Proteinuria: diagnostic principles and procedures

Proteinuria has been thought of as the first sign of serious renal disease. However, in some patients proteinuria may last for years without other evidence of kidney damage, and in other patients it may only be an insignificant and transient laboratory finding. The nature and severity of renal involvement in a particular patient are often suggested by the clinical picture, and the pattern and amount of proteinuria. The physician should use this information in evaluating the severity of the patient's disease. An approach for such evaluations is offered by briefly reviewing the causes and prognosis of the various types of proteinuria and by suggesting steps to take in treating patients with increased protein excretion.     

Is diagnostic ability related to relevant training and experience?

We examined the relationship of presumably relevant education and experience to the diagnosis of psychopathology, a relationship that has been elusive in earlier research. On the basis of the argument that earlier studies may have suffered from a restricted range of relevant education and experience (because most participants have been graduate students and practicing psychologists), we focused on participants at lower levels on these variables. Participants were undergraduate and graduate students in psychology with varying amounts of experience in working in a human service setting, and a few paraprofessionals. Accuracy of clinical diagnosis was measured via a test devised for that purpose; ratings of perceived severity of psychopathology were also obtained for the case histories used in the test. The results indicated that diagnostic accuracy increased significantly in the sampled population with relevant education and with relevant experience. Perceived severity of pathology displayed complex curvilinear relationships with amount of experience and with amount of presumably relevant education. The findings show that if lower levels of education and experience are sampled, a robust relationship between accuracy of diagnostic categorization and both relevant education and experience can indeed be demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of diagnostic errors and recommendations of diagnostic procedures in bacteriologically negative pulmonary tuberculosis

Malaria infection in a vertebrate host is initiated when Plasmodium sporozoites invade hepatocytes after injection by an infected mosquito. In vitro, the parasites invade and develop in HepG2 cells and these cells have been used to study target cell invasion by sporozoites. Previously described in vitro invasion assays involve staining and counting of intracellular sporozoites or exoerythrocytic forms of the parasite. Here we describe an immunoradiometric assay that can quantify sporozoite invasion of HepG2 cells in vitro. The assay relies on the differential detection of intracellular and extracellular circumsporozoite protein (CS; the major surface protein of the sporozoite) which can then be used to calculate the efficiency of invasion. Since this assay can be performed more rapidly than the current assays in which parasites must be counted under a microscope, it enables investigators to more rapidly screen inhibitors of sporozoite invasion.     

Laboratory tests and diagnostic procedures in orthopedic nursing practice

Orthopedic nurses need to know the clinical significance of their clients' laboratory test because critical analysis of the results is essential for clinical decision making. Nurses are expected to use the results in their own plan of care. Client education about diagnostic tests is also an important role of the orthopedic nurse.     

An analysis of the value of additional diagnostic procedures

When several diagnostic procedures are performed on a patient, the probability of his having or not having a specific ailment will change as the result of each procedure is known. This paper describes how such a change is readily calculated using Bayes' theorem. Information theory is also used to find the increment in information from each successive test. Numerical estimates are made using data pertinent to lung X-ray examinations. Finally, some implications for diagnostic examinations in general are drawn.     

Estimation of fetal dose to patients undergoing diagnostic X-ray procedures

The estimation of fetal dose incurred by patients undergoing various radiologic procedures can be very perplexing. The problem is especially critical for women who do not know that they are pregnant at the time of x-ray exposure. A desciption is offered of efforts to quantitate the fetal dose by after-the-fact calculations. Such conservatively employed calculations may be essential for a clinical decision regarding therapeutic abortion.     

Aorto-enteric fistula: current information on diagnostic and therapeutic procedures

The Authors point out how AEFs represent a serious complication of aortic vascular surgery. Special attention is given to the diagnostic and therapeutic approach, also supported by a wide review of the literature.     

Rehabilitation following surgical procedures to address articular cartilage lesions in the knee

Knowledge of the structure and function of articular cartilage is important when considering rehabilitation following surgical procedures for articular cartilage lesions of the knee. Articular cartilage is avascular and derives its nutrition primarily from synovial fluid, resulting in a limited potential for regeneration. Basic science evidence has demonstrated that compressive loading may have a positive impact on articular cartilage healing; however, excessive shear loading may be detrimental. Rehabilitation following surgical procedures for articular cartilage lesions should include controlled range of motion exercises. Exercises to enhance muscle function must be done in a manner which minimizes shear loading of the joint surfaces in the area of the lesion. A period of protected weight bearing is often necessary and should be followed by progressive loading of the joint. This article will: 1) provide a brief review of the structure and function of articular cartilage lesions as it relates to rehabilitation; 2) describe common surgical procedures to address articular cartilage lesions; and 3) provide guidelines for rehabilitation following surgical management of articular cartilage lesions.     

Roaming through methodology. X. The testing of diagnostic procedures

In this era of evidence-based medicine, diagnostic tests cannot escape close scrutiny of their effectiveness. Sensitivity and specificity have up till now played a central role in the evaluation of diagnostic tests. These terms are not without their shortcomings when it comes to the characterisation of a test's true worth for patients. Randomised clinical trials are increasingly used for evaluation of medical tests and outlining of strategy. The indirect relationship between test results and health outcome creates additional challenges for designers of such trials.     

Physical diagnostic procedures: whispered speech and tuning fork test]

Hearing impairment occurs in 10% of the Dutch population and may lead to major communication problems and even social isolation. A good method to detect hearing loss in a general practice is the screening audiometer. The treating physician may further use the whispered speech test and tuning fork tests which together give a good impression of the severity and the nature of the hearing loss if any. The whispered speech test is best performed in the standardized form according to the guideline 'Slechthorendheid' [hardness of hearing] of the Dutch College of General Practitioners (NHG), in which certain combinations of letters are recommended. The tuning fork tests according to Rinne and Weber indicate a difference in perception and conduction deafness, and are decisive for any hearing asymmetry. Use of the whispered speech test and of the tuning fork tests is recommended for adults and children from the age of 7.     

