167 research outputs found
Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis".
Acute unilateral peripheral and central vestibular lesions
can cause similar signs and symptoms, but they require
different diagnostics and management. We therefore
correlated clinical signs to differentiate vestibular neuritis
(40 patients) from central ââvestibular pseudoneuritisââ (43
patients) in the acute situation with the final diagnosis
assessed by neuroimaging. Skew deviation was the only
specific but non-sensitive (40%) sign for pseudoneuritis.
None of the other isolated signs (head thrust test,
saccadic pursuit, gaze evoked nystagmus, subjective
visual vertical) were reliable; however, multivariate
logistic regression increased their sensitivity and specificity
to 92%
Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice.
Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patientâs needs, values, preferences, and circumstances.
Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application.
The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversation
Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments
Objectives Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department ( ED ). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. Methods This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined publicâuse ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey ( NHAMCS ) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey ( MEPS ). We calculated total visits, test utilization, and ED diagnoses from NHAMCS . Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP â CCS ). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit costâperâdiagnosisâgroup from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. Results The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [ CI ] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography ( CT ), magnetic resonance imaging ( MRI ), or both in 2011 was estimated to be 39.9% (39.4% CT , 2.3% MRI ). The mean perâ ED âdizzinessâvisit cost was 3.9 billion. HCUP â CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, costâperâ ED âvisit, attributable annual national costs): otologic/vestibular (25.7%; 757 million), cardiovascular (16.5%, 941 million), and cerebrovascular (3.1%; 127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 ( CT scans 110 million). Conclusions Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced. Resumen Incremento Anual de los Costes de las Atenciones por Mareo en los Servicios de Urgencias de Estados Unidos Objectivos El mareo y el vĂ©rtigo suman aproximadamente el 4% de los motivos de consulta en el servicio de urgencias ( SU ). Se conoce poco sobre los costes globales de las evaluaciones del SU en estos pacientes. Se buscĂł estimar los costes anuales nacionales asociados con las visitas al SU por mareo. MetodologĂa Este estudio de costes de visitas al SU de adultos norteamericanos que acudieron con mareo o vĂ©rtigo combinĂł los datos pĂșblicos de las visitas a los SU (1995 a 2009) recogidos por el National Hospital Ambulatory Medical Care Survey ( NHAMCS ) y los costes (2003 a 2008) recogidos por el Medical Expenditure Panel Survey ( MEPS ). Se calcularon el total de visitas, el uso de pruebas diagnĂłsticas y los diagnĂłsticos del SU del NHAMCS . Los grupos diagnĂłsticos se definieron segĂșn el Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP â CCS ). Los datos del año 2011 se documentaron en dĂłlares de 2011. El total de visitas y la proporciĂłn de neuroimagen llevada a cabo en los futuros años se extrapolĂł usando un modelo predictivo autorregresivo. La media del coste por visita al SU por grupo diagnĂłstico del MEPS se calculĂł, ajustĂĄndose a dĂłlares de 2011, mediante el Ăndice de precios de los Hospital Personal Health Care Expenditures. Se utilizĂł una media ponderada global entre los grupos diagnĂłsticos para estimar los costes totales nacionales. Resultados El nĂșmero de visitas al SU en Estados Unidos en 2011 por mareo o vĂ©rtigo fue de 3,9 millones ( IC 95% = 3,6 a 4,2 millones). El porcentaje de pruebas diagnĂłsticas de imagen llevadas a cabo por tomografĂa computarizada ( TC ), resonancia magnĂ©tica ( RM ) o ambas en 2011 se estimĂł en un 39,9% (39,4% TC , 2,3% RM ). La media de coste por visita al SU por mareo fue de 1.004 dĂłlares de 2011. Los costes totales, extrapolados para todo el paĂs, fueron de 3.900 millones de dĂłlares. Los grupos diagnĂłsticos HCUP â CCS para aquĂ©llos que presentaron mareo o vĂ©rtigo incluyeron los siguientes (proporciĂłn de visitas por mareo; coste por visita al SU ; costes anuales nacionales atribuibles): otolĂłgico/vestibular (25,7%; 768 dĂłlares; 757 millones de dĂłlares), cardiovascular (16,5%, 1.489 dĂłlares; 941 millones de dĂłlares) y cerebrovascular (3,1%; 1.059 dĂłlares; 127 millones de dĂłlares). Se estimĂł una suma en la neuroimagen del 12% del total de costes para las visitas por mareo en 2011 (360 millones de dĂłlares para la TC y 110 millones de dĂłlares para la RM ). Conclusiones Los costes totales en Estados Unidos para los pacientes que acuden por mareo al SU son sustanciales, y se estima que sobrepasan en estos momentos los 4.000 millones de dĂłlares por año (aproximadamente un 4% de los costes totales del SU ). El incremento de los costes con el paso del tiempo parece reflejar el crecimiento de la prevalencia de las visitas al SU por mareo y el aumento de porcentajes de utilizaciĂłn de la neuroimagen. Futuros estudios econĂłmicos deberĂan centrarse en el desglose de los costes totales, y hacer Ă©nfasis en las ĂĄreas de alto uso y coste que pueden ser reducidas sin riesgo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/1/acem12168.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/2/acem12168-sup-0001-DataSupplementS1.pd
