scholarly journals 2198. Weak Interobserver Reliability in the Clinical Diagnosis of Pneumonia Among Infectious Disease Trained Physicians

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S749-S749
Author(s):  
Virginia Sheffield ◽  
Robert Dickson ◽  
Rishi Chanderraj
Keyword(s):  
Decision Making ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Interobserver Reliability ◽  
Laboratory Data ◽  
Diagnostic Tools ◽  
Pulmonary Medicine ◽  
Chest Imaging ◽  
Surveillance Network ◽  
Diagnostic Reliability

Abstract Background Pneumonia remains a common global cause of death. Varied definitions of pneumonia rely on clinical features, imaging, and microbiological data. The Center for Diseases Control/National Healthcare Surveillance Network (CDC/NHSN) definition is used to study population-level trends. Prior studies have revealed discordance in components of the definition, yet reliability of overall clinical diagnosis has not been evaluated, nor has it been compared with the surveillance definitions. This study was designed to determine the overall concordance in the diagnosis of pneumonia by Infectious Diseases (ID) clinicians and the agreement between this and the surveillance definition. We then set out to determine which clinical features were weighted most heavily in provider decision-making. Methods Using an iterative approach with input from ID and Pulmonary Medicine physicians, we designed and refined an adjudication tool for diagnosis of pneumonia that consolidates clinical features, laboratory data, and imaging. Cases were analyzed by strict CDC/NHSN surveillance criteria and adjudicated independently by ID-trained physicians based on overall clinical opinion. Kappa coefficient (κ) was used to determine diagnostic reliability, and a random forest model was used to identify clinical factors most heavily weighted by physicians. Results Twenty-eight cases were adjudicated by three ID-trained physicians. Overall, interrater agreement was low (κ = 0.438). In comparing providers’ clinical adjudication with CDC/NHSN criteria, agreement was even worse (κ range 0.125 to 0.378). Among specific clinical features, positive culture growth strongly informed clinician diagnosis of pneumonia, while chest imaging did not play a significant role. Conclusion Overall agreement in the clinical diagnosis of pneumonia is poor, even among ID-trained physicians. Culture results more strongly inform clinician decision-making than does chest imaging. The surveillance definition used by the CDC/NHSN has only weak agreement with in-practice clinical assessment. These results underscore the need for more precise diagnostic tools in cases of suspected pneumonia. Disclosures All authors: No reported disclosures.

Hepatitis C an Ayurvedic approach - A Case Study

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Vidyadhar Balikai ◽  
Prashanth A. S. ◽  
S. G. Chavan
Keyword(s):  
Hepatitis C ◽  
Clinical Features ◽  
Daily Basis ◽  
Diagnostic Tools ◽  
Weekly Basis ◽  
General Weakness ◽  
Loss Of Appetite

The effect of Gandharva Haritaki, Sudarshana Vati, Arogyavardhini Vati along with Punarnavadi Kashaya were studied clinically on a case of Hepatits - C by modern diagnostic tools with USG Abdomen and Hematological investigations. The review of the patient was done on daily basis in IPD and weekly basis after discharge, the clinical features like loss of appetite, heaviness of abdomen and general weakness were completely subsided during the 2nd month of treatment.

scholarly journals Procalcitonin Correlates With but Is Not Superior to Other Diagnostic Markers of Bacterial Pneumonia

2020 ◽  
Author(s):  
Nadia Ayala-Lopez ◽  
David R Peaper ◽  
Roa Harb
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Bacterial Pneumonia ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Chest Imaging ◽  
Wbc Count ◽  
Tract Infections ◽  
Guided Therapy

Abstract Objectives Despite extensive research on procalcitonin (PCT)-guided therapy in lower respiratory tract infections, the association between PCT and bacterial pneumonia remains unclear. Methods We evaluated retrospectively the performance of PCT in patients presenting with lower respiratory tract infection symptoms and grouped by seven diagnoses. All patients had microbial testing, chest imaging, and CBC counts within 1 day of PCT testing. Results Median PCT level in patients diagnosed with bacterial pneumonia was significantly higher than in patients diagnosed with other sources of infections or those not diagnosed with infections. Median PCT levels were not different among patients grouped by type or quantity of pathogen detected. They were significantly higher in patients with higher pathogenicity scores for isolated bacteria, those with abnormal WBC count, and those with chest imaging consistent with bacterial pneumonia. A diagnostic workup that included imaging, WBC count, and Gram stain had an area under the receiver operating characteristic curve of 0.748, and the addition of PCT increased it to 0.778. Conclusions PCT was higher in patients diagnosed with bacterial pneumonia. Less clear is its diagnostic ability to detect bacterial pneumonia over and above imaging and laboratory data routinely available to clinicians.

