Specific Diagnosis In Patients Research Articles

Activity-Dependent Plasticity in the Adult Auditory Brainstem

Over the past few years we have studied the plasticity of the adult auditory brainstem in the rat following unilateral changes to the pattern of sensory activation, either by intracochlear electrical stimulation or by deafening. We discovered that modifications to afferent activity induced changes in the molecular composition and cellular morphology throughout the auditory brainstem, including its major centers: the cochlear nucleus complex, the superior olivary complex, and the inferior colliculus. The time window studied ranged from 2 h to over 1 year following induction of changes to afferent activity. The molecular markers employed include the NMDA receptor subunit type 1, the cAMP response element binding protein (CREB), the immediate early gene products c-Fos, c-Jun and Egr-1, the growth and plasticity-associated protein GAP-43 and its mRNA, the calcium binding protein calbindin, the cell adhesion molecule integrin-α₁, the microtubule-associated protein MAP-1b, and the neurofilament light chain (NF-L). As a consequence of the specific electrical stimulation of the auditory afferents or the loss of hearing, a cascade of events is triggered that apparently modifies the integrative action and computational abilities of the central auditory system. An attempt is made to relate the diverse phenomena observed to a common molecular signaling network that is suspected to bridge sensory experience to changes in the structure and function of the brain. Eventually, a thorough understanding of these events will be essential for the specific diagnosis of patients, optimal timing for implantation, and suitable parameters for running of a cochlear implant or an auditory brainstem implant in humans. In this report an overview of the results obtained in the past years in our lab is presented, flanked by an introduction into the history of plasticity research and a model proposed for intracellular signal cascades related to activity-dependent plasticity.

Dimensions of perioperative nursing for a national specialty nomenclature.

Dimensions of perioperative nursing for a national specialty nomenclature Before nurses can develop a clinical database capable of evaluating quality of care or validating their impact on health or illness, they must describe the basic dimensions of their specialty. The purpose of this study was to define the dimensions of clinical perioperative nursing practice. Experienced perioperative nurses (n=239) were mailed a survey and asked to rank the frequency with which specific patient diagnoses occurred in their daily practice (1=never occurs; 5=occurs almost all the time) and the priority of treatment each diagnosis required (1=never requires attention of the nurse; 5=demands immediate attention of the nurse). Completion of the form indicated consent to participate in the study. Following a principal component analysis and theoretical discussion by perioperative experts, four dimensions of perioperative practice were delineated: (a) patient and family behavioural responses to surgery (26.7% of variance, alpha=0.92); (b) perioperative patient safety (10.1% of variance, alpha=0.89); (c) perioperative physiological response to surgery (5.7% of variance, alpha=0.87); and (d) the health systems required to deliver perioperative care. Dimensions extracted in this analysis served as the domains for the new perioperative nursing nomenclature.

Electrophysiological studies in the different genotypes of Charcot-Marie-Tooth disease.

Electrophysiological studies remain one of the cornerstones in the diagnosis of Charcot-Marie-Tooth syndrome and related genetic neuropathies. They are helpful in defining the subtypes of this heterogeneous group of hereditary neuropathies and in differentiating them from acquired neuropathies. Major advances in defining the molecular genetics of Charcot-Marie-Tooth disease are occurring. The increasingly refined diagnosis of these disorders is highlighted. It is possible by the combination of electrophysiological studies and genetic testing. These developments are especially important for practicing neurologists as they can result immediately in more specific diagnosis of patients with inherited neuropathies.

Validation of a Rapid Urine Screening Assay for Cocaine Use among Pregnant Emergency Patients

To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics. A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry. Twenty of 342 (5.9%, 95% CI 3.4-8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics. ED screening for cocaine use among pregnant patients can be accurately performed using the OnTrak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.

Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis.

To assess the value of clinical, chest radiographic, and computed tomographic (CT) findings in classifying chronic diffuse infiltrative lung disease (CDILD) MATERIALS AND METHODS: Two samples from the same population were consecutively studied: the training set (group A, n = 208) for the development of the decision aid and the test set (group B, n = 100) for validation. Computer-aided diagnoses were made with a Bayesian model that assigned to each patient diagnostic probabilities based on clinical, radiographic, or CT variables. In group A, a correct diagnosis based on clinical data was obtained in 29% of cases; radiography, 9%; and CT, 36%. This increased to 54% when clinical and radiographic variables were combined (P < .0001) and to 80% when data from all three were analyzed together (P < .0001). With prior and conditional probabilities determined from group A, the frequency of correct diagnosis in group B was 27% with clinical data, which increased to 53% (P < .0001) with radiographic findings and 61% after including CT data (P = .07). CT can help determine the specific diagnosis in patients with CDILD.

Assessment of resident physicians' knowledge of physical therapy.

Half of all US medical schools offer courses in rehabilitation medicine; however, 46 states require physician referrals for physical therapy services. The purpose of this study was to identify areas of deficit in resident physicians' knowledge of selected physical therapy modalities and evaluative procedures and to determine if resident physicians perceived themselves to have adequate background to refer patients to physical therapy effectively. We mailed a questionnaire to 345 resident physicians chosen from area hospitals and obtained a response rate of 32 percent. The demographic portion of the questionnaire was analyzed by the use of descriptive and chi-square statistics. We tested knowledge of modalities and evaluative procedures through matching of treatment referrals with specific patient diagnoses and analyzed the data in terms of chi-square, frequencies, and correlated statistics. The results indicated that the majority of respondents refer patients to physical therapy (98%) and feel adequately informed to do so (54%). Test results, however, ranged from 1 to 73 percent correct, with only one score above 70 percent correct. This finding indicated a deficit in resident physicians' knowledge of physical therapy. We also identified a need for physical therapists to educate physicians about treatment modalities and evaluative procedures through continuing education programs.

Fat deposition in the cavernous sinus in Cushing disease.

Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, parasellar fat was incidentally noted in one patient with acromegaly.