Automated LGE Myocardial Scar Segmentation Using MaskSLIC Supervoxels - Replicating the Clinical Method

2017 ◽  
pp. 229-236 ◽  
Author(s):  
Iulia A. Popescu ◽  
Alessandra Borlotti ◽  
Erica Dall’Armellina ◽  
Vicente Grau
Keyword(s):  
Myocardial Scar ◽  
Clinical Method

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Modern approaches to the treatment of mastitis in women of reproductive age

2016 ◽  
pp. 191-108
Author(s):  
A.A. Sukhanova ◽  
◽  
Yu.M. Melnik ◽  
O.O. Karlova ◽  
◽  
...  
Keyword(s):  
Ultrasound Examination ◽  
Clinical Signs ◽  
Reproductive Age ◽  
Herbal Remedies ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Clinical Method ◽  
Gynecological Examination ◽  
Study Results ◽  
Observation Period

The aim of the study: to study the efficacy and safety of use Mastofemin in the treatment of various forms of mastitis in women of reproductive age. Materials and methods. The study included 62 women of reproductive age (mean age of 33.5±2.3 years) who were screened in the Kiev city center reproductive and perinatal medicine. Women were divided into 2 groups. The first (main) group consisted of 32 patients who received the proposed treatment using herbal remedies Mastofemin 1 capsule 2 times per day for 3 months; 30 patients of the second (control) group were under observation and received no treatment. These groups were representative and homogeneous on age, clinical symptoms and sonographic characteristics. The clinical method included evaluation of complaints of patients, anamnesis, presence of concomitant gynecologic pathology, inspection, palpation of the lymph nodes and the breast and obtaining a discharge from the nipples to conduct cytological examination, which allowed excluding from the study women with suspected malignancy of the process. All the patients were performed ultrasound examination of the breast. The review was supplemented with vaginal gynecological examination and ultrasound examination of small pelvis organs to assess the condition of the uterus and its appendages, the diagnosis of gynecological diseases. Results. Summarizing obtained in this study results one should stress the positive long-term effect of applying Mastofemin for the treatment of proliferative changes of the breast in women of reproductive age. This is manifested by a decrease in the intensity of clinical signs of mastitis, consistent with the results of sonographic control. Established positive dynamics in the treatment of cystic mastitis, dectective and when combined cystic mastopathy with dectective. In the control group of patients for a given observation period (6 months) no significant changes in clinical signs of mastitis and sonographic characteristics. Regression of disease has not occurred in any of the patients, in 2 patients increased sensitivity of the breast after 6 months moved to the soreness. Sonographic characteristics of mastitis during the observation period did not change. Thus, the use of Mastofemin aimed at pathogenetic treatment of mastitis and prevention of breast cancer. Conclusion. Application of Mastofemin during the treatment of mastitis in women of reproductive age significantly improves the clinical condition of patients; reduce the subjective and objective symptoms of the disease. The positive effect of the treatment with Mastofemin proved in the case of the treatment of sonographic following forms of mastitis: cystic mastopathy, cystic mastopathy with dectectasy. Mastofemin may be the drug of choice for complex conservative monotherapy in women of reproductive age with proliferative changes in the breast, and can also be used as part of complex treatment in patients with diffuse changes of the breast when combined with hyperplastic processes of the myometrium and endometrium. Keywords: mastopathy, breast gland, herbal medicine, herbal remedies, Mastofemin.

Comparison of categorical and dimensional approaches to the diagnosis of personality disorders

2020 ◽  
pp. 15-25
Author(s):  
T. G. Gadisov ◽  
A. A. Tkachenko
Keyword(s):  
Comparative Study ◽  
Personality Disorders ◽  
Big Five ◽  
Factor Model ◽  
Five Factor Model ◽  
Personality Structure ◽  
Categorical Approach ◽  
Personal Traits ◽  
Clinical Method ◽  
Neo Five Factor Inventory