scholarly journals Clinical manifestations of focal segmental glomerulosclerosis in Japan from the Japan Renal Biopsy Registry: age stratification and comparison with minimal change disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takaya Ozeki ◽  
Shoichi Maruyama ◽  
Toshiyuki Imasawa ◽  
Takehiko Kawaguchi ◽  
Hiroshi Kitamura ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Focal Segmental Glomerulosclerosis ◽  
Clinical Diagnosis ◽  
Clinical Characteristics ◽  
Minimal Change Disease ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Minimal Change ◽  
Segmental Glomerulosclerosis

AbstractFocal segmental glomerulosclerosis (FSGS) is a serious condition leading to kidney failure. We aimed to investigate the clinical characteristics of FSGS and its differences compared with minimal change disease (MCD) using cross-sectional data from the Japan Renal Biopsy Registry. In Analysis 1, primary FSGS (n = 996) were stratified by age into three groups: pediatric (< 18 years), adult (18–64 years), and elderly (≥ 65 years), and clinical characteristics were compared. Clinical diagnosis of nephrotic syndrome (NS) was given to 73.5% (97/132) of the pediatric, 41.2% (256/622) of the adult, and 65.7% (159/242) of the elderly group. In Analysis 2, primary FSGS (n = 306) and MCD (n = 1303) whose clinical diagnosis was nephrotic syndrome (NS) and laboratory data were consistent with NS, were enrolled. Logistic regression analysis was conducted to elucidate the variables which can distinguish FSGS from MCD. On multivariable analysis, higher systolic blood pressure, higher serum albumin, lower eGFR, and presence of hematuria associated with FSGS. In Japanese nationwide registry, primary FSGS patients aged 18–64 years showed lower rate of NS than those in other ages. Among primary nephrotic cases, FSGS showed distinct clinical features from MCD.

scholarly journals FRI0197 THE DIAGNOSTIC ACCURACY OF VASCULAR ULTRASOUND IN PATIENTS SUSPECTED OF GCA: A DANISH MULTICENTRE PROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 682.1-682
Author(s):  
S. Chrysidis ◽  
U. Møller Døhn ◽  
L. Terslev ◽  
U. Fredberg ◽  
T. Lorenzen ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Diagnostic Accuracy ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Diagnosis ◽  
Axillary Artery ◽  
Laboratory Data ◽  
Temporal Artery ◽  
Large Vessel ◽  
The Us

