Irrelevant Symptoms Research Articles

Over- and underreporting of seizures: How big is the problem?

Clinical decisions on managing epilepsy patients rely on patient accuracy regarding seizure reporting. Studies have noted disparities between patient-reported seizures and electroencephalographic (EEG) findings during video-EEG monitoring periods, chiefly highlighting underreporting of seizures, a well-recognized phenomenon. However, seizure overreporting is a significant problem discussed within the literature, although not in such a large cohort. Our aim is to quantify the over- and underreporting of seizures in a large cohort of ambulatory EEG patients. We performed a retrospective data analysis on 3407 patients referred to a diagnostic service for ambulatory video-EEG between 2020 and 2022. Both patient-reported events and events discovered on review of the video-EEG were analyzed and classified as epileptic, psychogenic (typically clinical motor events, without accompanying EEG change), or noncorrelated events (NCEs; without perceivable clinical or EEG change). Events were analyzed by state of arousal and indication for referral. Subgroup analysis was performed in patients with focal and generalized epilepsies. A total of 21 024 events were recorded by 3407 patients. Fifty-eight percent of reported events were NCEs, whereas 27% of all events were epileptic. Sixty-four percent of epileptic seizures were not reported by the patient but discovered by the clinical service on review of the recording. NCEs were in the highest proportion in the awake and drowsy arousal states and were the most common event type for the majority of referral indications. Subgroup analysis found a significantly higher proportion of NCEs in the patients with focal epilepsy (23%) compared to generalized epilepsy (10%; p < .001, chi-squared proportion test). Our results reaffirm the phenomenon of underreporting and highlight the prevalence of overreporting. Overreporting likely represents irrelevant symptoms or electrographic discharges not represented on scalp electrodes, identification of which has important clinical relevance. Future studies should analyze events by risk factors to elucidate relationships clinicians can use and investigate the etiology of NCEs.

Assessment of a Potential UTI–Using Videos to Analyze a Simulated Nursing Home Experience

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.

Performance Evaluation of a Proposed Machine Learning Model for Chronic Disease Datasets Using an Integrated Attribute Evaluator and an Improved Decision Tree Classifier

There is a consistent rise in chronic diseases worldwide. These diseases decrease immunity and the quality of daily life. The treatment of these disorders is a challenging task for medical professionals. Dimensionality reduction techniques make it possible to handle big data samples, providing decision support in relation to chronic diseases. These datasets contain a series of symptoms that are used in disease prediction. The presence of redundant and irrelevant symptoms in the datasets should be identified and removed using feature selection techniques to improve classification accuracy. Therefore, the main contribution of this paper is a comparative analysis of the impact of wrapper and filter selection methods on classification performance. The filter methods that have been considered include the Correlation Feature Selection (CFS) method, the Information Gain (IG) method and the Chi-Square (CS) method. The wrapper methods that have been considered include the Best First Search (BFS) method, the Linear Forward Selection (LFS) method and the Greedy Step Wise Search (GSS) method. A Decision Tree algorithm has been used as a classifier for this analysis and is implemented through the WEKA tool. An attribute significance analysis has been performed on the diabetes, breast cancer and heart disease datasets used in the study. It was observed that the CFS method outperformed other filter methods concerning the accuracy rate and execution time. The accuracy rate using the CFS method on the datasets for heart disease, diabetes, breast cancer was 93.8%, 89.5% and 96.8% respectively. Moreover, latency delays of 1.08 s, 1.02 s and 1.01 s were noted using the same method for the respective datasets. Among wrapper methods, BFS’ performance was impressive in comparison to other methods. Maximum accuracy of 94.7%, 95.8% and 96.8% were achieved on the datasets for heart disease, diabetes and breast cancer respectively. Latency delays of 1.42 s, 1.44 s and 132 s were recorded using the same method for the respective datasets. On the basis of the obtained result, a new hybrid Attribute Evaluator method has been proposed which effectively integrates enhanced K-Means clustering with the CFS filter method and the BFS wrapper method. Furthermore, the hybrid method was evaluated with an improved decision tree classifier. The improved decision tree classifier combined clustering with classification. It was validated on 14 different chronic disease datasets and its performance was recorded. A very optimal and consistent classification performance was observed. The mean values for accuracy, specificity, sensitivity and f-score metrics were 96.7%, 96.5%, 95.6% and 96.2% respectively.

