Parents' perceptions of medical diagnoses and related issues for their high-risk infants

INTRODUCTION: The objectives of this study were (a) to compare maternal and paternal perceptions of infant medical diagnoses with hospital-chart diagnoses, (b) to examine whether parental perceptions of infant medical condition (using three variables) were related to eight other parental perceptions, and (c) to determine what medical diagnoses were associated with parental expectations that neonatal diagnoses were having current effects of would have future effects on their infant. METHOD: With a questionnaire format 76 parents reported information about medical diagnoses and their perceptions about eight other issues for their infants who had been hospitalized in an NICU. RESULTS: Parents reported approximately 62% of the medical diagnoses for their infants during NICU hospitalization; these significantly differed from hospital-chart diagnoses. Parents who reported current or future effects of neonatal diagnoses also (a) had fears for their infants while in the hospital or currently, (b) perceived prematurity as having current or future effects, (c) reported restrictions for their infants caused by neonatal diagnoses, and (d) gave less optimal ratings for their infants' current health status. Parents' perceptions of current or future effects of neonatal diagnoses appeared to be inaccurate given the actual diagnoses for their infants. DISCUSSION: The underreporting of diagnoses by parents raises several issues as to how accurately parents are perceiving their infants. Parents who perceived continued effects of neonatal diagnoses also had less optimal perceptions of other related issues. Parent's perceptions of continued effects of neonatal diagnoses appeared to be unwarranted with respect to the actual diagnoses assigned to their infants.     

The cooccurrence of DSM-III-R personality disorders

The distinction between personality disorder diagnoses is often unclear because of the frequent cooccurrence of one or more of the diagnoses. To date, studies using sample sizes large enough to evaluate the rates of cooccurrence in the less prevalent personality disorders have not been conducted. The Structured Interview for Diagnosis of Personality-Revised, a semistructured instrument designed to yield reliable personality disorder diagnoses, was used to evaluate 1116 subjects for the presence of DSM-III-R personality disorder diagnoses. Cooccurrence rates and odds ratios were calculated for each pair of diagnoses. There was a high degree of cooccurrence between the cluster A personality disorders, between the cluster C personality disorders, and between narcissistic, borderline, and histrionic disorders. In addition, there was also a high frequency of avoidant personality disorders within the cluster A personality disorder diagnoses. Possible explanations for the high degree of cooccurrence and the potential implications for the DSM-IV personality disorder diagnoses are discussed.     

Relevance of NANDA and health promotion diagnoses to school nursing. National Association of School Nurses

This is a report of a national survey of 490 members of the National Association of School Nurses which described the relevance of 109 nursing diagnoses approved by NANDA (1992) and 29 health promotion (wellness) diagnoses developed by the authors. The relevance of these 138 nursing diagnoses for school nursing was determined by the percent of participants who checked "Yes" for the diagnostic categories they observed in their practice and for which they provided one or more interventions. More than half of the sample checked "Yes" for 67 NANDA diagnoses; health promotion diagnoses were checked "Yes" by 45% to 89% of the sample. The implications are that NANDA and health promotion diagnoses are relevant to school nursing and could readily be incorporated into practice to facilitate data collection that supports both the funding of school nurses and program development for children, families, and school staff.     

Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data

OBJECTIVE: To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. METHOD: Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater (n = 15) and test-retest (n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 36 days). RESULTS: Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability kappa coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). CONCLUSION: Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.     

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1993

This report presents statistics on conditions diagnosed and surgical and nonsurgical procedures performed in non-Federal short-stay hospitals. The statistics are based on data collected through the National Hospital Discharge Survey from a national sample of the hospital records of discharged inpatients. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital.     

The relationships among nursing diagnoses in discharge planning for patients with lung cancer

An explanatory study was designed to investigate whether nursing diagnoses present at discharge from the hospital accurately describe the complexity of care required in the community. A sample of 196 patients with lung cancer referred to community agencies at discharge was described by types of nursing diagnoses; types of agencies needed and services required; and by age, gender, race, economic status, and hospital length of stay. Using multiple logistic regression, a model for home care referral resulted in four significant predictor diagnoses: altered nutrition: less than body requirements, bathing/hygiene self-care deficit, high risk for infection, and high risk for injury. The model for hospice referral resulted in four significant predictor diagnoses: anticipatory grieving, impaired skin integrity, high risk for impaired skin integrity, and pain. The data suggest that the nursing diagnoses described the discharge planning needs, which predicted the type of agency referral needed.     

Adolescents'' experiences of anger in a residential setting

The most common types of psychiatric diagnoses linked with substance abuse or dependence in women are defined and discussed. A framework is described to facilitate the nurse provider's understanding of the various relationships psychiatric symptoms can have to substance-using patterns. Guidelines are provided to assist the nurse in identifying problems of dual diagnoses and providing care to women with dual diagnoses in general care settings.     

Convergence and concurrent validity of DSM-III diagnoses and the Personality Inventory for Children (PIC).

