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《Best Practice & Research: Clinical Rheumatology》2014,28(6):921-934
In rheumatic diseases, classification criteria have been developed to identify well-defined homogenous cohorts for clinical research. Although they are commonly used in clinical practice, their use may not be appropriate for routine diagnostic clinical care. Classification criteria are being revised with improved methodology and further understanding of disease pathophysiology, but they still may not encompass all unique clinical situations to be applied for diagnosis of heterogenous, rare, evolving rheumatic diseases. Diagnostic criteria development is challenging primarily due to difficulty for universal application given significant differences in the prevalence of rheumatic diseases based on geographical area and clinic settings. Despite these shortcomings, the clinician can still use classification criteria for understanding the disease as well as a guide for diagnosis with a few caveats. We present the limits of current classification criteria, their use and abuse in clinical practice, and how they should be used with caution when applied in clinics. 相似文献
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Kelsey R. Allen Kevin A. Smith Joshua B. Tenenbaum 《Proceedings of the National Academy of Sciences of the United States of America》2020,117(47):29302
Many animals, and an increasing number of artificial agents, display sophisticated capabilities to perceive and manipulate objects. But human beings remain distinctive in their capacity for flexible, creative tool use—using objects in new ways to act on the world, achieve a goal, or solve a problem. To study this type of general physical problem solving, we introduce the Virtual Tools game. In this game, people solve a large range of challenging physical puzzles in just a handful of attempts. We propose that the flexibility of human physical problem solving rests on an ability to imagine the effects of hypothesized actions, while the efficiency of human search arises from rich action priors which are updated via observations of the world. We instantiate these components in the “sample, simulate, update” (SSUP) model and show that it captures human performance across 30 levels of the Virtual Tools game. More broadly, this model provides a mechanism for explaining how people condense general physical knowledge into actionable, task-specific plans to achieve flexible and efficient physical problem solving. 相似文献
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Jeffrey N. Katz Marianne Dalgas Gerold Stucki Nathaniel P. Katz James Bayley Anne H. Fossel Lily C. Chang Stephen J. Lipson 《Arthritis \u0026amp; Rheumatology》1995,38(9):1236-1241
Objective. To assess the value of the history and physical examination findings in the diagnosis of symptomatic degenerative lumbar spinal stenosis (LSS). Methods. The study was performed in 3 specialty clinics, and included patients with low back pain who were at least age 40. Findings from a standardized history and physical examination were compared with the diagnostic impression of expert attending clinicians. Imaging studies were available in 88% of those with LSS, and the findings further supported the diagnosis of LSS in each case. The sensitivity, specificity, and likelihood ratio associated with each history and physical examination finding were calculated in bivariate analyses, and independent correlates of LSS were identified with multivariate analyses. Results. Ninety-three patients were evaluated. History findings most strongly associated with the diagnosis of LSS (likelihood ratio ≥2) were greater age, severe lower-extremity pain, and absence of pain when seated. Physical examination findings most strongly associated with the diagnosis were wide-based gait, abnormal Romberg test result, thigh pain following 30 seconds of lumbar extension, and neuromuscular deficits. Independent correlates of LSS included advanced age (P = 0.0001), absence of pain when seated (P = 0.006), wide-based gait (P = 0.013), and thigh pain following 30 seconds of lumbar extension (P = 0.002). Conclusion. Specific history and physical examination findings are useful in the diagnosis of LSS and should be ascertained routinely in older patients with low back pain. 相似文献
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《Digestive and liver disease》2019,51(8):1144-1151
BackgroundTransjugular liver biopsy (TJLB) represents an alternative to percutaneous liver biopsy especially in patients with impaired coagulation and ascites.AimsTo describe safety and diagnostic yield of aspiration TJLB performed by hepatologists experienced in hepatic venous pressure gradient (HVPG) measurements.Methods445 TJLB of 399 patients between 01/2007–12/2016 were retrospectively assessed.ResultsHistological diagnosis was obtained in 423 (95.1%) biopsies — including 11 (100%) patients with acute liver failure and 34 (97.1%) patients after liver transplantation. A median number of 5 portal tracts (interquartile range:2–9) was obtained. HVPG negatively correlated with sample length (Spearman ρ = −0.310; p < 0.001) and number of portal tracts (ρ = −0.212; p < 0.001).Among n = 151 patients with unknown etiology of liver disease, etiology was successfully identified on liver histology in 126 patients (83.4%).Complications occurred in 28 biopsies (6.3%) including 25 (5.6%) minor and 3 (0.7%) major complications. No deaths due to TJLB were observed.Neither the presence of ascites (6.6% complications) nor of coagulopathy (platelets<50G/L and/or prothrombin time<50%; 4.8% complications) increased the risk for complications.ConclusionsTJLB performed by hepatologists experienced in HVPG measurements is safe - even in patients with ascites or coagulopathy. TJLB has good diagnostic value for histological evaluation of liver disease and acute liver failure. 相似文献
