Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: Updated Clinicopathologic Study

2020 ◽  
pp. 10.1212/CPJ.0000000000001016
Author(s):  
Charles H. Adler ◽  
Thomas G. Beach ◽  
Nan Zhang ◽  
Holly A. Shill ◽  
Erika Driver-Dunckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Gold Standard ◽  
Disease Duration ◽  
Clinical Signs ◽  
Confidence Levels ◽  
Clinicopathologic Study ◽  
Clinical Diagnostic ◽  
Neuropathological Diagnosis

AbstractObjectives:Update data for diagnostic accuracy of a clinical diagnosis of Parkinson’s disease (PD) using neuropathological diagnosis as the gold standard.Methods:Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) was used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, Possible PD (PossPD, never treated or not responsive) and Probable PD (ProbPD, 2/3 cardinal clinical signs + responsive to dopaminergic medications). Neuropathological diagnosis was the gold standard.Results:Based on first visit to AZSAND, 15/54 (27.8%) PossPD cases and 138/163 (84.7%) ProbPD had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 yrs and 114/128 (89.1%) with >5 yrs disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD.Conclusions:This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 yr disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation.Classification of Evidence:This study provides Class II evidence that a clinical diagnosis of probable PD at first visit identifies patients who will have pathologically confirmed PD with a sensitivity of 82.6% and specificity of 86.0%.

Could a low-cost audio-visual link be useful in rheumatology?

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 35-37 ◽  
Author(s):  
L E Graham ◽  
S Mcgimpsey ◽  
S Wright ◽  
G Mcclean ◽  
J Carser ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Junior Doctor ◽  
Low Cost ◽  
Clinical Signs ◽  
Final Diagnosis ◽  
Provisional Diagnosis ◽  
Face To Face ◽  
Significant Difference ◽  
Small Joint

We have investigated prospectively the diagnostic accuracy, specialist satisfaction and patient–specialist rapport of a low-cost audio-visual link between a junior doctor with a patient and a consultant rheumatologist. Using a telephone link and subsequently a video-phone link, 20 patients, with various rheumatological problems, were presented by a junior doctor to the consultant rheumatologist for provisional diagnosis. All patients were then seen face to face by the consultant, when a final diagnosis was made. An independent consultant rheumatologist made a ‘gold standard’ diagnosis. Thirty-five per cent of diagnoses were made correctly over the telephone and 40% over the video-phone – there was no significant difference in the diagnostic accuracy between these two methods of communication. Rapport over the video-phone was universally poor. Where it was important, clinical signs could not be visualized over the video-phone and in more than 85% of cases small joint swellings could not be seen clearly.

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 114-118 ◽  
Author(s):  
E Rabe ◽  
F Pannier
Keyword(s):  
Gold Standard ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Consensus Conference ◽  
Scientific Publications ◽  
Consensus Document ◽  
Venous Diseases ◽  
Ceap Classification ◽  
Definition Of

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords ‘CEAP’ and ‘venous insufficiency’, 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

scholarly journals Evaluation of gastric emptying by means of scintigra-phy using different test meals

2019 ◽  
Vol 7 (2A) ◽  
Author(s):  
Viviana Montoya ◽  
Viviane Parisitto ◽  
Mateus Fontes ◽  
Luiz Gonzaga ◽  
Luciene Das Graças ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Gold Standard ◽  
Delayed Gastric Emptying ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Mechanical Obstruction ◽  
Standard Meal ◽  
Solid Foods ◽  
Gastric Emptying Time

