• Title/Summary/Keyword: Pre-diagnosis Management

Search Result 76, Processing Time 0.03 seconds

When Are Circular Lesions Square? A National Clinical Education Skin Lesion Audit and Study

  • Miranda, Benjamin H.;Herman, Katie A.;Malahias, Marco;Juma, Ali
    • Archives of Plastic Surgery
    • /
    • v.41 no.5
    • /
    • pp.500-504
    • /
    • 2014
  • Background Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies. Methods We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars. Results There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square). Conclusions We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.

Development of Real-time PCR Assay Based on Hydrolysis Probe for Detection of Epichloë spp. and Toxic Alkaloid Synthesis Genes

  • Lee, Ki-Won;Woo, Jae Hoon;Song, Yowook;Rahman, Md Atikur;Lee, Sang-Hoon
    • Journal of The Korean Society of Grassland and Forage Science
    • /
    • v.42 no.3
    • /
    • pp.201-207
    • /
    • 2022
  • Fescues, which are widely cultivated as grasses and forages around the world, are often naturally infected with the endophyte, Epichloë. This fungus, transmitted through seeds, imparts resistance to drying and herbivorous insects in its host without causing any external damage, thereby contributing to the adaptation of the host to the environment and maintaining a symbiosis. However, some endophytes, such as E. coenophialum synthesize ergovaline or lolitrem B, which accumulate in the plant and impart anti-mammalian properties. For example, when livestock consume excessive amounts of grass containing toxic endophytes, problems associated with neuromuscular abnormalities, such as convulsions, paralysis, high fever, decreased milk production, reproductive disorders, and even death, can occur. Therefore, pre-inoculation with non-toxic endogenous fungi or management with endophyte-free grass is important in preventing damage to livestock and producing high-quality forage. To date, the diagnosis of endophytes has been mainly performed by observation under a microscope following staining, or by performing an immune blot assay using a monoclonal antibody. Recently, the polymerase chain reaction (PCR)-based molecular diagnostic method is gaining importance in the fields of agriculture, livestock, and healthcare given the method's advantages. These include faster results, with greater accuracy and sensitivity than those obtained using conventional diagnostic methods. For the diagnosis of endophytes, the nested PCR method is the only available option developed; however, it is limited by the fact that the level of toxic alkaloid synthesis cannot be estimated. Therefore, in this study, we aimed to develop a triplex real-time PCR diagnostic method that can determine the presence or absence of endophyte infection using DNA extracted from seeds within 1 h, while simultaneously detecting easD and LtmC genes, which are related to toxic alkaloid synthesis. This new method was then also applied to real field samples.

Surgical Treatment of Pulmonary Aspergillosis (폐 Aspergillosis의 외과적 치료)

  • Go, Yeong-Sang;Kim, Min-Ho;Kim, Gong-Su
    • Journal of Chest Surgery
    • /
    • v.26 no.9
    • /
    • pp.696-700
    • /
    • 1993
  • Pulmonary aspergillosis is relatively rare disease, most commonly presenting pre-existing cavitary disease. This investigation is designed to illustrate the clinical features, preoperative diagnosis and surgical role in the management of this disease. In retrospective review of opeative cases since Jan. 1988, total 16 cases were analysis. Peak incidence of age lies in the 3rd & 5th decade[81.3%].The common presenting symptoms were hemoptysis & blood tinged sputum[90.9%] & all cases had a history of treatment with antituberculous drugs, but the tuberculosis was revealed in only 3 cases in the pathologic studies on specimen after resection. The locations of lesion were upper lobes in 13 cases, lower lobe in 2 cases, and left whole lobe in 1 case. The operative procedures for treatment of aspergillosis were performed. The lobectomy was performed in 7 cases, lobectomy & segmentectomy in 2 cases, lobectomy & decortication in 2 cases, segmentectomy in 3 cases, bilobectomy & segmentectomy in 1 case and pneumonectomy in 1 case. There was one death due to respiratory insufficiency 21 days later,postoperatively, and empyemas & residual space problems were developed in 2 & 3 cases,respectively. The empyemas were treated with open thoracostomy and the dead spaces was filled with granulation tissues within 6 months. During follow up, there was no recurrence. In conclusion, surgical resection is the treatment of choice for symptomatic aspergillosis and needed in asymptomatic patient to prevent possible fatal sequelae in the future.

