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Journal of Clinical Sleep Medicine :... Oct 2011Guidance is needed to help clinicians decide which out-of-center (OOC) testing devices are appropriate for diagnosing obstructive sleep apnea (OSA). A new classification... (Review)
Review
Guidance is needed to help clinicians decide which out-of-center (OOC) testing devices are appropriate for diagnosing obstructive sleep apnea (OSA). A new classification system that details the type of signals measured by these devices is presented. This proposed system categorizes OOC devices based on measurements of Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters.Criteria for evaluating the devices are also presented, which were generated from chosen pre-test and post-test probabilities. These criteria state that in patients with a high pretest probability of having OSA, the OOC testing device has a positive likelihood ratio (LR+) of 5 or greater coinciding with an in-lab-polysomnography (PSG)-generated apnea hypopnea index (AHI) ≥ 5, and an adequate sensitivity (at least 0.825).Since oximetry is a mandatory signal for scoring AHI using PSG, devices that do not incorporate oximetry were excluded. English peer-reviewed literature on FDA-approved devices utilizing more than 1 signal was reviewed according to the above criteria for 6 questions. These questions specifically addressed the adequacy of different respiratory and effort sensors and combinations thereof to diagnose OSA. In summary, the literature is currently inadequate to state with confidence that a thermistor alone without any effort sensor is adequate to diagnose OSA; if a thermal sensing device is used as the only measure of respiration, 2 effort belts are required as part of the montage and piezoelectric belts are acceptable in this context; nasal pressure can be an adequate measurement of respiration with no effort measure with the caveat that this may be device specific; nasal pressure may be used in combination with either 2 piezoelectric or respiratory inductance plethysmographic (RIP) belts (but not 1 piezoelectric belt); and there is insufficient evidence to state that both nasal pressure and thermistor are required to adequately diagnose OSA. With respect to alternative devices for diagnosing OSA, the data indicate that peripheral arterial tonometry (PAT) devices are adequate for the proposed use; the device based on cardiac signals shows promise, but more study is required as it has not been tested in the home setting; for the device based on end-tidal CO(2) (ETCO(2)), it appears to be adequate for a hospital population; and for devices utilizing acoustic signals, the data are insufficient to determine whether the use of acoustic signals with other signals as a substitute for airflow is adequate to diagnose OSA.Standardized research is needed on OOC devices that report LR+ at the appropriate AHI (≥ 5) and scored according to the recommended definitions, while using appropriate research reporting and methodology to minimize bias.
Topics: Equipment Design; Humans; Monitoring, Ambulatory; Oximetry; Plethysmography, Impedance; Predictive Value of Tests; Respiratory Function Tests; Sleep Apnea, Obstructive; Transducers, Pressure
PubMed: 22003351
DOI: 10.5664/JCSM.1328 -
Medical Decision Making : An... May 2016The unconscious thought theory argues that making complex decisions after a period of distraction can lead to better decision quality than deciding either immediately or...
The unconscious thought theory argues that making complex decisions after a period of distraction can lead to better decision quality than deciding either immediately or after conscious deliberation. Two studies have tested this unconscious thought effect (UTE) in clinical diagnosis with conflicting results. The studies used different methodologies and had methodological weaknesses. We attempted to replicate the UTE in medical diagnosis by providing favorable conditions for the effect while maintaining ecological validity. Family physicians (N= 116) diagnosed 3 complex cases in 1 of 3 thinking modes: immediate, unconscious (UT), and conscious (CT). Cases were divided into short sentences, which were presented briefly and sequentially on computer. After each case presentation, the immediate response group gave a diagnosis, the UT group performed a 2-back distraction task for 3 min before giving a diagnosis, and the CT group could take as long as necessary before giving a diagnosis. We found no differences in diagnostic accuracy between groups (P= 0.95). The CT group took a median of 7 s to diagnose, which suggests that physicians were able to diagnose "online," as information was being presented. The lack of a difference between the immediate and UT groups suggests that the distraction had no additional effect on performance. To assess the decisiveness of the evidence of this null result, we computed a Bayes factor (BF01) for the 2 comparisons of interest. We found a BF01of 5.76 for the UT versus immediate comparison and of 3.61 for the UT versus CT comparison. Both BFs provide substantial evidence in favor of the null hypothesis: physicians' diagnoses made after distraction are no better than diagnoses made either immediately or after self-paced deliberation.
