scholarly journals Comparing a Single Clinician Versus a Multidisciplinary Consensus Conference Approach for Dementia Diagnostics

2021 ◽  
pp. 1-11
Author(s):  
Gorm Thorlacius-Ussing ◽  
Marie Bruun ◽  
Le Gjerum ◽  
Kristian S. Frederiksen ◽  
Hanneke F.M. Rhodius-Meester ◽  
...  
Keyword(s):  
Consensus Conference ◽  
Diagnostic Evaluation ◽  
Disease Etiology ◽  
Etiological Diagnosis ◽  
Evaluation Approach ◽  
Syndrome Diagnosis ◽  
Memory Clinics ◽  
Dementia Diagnostics ◽  
Optimal Evaluation

Background: Evidence-based recommendations on the optimal evaluation approach for dementia diagnostics are limited. This impedes a harmonized workup across clinics and nations. Objective: To evaluate the diagnostic performance of a multidisciplinary consensus conference compared to a single clinician approach. Methods: In this prospective study, we enrolled 457 patients with suspected cognitive decline, from two European memory clinics. A diagnostic evaluation was performed at baseline independently in two ways: 1) by a single clinician and 2) at a multidisciplinary consensus conference. A syndrome diagnosis and an etiological diagnosis was made. The confidence in the diagnosis was recorded using a visual analogue scale. An expert panel re-evaluation diagnosis served as reference for the baseline syndrome diagnosis and a 12-24-month follow-up diagnosis for the etiological diagnosis. Results: 439 patients completed the study. We observed 12.5%discrepancy (k = 0.81) comparing the baseline syndrome diagnoses of the single clinician to the consensus conference, and 22.3%discrepancy (k = 0.68) for the baseline etiological diagnosis. The accuracy of the baseline etiological diagnosis was significantly higher at the consensus conference and was driven mainly by increased accuracy in the MCI group. Confidence in the etiological diagnosis at baseline was significantly higher at the consensus conference (p <  0.005), especially for the frontotemporal dementia diagnosis. Conclusion: The multidisciplinary consensus conference performed better on diagnostic accuracy of disease etiology and increased clinicians’ confidence. This highlights the importance of a multidisciplinary diagnostic evaluation approach for dementia diagnostics, especially when evaluating patients in the MCI stage.

Impact of a Clinical Decision Support Tool on Dementia Diagnostics in Memory Clinics: The PredictND Validation Study

2019 ◽  
Vol 16 (2) ◽  
pp. 91-101 ◽  
Author(s):  
Marie Bruun ◽  
Kristian S. Frederiksen ◽  
Hanneke F.M. Rhodius-Meester ◽  
Marta Baroni ◽  
Le Gjerum ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Subjective Cognitive Decline ◽  
Etiological Diagnosis ◽  
Diagnosis Of Dementia ◽  
Memory Clinics ◽  
Differential Diagnosis Of Dementia

Background: Determining the underlying etiology of dementia can be challenging. Computer- based Clinical Decision Support Systems (CDSS) have the potential to provide an objective comparison of data and assist clinicians. Objectives: To assess the diagnostic impact of a CDSS, the PredictND tool, for differential diagnosis of dementia in memory clinics. Methods: In this prospective multicenter study, we recruited 779 patients with either subjective cognitive decline (n=252), mild cognitive impairment (n=219) or any type of dementia (n=274) and followed them for minimum 12 months. Based on all available patient baseline data (demographics, neuropsychological tests, cerebrospinal fluid biomarkers, and MRI visual and computed ratings), the PredictND tool provides a comprehensive overview and analysis of the data with a likelihood index for five diagnostic groups; Alzheimer´s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and subjective cognitive decline. At baseline, a clinician defined an etiological diagnosis and confidence in the diagnosis, first without and subsequently with the PredictND tool. The follow-up diagnosis was used as the reference diagnosis. Results: In total, 747 patients completed the follow-up visits (53% female, 69±10 years). The etiological diagnosis changed in 13% of all cases when using the PredictND tool, but the diagnostic accuracy did not change significantly. Confidence in the diagnosis, measured by a visual analogue scale (VAS, 0-100%) increased (ΔVAS=3.0%, p<0.0001), especially in correctly changed diagnoses (ΔVAS=7.2%, p=0.0011). Conclusion: Adding the PredictND tool to the diagnostic evaluation affected the diagnosis and increased clinicians’ confidence in the diagnosis indicating that CDSSs could aid clinicians in the differential diagnosis of dementia.