  • PDF

Plant Disease Identification using Deep Neural Networks

  • Mukherjee, Subham;Kumar, Pradeep;Saini, Rajkumar;Roy, Partha Pratim;Dogra, Debi Prosad;Kim, Byung-Gyu
    • Journal of Multimedia Information System
    • /
    • v.4 no.4
    • /
    • pp.233-238
    • /
    • 2017
  • Automatic identification of disease in plants from their leaves is one of the most challenging task to researchers. Diseases among plants degrade their performance and results into a huge reduction of agricultural products. Therefore, early and accurate diagnosis of such disease is of the utmost importance. The advancement in deep Convolutional Neural Network (CNN) has change the way of processing images as compared to traditional image processing techniques. Deep learning architectures are composed of multiple processing layers that learn the representations of data with multiple levels of abstraction. Therefore, proved highly effective in comparison to many state-of-the-art works. In this paper, we present a plant disease identification methodology from their leaves using deep CNNs. For this, we have adopted GoogLeNet that is considered a powerful architecture of deep learning to identify the disease types. Transfer learning has been used to fine tune the pre-trained model. An accuracy of 85.04% has been recorded in the identification of four disease class in Apple plant leaves. Finally, a comparison with other models has been performed to show the effectiveness of the approach.

A Study on the Related Factors and the Change after Foot-reflexo-massage Education Program for Diabetic Patients (당뇨병 환자의 발반사요법 교육프로그램 후 발관리지식, 자가간호행위, 생리적지표의 변화 및 관련요인분석)

  • Lee, Young-Hee
    • Korean Journal of Adult Nursing
    • /
    • v.16 no.2
    • /
    • pp.222-232
    • /
    • 2004
  • Purpose: The purpose of this study was to identify the change in foot care knowledge, self care behavior, and physiologic indexes after foot reflexomassage education program, and the related factors. Method: Data were collected from 20 patients who were visited out patients clinic. The change and difference were analyzed with non-parametric statistics. Result: There were significant differences in foot care knowledge(P=.001), self care behavior(P=.000), dosalis pedis blood flow volume (P=.011), skin temperature of foot(P=.001), dorsalis pedis pulse(P=.000), capillary filling time of foot (P=.000) between pre and post. The level of changes of foot care knowledge was significant differences according to admission experience (P=.049), and negative related to systolic blood pressure(P=.028). The level of changes of self care behavior was related to age(P=.049), that of dosalis pedis blood flow was significant difference according to smoking(P=.042), that of skin temperatureof foot(P=.002) and dosalis pedis pulse(P=.038) were significant difference according to weight. The level of changes of capillary filling time of foot was related to diagnosis period(P=.014). Conclusion: Foot-Reflexo-Massage education program is an effective nursing intervention to promote foot care in diabetic patients. And the related factors can be recommended for the management of diabetic patients.

  • PDF

Surgical Treatment of Pulmonary Aspergillosis[II] (폐 Aspergollosis의 외과적 치료[제 2보])

  • 차경태
    • Journal of Chest Surgery
    • /
    • v.25 no.11
    • /
    • pp.1292-1298
    • /
    • 1992
  • This investigation is designed to illustrate the clinical features '||'&'||' preoperative diagnosis, surgical role in the management of pulmonary aspergilloma, '||'&'||' compare with the previous study. We reviewed 42 cases of surgically treated pulmonary aspergillosis from Jan. 1984 to July 1992. The peak age incidence laid in the 2nd '||'&'||' 3rd decade of 25 cases[59.5%]. The 41 cases[97.6%] had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The most common complaint was hemoptysis in 28 cases[66.7%]. The 21 cases showed so called "Air-meniscus sign" on the preoperative chest X-ray. As a preoperative diagnostic modality, the positivity was 30.0%, 57.8%, 88.5% on the fungus culture of sputum for Aspergillus, Chest CT, serum immunodiffusion test for A. fumigatus, respectively. The 37 cases[88.1%] can be diagnosed as pulmonary aspergillosis pre-operatively by any diagnostic method. The anatomical location of aspergilloma was mainly upper lobe in 17 cases[40.5%] '||'&'||' the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 18 cases[41.0%] were combined with tuberculosis '||'&'||' 15 cases[34.1%] were not combined with any other disease[Pr imary Aspergillosis]. The 6 cases showed postoperative empyema including 4 cases of bronchopleural fistula, 3 cases showed postoperative bleeding. One case was died postoperatively due to respiratory failure. In conclusion, when the patient who has longstanding history fo pulmonary tuberculosis '||'&'||' hemoptysis, must be suspected fungal super infection. The resectional surgery is the treatment of choice for symptomatic localized disease. And compare with the previous study, preop. chest CT '||'&'||' immunodiffusion test were more commonly available '||'&'||' showed high positivity.

  • PDF

Management of Esophageal Perforation: Analysis of the Risk Factors Affecting the Outcome (식도 천공의 치료와 예후에 영향을 미치는 인자의 분석)

  • Park, Kyoung-Taek;Han, Il-Yong;Cho, Kwang-Hyun
    • Korean Journal of Bronchoesophagology
    • /
    • v.16 no.2
    • /
    • pp.126-130
    • /
    • 2010
  • Background: The esophageal perforation is related to high morbidity and mortality rates if the diagnosis and treatment are delayed. The aim of this study is to evaluate the affecting factors on outcome and prognosis of the patients who suffer from esophageal perforation. Material and Methods: Twenty-six patients were treated with esophageal perforation in our institute from Jan. 1992 to Feb. 2010. We retrospectively reviewed the results of treatment for esophageal perforation to understand the risk factors affecting survival in patients. Results: The subjects are 26 patients suffered with esophageal perforation and the mean age is $52{\pm}17.8$ years old. 16 esophageal perforations were caused spontaneously, 25 cases were treated surgically. The mortality rate is higher in the cases o pre-operative mediastinitis. Conclusion: The shortness time interval until the beginning of treatment should be achieved to reduce the incidence of fatal post-treatment morbidity and mortality.