Gastroparesis is a disorder characterized by symptoms and evidence of delayed gastric emptying (GE) in the absence of mechanical obstruction. Scintigraphy has been considered a "gold standard" for measuring Gastric Emptying Time (GET) and retention percentage of radio-labeled food, after four hours of ingestion. To obtain the images, it is recommended, worldwide, the use of the Tougas diet (255kcal) as a standard meal. The objective of this study was to compare the GET and the percentage of retention in the time of 4 h, obtained by scintigraphy using the Tougas diet (255 kcal) and the proposed diet (319 kcal). Thirty patients, both genders, aged 23 to 76 years,  were selected, they presenting clinical symptoms suggestive of gastroparesis. These parameters were measured for the same patient, but in different days. The results showed that the diet fat content used to obtain EG of solid foods by scintigraphy did not influence the retention percentage results after 4 hours of ingestion of the radiolabeled food. However, the time of two hours is an important parameter to be observed in the result of this examination. In addition, the data suggest that the proposed diet may be more efficient for the classification of the severity of EG delay in patients with clinical signs suggestive of gastroparesis. 

scholarly journals Autopsy as Gold Standard in FDG-PET Studies in Dementia

2010 ◽  
Vol 37 (3) ◽  
pp. 336-342 ◽  
Author(s):  
Pascali Durand-Martel ◽  
Dominic Tremblay ◽  
Catherine Brodeur ◽  
Nancy Paquet
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Pet Imaging ◽  
Gold Standard ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Histopathological Diagnosis ◽  
Evidence Based ◽  
Positron Emission ◽  
Diagnosis Of Dementia

Positron emission tomography (PET) imaging with F18-fluorodeoxyglucose (FDG) is increasingly used as an adjunct to clinical evaluation in the diagnosis of dementia. Considering that most FDG-PET studies in dementia use clinical diagnosis as gold standard and that clinical diagnosis is approximately 80% sensitive or accurate, we aim to review the evidence-based data on the diagnostic accuracy of brain FDG-PET in dementia when cerebral autopsy is used as gold standard. We searched the PubMed and Medline databases for dementia-related articles that correlate histopathological diagnosis at autopsy with FDG-PET imaging and found 47 articles among which there were only 5 studies of 20 patients or more. We were able to conclude that sensitivity and specificity of FDG-PET for Alzheimer's disease are good, but more studies using histopathological diagnosis at autopsy as gold standard are needed in order to evaluate what FDG-PET truly adds to premortem diagnostic accuracy in dementia.

scholarly journals Clinical Diagnostic Accuracy of Onychomycosis: A Multispecialty Comparison Study

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
David G. Li ◽  
Jeffrey M. Cohen ◽  
Anar Mikailov ◽  
Ramone F. Williams ◽  
Alvaro C. Laga ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Clinical Setting ◽  
Systemic Treatment ◽  
Periodic Acid ◽  
Comparison Study ◽  
Periodic Acid Schiff ◽  
Clinical Diagnostic ◽  
Prospective Investigation

Although onychomycosis can be diagnosed clinically, many guidelines still recommend pathologic confirmation of the diagnosis prior to initiation of systemic treatment. We retrospectively reviewed results from 541 toenail clippings (160 by dermatologists, 198 by podiatrists, and 183 by other provider types) sent to the Brigham and Women’s Department of Dermatopathology between January 2000 and December 2013 for confirmatory periodic acid-Schiff (PAS) testing of clinically diagnosed onychomycosis. Of these, 93 (58.1%), 125 (63.1%), and 71 (38.8%) were sent for confirmation of onychomycosis (as opposed to diagnosis of onychodystrophy) by dermatologists, podiatrists, and other provider types, respectively. Confirmatory PAS stains were positive in 70 (75.3%), 101 (80.8%), and 47 (66.2%) of samples ordered by dermatologists, podiatrists, and other providers, respectively. Our study demonstrates that clinical diagnosis of onychomycosis in the appropriate clinical setting is accurate across specialties. Further prospective investigation on the accuracy of clinical diagnosis of onychomycosis may be beneficial.

