Dissertations / Theses: 'Clinical diagnosis'

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Pujari, Goutam. "Current and future trends in proteomics (SELDI-TOF) in clinical diagnosis and clinical research." Thesis, Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31972111.

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Wung, Shu-Fen. "Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management." W B SAUNDERS CO-ELSEVIER INC, 2016. http://hdl.handle.net/10150/621215.

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Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole. Pharmacologic therapy and/or pacing are used to manage unstable or symptomatic bradyarrhythmias.

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Jayasekera, Dushyanti Samantha. "Clinical diagnosis and pathogenesis of Balamuthia mandrillaris." Thesis, Birkbeck (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437325.

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McKeith, Ian G. "The clinical diagnosis of Lewy body dementia." Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333615.

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Wong, Thomas Kwok Shing. "Clinical decision making in nursing." Thesis, Glasgow Caledonian University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283692.

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Cateriano-Alberdi, Maria Paula, Cecilia D. Palacios-Revilla, and Eddy R. Segura. "Survey of Diagnostic Criteria for Fetal Distress in Latin American and African Countries: Over Diagnosis or Under Diagnosis?" Glorigin LifeSciences, 2017. http://hdl.handle.net/10757/622212.

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Loh, Kah Meng, and not supplied. "Physiological System Modelling and Clinical Simulation for Diagnosis." RMIT University. Electrical and Computer Engineering, 2007. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080910.143512.

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Ahmed, Mobyen Uddin. "A Multimodal Approach for Clinical Diagnosis and Treatment." Doctoral thesis, Mälardalens högskola, Akademin för innovation, design och teknik, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-13166.

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A computer-aided Clinical Decision Support System (CDSS) for diagnosis and treatment often plays a vital role and brings essential benefits for clinicians. Such a CDSS could function as an expert for a less experienced clinician or as a second option/opinion of an experienced clinician to their decision making task. Nevertheless, it has been a real challenge to design and develop such a functional system where accuracy of the system performance is an important issue. This research work focuses on development of intelligent CDSS based on a multimodal approach for diagnosis, classification and treatment in medical domains i.e. stress and post-operative pain management domains. Several Artificial Intelligence (AI) techniques such as Case-Based Reasoning (CBR), textual Information Retrieval (IR), Rule-Based Reasoning (RBR), Fuzzy Logic and clustering approaches have been investigated in this thesis work. Patient’s data i.e. their stress and pain related information are collected from complex data sources for instance, finger temperature measurements through sensor signals, pain measurements using a Numerical Visual Analogue Scale (NVAS), patient’s information from text and multiple choice questionnaires. The proposed approach considers multimedia data management to be able to use them in CDSSs for both the domains. The functionalities and performance of the systems have been evaluated based on close collaboration with experts and clinicians of the domains. In stress management, 68 measurements from 46 subjects and 1572 patients’ cases out of ≈4000 in post-operative pain have been used to design, develop and validate the systems. In the stress management domain, besides the 68 measurement cases, three trainees and one senior clinician also have been involved in order to conduct the experimental work. The result from the evaluation shows that the system reaches a level of performance close to the expert and better than the senior and trainee clinicians. Thus, the proposed CDSS could be used as an expert for a less experienced clinician (i.e. trainee) or as a second option/opinion for an experienced clinician (i.e. senior) to their decision making process in stress management. In post-operative pain treatment, the CDSS retrieves and presents most similar cases (e.g. both rare and regular) with their outcomes to assist physicians. Moreover, an automatic approach is presented in order to identify rare cases and 18% of cases from the whole cases library i.e. 276 out of 1572 are identified as rare cases by the approach. Again, among the rare cases (i.e. 276), around 57.25% of the cases are classified as ‘unusually bad’ i.e. the average pain outcome value is greater or equal to 5 on the NVAS scale 0 to 10. Identification of rear cases is an important part of the PAIN OUT project and can be used to improve the quality of individual pain treatment.

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Reichmann, Heinz. "Clinical Criteria for the Diagnosis of Parkinson’s Disease." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-136567.

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The diagnosis of Parkinson’s disease (PD) follows the UK Brain Bank Criteria, which demands bradykinesia and one additional symptom, i.e. rigidity, resting tremor or postural instability. The latter is not a useful sign for the early diagnosis of PD, because it does not appear before Hoehn and Yahr stage 3. Early symptoms of PD which precede the onset of motor symptoms are hyposmia, REM sleep behavioral disorder, constipation, and depression. In addition, an increasing number of patients whose PD is related to a genetic defect are being described. Thus, genetic testing may eventually develop into a tool to identify at-risk patients. The clinical diagnosis of PD can be supported by levodopa or apomorphine tests. Imaging studies such as cranial CT or MRI are helpful to distinguish idiopathic PD from atypical or secondary PD. SPECT and PET methods are valuable to distinguish PD tremor from essential tremor if this is clinically not possible. Using all of these methods, we may soon be able to make a premotor diagnosis of PD, which will raise the question whether early treatment is possible and ethically and clinically advisable
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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Adams, Linda. "Clinical reasoning and causal attribution in medical diagnosis." Thesis, University of Plymouth, 2013. http://hdl.handle.net/10026.1/1535.

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Forming a medical diagnosis is a complicated reasoning process undertaken by physicians. Although there has been much research focusing on clinical reasoning approaches, there is limited empirical evidence in relation to causal attribution in medical diagnosis. The research on which this thesis is based explored and examined the social process of medical diagnosis and provides an explanation of the clinical reasoning and causal attribution used by physicians. The research was undertaken in an Emergency Department within an acute hospital, the data were collected using mixed method approach including one to one semi-structured interviews with individual physicians; observation of their medical assessments of patients and secondary data analysis of the subsequent recorded medical notes. The study involved 202 patients and 26 physicians. The analysis of the physicians’ semi-structured interviews, shows how physicians describe the diagnostic step process and how they blend their clinical reasoning skills and professional judgment with evidence-based medicine. Physicians apply prior learning of taught biomedical and pathophysiological knowledge to question patients using pattern recognition of common signs and symptoms of disease. These findings are portrayed through taped narratives of the physician/patient interaction during the medical diagnostic process, which shows how physicians control the medical encounter. The analysis/interpretation of documentary evidence (recorded medical notes) provides an insight into the way in which physicians used the information gathered during the diagnostic step process. By using SPSS it was possible to cluster the cases (individual patients) into groups. This stage-ordered classification procedure demonstrated commonality amongst individual cases whilst highlighting the uniqueness of any cases. A pattern emerged of two groups of cases: Group 1 - comprised of patients with the presenting complaints of chest pain, shortness of breath, collapse, abdominal pain, per rectal bleed, nausea, vascular and neurological problems and Group 2 - comprised of patients presenting with trauma, mechanical falls, miscarriage/gynaecological problems, allergies/rashes and dental problems. Findings show that the clinical reasoning approaches used varied according to the complexity of the patient’s presenting complaint. The recorded medical notes for the patients in Group 1, were comprehensive and demonstrated a combined approach of hypothetic-deductive and probabilistic reasoning which enabled the physicians to deal with the degree of uncertainty that is inherent in medicine. The recorded process in the medical notes was shortened for the majority of patients in Group 2, and here the clinical reasoning approach used was found to deterministic. It is acknowledged, that this is not always the case. By using crisp set QCA it was possible to explore causal conditions consistent with Group 1. Further analysis led to examination of the link of causal conditions presented in the medical notes with the individual impression/working diagnosis made by physicians.

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Gonçalves, Cristina Alexandra Azevedo Maciel. "Deepy infiltrating endometriosis pathogenesis, diagnosis and clinical managment." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20975.

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Reichmann, Heinz. "Clinical Criteria for the Diagnosis of Parkinson’s Disease." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27712.