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The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings 总被引:5,自引:0,他引:5
J N Katz M G Larson A Sabra C Krarup C R Stirrat R Sethi H M Eaton A H Fossel M H Liang 《Annals of internal medicine》1990,112(5):321-327
STUDY OBJECTIVE: To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome. DESIGN: Comparison of diagnostic tests with neurophysiologic testing. SETTING: Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies. METHODS: Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses. RESULTS: Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55, CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome. CONCLUSIONS: With the exceptions of age, Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies. 相似文献
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Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis 下载免费PDF全文
Simon Décary Debbie Feldman Pierre Frémont Jean‐Pierre Pelletier Johanne Martel‐Pelletier Michel Fallaha Bruno Pelletier Sylvain Belzile Marie‐Pierre Sylvestre Pascal‐André Vendittoli François Desmeules 《Musculoskeletal care》2018,16(3):370-379
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目的比较中国试行标准和修订的Duke标准对感染性心内膜炎的诊断价值,讨论感染性心内膜炎的临床特征。方法经病理确诊的感染性心内膜炎患者65例,平均年龄33岁,以修订的Duke标准和中国试行标准对其进行诊断评价,比较两种诊断标准对感染性心内膜炎诊断的敏感性。结果做2次以上血培养的40例(61.5%),其中血培养阳性并为相同病原菌的16例(24.6%),超声心动图发现心内膜受累征象49例(75.4%),有基础心脏病者61例(93.8%),胃肠外药物滥用者2例(3.1%),病变累及左心58例(89.2%),累及右心5例(7.7%),累及全心2例(3.1%)。按修订的Duke标准,符合临床确诊的15例(23.1%),按中国试行标准,符合临床确诊的41例(63.1%),两种结果的差异有统计学意义(χ2=21.21,P<0.01)。结论中国试行标准明显优于修订的Duke标准,采用经胸超声心动图结果作为心内膜受累证据和2项临床次要指标作为临床确诊依据,提高了感染性心内膜炎诊断的敏感性,在诊断感染性心内膜炎中更有价值。 相似文献
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C Swett C Cohen J Surrey A Compaine R Chavez 《The American journal of drug and alcohol abuse》1991,17(1):49-60
A total of 189 consecutive new women patients were surveyed at an adult psychiatric outpatient clinic which did not have a specific program for the treatment of alcoholics. Twenty-seven patients (14%) reported a history of heavy alcohol consumption measured by scores of 10 or more on the Michigan Alcoholism Screening Test (MAST), but only 16 had a diagnosis of alcohol abuse or alcohol dependence made by a clinician. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the MAST than those with no such history. When the first abuse occurred before the age of 18 years and there was no recent reported abuse, the association of abuse and high MAST scores persisted, suggesting that early physical or sexual abuse may be associated with current levels of alcohol use. 相似文献
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医院获得性肺炎的病原学及诊断标准研究进展 总被引:1,自引:0,他引:1
医院获得性肺炎的处理在临床工作中比较棘手,诊断方法的不明确以及逐渐增加的细菌耐药导致医院获得性肺炎的病死率较高,为降低医院获得性肺炎的发病率和病死率,进行其病原学以及诊断标准的研究显得非常重要。现就其病原学及诊断标准的进展作一综述。 相似文献
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目的 探讨心电图对诊断高血钾的临床价值。方法对48例高血钾患的心电图与血清钾浓度进行对照分析。结果血清钾高低与心电图改变并不呈绝对平行关系,排钾困难所致的高血钾心电图改变与血清钾测定有较好的一致性。不同程度的高血钾在心电图上有不同的特征表现,而细胞内钾外移所致的高血钾在心电图上无高血钾改变。结论心电图对高血钾改变的反应比血清钾测定更准确,可作为诊断高血钾,判定其程序和观察疗效的重要指标。 相似文献
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Edward L. Hannan Zaza Samadashvili Kimberly Cozzens Gary Walford Alice K. Jacobs David R. Holmes Jr. Nicholas J. Stamato Ferdinand J. Venditti Jeffrey P. Gold Samin Sharma Spencer B. King III 《International journal of cardiology》2014
Background
Appropriate use criteria (AUC) for diagnostic catheterization (DC) developed by the American College of Cardiology Foundation (ACCF) and other professional societies were recently published. These criteria have yet to be examined thoroughly using existing DC databases.Methods and results
New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC “for suspected coronary artery disease (CAD)” in 01/2010-06/2011 who underwent noninvasive stress testing. Patients rated for appropriateness using symptoms and stress test results were examined to determine the percentage with obstructive CAD and to explore the benefit of adding Global Risk Score (GRS) to the AUC. Of the 4432 patients who could be rated, 1530 (34.5%) had obstructive CAD, which varied from 22% for patients rated inappropriate to 47% for patients rated appropriate. Of all patients with low risk stress test results/no symptoms, all of whom were rated “inappropriate” for DC, only 8% of those patients with low GRS had obstructive CAD, whereas 44% of the patients with high GRS had obstructive CAD.Conclusions
Global Risk Score improved the ability of symptoms and stress test results to identify obstructive CAD in patients with “suspected CAD” with prior stress tests, and it might be helpful to add GRS to the DC AUC for those patients. These findings should be regarded as hypothesis generating unless/until they can be confirmed by other data bases. 相似文献17.