Background:Giant Cell Arteritis (GCA) is one of the most common systemic vasculitis. Temporal artery biopsy (TAB) has been the standard test to confirm the diagnosis of GCA. However, TAB has a lower sensitivity than clinical diagnosis and up to 44% of biopsy-negative patients are clinically diagnosed as having GCA.In a recent meta-analysis of the diagnostic performance of ultrasound (US) in GCA the sensitivity was 77 % (1). The included studies were performed by expert groups in single centres. In the to date only multicentre study (TABUL) investigating the diagnostic accuracy of US compared to clinical diagnosis after 6 months the sensitivity was lower (54%) (2)Objectives:To evaluate the diagnostic accuracy of vascular US compared to TAB in a multicentre study.Methods:In three Danish centres patients suspected for GCA were included during a period of two years. At baseline, clinical and laboratory data were collected and vascular US of temporal, facial, common carotid and axillary artery were performed. The US examinations were performed with high frequency transducers (15-18 MHZ) and followed by a TAB. All ultrasongraphers had participated in the same standardized US educational program and were blinded to clinical and laboratory data. An external expert blinded to clinical and laboratory data evaluated all images and made the final US diagnosis.A positive sign for vasculitis in cranial arteries was defined as a hypoechoic intima media complex (IMC) thickening (halo sign) and a positive compression sign. A homogeneous IMC increased thickness in axillary artery of ≥1mm and in common carotid artery ≥1.5mm was defined as vasculitis.The consultant rheumatologist’s diagnosis at 6 months after initial presentation was considered as the reference standard for the diagnosis of GCA.Results:During the recruitment period, 112 patients were included, 59% females, mean (SD) age 72.4(7.9) years, among which 91(81.3%) fulfilled the ACR 1990 classification criteria for GCA. 92% of the patients reported a newly emerged localized headache, while 49 (43.8%) experienced polymyalgia rheumatic symptoms.TAB was positive in 46(41.1%) and inconclusive in 6 patients, who were excluded from the analysis. Mean (SD) duration of glucocorticoid therapy prior to US and TAB was 0.91(1.55) and 4.02(2.61) days, respectively. In 62 patients, the final diagnosis was GCA.In all patients with a positive TAB, the US of the temporal artery was also positive for GCA. Of 19 cases with positive US and negative TAB, 12 were clinically diagnosed with GCA of whom 6 had isolated large vessel involvement on US. Among 41 patients with both negative US and TAB, 4 were clinically diagnosed with GCA (Box 1)US had a sensitivity of 93% and specificity of 84% for the diagnosis of GCA, while the sensitivity for TAB was lower (74%) with a specificity of 100%. For the diagnosis of GCA, US had a PPV of 89.2 % and a NPV of 90.2%, while for TAB the PPV was 100% and the NPV 73.3%.Conclusion:US evaluation of the temporal, facial and selected supraaortic arteries performed by trained ultrasonographers can replace biopsy in the diagnosis of GCA.Box.1References:[1]Duftner C, Dejaco C, et al. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and metaanalysis informing the EULAR recommendations. RMD Open 2018;4:e000612.[2]Luqmani R et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016;20:1_238.Disclosure of Interests:stavros chrysidis: None declared, Uffe Møller Døhn: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Ulrich Fredberg: None declared, Tove Lorenzen: None declared, Robin Christensen: None declared, Per Søndergaard: None declared, Jakob Matthisson: None declared, Knud Larsen: None declared, Andreas Diamandopoulos: None declared

Relapsing polychondritis: A 2016 update on clinical features, diagnostic tools, treatment and biological drug use

2016 ◽  
Vol 30 (2) ◽  
pp. 316-333 ◽  
Author(s):  
Alexis Mathian ◽  
Makoto Miyara ◽  
Fleur Cohen-Aubart ◽  
Julien Haroche ◽  
Miguel Hie ◽  
...  
Keyword(s):  
Drug Use ◽  
Clinical Features ◽  
Relapsing Polychondritis ◽  
Diagnostic Tools ◽  
Biological Drug

Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Robert M. McFadzean ◽  
David Doyle ◽  
Roy Rampling ◽  
Evelyn Teasdale ◽  
Graham Teasdale
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Visual Function ◽  
Pituitary Apoplexy ◽  
Diagnostic Errors ◽  
Large Series ◽  
Ocular Motility ◽  
Pathological Findings ◽  
Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

Quality specifications: self pleasure for clinical laboratories or added value for patient management?

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Added Value ◽  
Internal Quality ◽  
Laboratory Services ◽  
Management Procedures ◽  
Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

scholarly journals Identification of the Clinical Features Distinguishing Psoriatic Arthritis and Fibromyalgia

2012 ◽  
Vol 39 (4) ◽  
pp. 849-855 ◽  
Author(s):  
ANTONIO MARCHESONI ◽  
FABIOLA ATZENI ◽  
ANTONIO SPADARO ◽  
ENNIO LUBRANO ◽  
GIUSEPPE PROVENZANO ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Features ◽  
Disease Duration ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Fibromyalgia Impact Questionnaire ◽  
Somatic Symptoms ◽  
Tender Point ◽  
Antiinflammatory Drugs ◽  
Associated Symptoms