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The diagnosis of Parkinson’s disease (PD) follows the UK Brain Bank Criteria, which demands bradykinesia and one additional symptom, i.e. rigidity, resting tremor or postural instability. The latter is not a useful sign for the early diagnosis of PD, because it does not appear before Hoehn and Yahr stage 3. Early symptoms of PD which precede the onset of motor symptoms are hyposmia, REM sleep behavioral disorder, constipation, and depression. In addition, an increasing number of patients whose PD is related to a genetic defect are being described. Thus, genetic testing may eventually develop into a tool to identify at-risk patients. The clinical diagnosis of PD can be supported by levodopa or apomorphine tests. Imaging studies such as cranial CT or MRI are helpful to distinguish idiopathic PD from atypical or secondary PD. SPECT and PET methods are valuable to distinguish PD tremor from essential tremor if this is clinically not possible. Using all of these methods, we may soon be able to make a premotor diagnosis of PD, which will raise the question whether early treatment is possible and ethically and clinically advisable.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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Gonçalves, Cristina Alexandra Azevedo Maciel. "Deepy infiltrating endometriosis pathogenesis, diagnosis and clinical managment." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20975.

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Lam, Siu-Yuk Rebecca. "Acupuncturists' clinical problem-solving strategies." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=28477.

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This study investigates the clinical problem-solving among Western-trained and traditionally trained acupuncturists. Fifty-six subjects with varying clinical experience were divided into four groups: physicians without acupuncture training (control), physician-acupuncturists, non-licensed physician-acupuncturists, and traditionally trained acupuncturists. Three clinical cases (two routine and one non-routine), were given to the subjects to provide diagnostic and treatment plans. The data were quantitatively and qualitatively analyzed. Subjects' diagnostic and treatment plans were evaluated against reference models for Western medicine and traditional Chinese medicine (TCM).
The results indicate that acupuncturists were influenced by their initial medical training. Physician-acupuncturists and non-licensed physician-acupuncturists' practices were greatly influenced by the training in Western medicine, regardless of their exposure to traditional Chinese medicine. The traditionally trained practitioners outperformed the other groups of subjects in the non-routine case. Accuracy in diagnoses and treatments for the non-routine case was also positively related to the length of clinical experience. The findings support theories of expertise that experts use forward reasoning when coping with familiar cases, and backward reasoning when encountering difficult cases.

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Dando, Charlotte. "The diagnosis of symptomatic forefoot neuroma from a clinical diagnostic protocol for podiatric assessment." Thesis, University of Southampton, 2018. https://eprints.soton.ac.uk/427315/.

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There is limited evidence reporting the epidemiology of forefoot neuroma (FFN) in the general population of the United Kingdom (UK). Consequently, estimated incidence or prevalence are not known although the condition is considered common in the National Health Service (NHS) and private health care sectors. Therefore, there is a need to determine the extent of this condition to inform appropriate healthcare provision. Furthermore, it is thought that an accurate and timely diagnosis would improve the patient experience and use of pathways through the NHS. A specific set of symptoms, associated with FFN, has been consistently documented in the literature. Despite this, the optimal method for FFN diagnosis is challenging and anecdotally highly variable between clinicians; currently no reliable or valid clinical diagnostic protocol exists for the diagnosis of symptomatic FFN in podiatric practice. Therefore, there is a need to develop a clinical diagnostic protocol and to determine its reliability and validity. It was anticipated that accurate diagnosis will inform more targeted service planning and promote effective clinical decision making on the management options available to address participant reported symptoms. Three sequential studies were designed and delivered within a local NHS podiatry service line. In study one, the clinical pathways were reviewed and the numerical values of individuals accessing the local podiatry service for a forefoot assessment were defined. Study two developed a clinical assessment protocol (FNCAP) with agreed expert consensus for the diagnosis of FFN. Through study three, the content validity and reliability of FNCAP for the diagnosis of FFN was established. The findings of this thesis validate the estimated regional incidence and prevalence rates of symptomatic persons registered to the podiatry service line. However, records provided little insight into the diagnostic methods used to identify FFN from other forefoot pathology. This led to the development of a clinical diagnostic protocol from expert consensus for FFN. Through the Delphi study, six themes related to the clinical diagnosis of FFN: location of pain, non weight-bearing sensation, weight-bearing sensation, observations, clinical tests and imaging were identified. The themes were integrated such that 21 recommendations were identified and refined to form a clinical diagnostic protocol for FFN. The diagnostic test study indicated that there is content validity for the items that form FNCAP. The intra-rater reliability tests for the FNCAP revealed a 'moderate' threshold of agreement value. The sensitivity (100%) and specificity (95.6%) scores for FNCAP were high and indicated the FNCAP could be useful for diagnosing FFN in most cases. Feasibility testing of the FNCAP has indicated some usefulness in diagnosing FFN but further investigations are required to determine the FNCAP applicability in clinical practice.

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Llewelyn, David Evan Huw. "Assessing the validity of diagnostic tests and clinical decisions." Thesis, King's College London (University of London), 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325963.

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Aronoff, Derek N. "Errors in clinical judgment : the effect of temporal order of client information on anchoring, adjustment, and adjustment mitigation and category of clinical inferences." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq29876.pdf.

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Ching, K. Y., and 程潔怡. "Validating a quantified clinical screening tool in detecting aspiration." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B4500996X.

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Saleh, Meriam Naim. "Detecting Giardia: Clinical and Molecular Identification." Diss., Virginia Tech, 2017. http://hdl.handle.net/10919/89367.

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The protozoan parasite Giardia duodenalis (syn. G. lamblia, G. intestinalis) can cause diarrhea in humans, cats, dogs and other animals. Giardia duodenalis consists of eight assemblages (A-H) that are morphologically identical but genetically distinct. Assemblages C-H are generally species-specific, while A and B infect people and animals and are considered potentially zoonotic. Most canine and feline isolates belong to their respective species-specific assemblages, but isolates of assemblages A and B (predominantly found in humans) have also been recovered from dogs and cats. Diagnosis of infection has historically been by morphologic techniques (observing trophozoites on direct fecal smears or cysts on centrifugal zinc sulfate fecal flotations), and it is currently recommended to use morphologic techniques in conjunction with a sensitive and specific antigen test. Diagnosis is important for management of clinical giardiasis in cats and dogs and also to identify the assemblage present to determine its zoonotic potential. In my dissertation research I evaluated diagnostic techniques in use for companion animals, including centrifugal zinc sulfate fecal flotation, antigen tests optimized for use in dogs and cats, direct immunofluorescent assay (IFA), and Polymerase Chain Reaction (PCR). I showed that when compared to the reference IFA the veterinary optimized antigen tests performed similarly and had no statistically significant differences in sensitivity or specificity when combined with a centrifugal zinc sulfate fecal flotation test. Sensitivity and specificity by comparison to IFA was ≥ 82% and ≥ 90%, respectively, for all diagnostic tests evaluated in dogs and cats. When analyzed via Bayesian analysis sensitivity and specificity for all diagnostic tests was ≥83% and ≥95%, respectively. The Bayesian analysis also showed that using the direct immunofluorescent assay (IFA) as the reference test was supported. I also evaluated PCR as a molecular diagnostic technique to detect Giardia infections in dogs with soft stool or diarrhea (mimicking clinical signs of infection). I utilized both conventional and real time PCR assays and compared the results to the recommended method of diagnosis, the zinc sulfate fecal flotation combined with an immunoassay test. I found that agreement between PCR and microscopy combined with an immunoassay was poor to fair and varied depending on the molecular parameters and size of the DNA target underscoring the complexity of test evaluation and molecular diagnostics for Giardia. I also evaluated cats from a varied population (owned, shelter, feral) in Virginia to determine to what extent (if any) they were infected with potentially zoonotic assemblages of Giardia. The species-specific assemblage F was detected in 57% of the samples and assemblage A, which is considered potentially zoonotic, was recovered from 32% of the sampleI. In 11% both assemblages F and A were detected. We showed for the first time that cats in Virginia are infected with potentially zoonotic assemblages of Giardia.
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Bråthen, Geir. "The classification and clinical diagnosis of Alcohol-related seizures." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2001. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-533.

