Targets. What's the diagnosis?

A maximum wait for diagnostics of four to six weeks will be needed to hit the 18-week waiting-time target. Independent-sector procurement remains key to increasing capacity, but there are disputes around how it should be used. Advanced practitioners could address the problem of the different disciplines working in silos.     

An incorrect diagnosis of psychosis?

This article examines a recent claim in which a patient alleged his general practitioner had incorrectly diagnosed him as suffering from psychosis. The GP had prescribed Melleril, which was complicated by the development of pancytopaenia.     

Alcoholism: indictment or diagnosis?

This article presents reflections on how alcohol consumption is conceived as a sociological object, including proscribed forms linked to the definition of diseases or disregard for moral norms. Through considerations on the accumulated investment in a research process currently under way, the author highlights the ethical and epistemological dilemmas faced by anthropologists who focus on this issue.     

'Vascular depression': a valid diagnosis?

The diagnosis 'vascular depression' was reintroduced to old-age psychiatry about 10 years ago. The introduction of advanced imaging techniques has made it possible to link mood symptoms to vascular brain damage. In patients suffering from depression in which cerebrovascular damage plays an important role, different forms of diagnostics and treatment may be necessary. The symptom profiles of various depressive disorders do not differ widely, which makes it difficult to diagnose 'vascular depression' in daily practice. Thus, it does not meet the criteria of a distinct disease entity. However, the prognosis of patients with vascular depression is different and these patients respond less well to the usual therapy. Therefore, it is important to develop new treatment strategies for this patient group. The method of staging and profiling of depression in the elderly can be useful in this.     

Advice or diagnosis? A legal perspective

Nurses cannot diagnose, but they can--and do--assess, inform and advise. A nurse-attorney offers advice on choosing a demand management service and on understanding the sometimes-subtle distinction.     

Ventilator-associated pneumonia or not? Contemporary diagnosis.

Ventilator-associated pneumonia (VAP) is pneumonia in patients who have been on mechanical ventilation for > or =48 hours. VAP is most accurately diagnosed by quantitative culture and microscopy examination of lower respiratory tract secretions, which are best obtained by bronchoscopically directed techniques such as the protected specimen brush and bronchoalveolar lavage. These techniques have acceptable repeatability, and interpretation of results is unaffected by antibiotics administered concurrently for infection at extrapulmonary sites as long as antimicrobial therapy has not been changed for <72 hours before bronchoscopy.     

Double diagnosis or comorbidity? Definition and clinical observation

There is a high prevalence of a comorbid substance use disorder in subjects with psychotic or mood disorders. Psychiatric patients are reported to abuse alcohol or drugs. This comorbidity raises the question whether one disorder is a consequence of the other. The self-medication hypothesis of substance abuse suggests that drug abuse is driven by an attempt to alleviate specific psychological distress but this unidirectional causality is not supported. The main aims of this review are to describe the difference between dual diagnosis and comorbidity in psychiatric patients and the possible patterns of different clinical conditions.     

Dementias: mostly clinico-neuropsychological or mostly psychometric diagnosis?

In this paper many critical reflections on diagnosis management of patients affected by dementia have been reported. In particular, the importance of clinico-neuropsychological evaluation of patients with respect to management prevalently based on neuropsychological tests is underlined. In this view a periodic diagnostic exercise with the objective of improving the diagnostic approach of dementias has been proposed to the Alzheimer's disease units (UVA) included in the Cronos Project.     

The metabolic syndrome: is this diagnosis necessary?

Values of insulin-mediated glucose disposal vary continuously throughout a population of apparently healthy persons, and a difference of > or = 600% exists between the most insulin-sensitive and the most insulin-resistant persons. Approximately 50% of this variability can be attributed to differences in adiposity (25%) and fitness (25%), with the remaining 50% likely of genetic origin. The more insulin-resistant a person, the more likely that he or she will develop some degree of glucose intolerance, high triacylglycerol and low HDL concentrations, essential hypertension, and procoagulant and proinflammatory states, all of which increase the risk of cardiovascular disease (CVD). To identify persons at greater CVD risk because of these abnormalities, the World Health Organization, the Adult Treatment Panel III, and the International Diabetes Federation created a new diagnostic category, the metabolic syndrome. Although the components of the 3 versions of the metabolic syndrome are similar, the specific values for those components that define an abnormality are somewhat different, and the manner in which the abnormalities are used to make a positive diagnosis varies dramatically from version to version. This review will summarize the similarities in and differences between the 3 versions of the metabolic syndrome, point out that the clustering of components that make up all 3 definitions of the metabolic syndrome is not accidental and occurs only in insulin-resistant persons, develop the argument that diagnosing the metabolic syndrome in a person has neither pedagogical nor clinical utility, and suggest that the clinical emphasis should be on treating effectively any CVD risk factor that is present.     

How often is the diagnosis bronchial asthma correct?

BACKGROUND: There are studies indicating that bronchial asthma is often underdiagnosed, while only a little research has been conducted as concerns overdiagnosing asthma. OBJECTIVE: We aimed to estimate the number of patients who have been given the wrong diagnosis of asthma. METHODS: All patients aged above 18 years who had visited two GPs during 1994 or 1995, with the diagnosis of bronchial asthma confirmed in the medical register, were examined by a specialist in allergies. RESULTS: One hundred and twenty-three patients fulfilled the criteria for being included in the study. Eighty-six patients (70%) attended the examination. Of these, 51 (59%) had bronchial asthma, six (7%) asthma in combination with chronic obstructive pulmonary disease (COPD) and 29 (34%) no asthmatic disease. CONCLUSION: The study indicates that more accuracy is needed when diagnosing bronchial asthma.     

Regulating diagnosis in post-genomic medicine: Re-aligning clinical judgment?

In recent years, genomic technologies have entered oncology. In particular, so-called tumor signatures are now commercially available for diagnosing breast cancer. These new diagnostic tools have expanded the content and meaning of diagnosis, by adding a distinctive prognostic (will the disease recur?) and predictive (how will the disease react to treatment?) dimension to this activity, and modifying the relations between diagnosis and therapy. In particular, they raise the issue of the locus of clinical judgment and clinical decision-making insofar as they involve a re-alignment of the biological and clinical components of medical activities. Using as a case study a debate over the regulation of tests for genomic signatures by the US FDA, this paper examines how the actors problematize the issues related to the introduction of molecular diagnostics into clinical settings.