Objective.To identify the clinical features that can help to distinguish between psoriatic arthritis (PsA) and fibromyalgia (FM).Methods.Our cross-sectional study was carried out in 10 Italian rheumatology centers between January and September 2009, and enrolled all consecutive patients with PsA and FM who agreed to participate. Standard clinical and laboratory data for PsA and FM were collected from all patients. Records were made of somatic symptoms, response to nonsteroidal antiinflammatory drugs (NSAID), self-evaluated pain, general health, disability, and responses to the Fibromyalgia Impact Questionnaire. Data were statistically analyzed by univariate and multivariate analyses, and receiver-operating characteristic curves. The analysis concentrated on the clinical features shared by the 2 conditions.Results.Two hundred sixty-six patients with PsA (mean age 51.7 yrs; disease duration 10.2 yrs) and 120 patients with FM (mean age 50.2 yrs; disease duration 5.6 yrs) were evaluated. Univariate analysis showed that patients with FM had higher mean tender point and enthesitis scores, more somatic symptoms, and responded less to NSAID. Multivariate analysis showed that the presence of ≥ 6 FM-associated symptoms and ≥ 8 tender points was the best predictor of FM.Conclusion.The shared clinical features of PsA and FM that had the greatest discriminating power for FM were the number of FM-associated symptoms and tender point count.

The logical component of thinking as a predictor of decision-making about the presence of corruption risk in a situation

2021 ◽  
Vol 42 (6) ◽  
pp. 25-34
Author(s):  
I. N. Pogozhina ◽  
◽  
M. V. Sergeeva ◽  
Keyword(s):  
Decision Making ◽  
Emotional Intelligence ◽  
Correlation Analysis ◽  
University Students ◽  
Moral Values ◽  
Moral Judgments ◽  
Diagnostic Tools ◽  
Leading Role ◽  
Decision Making System

The links between elements of the decision-making system on the presence of corruption risk (CR) in a situation with the logical component of thinking as a predictor are considered. The hypothesis of the role of logical reasoning component as a predictor of (1) perceptions of corruption, (2) indicators of emotional intelligence and (3) moral judgement was tested on a sample of Moscow university students (N=134; M=35±11 years old). The following diagnostic tools were used: (1) the author's test for recognising CR situations, (2) the method for assessing the content of ideas about corruption (Pogozhina, Pshenichnyuk, Sergeyeva), (3) D. Lucin’s EmIn questionnaire, (4) Molchanov's Justice-Care technique. Correlation analysis and structural modeling were used to process the data. The logical component of thinking was a significant positive predictor of the level of development of perceptions of corruption and understanding one’s own emotions and those of others. Also, the logical component significantly negatively predicted moral judgments based on instrumental individualism, reflexive empathic orientation and unconscious but internalized moral values. The findings suggest that the logical component will play a leading role in the CR decision-making system and should be specifically shaped.

scholarly journals THE HOSPITAL EPIDEMIOLOGICAL SURVEILLANCE NETWORK AS NA INSRUMENT FOR THE STRENGTHENING OF COMPULSORY DISEASE AND CONSEQUENTIAL NOTIFICATION, PERNAMBUCO 2018

2021 ◽  
pp. 12
Author(s):  
◽  
Keyword(s):  
Decision Making ◽  
Information System ◽  
Descriptive Study ◽  
Health Surveillance ◽  
Data Sources ◽  
Epidemiological Surveillance ◽  
Surveillance Network ◽  
Study Type ◽  
Compulsory Notification ◽  
Made In

Objetive: Describe the contribution of the State Hospital Epidemiological Surveillance Network of Pernambuco (VEH/PE) for the registration of cases of diseases and conditions of immediate compulsory notification, in Pernambuco, 2018. Methods: Descriptive study, type of experience report, of surveillance of 31 hospitals of the VEH / PE Network, in 2018. The data sources were from the Notifiable Diseases Information System and the data referring to DNCI were from FormSus, available on the Center’s Platform Strategic Health Surveillance Information. The proportions of notifications for Compulsory Notification Disease from the VEH/PE Network were calculated in relation to the total number of notifications made at Sinan. Results: Among the DNC notifications registered by Sinan (Net, Online and Web influenza, 30,1% came from the 31 hospitals of the VEH/PE Network. When analyzed, by information system, the Network was responsible for 28,4% of the records made in Sinan Net by 2.687 reporting units, in Sinan Online, 25,9% in relation to 1.247 reporting units and for Sinan Web Influenza the contribution was 82,3% in relation to the 69 reporting units. Immediate compulsory notification diseases/conditions communicated to CIEVS, 50,2% of the communications came from the Network As for the opportunity for immediate notification of diseases and conditions, 90,7% were communicated in due time by the VEH/PE Network. Conclusion: It is important to strengthen the Network aiming at surveillance, disease/disease control and operationalization of information systems, in order to support the manager in decision making.

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