ADA及WHO糖尿病诊断标准在中国人中检出率的变化及迁移 总被引:11,自引:0,他引:11
目的 比较美国糖尿病协会1997年修订的糖尿病诊断标准[ADA(1997)]和世界卫生组织糖尿病诊断标准[WHO(1980~1985)]在中国人中检出率的变化及迁移。方法 对906例研究对象实施75g 口服葡萄糖耐量试验(OGTT)。结果 ADA(1997)空腹血糖(FPG)标准较WHO(1980~1985)标准敏感性提高11.15% ,并使近1/5的糖尿病(DM)患者可免于OGTT而被确诊,但仍有近半数经WHO(1980~1985)标准诊断的DM 患者被ADA(1997)FPG标准诊断为空腹血糖损害(IFG)或正常空腹血糖者(NFG)。结论 对用ADA(1997)FPG标准诊断为IFG及NFG,尤其是存在糖尿病高危因素者,有必要进行OGTT2小时血糖核查,以避免漏诊 相似文献
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Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos) 下载免费PDF全文
Seiki Kiriyama Kazuto Kozaka Tadahiro Takada Steven M. Strasberg Henry A. Pitt Toshifumi Gabata Jiro Hata Kui‐Hin Liau Fumihiko Miura Akihiko Horiguchi Keng‐Hao Liu Cheng‐Hsi Su Keita Wada Palepu Jagannath Takao Itoi Dirk J. Gouma Yasuhisa Mori Shuntaro Mukai Mariano Eduardo Giménez Wayne Shih‐Wei Huang Myung‐Hwan Kim Kohji Okamoto Giulio Belli Christos Dervenis Angus C. W. Chan Wan Yee Lau Itaru Endo Harumi Gomi Masahiro Yoshida Toshihiko Mayumi Todd H. Baron Eduardo de Santibañes Anthony Yuen Bun Teoh Tsann‐Long Hwang Chen‐Guo Ker Miin‐Fu Chen Ho‐Seong Han Yoo‐Seok Yoon In‐Seok Choi Dong‐Sup Yoon Ryota Higuchi Seigo Kitano Masafumi Inomata Daniel J. Deziel Eduard Jonas Koichi Hirata Yoshinobu Sumiyama Kazuo Inui Masakazu Yamamoto 《Journal of hepato-biliary-pancreatic sciences》2018,25(1):17-30
Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large‐scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30‐day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30‐day mortality among patients with Grade I or Grade III AC, but significantly lower 30‐day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included. 相似文献
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目的分析MRI检查及ADC值对肝腺瘤诊断的意义。方法以21例经病理检查证实的肝腺瘤患者为研究对象,观察患者术前和活检诊断结果、MRI表现,计算表观扩散系数(ADC),对比以上检查与病理检查结果。结果 2例患者存在肝硬化表现,1例患者9个病灶,5例2个病灶,15例患者为单个病灶。26个病灶内脂质成分多,8个病灶脂质成分少。术前19例患者确诊为良性肝腺瘤,2例考虑为局灶性结节增生。18例病灶直径3 cm,10例病灶直径在3~5 cm,6例病灶直径5 cm。T1WI信号低信号30例,高信号4例;T2WI扫描低信号11例,高信号23例;Gd-DTPA增强扫描,动脉期病灶信号明显强化,门静脉期病灶低信号12例,高信号22例;延迟期扫描病灶低信号12例,高信号22例;DWI扫描病灶低信号21例,高信号13例。可见假包膜样强化病灶14例,假包膜样强化未明确20例。34例病灶平均ADC值为(1.704±0.330)×10~(-3)mm~2/s,病灶周边正常肝实质ADC值为(1.357±0.214)×10~(-3)mm~2/s,病灶ADC值与病灶周边肝实质ADC值比值1。结论 MRI检查联合病灶ADC值测量可为诊断肝腺瘤提供更为准确的参考依据,提高临床诊断肝腺瘤的准确率。 相似文献
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目的:进一步提高对主动脉夹层(AD)的认识,减少误诊和漏诊。方法:对我院急诊内科、心内科、胸外科33例曾经误诊为其它疾病的主动脉夹层患者的临床资料进行回顾性分析。结果:33例中被螺旋CT证实16例(48.5%),磁共振证实10例(30.3%),彩色多普勒证实10例(30.3%),l例(3%)来不及检查,尸检证实。AD的临床特点:(1)50岁以上17例(81.8%);(2)伴高血压病24例(72.7%),动脉硬化25例(75.8%);(3)剧烈疼痛:都有剧烈疼痛,其中:胸腹痛29例(87.9%),腰痛8例(24.2%);(4)血压脉搏两侧不对称10例(30.3%),总误诊漏诊33例(100%),误诊时间(36.0±41.6)h,误诊疾病:心血管病10例(30.3%),消化系统疾病12例(36.4%),呼吸系统疾病8例(24.2%)。结论:熟悉主动脉夹层的临床特点,及时采用影像学检查方法,进行综合分析,可避免误诊和漏诊。 相似文献