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[Incidence of painful pronation in pediatric traumatology].

After examining the traumatic mechanism responsible for the lesion and considering the possible pathogenetic interpretations, the Authors pass to a description of the clinical picture and the simple but effective reduction manoeuvre. The attached cases tend to emphasize the by no means negligible frequency of painful pronation among childhood traumatisms, a condition often misunderstood and a source of wrong diagnostic interpretations.

Arm Injuries↗

Phraseology in pathology reports. A comparative study of interpretation among pathologists and surgeons.

This questionnaire based study compared the interpretation, use and preferences, among pathologists and surgeons, of descriptive phrases found in surgical reports. The results show that there is a wide variation in individual interpretation of phrases in both groups. The frequency of usage of phrases by pathologists and preference for phrases by surgeons were also diverse. The adoption of a limited number of descriptive phrases that are mutually understood and acceptable for use by both pathologists and clinicians is recommended to avoid interpretive ambiguity in pathology reports.

Communication↗

From EMG to formant patterns of vowels: the implication of vowel spaces.

With a few exceptions, EMG data are interpreted with reference to the intended output, such as the phonetic description of utterances spoken by speakers. For a more rigorous interpretation, the data should also be analysed in terms of the displacement of the articulators and the acoustic patterns. In this paper, we describe our attempts to calculate the formant patterns from EMG activity patterns via an articulatory model. The value of the model parameters, such as the tongue body position or tongue body shape, is derived from the EMG activities of the specific pairs of antagonistic tongue muscles. The model-calculated F1-F2 patterns for 11 American English vowels correspond rather well with those measured from the acoustic signals. What strikes us is the simplicity of the mappings from the muscle activities to vocal-tract configurations and to the formant patterns. We speculate that the brain optimally exploits the morphology of the vocal tract and the kinematic functions of the tongue muscles so that the mappings from the muscle activities (production) to the acoustic patterns (perception) are simple and robust.

Electromyography↗

Physical examination of the aged patient.

The aged patient presents challenges to the examining physician. Some of these relate to inefficient historical information transfer, reduced mobility, increased disease burden, cognitive and sensory alterations, and confusing background changes in the prevalence and interpretation of physical signs that would be unequivocally abnormal in the younger adult. This review suggests techniques to overcome these difficulties. Descriptions of methods of improving evaluation and interpretation are grouped into the following categories: general appearance and vital signs; skin; head and neck; respiratory and cardiovascular systems; abdomen, rectum and genitalia; musculoskeletal system; hands and fett; and neurologic and mental status evaluations. Several newly recognized signs are also described. The extra time, effort and ingenuity required for examination of the aged patient are richly repaid by enhanced diagnosis.

Aged↗

Highly effective techniques in computerized dental tissue morphometry.

The effectiveness of computer-aided morphometry is greatly dependent on the capabilities of the software platforms, but the literature provides only information about the measurement methods and their medical interpretation. The purpose of our work is to create a link between the technical algorithm and the medical significance, by a detailed description of measurement procedures, accompanied by the interpretation of their results. The developed techniques operate at a pixel level, by deriving a full benefit from the computational resources available in the modern software environments for image processing. The approach is built on three illustrative cases, formulated in a large sense, so as to cover classes of general problems, referring to cellular entities and tubular structures in cross and longitudinal section. Specimens belonging to the dentin-pulp complex were chosen, because they permit a quantitative analysis for each morphological element, as well as comparative discussion. With appropriate adaptations of the procedures, the measurements of other types of normal and pathological tissues can be analogously addressed. The design, implementation and exploitation of our procedures are supported by specific references to the use of an image analysis system (Zeiss KS400). The algorithmic background remains valid (except for some possible minor changes) when similar software is used. Consequently, the results and their interpretations, prove the importance of the numerical analysis in automating the quantitative evaluation of the structural features.

Algorithms↗

Temporal abstraction in intelligent clinical data analysis: a survey.

