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At least 991 records · Page 55Linked to original sources
PubMed1993

[Acute renal vein thrombosis in children. Early detection with duplex and color-coded Doppler ultrasound].

Two children with clinically suspected renal vein thrombosis were evaluated by duplex Doppler sonography and colour flow imaging. Both cases presented unspecific findings with an enlarged kidney and loss of cortico-medullary delineation on gray-scale ultrasound, but an unusual flow pattern with retrograde plateau-like frequency shifts during diastole. No venous signal could be obtained. By colour flow imaging only the main renal artery and its proximal branches could be visualised with a reverberating oscillation of blood flow. In addition, partial thrombosis of inferior vena cava in one patient and iliac vein thrombosis in the other could be demonstrated. Clinical improvement during fibrinolytic therapy in one case and nephrectomy in the other case confirmed the diagnosis.

Aortic Coarctation↗
PubMed1983

Problem-orientated categorisation of "other conditions" seen in a genitourinary medicine clinic.

The case sheets of patients coded as D2 (other conditions requiring treatment) and D3 (other conditions not requiring treatment) in 1981 were reclassified on a problem-orientated basis. Ten discreet categories were delineated with ease. Women with non-specific vaginitis and men with Gardnerella vaginalis urogenital infection, usually coded D2 or C4, should be reclassified under the C group of conditions as, for example, "Gardnerella or other bacterial genital infections." It is suggested that codes D2 and D3 be replaced by the following nine categories: genital skin lesions or rashes; genitourinary symptoms; enteric conditions; other sexually transmitted infections; normal genital architecture, congenital conditions, or unconfirmed genital discharges; asymptomatic patients attending for routine examination; uninfected contacts of patients with sexually transmitted diseases; psychosexual problems; and others.

Female↗
PubMed1996

Preoperative imaging of lower extremity varicose veins: color coded duplex sonography or venography.

We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.

Adult↗
PubMed1986

Quality control in the Multiple Risk Factor Intervention Trial Nutrition Modality.

One of the principal objectives of the MRFIT was to teach and motivate participants assigned to the SI group to adhere to a fat-controlled dietary regimen over the course of the trial. The magnitude of the trial (with more than 12,000 participants, half of them assigned to the SI protocol, to be followed for at least 6 years in 22 separate centers) presented new challenges for maintenance of quality control over a nutrition intervention program. Collection of data to monitor changes in dietary intake over time in SI and UC groups, as well as information to assess dietary adherence levels in SI participants also presented large-scale challenges in maintenance of quality control. The MRFIT formulated many of its initial nutrition intervention and data collection decisions based on experience of the earlier National Diet Heart Study (NDHS). In order to avoid coding 7-day dietary records by local clinic nutritionists (as in NDHS), the trial opted for collection of 24-hour dietary recalls that were coded centrally at the Nutrition Coding Center. It necessitated extra attention to training and certification of clinic nutritionist-interviewers to be certain that NCC coders had sufficiently precise information about all foods entered on dietary recall forms. Since dietary intake data were collected over a time span of approximately 10 years, procedures for updating the food composition database and coding rules were a necessity. Continuing attention to training and monitoring of performance of clinic nutritionist-interviewers also was important. The MRFIT nutrition intervention program was designed with the need for interclinic comparability of intervention techniques in mind. This required not only development of study-wide nutrition intervention materials, but also necessitated ongoing attention to staff training and monitoring procedures in order to ensure intercenter comparability of efforts. The success of the nutrition intervention modality depended upon the continuing efforts of the nutrition counselors not only to achieve dietary adherence but also to monitor levels of dietary adherence over time. The NDHS experience served as a springboard for designing the MRFIT nutrition intervention and data collection procedures. It is hoped that techniques for maintaining and monitoring quality control over the MRFIT nutrition modality as outlined in this chapter may prove useful to future planners.

Certification↗
PubMed1984

Collaborative evaluation of the Abbott yeast identification system.