Problematiche e contributi nella presa in carico dei pazienti affetti da Sclerosi Tuberosa

2003 ◽  
Vol 16 (3) ◽  
pp. 539-542
Author(s):  
E. Veneselli ◽  
R. Di Comite
Keyword(s):  
Pediatric Patients ◽  
Spontaneous Mutation ◽  
Basic Research ◽  
Consensus Conference ◽  
Diagnostic Evaluation ◽  
Benign Tumors ◽  
Clinical Approach ◽  
Autosomal Dominant Disorder ◽  
Spontaneous Mutation Rate

Tuberous Sclerosis Complex (TCS) is a multisystem autosomal dominant disorder, with high spontaneous mutation rate; it is charactherized by very different clinical phenotypes and widespread development of hamartias, or non-growing lesions, and hamartomas, wich can grow as benign tumors and rarely progress to malignances. We reported the TSC Consensus Conference Diagnostic Criteria, divided into major and minor features (1998), and Recommendations for diagnostic evaluation (1999). Since the age-dipendent appearance and the frequency of symptoms, their usefulness is limited in pediatric patients. Then we examined the data about the incidence of clinical features from infancy into childhood, with the aim of improving the diagnostic evaluation and the follow up of pediatric patients. Therefore, also on the basis of the personal experience, we stressed the opportunity of a flexible clinical approach and the existence of some features stimulating other clinical and basic research studies.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

DIAGNOSTIC EVALUATION AND FOLLOW-UP OF PATIENTS WITH AMENORRHEA-GALACTORRHEA UNDER TREATMENT WITH BROMOERGOCRYPTINE (CB-154)

1975 ◽  
Vol 80 (1_Suppla) ◽  
pp. S25
Author(s):  
A. E. Schindler ◽  
E. Keller ◽  
R. Göser ◽  
E. R. Jaeger-Whitegiver
Keyword(s):  
Diagnostic Evaluation

scholarly journals Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass

2019 ◽  
Vol 2019 ◽  
Author(s):  
N F Lenders ◽  
J R Greenfield
Keyword(s):  
Sensitivity And Specificity ◽  
Serum Biochemistry ◽  
Diagnostic Evaluation ◽  
Gas Chromatography Mass Spectrometry ◽  
List Type ◽  
Steroid Profiling ◽  
Rare Tumours ◽  
Adrenal Masses ◽  
Urinary Steroid

Summary Adrenal oncocytomas are rare tumours, with only approximately 160 cases reported in the literature. We report the use of urinary steroid profiling as part of their diagnostic evaluation and prognostication. A 45-year-old woman presented with clinical features of hyperandrogenism. Serum biochemistry confirmed androgen excess and computed tomography (CT) demonstrated a 3.2 cm adrenal tumour with density 39 HU pre-contrast. Urine steroid profiling showed elevated tetrahydro-11 deoxycortisol (THS), which is associated with adrenal malignancy. Laparoscopic adrenalectomy was performed, and histopathology diagnosed adrenal oncocytoma. Serum and urinary biochemistry resolved post-operatively and remained normal at 1-year follow-up. Learning points: Differential diagnosis of adrenal masses is challenging. Current techniques for differentiating between tumour types lack sensitivity and specificity. 24-h urinary steroid profiling is a useful tool for reflecting steroid output from adrenal glands. Gas chromatography-mass spectrometry (GC-MS) of urinary steroid metabolites has sensitivity and specificity of 90% for diagnosing adrenocortical carcinoma. Adrenal oncocytoma are rare tumours. Differentiating between benign and malignant types is difficult. Data guiding prognostication and management are sparse.

scholarly journals Consensus on Treatment and Follow-Up for Biochemical Recurrence in Castration-Sensitive Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries

2021 ◽  
pp. 538-544
Author(s):  
Fernando S. M. Monteiro ◽  
Fabio A. Schutz ◽  
Igor A. P. Morbeck ◽  
Diogo A. Bastos ◽  
Fernando V. de Padua ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Developing Countries ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Consensus Conference ◽  
Limited Resources ◽  
Response Options ◽  
Recommended Treatment ◽  
Clinical Scenarios

PURPOSE To present a summary of the treatment and follow-up recommendations for the biochemical recurrence in castration-sensitive prostate cancer (PCa) acquired through a questionnaire administered to 99 PCa experts from developing countries during the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 27 questions were identified as related to this topic from more than 300 questions. The clinician's responses were tallied and presented in a percentage format. Topics included the use of imaging for staging biochemical recurrence, treatment recommendations for three different clinical scenarios, the field of radiation recommended, and follow-up. Each question had 5-7 relevant response options, including “abstain” and/or “unqualified to answer,” and investigated not only recommendations but also if a limitation in resources would change the recommendation. RESULTS For most questions, a clear majority (> 50%) of clinicians agreed on a recommended treatment for imaging, treatment scenarios, and follow-up, although only a few topics reached a consensus > 75%. Limited resources did affect several areas of treatment, although in many cases, they reinforced more stringent criteria for treatment such as prostate-specific antigen values > 0.2 ng/mL and STAMPEDE inclusion criteria as a basis for recommending treatment. CONCLUSION A majority of clinicians working in developing countries with limited resources use similar cutoff points and selection criteria to manage patients treated for biochemically recurrent castration-sensitive PCa.