Topics: Adult; Aged; Bayes Theorem; Clinical Decision-Making; Diagnosis; Female; Humans; Male; Middle Aged; Models, Psychological; Physicians, Family; Reproducibility of Results; Unconscious, Psychology
PubMed: 25852079
DOI: 10.1177/0272989X15581352 -
World Journal of Gastroenterology Apr 2024In Japan, liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus (HCV) and diagnosing HCV-related hepatocellular... (Review)
Review
In Japan, liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus (HCV) and diagnosing HCV-related hepatocellular carcinoma (HCC). However, due to the development of effective antiviral treatments and advanced imaging, the necessity for biopsies has significantly decreased. This change has resulted in fewer chances for diagnosing liver disease, causing many general pathologists to feel less confident in making liver biopsy diagnoses. This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan. First, it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence. Second, it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions, because clinically diagnosable HCCs are not targets for biopsy. Third, the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs. In conclusion, pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.
Topics: Humans; Antiviral Agents; Biopsy; Carcinoma, Hepatocellular; Fatty Liver; Hepacivirus; Hepatitis C; Hepatitis C, Chronic; Immune Checkpoint Inhibitors; Japan; Liver; Liver Neoplasms
PubMed: 38681127
DOI: 10.3748/wjg.v30.i14.1949 -
International Journal of Infectious... Jul 2020Diagnosing pulmonary blastomycosis (PB) requires the detection of Blastomyces dermatitidis in pulmonary secretions or tissue, which can be achieved via bronchoscopic...
OBJECTIVES
Diagnosing pulmonary blastomycosis (PB) requires the detection of Blastomyces dermatitidis in pulmonary secretions or tissue, which can be achieved via bronchoscopic procedures like bronchoalveolar lavage (BAL) or brush and transbronchial biopsy (TBBx). This descriptive study retrieved the data of PB that was diagnosed by bronchoscopy to define which bronchoscopic procedure produced the highest yield.
METHODS
Retrospectively, all patients diagnosed with PB via bronchoscopic approach were identified. Non-invasive BAL was referred to when performed first in the order of bronchoscopic procedures, and invasive BAL was used when it was performed after other bronchoscopic procedures.
RESULTS
A total of 111 patients were included in the study. BAL produced the highest yield of all bronchoscopic procedures (>87%), regardless if it was performed first in order (non-invasive, 87.3%) or not (invasive BAL, 89.6%) (p = 0.43). Performing bronchoscopy and BAL earlier in the course of the disease resulted in a significantly better diagnostic yield.
CONCLUSIONS
BAL is probably enough to diagnose PB. Also, it had the best yield when performed earlier, regardless of whether it was performed first in order or not. BAL culture had a better yield in detecting Blastomyces dermatitidis over fungal stain and cytology.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blastomycosis; Bronchoalveolar Lavage; Bronchoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 32371194
DOI: 10.1016/j.ijid.2020.04.077 -
Frontline Gastroenterology 2021The global COVID-19 pandemic has changed healthcare across the world. Efforts have concentrated on managing this crisis, with impact on cancer care unclear. We...
OBJECTIVE
The global COVID-19 pandemic has changed healthcare across the world. Efforts have concentrated on managing this crisis, with impact on cancer care unclear. We investigated the impact on endoscopy services and gastrointestinal (GI) cancer diagnosis in the UK.
DESIGN
Analysis of endoscopy procedures and cancer diagnosis at a UK Major General Hospital. Procedure rates and diagnosis of GI malignancy were examined over 8-week periods in spring, summer and autumn 2019 before the start of the crisis and were compared with rates since onset of national lockdown and restrictions on elective endoscopy. The number of CT scans performed and malignancies diagnosed in the two corresponding periods in 2019 and 2020 were also evaluated.
RESULTS
2 698 2516 and 3074 endoscopic procedures were performed in 2019, diagnosing 64, 73 and 78 cancers, respectively, the majority being in patients with alarm symptoms and fecal immunochemical test+ve bowel cancer screening population. Following initiation of new guidelines for management of endoscopy services 245 procedures were performed in a 6 week duration, diagnosing 18 cancers. This equates to potentially delayed diagnosis of 37 cancers per million population per month. Clinician triage improved, resulting in 13.6 procedures performed to diagnose one cancer.
CONCLUSIONS
Our data demonstrate an 88% reduction in procedures during the first 6 weeks of COVID-19 crisis, resulting in 66% fewer GI cancer diagnoses. Triage changes reduced the number of procedures required to diagnose cancer. Our data can help healthcare planning to manage the extra workload on endoscopy departments during the recovery period from COVID-19.