The Abbott yeast identification system (Abbott Laboratories, Diagnostics Division, Irving, Tex.) is a 24-h, instrumental method for identifying medically important yeasts, based on matrix analysis of 19 biochemical reactions and the germ tube test. The system was evaluated in two clinical laboratories by using 179 coded isolates, which included a high percentage of the less frequently encountered species. Based upon results with these coded isolates and from previously obtained laboratory data, the system software was adjusted and accuracy of the yeast identification system was further evaluated with 378 isolates from clinical sources. Of the 378 clinical yeast isolates tested, 364 (96%) were correctly identified with the Abbott system. Isolates were deliberately selected so that germ tube-positive isolates made up less than 10% of the clinical isolates tested.

Candida↗
PubMed1997

[Decision support of clinical laboratory test by object-oriented data base].

We have constructed an object-oriented database system, using prescription, lab test result, and disease registry data, transmitted from the order entry system of Hamamatsu University Medical School Hospital. It serves not only numeric data but also semantics of laboratory results. The database system has a feature to categorize each data into structured hierarchies of attributes. By this, the user can retrieve abstract level descriptions such as "prescriptions of anti-inflammation medicines, suppository only", "any kind of gastric ulcer", etc., which is expected to be useful for researchers and students. In transferring order entry data from HIS, HL7-ASTM E1238 standard data formats using the Japan Association of Clinical Pathology lab test item code are utilized, proving this system's transferability to other hospitals. This is the first real use implementation of an object-oriented data base in a clinical setting, and results are promising in terms of providing an intelligent clinical database. Also discussed are future trends of clinical master files, hospital administrative tools, and multi vendor configurations of HIS.

Clinical Laboratory Techniques↗
PubMed2004

Accurate qualitative and quantitative proteomic analysis of clinical hepatocellular carcinoma using laser capture microdissection coupled with isotope-coded affinity tag and two-dimensional liquid chromatography mass spectrometry.

Laser capture microdissection (LCM) is a powerful tool that enables the isolation of specific cell types from tissue sections, overcoming the problem of tissue heterogeneity and contamination. This study combined the LCM with isotope-coded affinity tag (ICAT) technology and two-dimensional liquid chromatography to investigate the qualitative and quantitative proteomes of hepatocellular carcinoma (HCC). The effects of three different histochemical stains on tissue sections have been compared, and toluidine blue stain was proved as the most suitable stain for LCM followed by proteomic analysis. The solubilized proteins from microdissected HCC and non-HCC hepatocytes were qualitatively and quantitatively analyzed with two-dimensional liquid chromatography tandem mass spectrometry (2D-LC-MS/MS) alone or coupled with cleavable ICAT labeling technology. A total of 644 proteins were qualitative identified, and 261 proteins were unambiguously quantitated. These results show that the clinical proteomic method using LCM coupled with ICAT and 2D-LC-MS/MS can carry out not only large-scale but also accurate qualitative and quantitative analysis.

Affinity Labels↗
PubMedDate not supplied

Computer database for melanoma: a clinical management and research tool to ensure continuous quality assessment.

The need for an efficient method to handle data and for chart documentation is more apparent today than at any time in the past. High volume clinics for screening, diagnosis, and treatment are the rule rather than the exception in modern practice. A papermill medical record department or tumor registry fails on a day-to-day basis because of inefficiency of data collection, filing, storage, and abstraction. Requirements of the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) include the setting of standards and the ability to query data to ensure the standards are met. A PC-based software program has been developed with the following features: (1) ongoing timed queries of the data are possible on any variable collected in the database to monitor trends in the standards established for care in the clinic; (2) a daily update of the database is performed so that it may be used as a clinical management tool, acting as an electronic medical record or as a clinical research tool; (3) the software will summarize the chart by abstracting a predetermined list of key data elements to improve clinical efficiency; (4) chart documentation is improved for Medicare coding requirements to maximize physician reimbursement; and (5) clinic notes and referral letters are generated the same day as the clinic visit to allow patients to have a copy of their clinic notes or for same day FAXing to the referring doctors. To date, > 1,200 patients with melanoma have been registered and entered into the system.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗
PubMed2003

Clinical significance of atomic inner shell ionization (ISI) and Auger cascade for radiosensitization using IUdR, BUdR, platinum salts, or gadolinium porphyrin compounds.