Adrenal Incidentalomas: Diagnostic Evaluation and Long-Term Follow-Up

2008 ◽  
Vol 14 (3) ◽  
pp. 269-278
Author(s):  
Lucio Vilar ◽  
Maria da Conceição Freitas ◽  
Viviane Canadas ◽  
José Luciano Albuquerque ◽  
Carlos A. Botelho ◽  
...  
Keyword(s):  
Diagnostic Evaluation ◽  
Adrenal Incidentalomas ◽  
Long Term Follow Up

scholarly journals P1692CANCER-RELATED EPIDEMIOLOGY AND OUTCOMES IN KIDNEY ALLOGRAFT RECIPIENTS FROM TWO TRANSPLANT CENTRES IN ITALY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Letizia Zeni ◽  
Pietro Manuel Ferraro ◽  
Giuseppina D'Ettorre ◽  
Simona Simone ◽  
Loreto Gesualdo ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Incidence Rate ◽  
Solid Tumors ◽  
Induction Therapy ◽  
Cancer Development ◽  
Function Type ◽  
Disease Etiology ◽  
Post Transplant ◽  
Risk Of Cancer

Abstract Background and Aims One of the major immunosuppression-related complications of kidney transplant (KT) is the increased risk of cancer development. KT patients have at least a twofold higher risk of developing or dying from cancer than the general population. Indeed, malignancy is currently the second most common cause of death after cardiovascular disease in these patients. After the substantial rise in post-transplant graft survival in the last decades, the present study aims to evaluate the post–KT cancer incidence, the mortality risk and associated risk factors in two transplant centres over a long period of time. Method A retrospective cohort study used clinical and epidemiological information among KT patients transplanted between 1993 and 2017 in two renal transplant centres in Italy and diagnosed with de novo cancers (DNC). Data on vital status and graft loss were available for most subjects and assessed in December 2019. Survival analyses were performed using parametric survival models assuming a Weibull distribution of the baseline hazard; these models were used to test the association between predictors measured at baseline and a) time from KT to development of DNC, and b) time from development of DNC to death, loss to follow-up or administrative censoring, whichever occurred first. Hazard ratios (HR) and 95% confidence intervals (CI) were obtained. Kaplan–Meier curves were generated. A p-value &lt; 0.05 was considered as statistically significant. Data were analyzed using Stata. Results In the present study, 201 DNCs were diagnosed in subjects who underwent KT between 1993 and 2017. Median follow-up after kidney transplantation was 12.1 years (IQR: 7.0–17.5). The proportion of subjects who received allograft from deceased donor was 89%, 61% had 4 or more mismatches, 68% were male. At the time of KT, the average age was 52.4±12.3 years and renal replacement therapy (RRT) vintage was 39 months (IQR: 22–69). The incidence rate of DNC for the whole cohort was 145 per 1,000 person-years, with a median time to cancer from KT of 5.5 years (IQR: 2.8–10.5) [Figure 1]. Skin cancers accounted for most cases (59%), followed by solid tumors (30%), post-transplant lymphoproliferative disorders (6%), Kaposi’s sarcoma (3%) and other malignancies (2%). In the multivariable model, increasing age was significantly associated with time to development of DNC (HR for 1 year 1.03, 95% CI 1.01, 1.04; p = 0.001). Induction therapy with a combination of rabbit antithymocyte globulin and basiliximab resulted to be a risk factor for time to DNC (HR compared with none 3.16, 95% CI 2.04, 4.91; p &lt; 0.001). None of the following pre- and peri-transplant predictors was significantly associated with time to DNC: RRT vintage and technique, episodes of acute rejection, chronic kidney disease etiology, presence of delayed graft function, type of donor (deceased or living), number of mismatches. The incidence rate of death for the whole cohort was 47 per 1,000 person-years [Figure 2]. According to type of cancer, death incidence rate was 73, 56, 34 per 1,000 person-years for solid tumors, non-solid and non-skin tumors (i.e PTLD, Kaposi and other tumors) and skin cancer, respectively. In multivariable analysis, age at time of cancer (HR for 1 year 1.04, 95% CI 1.00, 1.07; p = 0.037) and previous acute rejection (HR 2.51, 95% CI 1.23, 5.11; p = 0.011) were significantly associated with time to death. Conclusion In a large sample of KT recipients with DNC, age and type of induction therapy were significantly associated with time to development of cancer. Age and previous acute rejection were significant predictors of death after DNC. Epidemiological studies could help in risk estimation of graft and patient survival after cancer development and guide in post KT clinical care.

Deep Venous Thrombosis of the Upper Limbs

1988 ◽  
Vol 3 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Haim Gutman ◽  
Meir Peri ◽  
Avigdor Zelikovski ◽  
Menashe Haddad ◽  
Raphael Reiss
Keyword(s):  
Natural History ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Surgical Approach ◽  
Symptomatic Treatment ◽  
Consensus Conference ◽  
Natural Course ◽  
Upper Limbs ◽  
Fibrinolytic Agents

Deep venous thrombosis of the upper limbs is rare and represents less than 2-3% of all cases of deep venous thrombosis. Reviewing our series of 25 patients we decided that follow-up and symptomatic treatment produce acceptable results, since the disease has a benign natural history. Fibrinolytic agents administered under strict limitations (The Consensus Conference 1980, Ann Int Med) are efficient in early cases, but its ability to change the natural course of the disease has not been proved. Surgical approach should be reserved for cases with secondary ischaemia and/or a resectable extraluminal mass.

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