Pathological findings in organs after diagnostic and therapeutic procedures (author's transl)]

An account is given of lesions in organs caused by diagnostic and/or therapeutic operations. First possible damages during reanimation in acute life threatenig diseases are described. Secondly indirect damages resulting from resuscitation are discussed, especially reanimation-caused encephalopathies. The predominantly quantitative variations of primary diseases and secondary diseases which can arise during intensivetherapy and during so called vita reducta, as well as damages caused by necessary and, as a rule, frequently repeated medical actions are mentioned...     

Assessment of diagnostic procedures. Some comments about classical indices (author's transl)

The assessment of diagnostic technologies, concerns today both clinicians and health care administrators. This assessment is based upon calculation of various indices measuring the informative value of diagnostic test: sensitivity, specificity, accuracy, predictive value. Despite their extreme semplicity, these indices can be misinterpreted and misused; in addition they are often calculated from very particular patients sample, especially when retrospective data are used. The main points which influence the value confered to a diagnostic test, the major bias to avoid designing such studies are pointed out this paper. The likeness between controlled therapeutic trial and comparative assessment of diagnostic technologies is particularly emphasized.     

A dummy orbit for training in diagnostic procedures and laser surgery with enucleated eyes

OBJECTIVES: The purpose of this study was to analyze duration of coverage among new Medicaid enrollees. METHODS: The 1991 Survey of Income and Program Participation was used to examined the duration of coverage for individuals who did not have Medicaid in January 1991 and obtained coverage by May 1993. RESULTS: Of new Medicaid enrollees, 38% (90% confidence interval [CI] = 34%, 42%) remained covered 1 year later; 26% (90% CI = 21%, 31%) remained covered at 28 months. Of those older than 65 years, 54% (90% CI = 31%, 77%) retained Medicaid for 28 months, vs 20% (90% CI = 14%, 26%) of children. Of people who lost Medicaid, 54% (90% CI = 31%, 77%) had no insurance the following month. CONCLUSIONS: Almost two thirds of new Medicaid recipients lose coverage within 12 months. It is unlikely that Medicaid managed care will enhance continuity of care for new recipients.     

Limitations of current diagnostic procedures for the diagnosis of Taenia solium cysticercosis in rural pigs

New evidence has been presented from our laboratory that the gliding bacterium, Myxococcus xanthus, does not home by chemotaxis toward a nutrient source. Our experiments, those of others, and the theory presented here combine to suggest a model, called the 'Pied Piper' model. It hypothesizes a gene that has a high mutation rate forward and back (say something in excess 10(-4) mutations per cell generation) which leads to switching between two motility states. Occasionally rare organisms become genetically, but reversibly, changed so that they move unidirectionally instead of mostly forward and back as do the bulk of the cells. When such a 'leader' cell arises, it continues to move in its original orientation, and causes a cohort of cells to move together away from the bulk of the cells. That is, in the less common mutational state it counteracts the usual tendency to just move forward and backward achieving little net movement. The assumption of a genetic element that mutates in a reversible way is suggested by numerous cases of reversible switches now known in a wide range of bacteria serving a variety of functions. A second aspect of the model is that mechanisms exist that cause cells to move in the same direction as their nearby neighbors. This process results in a regular spacing of bands of cells to form mounds in the absence of a leader. The action of C-factor, a factor-secreted by the cells which has been largely studied in the laboratory of Dale Kaiser, and extracellular fibrils, (rod-shaped protein and carbohydrate bodies) largely studied in the laboratory of Martin Dworkin, may be key elements in coordinating (or linking) the movements of neighboring cells. Based on the assumption of the absence of chemotaxis, computer simulations of pattern formation for gliding bacterial swarms and flares are consistent with observed behaviors and thus are additional evidence that chemotactic motility of the type exhibited by Escherichia coli, is not necessary for the group movements of M. xanthus. Some tests for this model are suggested.     

Real-time measurement of radiation exposure to patients during diagnostic coronary angiography and percutaneous interventional procedures

An important research question in the study of the genetics of coronary artery disease (CAD) is whether information about genetic variation will improve our ability to predict CAD beyond established risk factors. This question is especially relevant to the goal of identifying young, asymptomatic adults with coronary atherosclerosis who would benefit most from interventions to reduce risk. Coronary artery calcification (CAC) detected by electron-beam computed tomography is a relatively new method for detecting coronary atherosclerosis in asymptomatic individuals that has been shown to be a more accurate indicator of coronary atherosclerosis in asymptomatic individuals than other noninvasive techniques. In a study of asymptomatic women (n=169) and men (n=160) between the ages of 20 and 59 representative of the Rochester, Minnesota population, we used logistic regression to ask whether the most common Apolipoprotein (Apo) E genotypes (epsilon3/2, epsilon3/3, and epsilon4/3) predict the presence of CAC. The addition of information about ApoE genotypes to logistic models containing each separate risk factor did not improve prediction of CAC (P>0.10 in both women and men). However, there was significant evidence (P<0.10) that associations between variation in the probability of having CAC and variation in body mass index, plasma total cholesterol, and plasma ApoB in men and body mass index, plasma triglycerides, plasma ApoA1, and plasma ApoE in women were dependent on ApoE genotype. Thus, variation in the gene coding for ApoE may play a role in determining the contribution of established risk factors to risk of CAC.