PURPOSE: Halogenated pyrimidines (iododeoxyuridine [IUdR] and bromodeoxyuridine [BUdR]), platinum salts, and gadolinium porphyrins are heavy atom compounds used as radiosensitizers. For IUdR, it has been hypothesized that iodine inner shell ionizations (ISI) and Auger cascades could be one of the primary radiosensitization mechanisms. The purpose of this paper is to estimate the number of ISI produced per tumor cell and per 2 Gy irradiation in clinically relevant modelings. MATERIALS AND METHODS: ISI were evaluated using a two-step method. Photon-induced ISI were calculated using the MCNP-4C Monte Carlo code, heavy atom concentrations from clinical data published in the literature, and at various depths in a water phantom irradiated with 6-MV, (60)Co, (137)Cs, or (192)Ir sources. Electron knock-on induced ISI on K, L, and M atomic shells were evaluated with an hybrid method, using simulated electron spectra and cross-sections derived from the Møller formalism. Using a biological dose equivalence of 0.05 Gy per cell ISI, relative biological effectiveness (RBE) values were calculated for each situation. RESULTS: For platinum and gadolinium, ISI occurs in far less than 0.1% of the cell, whichever is the configuration. For IUdR and BUdR, ISI occurs in between 45% to 483% of the cell. Due to spectrum degradation, about 3 times more photoelectric ISI are generated at greater than shallower depths, and 10 times more for (192)Ir compared with (60)Co or 6-MV X-rays. Photoelectric ISI are about 3 times more frequent for iodine than bromine, but electron knock-on ISI are more frequent on bromine, and at the end about the same number of ISI are generated for both elements. RBEs were found to be between 1.01 and 1.12 for clinically relevant irradiation settings. CONCLUSIONS: The mechanisms of radiosensitization for platinum and gadolinium are clearly not related to an Auger cascade. For halogenated pyrimidines, however, clinically relevant numbers of ISI are generated within each cell. For IUdR, ISI appears to be strongly tied to the photon spectra. Halogenated pyrimidines should be evaluated again clinically, but using lower energy photons like a (192)Ir implant.

Bromodeoxyuridine↗
PubMed1993

CPT (current procedure terminology) coding and patient accounting: controlling the process and improving billing efficiency.

As outpatient volumes increase in hospitals across the country, more and more coding responsibilities are being placed with the patient accounts department. Both registration and outpatient billers are involved in assigning current procedural terminology (CPT) codes for surgery and emergency room procedures, as well as maintaining the hospital's chargemaster. Often these responsibilities are assigned without regard for the level of coding expertise and degree of clinical knowledge of the personnel involved, which can lead to significant loss of reimbursement and untimely billing delays. This article addresses common problems and offers suggestions for improving coding, minimizing problems, and increasing billing efficiency.

Abstracting and Indexing↗
PubMed2002

Research ethics committees and public dissemination of clinical trial results.

Biomedical research involving human beings is subject to codes of ethical conduct that mandate review, approval, and monitoring of clinical trials by research ethics committees (RECs). The role of RECs in public dissemination of results of research is not addressed explicitly in international codes or national regulations governing human research. I contend that RECs should have a prominent role in ensuring that trial results are publicly disseminated. I also propose specific responsibilities and actions that should be assumed and implemented by RECs to promote this objective.

Bioethics↗
PubMedDate not supplied

The clinical reasoning of an occupational therapy assistant.

This qualitative case study focused on the clinical reasoning of a certified occupational therapy assistant who had 16 years of practice experience. Observation and interview methods were used to collect data. Transcripts and field notes were coded using a priori codes of the forms of clinical reasoning of occupational therapists identified in published research. The study participant demonstrated the use of pragmatic, procedural, interactive, conditional, and narrative reasoning. We encourage further research to support these findings and to increase the understanding of the forms of clinical reasoning used by occupational therapy assistants.

Clinical Competence↗
PubMed2000

Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.

Computer Communication Networks↗
PubMed1995

Evaluation of penile arteries with color-coded duplex sonography: prevalence and possible therapeutic implications of connections between dorsal and cavernous arteries in impotent men.

