The neurologic approach
Stanley Berent, James W. Albers in Neurobehavioral Toxicology, 2012
The neurologist's most important task is establishing the diagnosis for the patient's problem. Exactly how this is done is based on a combination of knowledge, training, and experience. However, several aspects of the diagnostic process are easily described. This process is supplementary to but not independent of the process of establishing the presence of a neurologic impairment. This does not mean, however, that a problem can be diagnosed only when a neurologic impairment is identified, as some neurologic diagnoses can be established with confidence in the absence of a neurologic impairment. For example, diagnoses such as migraine headache, seizure disorder, or sleep apnea do not produce abnormal findings on the clinical neurologic examination, yet they can be identified in most cases based on the patient's history and supportive information such as neurodiagnostic testing. The differential diagnosis is simply an inventory of explanations that are capable of explaining the patient's symptoms and signs. This conventional, commonsense approach of developing a differential diagnosis begins by localizing and characterizing the neurologic impairment using results of the history and neurologic examination (Miller et al., 1998).
Shellfish on the table not to blame for chronic cough in CÔte d'ivoire
Kristina Roesel, Delia Grace in Food Safety and Informal Markets, 2014
Lung fluke infections can be easily avoided by ensuring that fish, crabs and shellfish are well cooked. Treatment is easily administered with deworming medicine. Unfortunately, if symptoms of lung fluke infections are mistaken for those of tuberculosis, the patient will be treated with very expensive antibiotics that are not effective against worm infections. Differential diagnosis is therefore crucial. Raw shellfish from brackish saltwater is host to another agent likely to cause disease in humans: the Vibrio bacteria, including Vibrio cholerae that causes cholera.4 Because shellfish are an important source of food in Abidjan and are associated with two major diseases – lung fluke infection and cholera – the study team investigated the possible risks of shellfish consumption to human health.
Hydrops Fetalis
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Examinations for the differential diagnosis include: serum screening of the mother based on previous obstetric history, ethnic background, family history of heritable disorders, and recent exposure to infectious agent;detailed ultrasound examination to look for fetal structural abnormalities; a fetal echocardiogram is useful if there is any suspicion of a cardiac abnormality or arrhythmia;determining fetal karyotype and genetic microarray molecular testing (chorionic villous sampling, amniocen-tesis, or fetal blood sampling).
An argument against the use of Occam’s razor in modern medical education
Published in Medical Teacher, 2018
Occam’s razor should be used to distinguish between two theories, not two hypotheses. A theory needs to explain all the data whereas a hypothesis implies data yet to be collected, in order to prove or disprove the theory. In clinical medicine, a differential diagnosis should be considered a hypothesis not a theory. The purpose of constructing a differential diagnosis is to formulate tests that can prove or disprove the differential – in other words, data are yet to be collected. It is wrong to apply Occam’s razor at this step of the process. A difficulty arises in knowing when all available data has been collected. This is especially pertinent in the modern age when the quantity of data that can be accrued through biochemistry, radiology, electrophysiology, and histopathology is vast.
Evaluation of medical record quality and communication skills among pediatric interns after standardized parent training history-taking in China
Published in Medical Teacher, 2018
Mu Xue Yu, Xiao Yun Jiang, Yi Juan Li, Zhen Yu Shen, Si Qi Zhuang, Yu Fen Gu
Based on the information obtained from the history, physical examination, and laboratory data, the clinician decides on the diagnosis, generates a differential diagnosis, develops a management plan, and then completes the medical record (Richard et al. 2014). The process creating medical records requires clinical reasoning within the logic of clinical decision-making (Realdi et al. 2008). Moreover, history-taking is one of the important steps in writing medical records (Luce 2001). Effective communication skills improve history-taking ability (Keifenheim et al. 2015). A number of studies have evidence that the use of standardized patients (SPs) is effective for assessing student performance in history-taking (Luce 2001; Keifenheim et al. 2015). SPs provide an appropriate opportunity for new medical students to experience and learn history-taking and communication skills. SPs are actors trained to portray a set of symptoms consistently across clinical interactions. SPs adopt specific client roles and simulate patient behaviors, allowing for multiple clinicians to observe and treat particular patient symptoms at critical learning points (Fussell et al. 2008). In pediatric medical education, SPs have been adapted to become “standardized parents,” thus allowing educators to simulate the critical interactions between health care providers and a child’s parents (Serwint 2002).
Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning
Published in Expert Review of Medical Devices, 2021
Ruth A. Bryant, Zena EH. Moore, Vignesh Iyer
Logically, the early detection of pressure induced tissue damage (i.e. before it is manifest at the skin level) should provide the opportunity for the HCP to intervene early and thereby potentially reduce or even reverse tissue damage [13,40]. The International Clinical Practice Guidelines (CPG 2019) refer to this as the damage threshold [1]. This guideline recognizes the role of localized inflammatory edema/sub-epidermal moisture (SEM) as ‘one of the earliest signs of cell death in pressure injuries’ – a profound change and shift in the paradigm. However, the current definitions of a Stage I PI include contradictory characteristics (firm/soft, warm/cold, red/not red if dark skin toned) of skin and tissue status, the presence of visual discoloration of the skin and tissue, and the subjective interpretation by the HCP [1]. These conditions make a precise diagnosis, or even a differential diagnosis, highly challenging. While early detection of pressure induced tissue damage is ultimately desirable and potentially amenable to site-specific prevention interventions, the ability to do so has been limited by the definition of a Stage 1 and by available assessment tools [22]. Until now, the differential diagnosis of subclinical and clinical indications of pressure-induced tissue damage was not possible.
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