Evaluated the relations of Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses and the parent-informant PIC within a sample of 839 behaviorally disturbed children and adolescents. In addition, the ability of DSM-III diagnoses and the PIC to predict teacher and clinician behavior ratings was compared. High proportions of children assigned specific DSM-III diagnoses obtained elevated scores on related PIC scales, although the overlap was imperfect. Also, covariation of the teacher and clinician behavior ratings was much stronger with the PIC than with DSM-III diagnoses. Implications of these findings for clinical practice with children are discussed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing diagnosis of risks. Analysis of cost effectiveness

BACKGROUND: Today, there is a discussion on the importance of the utilization of the nursing diagnosis: This makes convenient to evaluate the principal two existing methodological alternatives, that they are: 1) the problems identification, 2) the diagnoses statement of the NANDA within process nursing. The study is centered on the risk diagnoses. OBJECT: 1) To know which the two work methodologies is more effective. 2) To know if exist economic differences. METHODS: It is accomplished a cohorts study, in a population of user included in Program of Handicapped. These were studied during a year. RESULTS: In the group of patients without diagnoses the incidence rate was of 0.64 conversions/person-year), in the group with diagnoses was of 0.22 (p < 0.001). The mean of visits after that the is made real, in the group with diagnoses was of 0.35, in the group without diagnoses of 1.69 (p = 0.012). DISCUSSION: The analysis cost-efficiency of the two work methodologies is clearly more favorable for the methodology than states nursing diagnosis of the taxonomy of the NANDA.     

Spiritual and coping needs of critically ill patients: validation of nursing diagnoses

Although testing of physiologic nursing diagnoses has occurred, critical care nurses have not validated the defining characteristics of the diagnoses, Spiritual Distress and Ineffective Individual Coping. This research report describes how critical care nurses rated the defining characteristics of these diagnoses. Specific strategies are given to assist nurses in recognizing the defining characteristics so that they can effectively intervene in the spiritual and coping needs of patients, thereby enhancing patient outcomes.     

Moving beyond content validation of nursing diagnoses

TOPIC: Studies to establish construct and criterion-related validity of nursing diagnoses. PURPOSE: The overwhelming majority of previous studies addressed content validation by nurse experts. This paper describes strategies to move beyond content validation research to construct and criterion-related validation. SOURCES: The range of studies that should be conducted for development of nursing diagnoses are reviewed with examples drawn from the field of psychology. Existing studies on the diagnoses of ineffective breathing pattern, ineffective airway clearance and impaired gas exchange are used as examples. CONCLUSIONS: Many types of studies are needed for each nursing diagnosis. Increased funding and support for nursing diagnosis research will be facilitated by attention to the accuracy of nurses' diagnoses and outcomes of the diagnostic process.     

Most common dermatologic problems identified by internists, 1990-1994

BACKGROUND: Internists in all settings see many patients with skin conditions. Thus, their education in dermatology is important. Information on which areas of dermatology are most commonly seen in internal medicine practices is necessary for designing effective educational programs on skin disease. OBJECTIVE: To determine what types of dermatologic problems internists most commonly diagnose. METHODS: National Ambulatory Medical Care Survey data from 1990 to 1994 were analyzed for dermatologic diagnoses. Physicians specializing in internal medicine and all its subspecialties were compared with dermatologists and with other physicians. RESULTS: The most common skin disorders diagnosed by internists were dermatitis (15.8% of all diagnoses) and bacterial skin infections (14.0% of all diagnoses). Combined, bacterial, fungal, and viral infections included 28.3% of the most common dermatologic diagnoses made by internists. The top 10 most common diagnoses accounted for 57.9% of all skin-related diagnoses and the top 20 most common diagnoses accounted for 72.8%. Internists were more likely to see patients for bacterial skin infections, herpes infection, exanthem, urticaria, and insect bites while dermatologists more commonly saw patients for actinic and seborrheic keratoses, warts, benign and malignant skin tumors, and psoriasis. CONCLUSIONS: The most common dermatologic diseases diagnosed by internists differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of internal medicine residents, it is important to recognize these differences to place emphasis on the proper areas of study. Some common or serious skin conditions not often diagnosed by internists such as psoriasis and melanoma also deserve attention in internal medicine training programs.     

Performance of four computer-based diagnostic systems

BACKGROUND: Computer-based diagnostic systems are available commercially, but there has been limited evaluation of their performance. We assessed the diagnostic capabilities of four internal medicine diagnostic systems: Dxplain, Iliad, Meditel, and QMR. METHODS: Ten expert clinicians created a set of 105 diagnostically challenging clinical case summaries involving actual patients. Clinical data were entered into each program with the vocabulary provided by the program's developer. Each of the systems produced a ranked list of possible diagnoses for each patient, as did the group of experts. We calculated scores on several performance measures for each computer program. RESULTS: No single computer program scored better than the others on all performance measures. Among all cases and all programs, the proportion of correct diagnoses ranged from 0.52 to 0.71, and the mean proportion of relevant diagnoses ranged from 0.19 to 0.37. On average, less than half the diagnoses on the experts' original list of reasonable diagnoses were suggested by any of the programs. However, each program suggested an average of approximately two additional diagnoses per case that the experts found relevant but had not originally considered. CONCLUSIONS: The results provide a profile of the strengths and limitations of these computer programs. The programs should be used by physicians who can identify and use the relevant information and ignore the irrelevant information that can be produced.     