OBJECTIVE: Intelligent clinical data analysis systems require precise qualitative descriptions of data to enable effective and context sensitive interpretation to take place. Temporal abstraction (TA) provides the means to achieve such descriptions, which can then be used as input to a reasoning engine where they are evaluated against a knowledge base to arrive at possible clinical hypotheses. This paper surveys previous research into the development of intelligent clinical data analysis systems that incorporate TA mechanisms and presents research synergies and trends across the research reviewed, especially those associated with the multi-dimensional nature of real-time patient data streams. The motivation for this survey is case study based research into the development of an intelligent real-time, high-frequency patient monitoring system to provide detection of temporal patterns within multiple patient data streams. RESULTS: The survey was based on factors that are of importance to broaden research into temporal abstraction and on characteristics we believe will assume an increasing level of importance for future clinical IDA systems. These factors were: aspects of the data that is abstracted such as source domain and sample frequency, complexity available within abstracted patterns, dimensionality of the TA and data environment and the knowledge and reasoning underpinning TA processes. CONCLUSION: It is evident from the review that for intelligent clinical data analysis systems to progress into the future where clinical environments are becoming increasingly data-intensive, the ability for managing multi-dimensional aspects of data at high observation and sample frequencies must be provided. Also, the detection of complex patterns within patient data requires higher levels of TA than are presently available. The conflicting matters of computational tractability and temporal reasoning within a real-time environment present a non-trivial problem for investigation in regard to these matters. Finally, to be able to fully exploit the value of learning new knowledge from stored clinical data through data mining and enable its application to data abstraction, the fusion of data mining and TA processes becomes a necessity.

Artificial Intelligence↗

Parse's theory in practice. An interpretive analysis.

Parse's theory of human becoming provides a foundation for understanding holistic nursing practice. The purpose of this article is to provide a description of Parse's theory based on an interpretive analysis of the author's nursing practice experiences. The interpretive analysis is not an outcome of formal study but results from reflective thought and journal writing. Details from reflections on nursing care experiences were analyzed for the concepts, processes, and rhythms inherent to Parse's theory. Praxis of Parse's theory creates the opportunity for nurses, patients, and families to reach profound dimensions of the human experience and participate in multidimensional healing. Outcomes of praxis for nurses also include personal and professional growth as well as discernment of holistic nursing practice.

Attitude of Health Personnel↗

Immunoglobulin deposition in skin of patients with lupus erythematosus: clinical correlates and indications for direct immunofluorescence.

LE is associated with deposition of immunoglobulins at the DEJ of both involved and uninvolved skin. A demonstration of these deposits by direct immunofluorescence can aid the clinician in establishing the diagnosis of LE, in separating between its types, and sometimes in gauging disease activity and prognosis. However, interpretation is not simple or straightforward. When the clinician receives the results, he or she must read the descriptive information as well as the immunopathologist's interpretation. The clinician must integrate this knowledge into the clinical setting to make a final interpretation. In addition to the immunofluorescence results, the clinician must consider the clinical status of the patient; the morphology, configuration, and distribution of skin lesions; the results of laboratory tests; and the results of biopsy for ordinary histopathologic examination. Despite these limitations, biopsy of skin for direct immunofluorescence examination is a very useful procedure that aids the clinician in the diagnosis and management of patients with various forms of LE.

Fluorescent Antibody Technique↗

Mathematical description of the interaction between prostaglandins and calcium.

The interpretation of the biological action of prostaglandins is very difficult because the shape of the dose-response curves in different assays is often unusual. Horrobin has attempted to explain these unusual curves by supposing special interactions between Ca and the prostaglandin receptors. This paper gives a mathematical description of his theoretical models. The results of computer simulation based on these models were in good agreement with the reported experimental observations.

Binding, Competitive↗

Fourth updated ESACP consensus report on diagnostic DNA image cytometry.

A task force of experts in the field of diagnostic DNA image cytometry, invited by the ESACP, and further scientists or physicians revealing experience in that diagnostic procedure (names are given in Addendum A), agreed upon the following 4th updated Consensus Report on Standardised Diagnostic DNA Image Cytometry during the 7th International Congress of that society in Caen, 2001. This report is based on the three preceding ones [6,14,17]. It deals with the following items:- Critical review and update of the definitions given in the 1997 Consensus Update;- Review and detailed description of basic terms, principles and algorithms for diagnostic interpretation;- Recommendations concerning diagnostic or prognostic applications in specific fields of tumour pathology. This update is not aimed to substitute the 1997 consensus, but to make necessary addenda and give more detailed descriptions of those items not unequivocally to interpret by potential users of the methodology.

Algorithms↗

A first-line nurse manager's goal-profile.

AIM: The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. BACKGROUND: The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. METHODS: The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. RESULTS: The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfillment. CONCLUSION: The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. RELEVANCE TO CLINICAL PRACTICE: This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice.

Female↗

The figure has a shape, but the ground does not: evidence from a priming paradigm.