Summary. Objective: A comparative study of the personality structure from the perspective the Five-factor personality model (“Big Five”) in mentally healthy and in people with personality disorders depending on the leading radical determined by the clinical method.Materials and methods: a comparative study of personality structures in the mentally healthy (13 people) and in individuals with personality disorders (47 people) was carried out. To assess the personality structure, the NEO-Five Factor Inventory questionnaire was used. Persons with personality disorders were divided into groups in accordance with the leading radical: 24 — with emotionally unstable; 13 — with a histrionic; 6 — with schizoid; 4 — with paranoid radicals.Results: There were no differences in the values of the domains of the Five-Factor personality model between a group of individuals with personality disorders and the norm. The features of domain indicators of the Five-factor personality model were revealed in individuals with personality disorder depending on theradical.Conclusion: The NEO-Five Factor Inventory questionnaire, like most other tools from the perspective of the Five-Factor Model, is not suitable for assessing a person in terms of assigning it to variants of a mental disorder. When comparing the categorical and dimensional approaches to assessing the structure of personality disorders, it was found that the obligate personality traits identified using the categorical approach are fully reflected in the «Big Five» in individuals with a leading schizoid radical. The relations of obligate personal traits with the domains of the Five-factor model of personality in individuals with other (paranoid, histrionic,and emotionally unstable) radicals are less clear.

Teaching a Clinical Method Adapted to Contemporary Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Clinical Observation ◽  
Skills Training ◽  
Spoken Language ◽  
Communication Skills Training ◽  
Clinical Method ◽  
Medical Interviewing ◽  
The Status ◽  
Clinical Thinking ◽  
Contemporary Medicine ◽  
Person Centered Approach

A truly person-centered curriculum requires important changes to how the clinical method is taught. Medical interviewing demands explicit instruction in how the spoken language works and specific strategies that elevate the status of attentive listening so that this aspect is seen as important as the more mechanical aspects of traditional communication skills training. The term chief complaint is declared outdated and suggestions for its replacement are offered. The medical record is considered an important educational instrument, and recommendations are made so that it is in service of functional assessment and better aligned to a person-centered approach. Modifications to the physical examination, particularly a renewed emphasis on clinical observation, are outlined. The chapter concludes with a discussion of clinical thinking and judgment. A plea is made for inculcating a receptiveness toward a narrative competence within medicine.

The Clinical Method and Subjectivity in Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Record ◽  
Chronic Conditions ◽  
Process Of Care ◽  
Clinical Method ◽  
Functional Assessments ◽  
Contemporary Medicine

The clinical method is defined as the means by which doctors gather information about their patients, think about and evaluate these medical facts, and enter the facts into their process of care. Its key components are the medical history, including the process by which it is acquired from patients and its subsequent documentation in the medical record, as well as the physical examination. Characteristics, such as the reproducibility and accuracy of various components, are discussed with a reference to prevailing opinions of subjectivity and objectivity in medicine. It is argued that as a consequence of a shift in the prevalence of illness, from acute to chronic conditions, a misalignment exists between the clinical method currently taught and contemporary medicine. It is suggested that a renewed and repurposed clinical method must incorporate enhanced strategies for functional assessments.

scholarly journals Clinical application of thioredoxin reductase as a novel biomarker in liver cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xuping Wu ◽  
Qi Wang ◽  
Yousheng Lu ◽  
Jinye Zhang ◽  
Hanwei Yin ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Tumor Markers ◽  
Clinical Application ◽  
Thioredoxin Reductase ◽  
Superior Performance ◽  
Percutaneous Ablation ◽  
Hepatic Cancer ◽  
Diagnostic Efficiency ◽  
Malignant Diseases ◽  
Clinical Method