Questionnaire for Eating Disorder Diagnoses: Reliability and validity of operationalizing DSM—IV criteria into a self-report format.

The Questionnaire for Eating Disorder Diagnoses (Q-EDD) operationalizes eating disorder criteria of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and differentiates (a) between those with and without an eating disorder diagnosis, (b) among eating-disordered, symptomatic, and asymptomatic individuals, and (c) between those with anorexia and bulimia diagnoses. Three studies examined the Q-EDD"s psychometric properties. Convergent validity was supported by correspondence between Q-EDD diagnoses and established inventory scores. Criterion validity was supported by high correspondence between Q-EDD and interview or clinician diagnoses. Incremental validity was supported by greater accuracy of Q-EDD diagnoses than those yielded by an established inventory. Test-retest reliability and interscorer agreement were very good. Future use is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent validity of a rule-based system

The purpose of this project was to test the concurrent validity of the diagnoses recommended by a rule-based expert system. Concurrent validity was determined first by comparing the expert system's computerized diagnostic recommendations with that of a Clinical Nurse Specialist (CNS Assessor) who assessed the patient, and secondly by comparing the expert system's candidate diagnoses with those of a panel of 10 clinical nurse specialists (CNS Panel). The expert system rule base for generating diagnoses was programmed for some of the most common nursing diagnoses (Metzger & Hiltunen, 1987) including: alteration in comfort, acute pain; impaired physical mobility; sleep pattern disturbance; impairment of skin integrity and self-care deficit (bathing, feeding, toileting, and dressing). Activity intolerance and potential for infection were also programmed as diagnostic possibilities in the rule base.     

Open-lung biopsy in the renal transplant recipient

In 22 renal transplant recipients, 23 open-lung biopsy procedures were performed. There were two (8.7%) biopsy-related complications (hemorrhage and pneumothorax) and five deaths (22.7%), although the deaths could not be definitely related to the biopsy procedure itself. Seventeen biopsy specimens yielded specific diagnoses, and six were nonspecific. The mortality rate for the patients with specific diagnoses was not significantly different from that of patients with nonspecific diagnoses (25% vs. 16.7%). Other factors analyzed, such as age, diabetes, hypoxia, leukopenia, and donor source, did not affect the result of biopsy. We conclude that the patient's underlying disease and added immunosuppressive therapy are the factors most responsible for the clinical outcome. We suggest that without early treatment of the infectious agents, the mortality rate of the group with specific diagnoses would likely have been higher.     

Use of fine needle aspiration cytology for investigating lymphadenopathy in HIV positive patients

The cytological diagnoses of 27 lymph node aspirates were compared with the histological diagnoses or clinical outcome in 23 HIV positive patients. There was agreement between the cytological and histological diagnoses in 14 of the 16 surgically biopsied cases. The clinical outcome in the remaining 11 cases was consistent with the cytodiagnosis. Fine needle aspiration (FNA) is a reliable, minimally traumatic, cost effective method with high specificity. It is suitable for an initial rapid diagnosis in HIV positive patients with lymphadenopathy.     

Utilization of nursing diagnosis according to Nanda's classification for the systematization of nursing care in breast feeding

The present study aimed at describing the reformulated instrument used in the puerperal woman nursing consultation based on the identified diagnoses classification according to the Taxonomy-I reviewed by NANDA, and the identification of the most frequent nursing diagnoses concerning maternal breastfeeding, based on the reformulated instrument. The diagnoses found as being over 50% were: knowledge deficit (100%); sleep pattern disturbance (75%), altered sexuality patterns (75%), ineffective breastfeeding (66.6%) and impaired physical mobility (66.6%).     

Medical Records for Building Health Management

Medical records provide essential information for evaluating a patient’s health. Without them, it would be difficult for doctors to make accurate diagnoses. Similar to diagnoses in medical science, building health management also requires building medical records for making accurate diagnoses. At later stages of a building’s life cycle, when the budget is limited, organizations responsible for building repairs and maintenance are unable to digitalize building health diagnoses and keep complete medical records of buildings; as a result, maintenance crews usually cannot fully understand buildings’ overall health conditions and their medical histories, which may result in erroneous diagnoses directly or public safety dangers indirectly. Using the problem-oriented medical record adopted for the medical diagnosis of human diseases, this paper designs a building medical record (BMR), which allows simple electronic archiving, and evaluates its practicability with a case study of school buildings. The purpose of a BMR is to enable maintenance engineers (building doctors), building managers, and contractors of school buildings to have low-cost access to required information for making complete evaluations and maintenance suggestions for buildings.