PubMed: 33907616
DOI: 10.1136/flgastro-2020-101543 -
Respiratory Medicine Aug 2017Chronic obstructive pulmonary disease (COPD) has serious implications at both the individual and the societal level. It is crucial that COPD is diagnosed correctly to... (Review)
Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) has serious implications at both the individual and the societal level. It is crucial that COPD is diagnosed correctly to ensure provision of the right treatment. However, the current diagnostic procedures may lead to misdiagnosis.
AIM
The aim of this scoping review was to disseminate knowledge about potential causes of misdiagnosis of COPD.
METHODS
A systematic, comprehensive search was performed in PubMed, Embase and Cinahl.
RESULTS
A thorough review produced a sample of 73 articles. The synthesis revealed five potential causes of misdiagnosis of COPD, including: the threshold for defining COPD (n = 36), errors made in primary care (n = 15), errors linked to the spirometry test (n = 13), differential diagnoses (n = 10), and patient-related factors (n = 8).
CONCLUSIONS
The causes of misdiagnosis of COPD are attributable mainly to spirometry and to the healthcare professional performing the diagnostic assessment. With a view to limiting misdiagnosis of COPD, future research should help clarify strategies for alternative objective tests for determining if a patient has COPD and explore how to better support primary care in the diagnosing of COPD.
Topics: Awareness; Comorbidity; Diagnosis, Differential; Diagnostic Errors; Female; Forced Expiratory Volume; Humans; Male; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Spirometry; Vital Capacity
PubMed: 28732838
DOI: 10.1016/j.rmed.2017.05.015 -
PloS One 2022Diagnosing cardiac pauses that could produce syncopal episodes is important to guide appropriate therapy. However, the infrequent nature of these episodes can make...
Diagnosing cardiac pauses that could produce syncopal episodes is important to guide appropriate therapy. However, the infrequent nature of these episodes can make detection challenging with conventional monitoring (CM) strategies with short-term ECG monitors. Insertable cardiac monitors (ICMs) continuously monitor for arrhythmias but present a higher up-front cost. It is not well understood whether these higher costs are offset by the costs of repeat evaluation in CM strategies. We simulated the likelihood of diagnostic success and cost-per-diagnosis of pause arrhythmias with CM strategies compared to ICM monitoring. ICM device data from syncope patients diagnosed with pause arrhythmias was utilized to simulate patient pathways and diagnostic success with CM. We assumed that detected true pause episodes (≥5 seconds) were symptomatic and prompted a hospital encounter and further evaluation with CM. Subsequent true pause episodes in yet-undiagnosed patients triggered additional rounds of CM. Costs of monitoring were accrued at each encounter and represent the U.S. payer perspective. Cost per diagnosed patient was calculated as the total costs accrued for all patients divided by the number of patients diagnosed, across 1,000 simulations. During a mean 505±333 days of monitoring ICM detected 2.4±2.7 pause events per patient, with an average of 109±94 days until the first event. CM was projected to diagnose between 13.8% (24-hour Holter) and 30.2% (two 30-day monitors) of the ICM-diagnosed patients. Total diagnostic costs per ICM-diagnosed patient averaged $7,847, whereas in the CM strategies average cost-per-diagnosis ranged from $12,950±2,589 with 24-hour Holter to $32,977±14,749 for two 30-day monitors. Relative to patients diagnosed with pause arrhythmias via ICM, CM strategies diagnose fewer patients and incur higher costs per diagnosed patient.
Topics: Atrial Fibrillation; Electrocardiography; Electrocardiography, Ambulatory; Humans; Syncope
PubMed: 35749428
DOI: 10.1371/journal.pone.0270398 -
COV-MobNets: a mobile networks ensemble model for diagnosis of COVID-19 based on chest X-ray images.BMC Medical Imaging Jun 2023The medical profession is facing an excessive workload, which has led to the development of various Computer-Aided Diagnosis (CAD) systems as well as Mobile-Aid...
BACKGROUND
The medical profession is facing an excessive workload, which has led to the development of various Computer-Aided Diagnosis (CAD) systems as well as Mobile-Aid Diagnosis (MAD) systems. These technologies enhance the speed and accuracy of diagnoses, particularly in areas with limited resources or remote regions during the pandemic. The primary purpose of this research is to predict and diagnose COVID-19 infection from chest X-ray images by developing a mobile-friendly deep learning framework, which has the potential for deployment in portable devices such as mobile or tablet, especially in situations where the workload of radiology specialists may be high. Moreover, this could improve the accuracy and transparency of population screening to assist radiologists during the pandemic.