NMFBFS: A NMF-Based Feature Selection Method in Identifying Pivotal Clinical Symptoms of Hepatocellular Carcinoma.

Background. Hepatocellular carcinoma (HCC) is a highly aggressive malignancy. Traditional Chinese Medicine (TCM), with the characteristics of syndrome differentiation, plays an important role in the comprehensive treatment of HCC. This study aims to develop a nonnegative matrix factorization- (NMF-) based feature selection approach (NMFBFS) to identify potential clinical symptoms for HCC patient stratification. Methods. The NMFBFS approach consisted of three major steps. Firstly, statistics-based preliminary feature screening was designed to detect and remove irrelevant symptoms. Secondly, NMF was employed to infer redundant symptoms. Based on NMF-derived basis matrix, we defined a novel similarity measurement of intersymptoms. Finally, we converted each group of redundant symptoms to a new single feature so that the dimension was further reduced. Results. Based on a clinical dataset consisting of 407 patient samples of HCC with 57 symptoms, NMFBFS approach detected 8 irrelevant symptoms and then identified 16 redundant symptoms within 6 groups. Finally, an optimal feature subset with 39 clinical features was generated after compressing the redundant symptoms by groups. The validation of classification performance shows that these 39 features obviously improve the prediction accuracy of HCC patients. Conclusions. Compared with other methods, NMFBFS has obvious advantages in identifying important clinical features of HCC.

Noise from the periphery in autism

No two individuals with the autism diagnosis are ever the same – yet many practitioners and parents can recognize signs of ASD very rapidly with the naked eye. What, then, is this phenotype of autism that shows itself across such distinct clinical presentations and heterogeneous developments? The “signs” seem notoriously slippery and resistant to the behavioral threshold categories that make up current assessment tools. Part of the problem is that cognitive and behavioral “abilities” typically are theorized as high-level disembodied and modular functions – that are assessed discretely (impaired, normal, enhanced) to define a spectral syndrome. Even as biology reminds us that organic developing bodies are not made up of independent switches, we remain often seduced by the simplicity of mechanistic and cognitive models. Developmental disorders such as autism have accordingly been theorized as due to different modular dysfunctions -typically of cortical origin, i.e. failures of “theory of mind” (Baron-Cohen et al., 1985), of the “mirror neuron system” (Ramachandran and Oberman, 2006), of “weak central coherence”(Happe and Frith, 2006) or of the balance of “empathizing” and “systemizing” (Baron Cohen, 2009), just to list a few. The broad array of autonomic (Ming et al., 2005;Cheshire, 2012) and sensorimotor (Damasio and Maurer, 1978;Maurer and Damasio, 1982;Donnellan and Leary, 1995;Leary and Hill, 1996;Donnellan et al., 2012) differences experienced and reported by people with autism have by such theories typically been sidelined as “co-morbidities”, possibly sharing genetic causes, but rendered as incidental and decisively behaviorally irrelevant symptoms –surely disconnected from cognition. But what if the development of cortically based mental processes and autonomous control relies on the complexities and proper function of the peripheral nervous systems? Through such an “embodied” lense the heterogeneous symptoms of autism invites new interpretations. We propose here that many behavioral-level findings can be re-defined as downstream effects of how developing nervous systems attempt to cope and adapt to the challenges of having various noisy, unpredictable and unreliable peripheral inputs.