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The aims of this dissertation were to investigate alcohol-related seizures in clinical neurological practice. We wanted to assess the extent of this problem, to classify the seizures, and to investigate methods to improve the clinical diagnosis of such seizures. We propose an arbitrary but simple and reproducible way of diagnosing alcohol-related seizures and alcohol withdrawal seizures. Papers I and II relate to seizure classification and the extent of the problem in relation to the level and weekly pattern of alcohol use. Paper III investigates the performance of various biological markers as aids in the diagnosis of alcohol-related seizures. Paper IV explores pitfalls in the result interpretation for two methods for detection of CDT in patients with neurological disorders. Paper V investigates the utility of standard EEG for the identification of alcohol-related seizures.

Even though the general alcohol consumption in our region is low, every third patient with an epileptic seizure leading to hospitalisation had hazardous alcohol consumption.

Evidence of focal lesions or focal seizure start was found in a high proportion of alcohol-related seizures. All such seizures were secondarily generalized and thus, we challenge the establishment impression that the vast majority of alcohol-related seizures are primarily generalized. Binge drinking (more than six drinks for men or four drinks for women, in a single drinking occasion) was common, but had little influence on seizure susceptibility or timing of seizures. In contrast to prior knowledge, we found that in some patients there was no time lag from cessation of drinking to the occurrence of a seizure, but falling intake levels prior to withdrawal seizures were demonstrated. This indicates that a state of relative withdrawal while still drinking may be sufficient to induce a seizure. Carbohydrate-deficient transferring (CDT) is the most accurate biomarker for alcohol use and good adjunct to the diagnosis of alcohol-related seizures, but its accuracy does not compete with a good clinical investigation. Generally poor accuracy should be expected for fertile women. Women on enzyme-inducing antiepileptic drugs who drink no or little alcohol seem to be at risk of having false positive CDT. Other variables associated with increased CDT were low body mass index, or having total transferring levels outside normal range. A definitely abnormal EEG suggests epilepsy or symptomatic seizures unrelated to alcohol use. The predictive value of a normal EEG is limited, but the typical post-ictal finding in alcohol-related seizures is nevertheless a normal low-amplitude EEG record.

The best method for identification of alcohol-related seizures is a clinical work-up based on a thorough medical history. The Alcohol Use Disorders Identification Test (AUDIT) provides a reliable measure of drinking habits. CDT is a good supplement to the clinical diagnosis when there is doubt, if factors associated with false-positive values are appreciated. The diagnostic value of EEG is limited.

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Alemany, Ripoll Montserrat. "MRI Diagnosis of Intracranial Hemorrhage : Experimental and Clinical Studies." Doctoral thesis, Uppsala University, Department of Oncology, Radiology and Clinical Immunology, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3333.

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The purpose of this work was to improve the diagnosis of intracranial hemorrhage with MRI, using, among others, T2*-w GE sequences. Various sequences were tested in rabbits at two magnetic field strengths. Then, the most effective technique was applied to stroke patients.

Experimental studies: The MR detectability of small experimental haematomas in the brain and of blood in the cerebrospinal fluid (CSF) spaces of 30 rabbits was evaluated. MRI examinations were performed at determined intervals. The last MR images were compared to formalin fixed brain sections and, in 16 rabbits, also to the histological findings. T2*-weighted GE sequences revealed all the intraparenchymal haematomas at 1.5 T, appearing strongly hypointense. Their signal patterns remained unchanged during the follow-up. Blood in the CSF spaces was best detected at 1.5T with T2*-weighted GE sequences during the first 2 days. FLAIR and SE sequences were rather insensitive.

Clinical studies: MR examinations were performed at 1.5T, including T1- and T2-w SE, FLAIR and T2*-w GE sequences. In the first clinical study, 66 intraparenchymal hematomas (IPH) of different sizes and ages were examined. T2*-w GE sequence was the most sensitive. On all the sequences, we found a big variety of signal patterns, without a clear relationship to the age of the hematomas.

In a second clinical study, MR examinations were performed to 83 patients with acute stroke: 43 presented acute IPH and 40 were used as controls. Old microhemorrhages (OMHs) were found in 60% of the patients with IPH, and in 15% of the controls.

Conclusion: T2*-weighted GE sequences are capable of revealing very small intraparenchymal hemorrhages at any stage, and blood in CSF spaces during at least the first 2 days. The age of IPHs cannot reliably be estimated with MRI. We have found a correlation between the presence of OMHs and acute intraparenchymal hematomas.

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Hoskins, Peter R. "Measurement and validation in arterial mechanics for clinical diagnosis." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29162.

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The theme of the thesis is ‘arterial mechanics’ incorporating blood flow, wall dynamics and wall stress. The underpinning aim has been the development and assessment of techniques for use in clinical diagnosis. These techniques include peak systolic velocity within arterial stenosis for estimation of the degree of stenosis; mean velocity for assessment of volumetric flow; wall stress for prediction of disease development and rupture; and elastic modulus for prediction of disease development and rupture. The thesis is divided into 3 themes; ‘development of phantoms’, ‘velocity measurement’ and ‘wall dynamics and stress measurement’. The author developed ‘phantom’ based methods for simulation of flow and wall motion, principally the flow phantom, but also string and electronic injection phantoms. The author evaluated the magnitude and origin of velocity measurement errors in clinical ultrasound systems. The author developed and was involved in clinical evaluation of simplified methods for estimation of wall shear stress and of arterial elasticity. Concluding the thesis as a while; for the measurement of quantities relevant to arterial mechanics for clinical diagnosis, care and attention must be paid in the development of measurement methods with high accuracy, properly validated using an appropriate tissue-mimicking phantom. There is an ongoing clinical problem on velocity measurement for degree of stenosis with no apparent intention to resolve this on the part of manufacturers. Simplified imaging-based measurement methods, of volumetric flow, wall shear stress and arterial elasticity, may have clinical roles where the model assumptions can be justified, which is principally in healthy arteries and early disease. In advanced disease, where there is complex 3D geometry and anisotropy, estimation of flow field data, wall stresses and elasticity should be performed using image guided modelling.

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Moni, Mohammad Ali. "Clinical bioinformatics and computational modelling for disease comorbidities diagnosis." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708646.

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Martins, Maria Joana da Gama Lobo Paula. "Sacroiliac dysfunction - Diagnosis and treatment approaches: a clinical study." Master's thesis, Universidade de Évora, 2022. http://hdl.handle.net/10174/31364.