In four experiments, the authors examined the extent to which the ground interpretation of an edge may receive a shape description. These experiments used the priming effect that shapes have on perceptual judgments on a subsequent trial. A robust reduction in error rates and reaction times was seen when the figural shape was the same as that on the previous trial. This repetition priming effect may be due to activation of the shape description of the figure that remained from the previous trial. In contrast, no priming by the shape of the ground was seen even when the contrast sign of the figure reversed between trials. Priming for figural shapes occurred at a relatively abstract level because it was robust across reversals of contrast and orientation. These data suggest that the figural interpretation of a shape receives a shape description but that the ground does not.

Adult↗

Analysis of ambiguity in visual pattern completion.

It is possible to construct an ambiguous line drawing representing several objects partly hidden behind another object. This article deals with two problems: (a) What are the necessary and sufficient conditions for ambiguity to occur? (b) How can the response frequencies of the completions of ambiguous drawings be explained? Whether completions occur or not, the predictions based on the coding theory, better termed the structural information theory, have been discussed in a previous article (Buffart, Leeuwenberg, & Restle, 1981). It is shown here that the theory also specifies the conditions for ambiguity to occur. The theory describes all possible interpretations of a drawing and selects those interpretations or completions to which subjects will respond. A direct relation between the response frequencies and the possible theoretical descriptions of each response is shown to exist. Two one-parameter models describing the behavior of subjects each fit the response frequencies measured in two experiments with 25 drawings. It is argued that the type of ambiguity that is studied in both experiments generally appears during the perceptual process. The character of the theoretical descriptions indicates that guidance of perceptual behavior by interpretations might occur.

Adolescent↗

Differentiation of small adnexal masses based on morphologic characteristics of transvaginal sonographic imaging: a multicenter study.

OBJECTIVE: The purpose of this study was to assess the diagnostic accuracy of transvaginal sonographic examination of small adnexal masses by simple descriptive sonographic scoring. METHODS: In a prospective multicenter study, 4 teaching hospitals and 2 regional hospitals with homogeneous standard sonographic equipment and operator experience recruited 677 consecutive patients with small adnexal masses of less than 5 cm. Morphologic scoring was obtained for each mass and recorded. The management of the mass was based on local protocols. The minimal requirement was that surgery had to be performed for complex masses scoring 8 or higher, and follow-up of at least 12 months had to be performed and recorded for patients not admitted to surgery. Sonographic results were compared with pathologic reports and follow-up findings. RESULTS: Fifty-two malignant tumors (19 borderline, 15 stage I-II, 15 stage III-IV, 2 tubal carcinomas, and 1 ovarian lymphoma), 243 benign tumors at pathologic examination, and 382 masses defined as benign according to follow-up findings were observed. Malignant tumors had a significantly higher mean +/- SD morphologic score (11.2 +/- 2.7) than benign masses (6.2 +/- 2.5) (P = .001). No difference was observed in the scoring assignment of malignant masses in different centers (P = .56). With a score of 8 or higher, the likelihood ratio was 3.61 (95% confidence interval, 3.09-4.21); sensitivity, 92%; specificity, 76.9%; and positive predictive value, 25.6%. CONCLUSIONS: Our results provide evidence that descriptive morphologic scoring may overcome the subjectivity of interpretation of morphologic characteristics in small masses, and, at the same time, it can incorporate criteria to avoid simplistic description of a complex mass.

Adnexa Uteri↗

What do they know?: a content analysis of women's perceptions of trial information.

OBJECTIVE: To examine interpretations of study information by women participating in ORACLE, a trial of antibiotics in preterm labour. DESIGN: Questionnaire survey sent to women recruited to the ORACLE trial. SETTING: United Kingdom. POPULATION: A questionnaire was sent to 3074 ORACLE participants in a purposively selected sample of 55 collaborating maternity units, chosen to reflect a range of regions and of district general and teaching hospitals. METHODS: Content analysis was applied to verbatim text provided in response to an open question. Responses were also compared with a framework based on key points about the purpose of ORACLE. Closed questions were analysed using descriptive statistics. MAIN OUTCOME MEASURES: Participants' interpretations of the purpose of the study. RESULTS: A response rate of 61% was achieved, and 1462 participants provided written answers to a specific question on why the study was being carried out. Content analysis suggested that the information leaflet was highly valued as a source of information about the trial. There was evidence that women's interpretations of the purpose of the trial were not identical to those that the investigators intended. Of the five key points about the trial described in the information leaflet, 400 (27%) participants reported one key point, 550 (38%) two key points, 229 (16%) three key points and 23 (1.5%) four key points. None reported five key points and it was not possible to classify 46 responses (3%). Vague, confused understanding or poor recall were evident in 204 (14%) of responses. CONCLUSION: Although the ORACLE trial was run as a model of good practice at the time, this study suggests that it may not be possible to demonstrate full understanding of trial purpose and design by all participants. Emphasis should be on the provision of full information that involves consumers in its design and evaluation.