METHODS
In this study, the Mobile Networks ensemble model called COV-MobNets is proposed to classify positive COVID-19 X-ray images from negative ones and can have an assistant role in diagnosing COVID-19. The proposed model is an ensemble model, combining two lightweight and mobile-friendly models: MobileViT based on transformer structure and MobileNetV3 based on Convolutional Neural Network. Hence, COV-MobNets can extract the features of chest X-ray images in two different methods to achieve better and more accurate results. In addition, data augmentation techniques were applied to the dataset to avoid overfitting during the training process. The COVIDx-CXR-3 benchmark dataset was used for training and evaluation.
RESULTS
The classification accuracy of the improved MobileViT and MobileNetV3 models on the test set has reached 92.5% and 97%, respectively, while the accuracy of the proposed model (COV-MobNets) has reached 97.75%. The sensitivity and specificity of the proposed model have also reached 98.5% and 97%, respectively. Experimental comparison proves the result is more accurate and balanced than other methods.
CONCLUSION
The proposed method can distinguish between positive and negative COVID-19 cases more accurately and quickly. The proposed method proves that utilizing two automatic feature extractors with different structures as an overall framework of COVID-19 diagnosis can lead to improved performance, enhanced accuracy, and better generalization to new or unseen data. As a result, the proposed framework in this study can be used as an effective method for computer-aided diagnosis and mobile-aided diagnosis of COVID-19. The code is available publicly for open access at https://github.com/MAmirEshraghi/COV-MobNets .
Topics: Humans; COVID-19; COVID-19 Testing; X-Rays; SARS-CoV-2; Deep Learning
PubMed: 37322450
DOI: 10.1186/s12880-023-01039-w -
Journal of Personalized Medicine Mar 2024The electrocardiogram is the first test that is undertaken when evaluating a patient's heart. Diagnosing congenital heart disease in an adult (ACHD) can be facilitated... (Review)
Review
The electrocardiogram is the first test that is undertaken when evaluating a patient's heart. Diagnosing congenital heart disease in an adult (ACHD) can be facilitated by knowing the classical electrocardiographic (EKG) findings. These EKG findings often result from the congenital defect that prevents a part of the cardiac conduction system from occupying its normal anatomic position. When these classical EKG findings are not present, the clinician should consider alternate diagnoses. As the patient with congenital heart disease ages, with native anatomy or after surgical or device repair, the EKG can be used to assess the patient's status and to decide if and when treatment requires adjustment. This is because the electrocardiogram (EKG) can diagnose the hypertrophy or enlargement in a cardiac chamber that results from the congenital defect or anomaly and can diagnose an arrhythmia that might compromise an otherwise stable anatomy. While ACHD often involves intracardiac shunting, in many cases the abnormality only involves cardiac electrical conduction block or ventricular repolarization. These life-threatening diseases can be diagnosed with an EKG. This review will demonstrate and explain how the EKG can be used to diagnose and follow adults with congenital heart disease. When coupled with history and physical examination, the value of the EKG in ACHD will be apparent. A diagnosis can then be made or a differential diagnosis proposed, before an imaging study is ordered.
PubMed: 38672995
DOI: 10.3390/jpm14040367 -
Pediatric Allergy and Immunology :... Jan 2022It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double-blind placebo-controlled... (Review)
Review
BACKGROUND
It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double-blind placebo-controlled food challenge (DBPCFC) has been regarded as the 'gold standard' for decades. However, DBPCFCs are costly, and time- and resource-intensive procedures. Structural implementation of less demanding open food challenges will only find support if research demonstrates that their outcome is comparable to DBPCFC, yet this has been proven difficult to investigate.
METHODS
We performed a literature review to investigate the diagnostic accuracy of oral food challenges and interviewed 19 parents of children with proven or suspected food allergy about the design of a trial to study this.
RESULTS
An overview of the dilemma of diagnosing food allergy using oral food challenges, and the methodological issues and parents' opinions to study this. No comparative studies have been performed using the latest guidelines on oral food challenges.
CONCLUSIONS
There is an urgent need to investigate the diagnostic accuracy of different oral food challenge protocols. We present the rationale and design of the ALDORADO trial (ALlergy Diagnosed by Open oR DOuble-blind food challenge) that has been set up to investigate whether the outcome of the open food challenge is comparable to DBPCFC.
Topics: Allergens; Child; Double-Blind Method; Food; Food Hypersensitivity; Humans; Randomized Controlled Trials as Topic; Skin Tests
PubMed: 34435396
DOI: 10.1111/pai.13654