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The present work entails all the activities performed and assisted during the externships at Lingehoeve Diergeneeskunde, under the guidance of Peter Wiemer, and at Paardenkliniek Venlo, under the guidance of Liana Peters. The first part of this report partakes a descriptive statistic of the caseload. It is divided into different areas of the equine medicine and a small theoretical background is included for contextualization of a representative case chosen for each area of practice. The second part consists of a monography, involving a bibliographic revision of sacroiliac dysfunction associated with poor performance in sports horses, followed by a clinical study on the diagnostic and treatment approaches to this condition, based on the caseload assisted during the externship at De Lingehoeve, to provide a synthesis of the signs associated with this condition and assess the validity and success of the treatments instated; Disfunção Sacroilíaca – Abordagens diagnósticas e terapêuticas: um estudo clínico Resumo: Este trabalho relata as atividades realizadas e assistidas ao longo dos estágios curriculares realizados no hospital De Lingehoeve Diergeneeskunde, sob orientação do Dr. Peter Wiemer, e na clínica Paardenkliniek Venlo, sob orientação da Dr.ª. Liana Peters. A primeira parte deste relatório apresenta uma estatística descritiva da casuística. Foi incluído um breve resumo teórico para cada área da medicina de equinos, para contextualização dos casos selecionados considerados relevantes para cada uma destas áreas. A segunda parte é composta por uma monografia de revisão bibliográfica acerca da disfunção sacroilíaca associada com perda de performance em cavalos de desporto, seguida um estudo clínico das abordagens diagnósticas e de tratamento desta condição, tendo como base de dados a casuística acompanhada durante o estágio em De Lingehoeve, e que pretende, para além de providenciar uma síntese dos sinais clínicos e imagiológicos associados a esta condição, avaliar a validade e sucesso dos tratamentos instituídos.

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Horbatiuk, I. B. "Optimization of clinical diagnosis of acute tonsillopharyngitis in children." Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17662.

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Pourchot, Aloïs. "Improving Radiographic Diagnosis with Deep Learning in Clinical Settings." Electronic Thesis or Diss., Sorbonne université, 2022. http://www.theses.fr/2022SORUS421.

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Les succès impressionnants de l'apprentissage profond au cours de la dernière décennie ont renforcé son statut de norme pour résoudre les problèmes difficiles d'apprentissage automatique, et ont permis sa diffusion rapide dans de nombreux domaines d'application. L'un de ces domaines, qui est au cœur de ce doctorat, est l'imagerie médicale. L'apprentissage profond a fait de la perspective exaltante de soulager les experts médicaux d'une fraction de leur charge de travail grâce au diagnostic automatisé une réalité. Au cours de cette thèse, nous avons été amenés à considérer deux problèmes médicaux : la tâche de détection des fractures, et la tâche d'évaluation de l'âge osseux. Pour chacune de ces deux tâches, nous avons cherché à explorer les possibilités d'amélioration des outils d'apprentissage profond visant à faciliter leur diagnostic. Avec cet objectif en tête, nous avons exploré deux stratégies différentes. La première, ambitieuse mais arrogante, nous a conduit à étudier le paradigme de la recherche d'architecture neuronale, une succession logique de l'apprentissage profond qui vise à apprendre la structure même du modèle de réseau neuronal utilisé pour résoudre une tâche. Dans une seconde stratégie, plus simple mais aussi plus sage, nous avons tenté d'améliorer un modèle par l'analyse méticuleuse des sources de données à disposition. Dans les deux cas, un soin particulier a été apporté à la pertinence clinique de nos différentes contributions, car nous pensons que l'ancrage pratique de nos différents résultats est tout aussi important que leur obtention théorique
The impressive successes of deep learning over the course of the past decade have reinforced its establishment as the standard modus operandi to solve difficult machine learning problems, as well as enabled its swift spread to manifold domains of application. One such domain, which is at the heart of this PhD, is medical imaging. Deep learning has made the thrilling perspective of relieving medical experts from a fraction of their burden through automated diagnosis a reality. Over the course of this thesis, we were led to consider two medical problems: the task of fracture detection, and the task of bone age assessment. For both of them, we strove to explore possibilities to improve deep learning tools aimed at facilitating their diagnosis. With this objective in mind, we have explored two different strategies. The first one, ambitious yet arrogant, has led us to investigate the paradigm of neural architecture search, a logical succession to deep learning which aims at learning the very structure of the neural network model used to solve a task. In a second, bleaker but wiser strategy, we have tried to improve a model through the meticulous analysis of the data sources at hands. In both scenarios, a particular care was given to the clinical relevance of our different results and contributions, as we believed that the practical anchoring of our different contrivances was just as important as their theoretical design

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Hansen, Bente Synnøve. "Exploring the experience of psychogenic syncope following diagnosis." Thesis, University of Hull, 2015. http://hydra.hull.ac.uk/resources/hull:11359.

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This portfolio has three parts. I. Part one is a systematic literature review entitled ‘What are the psychological factors associated with psychogenic syncope or psychogenic non-epileptic seizures? Psychological factors that appear to be commonly linked to syncopal events of unknown medical origin are explored in relation to psychogenic syncope. Studies have widely acknowledged psychological distress in this patient group. The prevalence of psychological factors and their impact on people remains uncertain. A systematic search of four databases identified eleven studies. The findings are summarised and discussed from various perspectives. Clinical implications and areas of future research are highlighted. II. Part two is an empirical paper, utilising Interpretative Phenomenological Analysis (IPA) entitled: ‘What are the experiences of people diagnosed with psychogenic syncope?’ The study explores peoples’ perspective of living with psychogenic syncope. A total of six people chose to participate in the study, which employed a semi-structured interview based on the self-regulation model (Leventhal, Nerenz & Steele, 1984). Five superordinate and seven subordinate themes emerged from the data. Peoples’ experience of psychogenic syncope was conceptualised by drawing on various theories in order to highlight a need for holistic healthcare practice. Wider psychosocial influences on people diagnosed with psychogenic syncope were also considered. III. Part three comprises appendices relating to part one and part two. Included in this is an epistemological statement of the stance of the researcher, and a reflective statement on the process of conducting the research, and its challenges.

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Woods, Nicole Natasha Brooks Lee R. "The role of biomedical knowledge in medical diagnosis by learners." *McMaster only, 2005.

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Azin, Francisca Raimunda Felizardo Guerreiro. "DinÃmica do perfil hematolÃgico e bioquÃmico dos pacientes com dengue internados no Hospital SÃo JosÃ de DoenÃas Infecciosas em Fortaleza â CearÃ no perÃodo de janeiro a maio de 2008." Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=6622.