Anti-Bacterial Agents↗

Symbolic representation and visual querying of left ventricular image sequences.

In the evaluation of regional left ventricular function, relevant cardiac disorders manifest themselves not only in static features, such as shape descriptors and motion excursion in end-diastolic and end-systolic frames, but also in their temporal evolution. In common diagnostic practice, such dynamic patterns are analysed by direct inspection of frame sequences through the use of a moviola. This permits only a subjective and poorly defined evaluation of functional parameters, and definitely prevents a systematic and reproducible analysis of large sets of reports. Retrieval by contents techniques may overcome this limitation by permitting the automatic comparison of the reports in a database against queries expressing descriptive properties related to significant pathological conditions. A system is presented which is aimed at investigating the potential of this approach by supporting retrieval by contents from a database of cineangiographic or echocardiographic images. The system relies on a symbolic description of both geometrical and temporal properties of left ventricular contours. This is derived automatically by an image processing and interpretation module and associated with the report at its storage time. In the retrieval stage, queries are expressed by means of an iconic visual language which describes searched content properties over a computer screen. The system automatically interprets iconic statements and compares them against concrete descriptions in the database. This enables medical users to interact with the system to search for motion and shape abnormalities on a regional basis, in single or homogeneous groups of reports, so as to enable both prospective and retrospective diagnosis.

Cineangiography↗

Indexes of contrast and quantitative significance for comparisons of two groups.

Although boundaries for 'large' and 'small' differences are needed to plan research and interpret results, the diverse indexes of descriptive contrast for the central indexes, A and B, of two groups, have not received intensive attention. For two means, the increment of mid R:A-Bmid R: reflects the slope of a line showing the 'effect', but is altered by different units of measurement. Division of mid R:A-Bmid R: by the common standard deviation produces the standardized increment (SI), which is sometimes called the 'effect size'. Despite many advant ages, it does not contrast the relative magnitudes of A and B. For the latter contrast, the relative change or proportionate increment (mid R:A-Bmid R:/B) is particularly easy to understand, and the relative translocation (mid R:A-Bmid R:/[A+B]) produces a bounded range from -1 to +1. Nevertheless, all indexes of relative magnitude ablate the scales of measurement, thereby increasing difficulty in interpretation. Although seldom applied, proportionate reduction in overall system variance can be highly useful. Its square root leads to eta, the analogue of a correlation coefficient, which corresponds to a standardized slope for the direct increment. The values of eta usually approximate (SI)/2. Although arbitrary levels have been proposed for 'quantitative significance' of the SI, the proportionate reduction in overall system variance is often regarded as ineffectual unless >/=10 per cent. With this belief, minimum boundaries for quantitative significance can often be set at eta>/=0.3 and SI>/=0.6. In indexes of relative magnitude for two proportions (or rates), p(A) and p(B), confusion is produced if q(A) and q(B) are alternatively chosen for the denominators. The odds ratio, (p(A) q(B)/p(B) q(A)), avoids these choices, but is often difficult to interpret. For easy understanding and communication, the preferred index is NNE, the number needed to produce one excess effect, calculated as the inverse of the direct increment, that is, 1/mid R:p(A)-p(B)mid R: The standardized increment, mid R:p(A)-p(B)mid R:/ radical(PQ), (where P is the average of p(A) and p(B) and Q=1-P) could offer a single index applicable to both dimensional and binary data, but when P becomes quite small, that is, <0.01, radical(PQ) requires special calculations and also approaches the value of radicalP. Boundaries of 'quantitative significance' are particularly difficult to establish for comparisons of two rates, because of additional consequences in populational extrapolations and clinical implications. Nevertheless, the principles of quantitative significance can aid the ad hoc construction of boundaries that must be set for medical importance when sample sizes are calculated and when results are interpreted for studies of either efficacy or equivalence.

Clinical Trials as Topic↗