Response to a cardiac event in relation to cardiac knowledge and risk perception in a Lebanese sample: A cross sectional survey

Background Heart disease is the leading cause of morbidity and mortality in many countries, including Lebanon. The continuing advances in the treatment of heart disease have improved patient outcomes significantly over the years. Nevertheless, prompt treatment remains essential to treatment success, which depends on the person's early recognition of cardiac symptoms and quick seeking of care. Objective The purpose of the study was to examine the relationship between knowledge of symptoms of heart disease, perceived cardiac risk and the potential response to a heart attack in a sample of Lebanese adults. Design A cross sectional descriptive survey design was used. A convenience sample of 399 adult hospital visitors who did not have heart disease were interviewed in two major referral hospitals in Beirut. Measures The Illness Perception Questionnaire and the Behavioral Risk Factor Surveillance System were used; in addition an open-ended question was asked to elicit what the visitor would do in case he/she experienced cardiac symptoms. Results While most participants (94%) correctly recognized major symptoms of heart disease (like chest pain and dyspnea), they also reported irrelevant symptoms to be associated with heart disease (like irritability by 68% and muscle cramps by 52%). Only 21% of participants reported that they would seek emergency care as their first response if they were experiencing a heart attack. Knowledge of symptoms and perceived cardiac risk were not associated with the response to a heart attack. Being single was the only significant predictor of choosing the appropriate response when experiencing a cardiac event. Conclusion The findings suggest lack of adequate knowledge of cardiac symptoms and a high potential for inappropriate responses when symptoms occur. Public health heart health campaigns are needed to raise awareness about heart disease in Lebanon.

Processing Illness Information: The Role of Disease Prototypes

Recently Bishop and Converse (1986) proposed that information about physical symptoms is interpreted by relating those symptoms to preexisting disease prototypes. The two present studies further examined this formulation by testing hypotheses concerning the speed of processing symptom information as well as associations made to sets of physical symptoms as a function of prototypicality. As predicted, Experiment 1 showed that response time to highly prototypical symptom sets was significantly shorter than that for symptom sets containing irrelevant symptoms. Also as predicted, the results of Experiment 2 showed significant differences in the associations made by experiment participants to symptom sets as a function of the prototypicality of the symptoms in those sets. Participants made more category-based associations to highly prototypical symptom sets than to those lower in prototypicality but made more associations to individual symptoms for symptom sets low in prototypicality. Implications for the prot...

Caffeine ingestion, misattribution therapy, and speech anxiety

While theoretical analogs of misattribution therapy appeared promising ( Nisbett & Schachter, 1966; Ross, Rodin, & Zimbardo, 1969), attempts with clinically relevant behaviors have not been so successful ( Kellogg & Baron, 1975; Singerman, Borkovec, & Baron, 1976). Since the plausibility of the misattribution manipulation appears to be the central problem, the present study attempted to increase plausibility by manipulating familiarity with the setting and actual psychological arousal in a clinically relevant situation. Subjects only slightly fearful of giving speeches presented a speech in front of two observers. Familiarity was varied by having half of the subjects give a pretest speech, while arousal was manipulated by having half of the subjects ingest caffeine while the others ingested a placebo just prior to the test speech. The subjects' attributions were varied by giving them either arousal or irrelevant symptom instructions regarding the effects of the ingested drug. Direct suggestion rather than misattribution effects occurred: Those subjects receiving arousal symptoms reported more nervousness than subjects who had received irrelevant symptoms. The authors conclude that while the misattribution effect may have experimental validity, it is not effective with clinically relevant behavior.

Aggression and the attribution process.

Summary The present study demonstrated that Ss who were led to believe that an external cause was responsible for their arousal at being yelled at behaved less aggressively than those who attributed their arousal as due to the insult. Ss were led to believe that listening to a loud noise would cause either arousal or irrelevant physiological symptoms; those in the arousal symptoms group subsequently were less aggressive to a confederate and reported themselves to be experiencing a greater degree of arousal than those in the irrelevant symptoms group. These results support Schachter's cognitive attribution theory of emotion and suggest its importance in explaining aggressive behavior.

Helping and the attribution process.