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Trata-se de um estudo observacional, descritivo e retrospectivo de 154 pacientes com diagnÃstico clÃnico e sorolÃgico de dengue internados em um hospital pÃblico terciÃrio, de referÃncia em doenÃas infecto-contagiosas, em Fortaleza-Ce, no perÃodo de janeiro a maio de 2008. O objetivo foi correlacionar exames laboratoriais, sintomas e sinais de alerta dentro da evoluÃÃo cronolÃgica da dengue, observando suas freqÃÃncias nas formas mais graves para que se possa ajudar nas tomadas de conduta terapÃuticas mais eficazes. A idade dos pacientes variou de 2 a 85 anos. A amostragem foi dividida em dois grupos: pacientes < 15 anos (n=66) e ≥15 anos (n=88). Na classificaÃÃo clÃnica, por se tratar de pacientes de um hospital terciÃrio, predominou a FHD (58,4%) seguido de DG (28,6%) e de DC (13%). Nos pacientes com DC foi observado alteraÃÃes laboratoriais importantes como plaquetopenia e elevaÃÃo nas transaminases, que motivaram suas internaÃÃes. As principais alteraÃÃes laboratoriais encontradas na FHD foram: plaquetopenia, hemoconcentraÃÃo, elevaÃÃo de transaminases. Resultados semelhantes foram observados no DG, no entanto hemoconcentraÃÃo nÃo foi detectada. Os sinais de alarme foram verificados com maior freqÃÃncia nas duas formas graves da dengue. Na DG, nos grupos <15 anos e ≥15 anos foram observados respectivamente manifestaÃÃes hemorrÃgicas: 55,55%, 69,23%; dor abdominal intensa e contÃnua: 72,22%, 65,38%; tontura postural: 11,11%, 23,08%; vÃmitos: 61,10%, 38,40%. Na FHD nas faixas etÃrias <15 anos e ≥15 anos apresentaram respectivamente manifestaÃÃes hemorrÃgicas: 52,27%, 65,22%; dor abdominal intensa e contÃnua: 97,73%, 71,74%; tontura postural: 9,09; 43,48; vÃmitos: 81,80%; 58,70%. Estes resultados dentro da evoluÃÃo cronolÃgica da doenÃa foram importantes, independente da forma clÃnica da dengue e da faixa etÃria. As alteraÃÃes laboratoriais foram na sua maioria a partir do 3Â dia sendo mais evidentes no 5Â dia e com restabelecimento dos valores atÃ o 11Â dia. A detecÃÃo dos sinais de alerta em dengue dentro desta cronologia foi importante para a caracterizaÃÃo clÃnica de pacientes com FHD e DG. Portanto, esses resultados sÃo relevantes na avaliaÃÃo da doenÃa, pois estas alteraÃÃes e a detecÃÃo dos sinais de alerta dentro da evoluÃÃo cronolÃgica da doenÃa podem ser utilizados como sinalizadores para as formas mais graves e ajudar precocemente na tomada de conduta terapÃutica eficaz para o paciente.
This is an observational, descriptive and retrospective study of 154 patients who have been diagnosed clinically and serologically for dengue fever, interned in a tertiary public hospital in the city of Fortaleza of CearÃ State, during the period of January â May, 2008, for the purpose of correlating the laboratory examinations, symptoms and alarming signs with the chronological evolution of the disease and to observe the frequencies of the more severe clinical forms of disease, so as to help adopt therapeutic conducts that are more effective. The patientsâ ages varied from two to 85 years. The study sample was divided in to two groups: patients < 15 years (n=66) and those ≥15 years (n=88). As the patients were all from a tertiary public hospital, the clinical classification of cases showed that hemorrhagic dengue fever (HDF) was predominant (58.4%), followed by severe dengue (SD â 28.6%) and classic dengue (CD - 13%). The CD patients showed alterations in the laboratory findings such as thrombocitopenia and rise of transaminases, which motivated their hospitalization. The principal laboratory alterations found in HDF patients were: thrombocytopenia, hemoconcentration and rise of transaminases. Similar alternations were found in SD patients, but hemoconcentration was not detected in them. The alarming signs were observed more frequently in the two severe forms of dengue. In the <15-years and ≥15-year groups, the respective clinical pictures were: hemorrhagic manifestations â 55, 55% and 69,23%; acute and continuous abdominal pain â 72,22% and 65,38%; and postural dizziness â 11,11% and 23,08%; vomiting â 61,10% and 38,40%. In the HDF patients, in the <15-years and ≥15-year subgroups, the respective hemorrhagic manifestations were: 52,27% and 65,22%; acute and continuous abdominal pain â 97,73% and 71,74%; and postural dizziness â 9,09% and 43,48%; vomiting â81,80% and 58,70%. Within the chronologic evolution of the disease, these results were important and were independent of the clinical form of the disease and the age group of the patients. In the majority of cases, the laboratory alterations were observed from the 3rd day onwards, being more evident on the 5th day and stabilizing to normal values by the 11th day. Within this chronology, the detection of alarming signs was important for the clinical characterization of HDF and SD cases in patients. These results appear to be relevant for the evaluation of the clinical disease, as the detection of the alarming signs within the chronologic evolution may be utilized as warning signals for the more severe forms of the disease, and hence could help in the early adoption of more efficient therapeutic strategies for the patients.

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Hellström, Ann-Cathrin. "Primary fallopian tube cancer : a clinical, histopathological, biological and prognostic study /." Stockholm, 1997. http://diss.kib.ki.se/1997/91-628-2742-1.

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Verhey, Franciscus Rochus Jozef. "Dementia, depression and forgetfulness clinical studies of the early diagnosis and the differential diagnosis of dementia /." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1993. http://arno.unimaas.nl/show.cgi?fid=5854.

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Summerton, Nicholas. "Generating clinical indicants in order to refine diagnostic discrimination in general practice." Thesis, University of Oxford, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249561.

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Lindström, Per. "Diabetic neuropathy : clinical and experimental studies /." Stockholm, 1997. http://diss.kib.ki.se/1997/19971003lind.

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Kelly, David Jonathan. "The identification and clinical validation of the defining characteristics of the nursing diagnosis Alteration in Tissue Perfusion: Cardiac." Thesis, The University of Arizona, 1989. http://hdl.handle.net/10150/277146.

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This exploratory study used Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Cardiac. The literature based Kelly Cardiac Assessment Tool (KCAT) was designed as the data collection tool. The diagnostic content validity of the KCAT was 0.70. Twenty subjects, 18 years old and older were selected from a population who were admitted as inpatients in a southwestern university affiliated hospital. Data were collected through patient interviews, independent nurse assessment, and review of laboratory data. Using the steps described in Fehring's CDV model (1986) one major defining characteristic and 13 minor defining characteristics were clinically validated. The tool CDV score was 0.62. The nursing diagnosis Alteration in Tissue Perfusion: Cardiac was clinically validated and one major and 13 minor defining characteristics were identified.

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Soler, Aznar Maria. "Nanoplasmonic biosensors for clinical diagnosis at the point of care." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/298172.

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Aquesta Tesi Doctoral se centra en el desenvolupament de noves metodologies analítiques en biosensors òptics com a solucions alternatives per a la diagnosi o la monitorització terapèutica de diferents malalties, com ara l’al·lèrgia, la celiaquia o el càncer. En particular, es proposa l’ús de biosensors nanoplasmònics per a la detecció de biomarcardors presents en fluids humans de manera ràpida, sensible i que no requereixi d’amplificació de senyal o de l’ús d’etiquetes. Tant el ja ben establert biosensor de Ressonància de Plasmó Superficial (SPR) com un innovador biosensor nanoplasmonic basat en nanodiscs d’or han estat avaluats per a la seva aplicació real en l’àrea clínica. Les distintes metodologies biosensores presentades estan basades en l’ús d’anticossos, tant com a elements de bioreconeixement o com a biomarcadors específics de malalties. Primer, es presenta un estudi en profunditat de dues estratègies d’immobilització orientada d’anticossos per tal d’obtenir immunoassaigs en format directe de biomarcadors proteics en fluids biològics. En segon lloc, es proposa una nova estratègia immunosensora per a la detecció de pèptids derivats del gluten directament en orina com a tècnica ràpida i no invasiva per al control dietètic de pacients celíacs. A més, s’han desenvolupat dues metodologies utilitzant el biosensor nanoplasmònic per a detectar anticossos circulants en sang com a biomarcadors de malalties. Per una banda, s’ha dissenyat una estratègia alternativa per a la diagnosi d’al·lèrgia als medicaments (en particular a l’antibiòtic amoxicil·lina) basada en uns receptors dendrimèrics per a la detecció directa d’anticossos tipus IgE en sèrum. Finalment, s’ha avaluat una nova estratègia biosensora per a quantificar específicament autoanticossos tumorals per a la diagnosi precoç de càncer colorectal. El treball d’aquesta Tesi combina l’experiència del grup de recerca en el disseny i fabricació de tecnologia biosensora avançada i innovadora amb el desenvolupament de tècniques bioanalítiques i de química de superfície per tal de superar els reptes actuals relacionats amb el cost i el temps requerit per a les anàlisis clíniques. A més, l’àmplia experiència del grup de recerca en transferència tecnològica i les col·laboracions establertes durant la tesi doctoral amb empreses com Biomedal S.L. o Protein Alternatives S.L. obren oportunitats interesants de cara a facilitar el procés de transferència tecnològica per a la implementació real de biosensors tipus Point-of-Care.
This Doctoral Thesis focuses on the development of novel analytical methodologies in optical biosensors as alternative solutions for diagnosis or therapy monitoring of relevant diseases, such as allergy, celiac disease or cancer. In particular, we propose the use of nanoplasmonic biosensors for a rapid, sensitive and label-free detection of biomarkers present in human fluids. Both the well-known Surface Plasmon Resonance (SPR) biosensor and an innovative nanoplasmonic biosensor based on gold nanodisks surfaces have been evaluated for their real application in the clinical field. The different biosensor methodologies make use of antibodies, either as biorecognition elements in immunoassays or as specific disease biomarkers for diagnostics. First, an in-depth study of two site-directed antibody immobilization strategies is presented for the direct immunoassay of protein biomarkers in biological fluids. In second place, a novel immunosensing strategy is proposed for the detection of gluten-derivative peptides in urine as a rapid and non-invasive technique for dietary control in celiac patients. On the other hand, two assays have been developed employing the nanoplasmonic biosensor to detect blood circulating antibodies as disease biomarkers. First, we have designed an alternative approach for drug allergy diagnosis (in particular for amoxicillin) based on dendrimer-based receptors, which enable the detection IgE antibodies directly in serum. And second, a new biosensing strategy is assessed to quantify specific tumor-related autoantibodies for the early diagnosis of colorectal cancer. The work in this Thesis combines the wide knowledge of the research group in the design and fabrication of powerful biosensor technology with the development of surface activation chemistry and bioanalytical techniques to overcome current challenges related to costly and time-consuming clinical analysis. Besides, the strong experience of our research group in technological transfer and the established collaborations during this doctoral work with companies as Biomedal S.L. or Protein Alternatives S.L. open up interesting opportunities to facilitate the technology-transfer process for the real implementation of Point-of-Care biosensors.