  • PDF

Application of Cancer Genomics to Solve Unmet Clinical Needs

  • Lee, Se-Hoon;Sim, Sung Hoon;Kim, Ji-Yeon;Cha, SooJin;Song, Ahnah
    • Genomics & Informatics
    • /
    • v.11 no.4
    • /
    • pp.174-179
    • /
    • 2013
  • The large amount of data on cancer genome research has contributed to our understanding of cancer biology. Indeed, the genomics approach has a strong advantage for analyzing multi-factorial and complicated problems, such as cancer. It is time to think about the actual usage of cancer genomics in the clinical field. The clinical cancer field has lots of unmet needs in the management of cancer patients, which has been defined in the pre-genomic era. Unmet clinical needs are not well known to bioinformaticians and even non-clinician cancer scientists. A personalized approach in the clinical field will bring potential additional challenges to cancer genomics, because most data to now have been population-based rather than individualbased. We can maximize the use of cancer genomics in the clinical field if cancer scientists, bioinformaticians, and clinicians think and work together in solving unmet clinical needs. In this review, we present one imaginary case of a cancer patient, with which we can think about unmet clinical needs to solve with cancer genomics in the diagnosis, prediction of prognosis, monitoring the status of cancer, and personalized treatment decision.

Update on genetic screening and treatment for infertile men with genetic disorders in the era of assisted reproductive technology

  • Lee, Seung Ryeol;Lee, Tae Ho;Song, Seung-Hun;Kim, Dong Suk;Choi, Kyung Hwa;Lee, Jae Ho;Kim, Dae Keun
    • Clinical and Experimental Reproductive Medicine
    • /
    • v.48 no.4
    • /
    • pp.283-294
    • /
    • 2021
  • A genetic etiology of male infertility is identified in fewer than 25% of infertile men, while 30% of infertile men lack a clear etiology, resulting in a diagnosis of idiopathic male infertility. Advances in reproductive genetics have provided insights into the mechanisms of male infertility, and a characterization of the genetic basis of male infertility may have broad implications for understanding the causes of infertility and determining the prognosis, optimal treatment, and management of couples. In a substantial proportion of patients with azoospermia, known genetic factors contribute to male infertility. Additionally, the number of identified genetic anomalies in other etiologies of male infertility is growing through advances in whole-genome amplification and next-generation sequencing. In this review, we present an up-to-date overview of the indications for appropriate genetic tests, summarize the characteristics of chromosomal and genetic diseases, and discuss the treatment of couples with genetic infertility by microdissection-testicular sperm extraction, personalized hormone therapy, and in vitro fertilization with pre-implantation genetic testing.

The Effectiveness of Quality Control of 119 Emergency Medical Services on Survival Rate of Cardiac Arrest Patients (119구급서비스 품질관리가 병원 전 심정지 환자의 생존율에 미치는 영향)

  • Jung, Eun-Kyung;Yun, Hyeong-Wan
    • The Korean Journal of Health Service Management
    • /
    • v.7 no.1
    • /
    • pp.21-34
    • /
    • 2013
  • Hospitals in Korea are enforcing a quality control over 119Emergency Medical Services to increase the survival rate of Out of Hospital Cardiac arrest patients. This study is to analyze the factors that effect the survival rate of Out of hospital Cardiac arrest patients by comparing the results of before and after the quality control enforcement. Cardiac arrest patients can be assorted into pre-decision group and decision group. The study analyzed the survival factors which was based on the adequate use of 119 BLS and ACLS usage rates, response time of 119EMS, qualification of ambulance worker, number of EMS team members, and adequate use of AED according to ECG diagnosis. The analyzation was done over total 1,233 of Cardiac arrest patients from January 1, 2010 to December 31, 2011 After the enforcement of the quality control, the usage of Vital sign check and BLS showed a big difference. Especially, as the usage of ECG showed a significant difference, Shockable rhythm, which is the most important to Cardiac arrest patients, also showed a significant difference. After the enforcement of quality control, the performance of ACLS showed a significant difference in IV. The study showed 119 ambulance workers provided better service in Vital sign and BLS and ACLS after the enforcement of quality control. It is considered a 119 ambulance service effects the survival rate of Cardiac arrest patients. Therefore, it can increase the survival rate and it is necessary to continue a quality control.