Development and evaluation of an accelerometry system based on inverted pendulum to measure and analyze human balance
An accelerometry system was developed based on the inverted pendulum model and its effectiveness to measure the body's sway path and sway angle was verified in healthy adult volunteers. Sway path represents the bodyâs movement from its center of mass position projected to the ground surface while sway angle represents the body's orientation from the vertical. Mathematical models were developed to determine the sway displacement and sway angle from the accelerometry system. The resulting values were compared with the manual measurements obtained from a plumb bob based setup and found to correlate closely. Using the developed system, measures that analyzed the contribution of the visual, somatosensory and vestibular systems to balance were obtained. It was found that the accelerometry system followed the principle of motion of an inverted pendulum and provided information that can assist in better understanding of balance and thus it may assist clinicians in diagnosing balance dysfunctions
Profiling Dizziness in Older Primary Care Patients: An Empirical Study
The diagnostic approach to dizzy, older patients is not straightforward as many organ systems can be involved and evidence for diagnostic strategies is lacking. A first differentiation in diagnostic subtypes or profiles may guide the diagnostic process of dizziness and can serve as a classification system in future research. In the literature this has been done, but based on pathophysiological reasoning only
Integrated diagnostics: proceedings from the 9th biennial symposium of the International Society for Strategic Studies in Radiology
published_or_final_versio
Situational awareness within objective structured clinical examination stations in undergraduate medical training - a literature search
Background: Medical students may not be able to identify the essential elements of situational awareness (SA) necessary for clinical reasoning. Recent studies suggest that students have little insight into cognitive processing and SA in clinical scenarios. Objective Structured Clinical Examinations (OSCEs) could be used to assess certain elements of situational awareness. The purpose of this paper is to review the literature with a view to identifying whether levels of SA based on Endsley's model can be assessed utilising OSCEs during undergraduate medical training. Methods: A systematic search was performed pertaining to SA and OSCEs, to identify studies published between January 1975 (first paper describing an OSCE) and February 2017, in peer reviewed international journals published in English. PUBMED, EMBASE, PsycINFO Ovid and SCOPUS were searched for papers that described the assessment of SA using OSCEs among undergraduate medical students. Key search terms included "objective structured clinical examination", "objective structured clinical assessment" or "OSCE" and "non-technical skills", "sense-making", "clinical reasoning", "perception", "comprehension", "projection", "situation awareness", "situational awareness" and "situation assessment". Boolean operators (AND, OR) were used as conjunctions to narrow the search strategy, resulting in the limitation of papers relevant to the research interest. Areas of interest were elements of SA that can be assessed by these examinations. Results: The initial search of the literature retrieved 1127 publications. Upon removal of duplicates and papers relating to nursing, paramedical disciplines, pharmacy and veterinary education by title, abstract or full text, 11 articles were eligible for inclusion as related to the assessment of elements of SA in undergraduate medical students. Discussion: Review of the literature suggests that whole-task OSCEs enable the evaluation of SA associated with clinical reasoning skills. If they address the levels of SA, these OSCEs can provide supportive feedback and strengthen educational measures associated with higher diagnostic accuracy and reasoning abilities. Conclusion: Based on the findings, the early exposure of medical students to SA is recommended, utilising OSCEs to evaluate and facilitate SA in dynamic environment
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