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Fältskog, Andreas. "Efficient user interaction for clinical diagnosis using digital volume images." Thesis, Linköping University, Department of Science and Technology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-12346.

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Medical imaging is going through a continuous development leading to more available information for the reviewing doctors. The information is a powerful tool in the strive to make reliable diagnosis but it can also be a challenge for the doctor to make use of all the information. This thesis investigates if the computer-based review workplace can be made more efficient using other input devices than the traditional mouse and keyboard. To acquire knowledge about the existing user interactions six interviews have been conducted at two Swedish hospitals. In the thesis a 3D mouse has been integrated into Sectra's review workstation to show what value a complementary device can bring.

The interviews show that the doctors are quite satisfied with the existing workplace but there are areas of improvement. This together with the integration of the 3D mouse gives a hint about the complexity of finding a device that adds enough value to take place on the reviewing doctor's desk.

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Chan, Koon-ho, and 陳灌豪. "Clinical features, diagnosis and immunopathogenesis of neuromyelitis optica spectrum disorders." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48521681.

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Neuromyelitis optica (NMO) is a central nervous system inflammatory demyelinating disorders (CNS IDD) characterized by acute myelitis (AM) and optic neuritis (ON), especially clinically severe longitudinally extensive transverse myelitis (LETM) and simultaneous bilateral ON. Patients with recurrent AM especially LETM without ON, and patients with recurrent ON without AM may have disorders belonging to the spectrum of NMO, neuromyelitis optica spectrum disorders (NMOSD). NMO is likely autoimmune in nature as a significant proportion of patients are seropositive for aquaporin-4 (AQP4) autoantibodies. I studied the clinical features of local Chinese NMOSD patients and their AQP4 autoantibodies seropositivity rates of by indirect immunofluorescence using tissue slides containing primate cerebellum (tissued-based immunofluorescence assay) in patients with 1) NMO, 2) classical multiple sclerosis (CMS), 3) acute disseminated encephalomyelitis (ADEM), 4) single attack or relapsing AM, 5) single attack or relapsing ON, and 6) other neurological disorders. The results showed that NMOSD are severe CNS IDD affecting patients with a wide range of onset ages. Chinese NMOSD patients predominantly have relapsing NMO and relapsing LETM with severe attack of LETM and/or ON. The six-year mortality rate of patients with NMO or relapsing myelitis with LETM was about 12%. Two-thirds of patients have poor neurological outcome at a mean duration of 6.0 years. The results confirmed that AQP4 autoantibodies are specific for NMOSD, and detection of AQP4 autoantibodies is clinically useful for early diagnosis of NMOSD and distinction from CMS. I proceeded to study a cell-based immunofluorescence assay using transfected human embryonic kidney cells overexpressing human AQP4 on cell membrane and found that cell-based assay has higher sensitivity than tissue-based assay in detection of AQP4 autoantibodies in NMO (78% versus 61%). As our NMOSD patients frequently presented clinically with severe brainstem symptoms and signs and lesions in brainstem and other brain regions on magnetic resonance imaging (MRI), I studied the clinical and neuroradiological characteristics of Chinese NMOSD patients with brain involvement. I found that 59% of NMOSD patients have clinical and/or radiological evidence of brain involvement. Importantly, brainstem is the most frequently affected brain region and 24% of NMOSD patients had clinical manifestation of brainstem encephalitis. I also studied the pathogenicity of AQP4 autoantibodies in the absence of complement activation by passive transfer of IgG isolated from sera of NMOSD patients into mice pretreated with complete Freund’s adjuvant (CFA, containing heat-killed mycobacterium tuberculosis) and pertussis toxin (PTx). I observed that pretreatment with CFA and PTx led to breach of BBB in mouse, and IgG isolated from sera of NMOSD patients seropositive for AQP4 autoantibodies led to asymptomatic loss of AQP4 in gray and white matter in mouse spinal cord without inflammatory cell infiltration, demyelination or astrocytic loss in the absence of complement activation (human IgG cannot activate mouse complements). My findings support that 1) AQP4 autoantibodies binding to astrocytic AQP4 per se can cause downregulation of AQP4 in the absence of complement activation, and 2) complement activation with resultant complement activation products play key roles in the inflammation, demyelination and astrocyte cytotoxicity in NMO.
published_or_final_version
Medicine
Doctoral
Doctor of Philosophy

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Gandhi, Saumil J. 1980. "A clinical Raman spectroscopy system for real-time disease diagnosis." Thesis, Massachusetts Institute of Technology, 2003. http://hdl.handle.net/1721.1/87415.

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Saatchi, Mohammad Reza. "Developments in signal processing for computerised diagnosis in clinical neurophysiology." Thesis, Sheffield Hallam University, 1992. http://shura.shu.ac.uk/14384/.

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The aim of this study was to apply signal processing techniques to a potential known as the contingent negative variation (CNV) in order to aid detection of schizophrenia, Parkinson's disease (PO) and Huntington's Disease (lID). A data recording system was constructed and used to obtain data from 20 schizophrenic patients, 16 PO patients, 21 -at-risk- of HD patients, 11 HD patients and 43 normal control subjects. The data included the CNV, electro-oculograms (required for the preprocessing of the CNV) and the subjects reaction times to an acoustic stimulus. The CNV waveforms were initially preprocessed. This reduced the effects of background electroencephalogram and ocular artefact potentials. The CNV waveforms were then processed using a method which involved the discrete Fourier transform (OFf) and discriminant analysis. This method developed from the work of Martin Nichols and Michael Coelho. It was possible to successfully identify the majority of the patients using this method. In order to reduce the complexity of patients' Identification a different method of CNV signal processing was considered. This involved obtaining the CNV features in the time domain and using them in neural networks. This method was as effective as the method which used OFf and discriminant analysis in identifying the patients. To establish whether HO could presymptomatically be detected in the at-risk of HD group, the CNV was analysed using principal component analysis (PCA) and Ward's clustering method. This resulted in identification of 7 patients who were suggested would develop HO. The subjects' reaction times were also analysed. This indicated that the reaction times of schizophrenic, PO, HO and some at-risk of HD patients were significantly different from the reaction times of their normal control subjects.