Summary The present experiment demonstrated that Ss led to believe that an external cause is responsible for their arousal at seeing a woman in pain will be less likely to help her than those attributing their arousal to sympathy for her. Ten men and 10 women were told that exposure to an aversive noise would produce symptoms of physiological arousal; another 10 men and 10 women were told that irrelevant symptoms might occur. Those expecting irrelevant symptoms from noise bombardment helped a woman with a hurt knee significantly more than those expecting the noise to cause symptoms typical of arousal; these results provided support for both Schachter's cognitive attribution theory of emotion and Aronfreed's empathy theory of altruism.

Interpersonal simulation of an attribution experiment.

Bem ( 1 ) demonstrated interpersonal observers could replicate the results of cognitive dissonance experiments. Each of his Ss heard a tape recording of a single S participate in a dissonance experiment and was asked to predict S's response. If the observer could predict S's responses from external cues, S's response could also have been determined by external cues. Bem thought dissonance results were not due to the reduction of a negative drive state but to Ss' responses to perception of their own behavior. This reasoning has been extended by Weiner ( 4 ) to work on cognitive attribution. Schachter ( 3 ) theorized that an emotional response is dependent upon arousal of the autonomic nervous system and a cognitive label for that arousal. Nisbett and Schachter ( 2 ) have demonstrated that could be reduced by manipulating the cognitive label. Ss in a low or high fear condition given a placebo which they were told would cause either the physiological concomitants of pain (pill-relevant) or symptoms totally irrelevant to pain (pill-irrelevant). Those in the low fear condition with pill-relevant instructions took more shocks to reach tolerance threshold. Under high fear Ss did not attribute thcir arousal to the placebo and a reduction of tolerance was not obtained. These authors did not control for contiguity of administration of the placebo and onset of arousal; fear was aroused prior to S's taking the placebo. The present work attempted interpersonal simulation of the high fear condition with contiguity controlled. If the placebo was administered prior to induction of fear, interpersonal observers would indicate that pain was reduced for Ss. Naive college students were randomly assigned to the pill-relevant or pill-irrelevant condition. All 30 Ss heard a tape recording of a participant under the high fear ( 2 ) , but induction of fear now followed administration of the placebo. Also, from prior to the administration of the placebo to after the induction of fear observers heard S report an increase in palpitations (from 30 to 80 on a 100-point scale), tremor (20 to 75) , and increase over usual rate of breathing (25 to 70). The irrelevant symptoms remained the same. Observers were asked to predict the number of the shock upon which S first reported that it was painful and the number of shocks tolerated by S. Observer was asked to check those symptoms caused by the placebo. The check on the manipulation indicated that those Ss in the pill-relevant condition attributed the physiological concomitants of pain to the placebo more so than did the pillirrelevant group ( X Z = 5.28, # < .07). Observers predicted that Ss in the pill-relevant condition would take fewer shocks prior to reporting (5.99) than those in the pillirrelevant condition (8.51; t = 2.00, $ < .06), exactly opposite results of Nisbett and Schachter ( 2 ) . Observers also predicted Ss in the pill-relevant condition would take fewer shocks prior to reaching their tolerance threshold (11.29 vs 13.94) although this difference did not approach significance ( t = 1.39) . These results suggest external cues were not sufficient to explain the prior data ( 2 ) .

PATHOLOGY OF GOITER

Attempts have frequently been made to formulate a classification of goiters which should provide a separate group for all the various pathological and clinical entities. The more I study goiters the more I am convinced that the goiterous disease is a more or less continuous process, and the various pictures declare the state of development rather than a pathological or clinical entity. We should speak of the stages of goiters rather than of kinds. One does not have the proper mental equipment for the study of goiters unless he knows the life history of patients who run their course without treatment. Practicing in one community for a lifetime, I have been able to trace repeatedly the process from the adolescent colloid to the bossilated masses of middle life, and finally the cardiac decompensation and evidence of dysthyroidism. One of the chief difficulties lies in the proper interpretation of the clinical picture. The patients must be considered aside from the goiter in order that irrelevant symptoms may...