Penile revascularization for cases of arteriogenic impotence is based on the assumption of hemodynamically relevant connections between the dorsal penile and cavernous arteries. In 325 clinically impotent patients color-coded duplex sonography was performed with the penis flaccid and tumescent after intracavernous injection of 10 micrograms prostaglandin E1. We measured peak flow velocity, end diastolic flow velocity and resistance in the dorsal arteries, deep cavernous arteries and connections perforating the tunica albuginea between the 2 systems. Of our patients 14% had at least 1 such anastomosis with a peak flow velocity exceeding 25 cm. per second after stimulation. Peak flow velocities less than 20 cm. per second were noted only in arteriogenically impotent patients, while those exceeding 25 cm. per second without later rigid erection occurred only in patients with venous occlusive dysfunction and end diastolic flow velocity exceeded 5 cm. per second. We conclude that penile revascularization should be contemplated only if hemodynamically relevant connections are detected, peak flow velocity in the cavernous arteries is less than 20 cm. per second and end diastolic flow velocity is less than 5 cm. per second.

Alprostadil↗
PubMedDate not supplied

A pleasure to work with--an analysis of written comments on student evaluations.

OBJECTIVE: Studies assessing rating scales on student evaluations are available. However, there are no data related to the written comments on these evaluations. This study was designed to evaluate these comments. METHODS: A content analysis was performed on the narrative section of pediatric clerks' evaluations. Final evaluations were obtained from 10 outpatient clinical sites staffed by full-time faculty over 14 months. A coding dictionary containing 12 categories (7 linked to clinical skills) was used. RESULTS: One thousand seventeen comments on 227 evaluations were coded. The mean number of comments per evaluation was 4. Learner and personal characteristics were the largest categories. Normative comments, such as "good physical exam," as opposed to more specific comments, such as "complete presentation," predominated in all categories. CONCLUSIONS: Evaluation comments were infrequently related to basic clinical skills and were not often specific enough to lead to effective change in a student's performance. Faculty development is needed to make final evaluation comments more useful for students.

Clinical Clerkship↗
PubMed1997

Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease.

In administrative databases the International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) is often used to identify patients with specific diagnoses. However, certain conditions may not be accurately reflected by the ICD-9 codes. We assessed the accuracy of ICD-9 coding for cerebrovascular disease by comparing ICD-9 codes in an administrative database with clinical findings ascertained from medical record abstractions. We selected patients with ICD-9 diagnostic codes of 433 through 436 (in either the primary or secondary positions) from an administrative database of patients hospitalized in five academic medical centers in 1992. Medical records of the selected patients were reviewed by trained medical abstractors, and the patients' clinical conditions during the admission (stroke, TIA, asymptomatic) were recorded, as well as any history of cerebrovascular symptoms. Results of the medical record review were compared with the ICD-9 codes from the administrative database. More than 85% of those patients with the ICD-9 code 433 were asymptomatic for the index admission. More than one-third of these asymptomatic patients did not undergo either cerebral angiography or carotid endarterectomy. For ICD-9 code 434, 85% of patients were classified as having a stroke and for ICD-9 code 435, 77% had TIAs. For code 436, 77% of patients were classified as having strokes. Limiting the identifying ICD-9 code to the primary position increased the likelihood of agreement with the medical record review. The ICD-9 coding scheme may be inaccurate in the classification of patients with ischemic cerebrovascular disease. Its limitations must be recognized in the analyses of administrative databases selected by using ICD-9 codes 433 through 436.

Arterial Occlusive Diseases↗
PubMed1999

[Analysis of transfusion in kidney surgery].

OBJECTIVE: To analyze the likelihood of perioperative transfusion in patients undergoing renal surgery. METHODS: The records of all patients who had undergone renal surgery in 1996 were reviewed. The abstracted patient discharge records, encoded according to the ICD-9-CM, were analyzed for gender, age, diagnosis, surgical and non-surgical procedures including transfusions of blood products. RESULTS: 21 (23.3%) of 90 patients who had undergone renal surgery required transfusion. By univariate analysis, the incidence of transfusion was statistically significantly higher in patients with chronic nephropathy, patients undergoing total nephrectomy and renal transplantation, and those having a greater number of ICD-9-CM diagnosis codes (indirect indicator of the clinical severity and comorbidity). By multivariate logistic regression analysis, the surgical procedure was found to be the only predictive factor for blood transfusion (p = 0.013). The main diagnosis, number of diagnosis codes, gender, number of surgical techniques and age were not found to be predictors of transfusion. CONCLUSIONS: Our data show that of the variables analyzed, the surgical procedure is the only predictive factor of the likelihood of requiring blood transfusion.

Adult↗