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Beffara, Flavien. "SERS biosensors based on special optical fibers for clinical diagnosis." Thesis, Limoges, 2021. http://www.theses.fr/2021LIMO0009.

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Malgré d'importantes percées dans le domaine de la biodétection, nous avons toujours besoin de nouveaux capteurs qui faciliteraient la détection précoce de maladies graves comme le cancer. La biopsie tissulaire classique reste la référence dans de nombreux cas. Bien que cette approche ait montré son potentiel, elle reste invasive pour les patients et les techniques de détection sont fastidieuses ou manquent de sensibilité pour détecter la maladie à un stade précoce. La spectroscopie Raman a démontré son intérêt pour la biodétection. Sa capacité à caractériser la nature chimique, la structure et l'orientation d'un analyte, en fait un candidat idéal. Les pics Raman très nets d'une molécule peuvent être considérés comme une véritable empreinte digitale. Malheureusement, le signal Raman diffusé est extrêmement faible. Cette limitation a été surmontée par la spectroscopie Raman exaltée de surface (SERS), car elle augmente considérablement le signal Raman diffusé tout en maintenant la largeur des pics du spectre d'une molécule. Malheureusement, la plupart des substrats SERS actuels sont soit des surfaces métalliques nano-rugueuses en 2D soit des nanoparticules colloïdales, qui manquent de sensibilité et de fiabilité dans les mesures avec une faible répétabilité et reproductibilité des données. Ces dernières années, des fibres optiques spéciales ont été utilisées comme plateformes SERS. Elles comportent des trous qui s'étendent sur toute leur longueur. Ces trous permettent d'incorporer l'analyte à l'intérieur de la fibre. Ainsi, une telle plate-forme représente une alternative prometteuse aux substrats plans puisque l'analyte et la lumière d'excitation peuvent interagir sur une plus grande longueur à l'intérieur des fibres. De plus, les fibres optiques sont très flexibles, compactes, et permettent un guidage de la lumière à faible perte. Par conséquent, ces capteurs à fibres présentent à la fois les capacités de détection exceptionnelles du SERS, les avantages des fibres optiques et une sensibilité et une fiabilité améliorées. Dans ce manuscrit, nous visons à créer une plateforme de biodétection qui pourrait être utilisée dans un cadre clinique. Pour cela, nous proposons d'optimiser les caractéristiques d'une topologie de fibre déjà existante. Cela nous permet d'augmenter sa sensibilité tout en améliorant sa fiabilité et sa facilité d’utilisation. Grâce à ce capteur amélioré, nous avons pu pour la première fois détecter le biomarqueur du cancer de l'ovaire dans les fluides de kystes cliniques, ce qui nous a permis de différencier le stade du cancer. Par la suite, nous proposons une nouvelle topologie de fibre, spécifiquement conçue pour augmenter encore la sensibilité des sondes à fibre basées sur le SERS. Cette amélioration est réalisée en augmentant la surface d'interaction par rapport aux sondes à fibre standard. Pour cela, le diamètre du noyau est considérablement augmenté et la quantité de lumière qui interagit avec l'analyte est contrôlée avec précision. Nous envisageons que de tels capteurs à fibres fonctionnalisés puissent être incorporés à l'intérieur d'une aiguille de biopsie afin de créer un capteur deux-en-un pour la collecte et l’analyse de fluides corporels. Les limitations associées aux aiguilles de biopsie actuelles, qui exigent une collecte et une analyse des échantillons en deux étapes, pourraient ainsi être surmontées
Despite important breakthroughs in biosensing, we are still in need of new sensors that would facilitate the early detection of severe diseases such as cancer. Classical tissue biopsy remains the gold standard in many cases. Although this approach has shown its potential, it remains invasive for the patients and the detection techniques are either tedious or lack the sensitivity to detect the disease at an early stage. Raman spectroscopy has demonstrated its interests for biosensing. Its ability to characterize the chemical nature, structure and the orientation of an analyte makes it an ideal candidate. The sharp Raman peaks of a molecule can be seen as a true fingerprint. Regrettably, Raman scattered signal is extremely weak. This limitation was overcome by surface enhanced Raman spectroscopy (SERS), since it drastically increases the Raman scattered signal while maintaining the sharp peak of the fingerprint spectrum of a molecule. Unfortunately, most of the current SERS substrates are 2D nano-roughened metal surfaces or colloidal nanoparticles, which lack the sensitivity and reliability in measurement with poor repeatability and reproducibility in the data. In the recent years, special optical fibers have been used as SERS platforms. They feature holes that run along their entire length. These holes allow for the analyte to be incorporated inside the fiber. Thus, such platform represents a promising alternative to planar substrates since the analyte and the excitation light can interact for longer length inside the fibers. In addition, optical fibers are very flexible, compact and allow for low-loss light guiding. Therefore, such fiber sensors exhibit the outstanding detection abilities of SERS, the advantages of optical fibers and improved sensitivity and reliability. In this manuscript, we aim to create a biosensing platform that could be routinely used in a clinical setting. For that, we propose to optimize the features of an already reported fiber topology. This allows us to increase its sensitivity while simultaneously improving its reliability and practicability. With this improved sensor, for the first time, we could detect the biomarker for ovarian cancer in clinical cyst fluids, which allowed us to differentiate the stage of the cancer. Subsequently, we propose a novel fiber topology, specifically designed to further increase the sensitivity of SERS-based fiber probes. This is achieved by increasing the surface of interaction compared to standard fiber sensors. For that, the core diameter is significantly increased and the amount of light that interacts with the analyte is precisely controlled. We envision that such functionalized fiber sensors could be incorporated inside a biopsy needle to create a two-in-one sensor for body fluid collection and readout that can eventually overcome the limitations associated with existing biopsy needle platforms, which demands for two-step sample collection and readout

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Wang, Silun. "Clinical applications of cardiac multi-detector computed tomography." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36944087.

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Bull, Elizabeth E. A. "Towards a low-cost clinical multiple mutation diagnostic : cystic fibrosis as a model." Thesis, Cranfield University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269523.

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Parry, Anne. "Sexual self-concept, stigma & shame following a chlamydia diagnosis." Thesis, University of Hull, 2012. http://hydra.hull.ac.uk/resources/hull:6304.

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The portfolio has three parts: a systematic literature review, an empirical study and a set of appendices. Part one is a systematic literature review in which empirical literature relating to the sexual risk taking behaviour and sexual self-concept is reviewed and critically evaluated. It aims to present an understanding of how dimensions of sexual self-concept can influence sexual risk taking behaviours. Recommendations are made for future research and clinical implications are discussed. Part two is an empirical paper exploring the relationship between sexual self-concept, stigma and shame following a Chlamydia diagnosis. People attending a sexual health clinic for the treatment of Chlamydia were approached to participate in the study. Quantitative data were collected using a cross sectional design. The clinical implications and methodological limitations are also discussed and areas requiring further research are identified. Part three comprises the Appendices to support the work in the first two parts and a reflective statement of the research process.

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Leung, Nga-yi, and 梁雅怡. "Clinical use of basophil activation test in diagnosis of chronic idiopathic urticaria." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46700687.

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Adams, Barbara L. Rhodes Dent. "Making clinical decisions baccalaureate nursing student thought processes /." Normal, Ill. Illinois State University, 2003. http://wwwlib.umi.com/cr/ilstu/fullcit?p3106754.

