scholarly journals Histopathology of vasculitis

Reumatismo ◽  
2018 ◽  
pp. 155-164 ◽  
Author(s):  
G. Bajocchi ◽  
A. Cavazza
Keyword(s):  
Clinical Practice ◽  
Clinical Assessment ◽  
Gold Standard ◽  
Sampling Error ◽  
Systemic Vasculitis ◽  
Clinical Implications ◽  
Disease Evolution ◽  
Changes Over Time ◽  
Broad Complex ◽  
Over Time

The range of pathologies that are related to primitive vasculitis is broad, complex and not as typical as we would expect. Clinicians should be aware that several forms of primitive and systemic vasculitis, regardless of the size of the affected vessel, may exhibit identical histological alterations. This observation has important clinical implications as it means that cases of vasculitis do not correspond clinically and histologically. Thus, while histology remains the diagnostic gold standard, it can be used only as part of the most complete clinical assessment possible. Another point worth of the clinician’s attention is that vasculitis histology changes over time, as do disease evolution and activity, even without considering the masking effects of treatment and the possibility of sampling error due to the patchy occurrence of vasculitis. The purpose of this review is to identify the most common forms of vasculitis in clinical practice, and to provide guidance to the clinician on the pathology of the vessels.

A Questionnaire Using the Modified 2010 American College of Rheumatology Criteria for Fibromyalgia: Specificity and Sensitivity in Clinical Practice

2013 ◽  
Vol 40 (9) ◽  
pp. 1590-1595 ◽  
Author(s):  
Robert Ferrari ◽  
Anthony S. Russell
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Sensitivity And Specificity ◽  
Clinical Assessment ◽  
Gold Standard ◽  
A Priori ◽  
Cutoff Score ◽  
Widespread Pain ◽  
American College Of Rheumatology ◽  
Specificity And Sensitivity

Objective.To determine the specificity and sensitivity of the Modified 2010 American College of Rheumatology (ACR) Diagnostic Criteria for Fibromyalgia (given as a self-administered questionnaire) in clinical practice.Methods.A cohort of patients with widespread pain, referred by primary care physicians to rheumatologists, completed the questionnaire for the Modified ACR 2010 criteria. Prior to completion of the questionnaire, patients were diagnosed by at least 1 rheumatologist as either having fibromyalgia (FM) or not having FM, using the rheumatologist’s clinical assessment as the gold standard for diagnosis of FM. The Modified ACR 2010 criteria were then applied to determine whether a diagnosis of FM was satisfied by the criteria. Sensitivity and specificity were determined, using the rheumatologist’s clinical assessment as the gold standard. A score ≥ 12 on the Modified ACR 2010 criteria questionnaire was also tested as the criterion to satisfy a diagnosis of FM, and subsequently to determine sensitivity and specificity. We examined the effect of using a cutoff score ≥ 13, as previous research indicated that this may be a more useful cutoff value.Results.A total of 451 subjects completed the questionnaire: 174 with an a priori diagnosis of FM by a rheumatologist and 277 with widespread pain who did not have an a priori clinical diagnosis of FM by a rheumatologist. The Modified ACR 2010 criteria were satisfied by 90.2% of patients with an a priori diagnosis of FM, and by 10.5% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, sensitivity and specificity are 90.2% and 89.5%, respectively, using the Modified ACR 2010 criteria. A score ≥ 12 on the Modified ACR 2010 criteria was observed in 97.4% of patients with an a priori diagnosis of FM, and 14.8% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, the sensitivity and specificity are 97.4% and 85.2%, respectively, using a cutoff score ≥ 12. Using a score of ≥ 13, however, the sensitivity was 93.1% and the specificity was 91.7%.Conclusion.The Modified ACR 2010 criteria questionnaire can be used in primary care as a tool to assist physicians in the diagnosis of FM with high specificity and sensitivity. Calculating the total score on a Modified ACR 2010 criteria questionnaire, and setting the value of ≥ 13 as the cutoff for a diagnosis of FM appears to be the most effective approach. The Modified ACR 2010 criteria may reduce the need for rheumatology referral simply for the diagnosis of FM.

scholarly journals Assessing Health-Related Quality of Life in Patients with Migraine

2002 ◽  
Vol 29 (S2) ◽  
pp. S16-S22 ◽  
Author(s):  
W.J. Becker
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Current Status ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Changes Over Time ◽  
Over Time