Modified Dermoscopic Algorithm for the Differentiation between Melanocytic and Nonmelanocytic Skin Tumors

2006 ◽  
Vol 10 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Andreas Blum ◽  
Jennifer Clemens ◽  
Giuseppe Argenziano
Keyword(s):  
Diagnostic Accuracy ◽  
Basal Cell ◽  
Skin Lesions ◽  
Skin Tumors ◽  
Melanocytic Tumors ◽  
Melanocytic Tumor ◽  
Clinical Diagnostic ◽  
Basal Cell Carcinomas ◽  
Surface Microscopy

Background: The use of dermoscopy (dermatoscopy, epiluminescence microscopy, surface microscopy) improves the clinical diagnostic accuracy of skin tumors by applying different algorithms or scores. The first step in the dermoscopic evaluation is the differentiation between melanocytic and nonmelanocytic skin tumors. Objective: To evaluate the diagnostic accuracy of the established dermoscopic algorithm (EDA) and the modified dermoscopic algorithm (MDA) for melanocytic versus nonmelanocytic skin tumors. Methods: Two hundred forty-nine patients with melanocytic and nonmelanocytic skin lesions were included. Dermoscopic images of the tumors were taken with 10-fold magnification, followed by surgery and histopathology at the departments of Dermatology at the universities of Tuebingen, in Germany, and Naples, in Italy. Each lesion was classified using the EDA and MDA. In the MDA, accessory nipples and dermatofibromas were considered in particular. Results: With the EDA, 225 of 249 (90.4%) skin tumors were correctly classified in one of the six groups. With the MDA, 237 of 249 (95.2%) were correctly classified. Improvement was achieved in 12 (4.8%) better classified skin tumors. In both algorithms, no melanoma was classified as a nonmalignant melanocytic tumor. All melanomas were classified in the group of melanocytic tumors and one melanoma was classified in the group of basal cell carcinomas. Conclusion: Both dermoscopic algorithms for the differentiation between melanocytic and nonmelanocytic skin tumors were simple and effective when applied step by step. The MDA is an improvement on the EDA with the classification of accessory nipples and dermatofibromas.

scholarly journals Low clinical diagnostic accuracy of early vs advanced Parkinson disease: Clinicopathologic study

Neurology ◽  
2014 ◽  
Vol 83 (5) ◽  
pp. 406-412 ◽  
Author(s):  
C. H. Adler ◽  
T. G. Beach ◽  
J. G. Hentz ◽  
H. A. Shill ◽  
J. N. Caviness ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Parkinson Disease ◽  
Clinicopathologic Study ◽  
Clinical Diagnostic

Sensitivity of the Classification of Psoriatic Arthritis Criteria in Early Psoriatic Arthritis

2009 ◽  
Vol 36 (2) ◽  
pp. 368-370 ◽  
Author(s):  
SALVATORE D’ANGELO ◽  
GIANNA ANGELA MENNILLO ◽  
MARIA STEFANIA CUTRO ◽  
PIETRO LECCESE ◽  
ANGELO NIGRO ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Rheumatoid Factor ◽  
Clinical Diagnosis ◽  
Small Proportion ◽  
Disease Duration ◽  
Lower Sensitivity ◽  
Satisfactory Performance ◽  
Early Psoriatic Arthritis

Objective.To determine the sensitivity of the CASPAR criteria in patients with early psoriatic arthritis (PsA).Methods.Consecutive patients with a clinical diagnosis of PsA and a disease duration < 12 months were enrolled for study. The proportion of patients meeting the criteria (i.e., the sensitivity) was determined.Results.Forty-four patients with early PsA (23 women, 21 men; mean age 51 yrs, range 16–90) were enrolled. Mean disease duration (± SD) was 15.8 ± 14.3 weeks (range 0.1–50.9 wks). Thirty-four patients satisfied the criteria at the first visit (sensitivity 77.3%). Most patients met the skin and laboratory criterion, i.e., they were rheumatoid factor-negative, while only 2 satisfied the radiologic criterion.Conclusion.Our findings suggest a less satisfactory performance of the CASPAR criteria when applied in early PsA. Lower sensitivity could mainly depend on the small proportion of patients fulfilling the radiologic criterion.

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