This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring. 相似文献
Introduction: Neuropsychiatric systemic lupus erythematosus (NPSLE) is characterized by a heterogeneity of clinical manifestations. The absence of diagnostic criteria and the lack of clinical trials is a challenge in clinical practice.
Areas covered: A literature review was performed to describe epidemiology, characterization (clinical, immunological, and imaging), diagnosis and treatment of NPSLE. Classification criteria have been the first step towards a uniform definition. More recently, different attribution models have been developed to help to determine if the NP event is due to SLE. Disease activity is a major risk factor for NP events. Cytokines and autoantibodies are associated with NP events, however, only a few studies have identified risk factors for individual NP events.
Expert opinion: Further research needs to search for and validate biomarkers for NPSLE and individual NP events, including neuroimaging findings, attribution models, and serologic markers. This will be a fundamental step in planning randomized control trials in the treatment of NPSLE to improve outcome. 相似文献
Until recently, MR examinations of the pancreas were limited by motion artifacts, vascular pulsatility and poor spatial resolution. Today, new techniques have been developed, which allow to overcome these problems and provide additional information such as selective images of biliary and pancreatic ducts and vascular structures. MR examinations of the pancreas need to include either breath-hold or nonbreath-hold morphological T1- and T2-weighted images; a contrast agent is required when the study is performed with fast imaging which allow the acquisition of dynamic images in arterial and portal venous phases. Recently, a new liver-specific contrast agent (Mn-DPDP) has been demonstrated to provide selective pancreatic enhancement. As a complement to baseline sequences, MR cholangiopancreatography images can be acquired, possibly integrated by functional examination after secretin administration. Finally, contrast-enhanced MR angiography opens new perspectives for vascular studies, particularly for the locoregional staging of pancreatic cancer. 相似文献
Paracoccidioidomycosis (PCM) is caused by the dimorphic fungus
Paracoccidioides brasiliensis (Pb) and corresponds to prevalent
systemic mycosis in Latin America. The aim of the present work was to evaluate the
dose response effect of the fungal yeast phase for the standardization of an
experimental model of septic arthritis. The experiments were performed with groups of
14 rats that received doses of 103, 104 or 105P. brasiliensis (Pb18) cells. The fungi were injected in 50 µL of
phosphate-buffered saline (PBS) directly into the knee joints of the animals. The
following parameters were analyzed in this work: the formation of swelling in knees
infused with yeast cells and the radiological and anatomopathological alterations,
besides antibody titer by ELISA. After 15 days of infection, signs of inflammation
were evident. At 45 days, some features of damage and necrosis were observed in the
articular cartilage. The systemic dissemination of the fungus was observed in 11% of
the inoculated animals, and it was concluded that the experimental model is able to
mimic articular PCM in humans and that the dose of 105 yeast cells can be
used as standard in this model. 相似文献