Background:The place of health-related quality of life (HRQoL) instruments in clinical research trials and clinical practice as compared to more traditional clinical outcome measures such as headache intensity and frequency is unclear.Objectives:To review the current status of HRQoL measurement in migraine.Methods:A literature search was done for HRQoL and migraine. Selected articles dealing with migraine and commonly used HRQoL instruments and HRQoL measures used in recent clinical trials were reviewed.Results:Several general and migraine specific HRQoLinstruments can detect changes over time in response to at least major changes in migraine therapy. Both also show a correlation with clinical headache features. However, their sensitivity to detect clinically significant changes over time is not clear.Conclusion:The SF-36, a general HRQoLmeasure and several migraine-specific HRQoL instruments are useful endpoints for migraine clinical trials. Their role in clinical practice is yet to be established.

scholarly journals Two Years of Ethics Reflection Groups About the Use of Coercion. Changes Over Time in Employees’ Normative Attitudes Regarding the Use of Coercion, User Involvement, Team Cooperation and the Handling of Disagreement

2020 ◽  
Author(s):  
Bert Molewijk ◽  
Reidar Pedersen ◽  
Almar Kok ◽  
Reidun Førde ◽  
Olaf Aasland
Keyword(s):  
Clinical Practice ◽  
Evaluation Studies ◽  
User Involvement ◽  
Reflection Groups ◽  
Team Cooperation ◽  
Critical Attitude ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time ◽  
Ethics Reflection

Abstract Background: Research on the impact of ethics reflection groups (ERG) or moral case deliberations (MCD) is complex and scarce. Within a larger study, ERG has been used as an intervention for stimulating critical ethical reflection and improved team cooperation while observing changes over time.Research question: Are there – during and after two years of ERGs - changes over time regarding employees’ normative attitudes regarding the use of coercion and how employees perceive user involvement, team cooperation and the handling of disagreement in teams?Methods: Repeated cross-sectional survey to multidisciplinary employees at seven wards within three Norwegian mental health care institutions (T0-T1-T2). Changes in normative attitudes over time were estimated using linear mixed models.Results: In total, 817 surveys (from employees that did and did not participate in ERG) were included in the analyses. Of these, 7.6 % (N=62) responded at all three points in time, 15.5% (N=127) at two points, and 76.8 % (N= 628) once. On average, over time, respondents who participated in ERG agreed less that coercion can be seen a form of care or security. ERG participants more often reported that they involved users and that they handled disagreement within the team constructively. Furthermore, more frequent ERG participation was associated with a more critical attitude towards coercion and higher scores for user involvement, the coercion competence of the team and the constructive handling of disagreement within their teams.Conclusions: Structural ERGs or MCDs seem to contribute to employees reporting a more critical attitude towards coercion, more user involvement around coercion and a more constructive handling of disagreement. Differences were generally small in absolute terms possibly due to the low amount of longitudinal data and the relative low frequency of ERG’s during the two years. Studying changes over time in clinical practice and trying to find a relationship between CES interventions and CES outcomes is difficult yet important and needs to be further developed in future CES evaluation studies. This explorative quantitative study may be a first step from qualitative evidence towards more robust quantitative evidence of the contribution of CES to clinical practice and quality of care.

scholarly journals Within-Person Variation in Serum Thyrotropin Concentrations: Main Sources, Potential Underlying Biological Mechanisms, and Clinical Implications

2021 ◽  
Vol 12 ◽  
Author(s):  
Evie van der Spoel ◽  
Ferdinand Roelfsema ◽  
Diana van Heemst
Keyword(s):  
Circadian Rhythm ◽  
Clinical Practice ◽  
Clinical Research ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Clinical Implications ◽  
Biological Mechanisms ◽  
Serum Tsh ◽  
Tsh Levels ◽  
Over Time

BackgroundIndividuals exhibit fluctuations in the concentration of serum thyroid-stimulating hormone (TSH) over time. The scale of these variations ranges from minutes to hours, and from months to years. The main factors contributing to the observed within-person fluctuations in serum TSH comprise pulsatile secretion, circadian rhythm, seasonality, and ageing. In clinical practice and clinical research however, such within-person biological variation in serum TSH concentrations is often not considered. The aim of this review is to present an overview of the main sources of within-person variation in TSH levels, as well as the potential underlying biological mechanisms, and the clinical implications.SummaryIn euthyroid individuals, the circadian rhythm, with a nocturnal surge around 02:00–04:00 h and a nadir during daytime has the greatest impact on variations in serum TSH concentrations. Another source of within-person variation in TSH levels is seasonality, with generally higher levels during the cold winter months. Since TSH is secreted in a pulsatile manner, TSH levels also fluctuate over minutes. Furthermore, elevated TSH levels have been observed with ageing. Other factors that affect TSH levels include thyroid peroxidase (TPO)-antibody positivity, BMI, obesity, smoking, critical illness, and many xenobiotics, including environmental pollutants and drugs. Potential underlying biological mechanisms of within-person variation in TSH levels can be safely concluded from the ability of TSH to respond quickly to changes in cues from the internal or external environment in order to maintain homeostasis. Such cues include the biological clock, environmental temperature, and length of day. The observed increase in TSH level with ageing can be explained at a population level and at an organism level. In clinical practice, the season for thyroid testing can influence a patient’s test result and it occurs frequently that subclinical hypothyroid patients normalize to euthyroid levels over time without intervention.ConclusionsSerum TSH concentrations vary over time within an individual, which is caused by multiple different internal and external factors. It is important to take the within-person variations in serum TSH concentrations into account when testing a patient in clinical practice, but also in performing clinical research.