AbstractHepatic cancer is often amenable to surgery, including percutaneous ablation, trans-arterial chemoembolization. However, in metastatic cases, surgery is often not an effective option. Chemotherapy as a conventional clinical method for treatment of malignant diseases may be useful in such cases, but it is likewise not always able to slow or halt progression, therefore novel approaches for treatment of hepatic cancer are needed. Current research suggests that molecular tumor markers (TM) can play a crucial role for diagnosis and prognostic evaluation of malignancies, and TM such as AFP, CEA, CA19-9 have been reported in many malignant diseases. Thioredoxin reductase (TrxR), a type of anti-oxidant biomarker, has become a TM of significant interest. However, little is known about the above TM and TrxR activity in liver cancer. Therefore, this paper aimed to assess these TM with regards to diagnosis and and monitoring treatment efficacy in both primary and metastatic liver cancer. Our results showed TrxR had superior performance for discriminating between liver cancer patients and healthy controls than AFP, CEA, and CA19-9. TrxR also exhibited superior performance for assessing benefits of chemotherapy regardless if patients had PLC or MLC. Meanwhile, due to diagnostic efficiency of unresponsive chemotherapy patients, TrxR also showed a higher activity levels than other general markers in liver metastasis patients. Our results suggest that application of TrxR in combination with other tumor markers may maximize the efficiency of diagnosis and assessment of therapeutic efficiency, and provide new insights for the clinical application of TrxR as a candidate biomarker for liver cancer.

scholarly journals Diagnostic and prognostic impact of cardiac magnetic resonance, including scar quantification and strain imaging in patients with malignant ventricular arrhythmias and nonobstructed coronary arteries

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Szabo ◽  
V Bodi ◽  
CS Czimbalmos ◽  
ZS Dohy ◽  
V Horvath ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Coronary Arteries ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Scar Formation ◽  
Structural Abnormality ◽  
Icd Therapy ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Development and Innovation Fund of Hungary, National Research, Development and Innovation Office Background In case of malignant ventricular arrhythmias (VA) and nonobstructed coronary arteries, the differential diagnosis of the  underlying diseases is still challenging, due to the board spectrum of possible causes. Cardiac magnetic resonance (CMR) provides functional, morphological and tissue specific information, including necrotic and scar-tissue.  Aims   We aimed to assess the diagnostic and prognostic implications of CMR parameters including global strain values and myocardial scar in patients after ventricular fibrillation (VF) or sustained ventricular tachycardia (SVT) and nonobstructed coronary arteries. Methods Between 2011 and 2019, 99 patients (42 ±17 years, 54 male) presenting with VF or SVT and nonobstructed coronary arteries, who underwent CMR examination before secondary prevention implantable cardioverter defibrillator (ICD) implantation were included in our study. Post-processing included feature-tracking strain analysis and left ventricular (LV) scar quantification. Patients were followed for the combined endpoint of all-cause-mortality and appropriate ICD therapy. Results CMR examination proved structural myocardial disease in 72%: dilated (n = 21), arrhythmogenic (n = 11), hypertrophic cardiomyopathy (n = 7) and other cardiomyopathies (n = 3). We found LGE patterns showing chronic myocardial infarction (n = 4), suggesting chronic myocarditis (n = 4) and aspecific nonischemic scar formation (n = 14). In 7 cases aspecific structural alterations without scar formation were detected. Overall, myocardial scar was found in 52%, with an average extent of 12 ± 8% of the LV myocardium. The CMR examination changed the clinical diagnosis in 55% of the patients.  During a median follow-up at 2 years, 6 patients died and 42 experienced appropriate ICD therapy. We found an association between cardiac events and the presence of structural abnormality and myocardial scar (logrank: 4,553, p < 0.05 and 8.375, p <0.01).  On Cox proportional-hazards modell LV ejection fraction, LV stroke volume index, the presence of structural abnormality, the presence and extent of  myocardial scar, global LV strain parameters including longitudinal and circumferential strain, and a global left ventricular dssynchrony parameter (mechanical dispersion) were univariate predictors of the combined endpoint of all-cause-mortality and appropriate ICD therapy(p < 0.05).  Conclusion CMR performed in patients after malignant VA and nonobstructed coronary arteries not only establishes the diagnosis in a high proportion of patients, but may also provide additional prognostic factors. This may indicate that CMR could play a complementary role in the risk stratification in this patient population. Abstract Figure.

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