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Screening and Diagnostic Tests
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
A test is a tool used to determine the existence or nonexistence of some quality. In health, this framework is particularly useful when we are trying to establish whether an individual has or does not have a specified medical condition. In this case, we often use some sort of biological test. What all such tests have in common is that they are imperfect. As a consequence, if a test yields a positive reading indicating the existence of a condition or disease, or a negative reading indicating nonexistence of the condition, we do not know for certain that the test result is correct. Furthermore, we cannot identify the particular individuals for whom the result is wrong. What we can do is talk about the aggregate behavior of the test, and study the probabilities of both correct and incorrect outcomes. These probabilities can then be used to evaluate subsequent test results, and determine the appropriate action to be taken. The aggregate behavior of medical tests is what we study in this chapter.
Skin: Resilience
Published in Philip Berry, Necessary Scars, 2021
Five scenes demonstrating detachment, the absence of kindness, of patience, of empathy, of care. Yet in one scene, a glimpse of the patient’s awful life expanded my mind and led me back to a true understanding of why he had wrecked his liver. Detachment happens. Any patient reading this will recognise the picture of an uninterested doctor; it is one of the ways we preserve our skin. Yet, we must maintain the ability to feel, to be touched, to open up, and to understand when it is necessary. Otherwise, we are as cold as the patients who don’t make it out alive.
Visualising illness
Published in Chinmay Murali, Sathyaraj Venkatesan, Infertility Comics and Graphic Medicine, 2021
Chinmay Murali, Sathyaraj Venkatesan
The therapeutic power of graphic medicine not only lies in the process of creating comics since reading comics on illness can be cathartic and therefore, psychologically rewarding. The reader plays a crucial role in the creation of meaning in comics as the medium “offer[s] the readers the chance to actively construct, critically interpret, and consciously reflect on and relate to specific messages” (Carleton 2014, 161). Additionally, in the context of graphic medicine, reading is “an image based process of bearing witness” (Guerin and Hallas 2007, 11) where the reader not only becomes a co-creator of the meaning but also relates to the experiential realities of suffering that the author underwent. The reader gets access to the inarticulate pain and inordinate trauma that an illness engenders in the subject without literally experiencing it. Comic artist Sarah Leviatt acknowledges this healing power of graphic medicine when she recounts her experience, both as a reader and as a creator: “[g]raphic medicine has comforted and sustained me in hard times: both reading others’ work and creating my own. The comics we call graphic medicine can actually act as medicine themselves – the kind of medicine that makes you feel better with no side effects” (as quoted in Czerwiec et al. 2015, 168).
How to effectively utilize imaging in disease-modifying treatments for osteoarthritis clinical trials: the radiologist’s perspective
Published in Expert Review of Molecular Diagnostics, 2021
Daichi Hayashi, Frank W. Roemer, Ali Guermazi
Notably, there are three key considerations for utilizing X-ray-based patient selection/screening for DMOAD trials (Tables 2 and 3). In summary, a standardized AP or PA X-ray of the knee is paramount for KL grading for adequate inclusion of subjects for DMOAD trials. One should also be cognizant of the need for an assessment of additional protocol-defined exclusionary findings at eligibility. As subtle but highly relevant diagnoses need to be recorded, a centralized reading by highly experienced expert radiologists is advisable to ensure reliable and valid evaluation [29]. The purpose of such centralized reading is to ensure inclusion of patients with KL grades 2 and 3, and exclude those who fulfill protocol-defined exclusionary criteria. Measurements of the mJSW and definition of the anatomical axis can be performed using available semiautomated software.
Full duodenal rupture after direct abdominal trauma in soccer: a case report of an elite soccer player with follow up and return to play protocol
Published in Science and Medicine in Football, 2021
Bahar Hassanmirzaei, Farinaz Fahimipour, Afifeh Khosravi, Tohid Seif Barghi
After 9 hours of observation, the pain keeps rising, and her abdomen developed involuntary guarding. She was transferred to perform an abdominal CT scan with IV contrast. The first reading of her CT scan images revealed no abnormal finding. As her abdominal pain worsened (8/10 on a VAS scale), the images were reevaluated by a group of 3 expert radiologists. They report free fluid in the peritoneal cavity and pneumoretroperitoneum (retroperitoneal Free air) around the left kidney, which suggests duodenal rupture (figure 2). Any Intra-abdominal organ rupture as a differential diagnosis, the player went to the surgery room for further abdominal exploratory laparotomy approximately 18 hours after the initial trauma. During the procedure, a longitudinal duodenal rupture at the D3 site with a diameter of 3 cm and a retroperitoneal hematoma in the peritoneal cavity were observed (figure 3). Other organs were intact. The hematoma was evacuated from the abdominal cavity, and the surgeons repaired the duodenal rupture in two layers. The peritoneal cavity was washed out, a Jackson-Pratt drain was placed next to the repair, and a nasogastric tube was also placed for any excess fluid drainage after the surgery and to permit evaluating any leakage.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2021
David A. Bellows, Noel C.Y. Chan, John J. Chen, Hui-Chen Cheng, Peter W. MacIntosh, Jenny A. Nij Bijvank, Michael S. Vaphiades, Konrad P. Weber, Sui H. Wong
Pituitary adenomas and nonadenomatous lesions in the sellar region may be difficult to distinguish by neuroimaging. Two neurosurgeons and 2 neuroradiologists of differing experience levels viewed deidentified MRIs of 18 nonadenomatous sellar lesions and 21 pituitary adenomas. Among the 18 nonadenoma cases, 11 (61%) were incorrectly diagnosed as adenoma by at least 1 reader, including Rathke cleft cyst, plasmacytoma, aneurysm, craniopharyngioma, chordoma, Langerhans cell histiocytosis, metastasis, and undifferentiated sinonasal carcinoma. Among the 21 adenoma cases, 8 (38%) were incorrectly diagnosed by at least 1 reader as craniopharyngioma, Rathke cleft cyst, sinonasal carcinoma, hemangioblastoma, and pituitary hyperplasia. Incorrect imaging diagnoses were made with high confidence in 13% of readings. In the misdiagnosis of adenomas as nonadenomatous lesions, avoidable errors occurred because readers failed to recognise imaging features more characteristic of adenomas and because cystic adenomas share features with craniopharyngiomas and Rathke cleft cysts. Awareness of these errors should lead to improved management of sellar lesions.