is not always possible under field conditions, the aim of this article is a detailed presentation of ultrasonography of the distal urethra of the male lamb...
June 2018: Tierärztliche Praxis. Ausgabe G, Grosstiere/Nutztiere
Arif Albulushi, Andreas Giannopoulos, Nikolaos Kafkas, Stylianos Dragasis, Gregory Pavlides, Yiannis S Chatzizisis
Acute right ventricle myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction and, occasionally, with anterior wall myocardial infarction. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography and coronary angiography, whereas non-invasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role...
June 14, 2018: Expert Review of Cardiovascular Therapy
Tammas Kelly
OBJECTIVES: Many studies indicate that bipolar disorders are underdiagnosed. Yet from 2007 to 2008, a series of publications asserted that bipolar disorders were being overdiagnosed. This review examines the methods used in the studies that reported bipolar disorders were being overdiagnosed. METHODS: A literature search for studies with original data related to overdiagnosis of bipolar disorders was performed. RESULTS: Four studies were found indicating bipolar disorders were being overdiagnosed...
June 14, 2018: International Journal of Methods in Psychiatric Research
Juanli Li, Jiacheng Xie, Zhaojian Yang, Junjie Li
To reduce the difficulty of acquiring and transmitting data in mining hoist fault diagnosis systems and to mitigate the low efficiency and unreasonable reasoning process problems, a fault diagnosis method for mine hoisting equipment based on the Internet of Things (IoT) is proposed in this study. The IoT requires three basic architectural layers: a perception layer, network layer, and application layer. In the perception layer, we designed a collaborative acquisition system based on the ZigBee short distance wireless communication technology for key components of the mine hoisting equipment...
June 13, 2018: Sensors
L V Rodrigues, G Samouco, R Gomes, C Santos, L Ferreira
If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017...
June 10, 2018: Pulmonology
Peter L Elkin, Daniel R Schlegel, Michael Anderson, Jordan Komm, Gregoire Ficheur, Leslie Bisson
Evoking strength is one of the important contributions of the field of Biomedical Informatics to the discipline of Artificial Intelligence. The University at Buffalo's Orthopedics Department wanted to create an expert system to assist patients with self-diagnosis of knee problems and to thereby facilitate referral to the right orthopedic subspecialist. They had two independent sports medicine physicians review 469 cases. A board-certified orthopedic sports medicine practitioner, L.B., reviewed any disagreements until a gold standard diagnosis was reached...
April 2018: Applied Clinical Informatics
Nicole J Fernandez, Catherine R Wagg, Amy L Warren
Veterinary students are challenged to develop new, nonlinear ways of thinking as they learn diagnostic reasoning skills. To support this process, we use real-life cases in our clinical pathology course. Changes in student perceptions regarding the use of cases and changes in study strategies over time have not been previously investigated or compared to student grades. Students participated in three voluntary online surveys that included 4-point Likert scale questions and open-ended questions on the helpfulness of cases for learning and study strategies used during the course...
June 13, 2018: Journal of Veterinary Medical Education
Jaak Ph Janssens, Klaus Schuster, Andreas Voss
Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system...
June 2018: EPMA Journal
Gia Deyab, Ingrid Hokstad, Jan Aaseth, Milada Cvancarova Småstuen, Jon Elling Whist, Stefan Agewall, Torstein Lyberg, Dag Tveiten, Gunnbjorg Hjeltnes, Kazem Zibara, Ivana Hollan
OBJECTIVES: The reason for increased cardiovascular risk in inflammatory arthritis (IA) is unclear. Interestingly, selenium-deficiency is suspected to contribute to the development of cardiovascular disease (CVD) in the general population. Although the reference range of serum selenium (s-selenium) is 50-120 μg/L, there are indications that levels up to 85 μg/L might not be sufficient for optimal cardioprotection. Our aim was to examine s-selenium levels in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), to evaluate the effect of anti-rheumatic treatment on s-selenium levels, and to assess relationships between s-selenium levels and clinical and laboratory parameters including markers of disease activity and CVD risk...
September 2018: Journal of Trace Elements in Medicine and Biology
Lucie De Léotoing, Yazdan Yazdanpanah, Laurent Finkielsztejn, Gwendoline Chaize, Alexandre Vainchtock, Gaëlle Nachbaur, Céline Aubin, Fabrice Bonnet
OBJECTIVES: To estimate the number of patients hospitalized for HIV-related reasons in France, to describe their characteristics and to estimate hospitalization-associated costs. DESIGN: A retrospective analysis of the French hospital medical information database (Programme de médicalisation des systèmes d'information en médecine, chirurgie, obstétrique et odontologie database). METHODS: Patients hospitalised with HIV in France in 2013 and 2014 were identified in the database through International Classification of Diseases, 10th revision diagnostic codes as well as comorbidities and opportunistic infections...
June 11, 2018: AIDS
R Vial, L Daniel, M Devos, B Bouchacourt, G Cazajous, H Sichez, K Mazodier, M Lankester, P Gobert, J Seguier, L Swiader, M Sallée, N Jourde-Chiche, J-R Harlé
INTRODUCTION: Chronic lymphoid leukemia (CLL) is a hematological malignant disease, associated with a clonal B cell proliferation. The incidence is 4400 new cases per year in France. The prevalence increases with age with a median age at diagnostic of 65 years. Renal involvement is rare and estimated at 1.2% of patients with CLL. Renal pathological diagnoses associated with CLL are variable and are not always related to the hematological disease. We report here on cases of patients with CLL who underwent a renal biopsy over the past 16 years in Marseille...
June 8, 2018: La Revue de Médecine Interne
Jovanna Thielker, Habib Bendella, Robert A Gaudin, Maria Grosheva, Fabian Gerd Volk, Orlando Guntinas-Lichius
There are numerous reasons for facial palsy, which range from idiopathic palsy (Bell's palsy) to destruction of the facial nerve by a malignant salivary gland tumor. If the chance of spontaneous recovery is low or there is no drug therapy available, surgery is a therapeutical option. Recently, larger studies were published by specialized centers which enable a more individualized therapeutical concept to achieve tone, symmetry and movement of the paralyzed face based on a detailed preoperative assessment. An important therapy target is the improvement of patient´s quality of life...
June 2018: Laryngo- Rhino- Otologie
J N de Boer, A E Voppel, M J H Begemann, H G Schnack, F Wijnen, I E C Sommer
Verbal communication disorders are a hallmark of many neurological and psychiatric illnesses. Recent developments in computational analysis provide objective characterizations of these language abnormalities. We conducted a meta-analysis assessing semantic space models as a diagnostic or prognostic tool in psychiatric or neurological disorders. Diagnostic test accuracy analyses revealed reasonable sensitivity and specificity and high overall efficacy in differentiating between patients and controls (n=1680: Hedges' g =...
June 8, 2018: Neuroscience and Biobehavioral Reviews
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