Estimates of Change in a Depressive Patient

1969 ◽  
Vol 115 (527) ◽  
pp. 1199-1200 ◽  
Author(s):  
Dorothy Rowe
Keyword(s):  
Clinical Practice ◽  
Depressed Patient ◽  
Subjective Assessment ◽  
Personal Construct ◽  
Personal Construct Theory ◽  
The World ◽  
Construct Theory ◽  
Changes Over Time ◽  
Over Time ◽  
Made In

A continuing problem in the care of patients suffering with depression is the assessment of how depressed the patient is, and how the level of depression changes over time. In clinical practice the patient is used as his own control, but the psychiatric assessment often has to be made in ways prone to the errors of subjective assessment. The psychiatrist is interested in how the depressed patient views himself and the world around him, that is, in terms of Kelly Personal Construct Theory, what constructs the patient uses to structure areas of his life and where on these constructs the patient sees himself. Personal Construct Theory and the Repertory Grid Techniques provide a useful framework for idiographic estimates of change.

Comparison of two devices for measuring exercise transcutaneous oxygen pressures in patients with claudication

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 355-362 ◽  
Author(s):  
Marie Urban ◽  
Alban Fouasson-Chailloux ◽  
Isabelle Signolet ◽  
Christophe Colas Ribas ◽  
Mathieu Feuilloy ◽  
...  
Keyword(s):  
Oxygen Pressure ◽  
Optical Sensors ◽  
Chemical Sensors ◽  
Transcutaneous Oxygen ◽  
Starting Values ◽  
Two Systems ◽  
Transcutaneous Oxygen Pressure ◽  
New Sensors ◽  
Changes Over Time ◽  
Over Time

Abstract. Summary: Background: We aimed at estimating the agreement between the Medicap® (photo-optical) and Radiometer® (electro-chemical) sensors during exercise transcutaneous oxygen pressure (tcpO2) tests. Our hypothesis was that although absolute starting values (tcpO2rest: mean over 2 minutes) might be different, tcpO2-changes over time and the minimal value of the decrease from rest of oxygen pressure (DROPmin) results at exercise shall be concordant between the two systems. Patients and methods: Forty seven patients with arterial claudication (65 + / - 7 years) performed a treadmill test with 5 probes each of the electro-chemical and photo-optical devices simultaneously, one of each system on the chest, on each buttock and on each calf. Results: Seventeen Medicap® probes disconnected during the tests. tcpO2rest and DROPmin values were higher with Medicap® than with Radiometer®, by 13.7 + / - 17.1 mm Hg and 3.4 + / - 11.7 mm Hg, respectively. Despite the differences in absolute starting values, changes over time were similar between the two systems. The concordance between the two systems was approximately 70 % for classification of test results from DROPmin. Conclusions: Photo-optical sensors are promising alternatives to electro-chemical sensors for exercise oximetry, provided that miniaturisation and weight reduction of the new sensors are possible.

Neuropsychological Symptoms in Posttraumatic Stress Disorder and Changes Over Time

2007 ◽  
Author(s):  
Miranda Olff ◽  
Mirjam Nijdam ◽  
Kristin Samuelson ◽  
Julia Golier ◽  
Mariel Meewisse ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Neuropsychological Symptoms ◽  
Changes Over Time ◽  
Over Time

Changes Over Time in Adaptive Behavior Functioning of Twice-Exceptional Children

2010 ◽  
Author(s):  
Rebecca D. Stinson ◽  
Zachary Sussman ◽  
Megan Foley Nicpon ◽  
Allison L. Allmon ◽  
Courtney Cornick ◽  
...  
Keyword(s):  
Adaptive Behavior ◽  
Exceptional Children ◽  
Twice Exceptional ◽  
Changes Over Time ◽  
Over Time
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