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Thesis (Ed. D.)--Illinois State University, 2003.
Title from title page screen, viewed October 19, 2005. Dissertation Committee: Dent M. Rhodes (chair), Cathy A. Toll, Eileen T. Borgia, Saundra L. Theis. Includes bibliographical references (leaves 108-116) and abstract. Also available in print.

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Woodley, Stephanie Jane, and n/a. "Lateral hip pain : an anatomical and clinical study." University of Otago. Department of Anatomy & Structural Biology, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061206.162321.

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Lateral hip pain (LHP), characterised by non-specific symptoms in the region of the greater trochanter, is a condition frequently encountered by physiotherapists and other health professionals. However, the pathogenesis of LHP is not well understood. Although pathology of the gluteal tendons and their associated bursae have long been implicated in the cause of this problem, trochanteric bursitis has emerged as the primary clinical diagnosis. In order to determine a differential diagnosis, clinicians are reliant on information collated from the patient history and physical examination, yet the validity of many of the tests used to diagnose LHP has not been established. Abnormalities of the gluteal bursae may give rise to LHP and therefore to ensure precision of clinical assessment and treatment techniques, knowledge of bursal morphology is essential. However, a review of the literature revealed that there are no complete morphological accounts of all the bursae in this area. Therefore, the main purposes of this study were (a) to determine the morphology of the bursae associated with the greater trochanter and (b) to examine the physiotherapy and radiological diagnoses of LHP, and the validity of selected tests used in the diagnosis of LHP. In the anatomical study, the bursae deep to each of the layered gluteal tendons were examined in 21 embalmed human hips (9 male, 12 female; mean age 79 years, SD 9.4 years) using macro-dissection and histological techniques. Morphological associations, size, positions and histological characteristics of the bursae were recorded. A total of 121 bursae were identified in ten different locations, with an average of six bursae per hip. Variation was evident, but it was typical that at least two bursae were found deep to gluteus maximus (GMax) and the fascia lata, and gluteus medius (GMed). In approximately two-thirds of specimens a single bursa was situated deep to the tendon of gluteus minimus (GMin). All of these bursae demonstrated a synovial lining, which was predominantly areolar in type. This study revealed that numerous bursae are intimately associated with the greater trochanter, and provides new morphological detail which is of significance when considering clinical and biomechanical models of LHP. A clinical study was undertaken whereby 40 consecutive patients (37 female, 3 male; mean age 54.4 years, SD 9.5 years) with unilateral LHP were recruited prospectively. Each eligible participant underwent a standardised physiotherapy assessment followed by a magnetic resonance (MR) imaging study of the pelvis and both hips. The MR images were analysed in random order by three radiologists blinded to clinical findings and symptomatic side, and the intra-and inter-observer reliability for image analysis was examined using the kappa statistic. To determine the validity of selected clinical tests as evaluated against MR imaging, sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated, and the chi-squared test was used to determine association. As demonstrated by MR imaging, GMed tendon pathology, bursitis, osteoarthritis (OA) and gluteal muscle atrophy are all associated with the report of LHP. Interestingly, these various pathologies were identified in asymptomatic as well as symptomatic limbs. However, while bursitis was equally prevalent in symptomatic and asymptomatic hips, GMed tendon pathology and OA were observed more frequently on the symptomatic side. Furthermore, muscle atrophy which predominantly affected GMin, was specific to symptomatic hips. Large variation was evident in the strength of agreement between radiologists and there was little agreement between physiotherapy and radiological diagnoses of pathology. Physiotherapists frequently diagnosed trochanteric bursitis as a cause of LHP and while palpation was identified as the most provocative test for reproducing patients complaint of LHP, it was not shown to be a valid technique. Instead, the outcomes pertaining to the validity of the clinical tests indicate that attention should be focused towards the assessment and treatment of gluteal tendon pathology. The two tests that appeared to be most useful for diagnosing gluteal tendon pathology were pain reproduction with passive hip abduction and resisted testing of GMed and GMin. While these findings demonstrate that various pathologies are associated with the report of LHP, they also highlight some problems associated with the use of MR imaging as a reference standard. Before further clinical validation studies of LHP are undertaken in larger populations, it is recommended that verification of MR imaging outcomes are performed against surgical and histological findings.

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47

Montoro, Richard. "The diagnosis of depression in advanced HIV disease /." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31274.

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Background. Diagnosing major depression in the medically ill is difficult because of the overlap of somatic symptoms between the two entities. No studies have examined this issue in advanced HIV disease. Methods. Male subjects with a CD4 count ≤200 were recruited from a specialised outpatient HIV treatment centre. They completed a 30 minute questionnaire and then participated in a diagnostic interview with an HIV psychiatrist. Results. Eight (19.0%) of 42 subjects were diagnosed with major depression. Both inclusive and exclusive approaches to the diagnosis increased the prevalence to 21.4%. Predictive items on the self-report depression scales were inserted in a logistic regression. Four items pertaining to self-worth, discouragement, crying and irritability were left in the model. All somatic items were excluded. Conclusion. This study is an important first step in devising a self-report instrument that would be useful in detecting clinical depression in patients with advanced HIV disease.

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48

Knöfler, Ralf, and Werner Streif. "Strategies in Clinical and Laboratory Diagnosis of Inherited Platelet Function Disorders in Children." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-136597.

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Inherited disorders of platelet function are a rare and heterogeneous group of diseases usually characterised by a mild to moderate bleeding tendency. Typical bleeding symptoms are easy bruising, epistaxis, menorrhagia as well as mucocutaneous and perioperative bleeding. The performance of platelet function diagnostics in children is hampered by age-dependent restriction of blood sample size, poor venous access, and the lack of reproducible test reference ranges for children of different age groups. Platelet function testing is limited to specialised centres, because platelet function test procedures are complicated and time-consuming, which most likely results in a relevant number of undiagnosed and incorrectly classified children with clinically relevant platelet function defects. Evaluation of bleeding history and bleeding symptoms is essential for a rational step-bystep approach to diagnosis. Platelet function diagnostics should be preceded by the exclusion of thrombocytopenia, von Willebrand disease, and secondary haemostasis defects. Light transmission aggregometry is still considered the standard for the assessment of platelet function. Every effort should be made to classify the specific platelet function defect in the patient, because this is essential for accurate treatment and counselling
Angeborene Thrombozytenfunktionsstörungen stellen eine seltene und heterogene Gruppe von Erkrankungen dar, welche meist durch eine leichte bis mittelschwere Blutungsneigung auffallen. Typische Blutungssymptome sind Hämatomneigung, Epistaxis, Menorrhagien sowie Schleimhaut- und perioperative Blutungen. Die Durchführung der Thrombozytenfunktionsdiagnostik bei Kindern wird erschwert durch die altersabhängig begrenzte Blutprobenmenge, schwierige Venenverhältnisse und das Fehlen von Referenzbereichen für Kinder unterschiedlichen Alters. Aufgrund der meist komplizierten und zeitaufwendigen Tests ist die Thrombozytendiagnostik auf spezialisierte Zentren begrenzt. Mit hoher Wahrscheinlichkeit wird eine relevante Anzahl von Kindern mit nichtdiagnostizierten bzw. unkorrekt klassifizierten, klinisch relevanten Thrombozytopathien übersehen. Die Erhebung der Blutungsanamnese und die Bewertung der Blutungssymptome sind erforderlich für eine stufenweise erfolgreiche Gerinnungsdiagnostik. Vor Durchführung einer Thrombozytenfunktionsdiagnostik sollten das Vorliegen einer Thrombozytopenie, einer von-Willebrand-Erkrankung und sekundärer Gerinnungsstörungen ausgeschlossen werden. Die Lichttransmissionsaggregometrie gilt noch immer als Standardmethode für die Beurteilung der Thrombozytenfunktion. Nach Möglichkeit sollte stets versucht werden, den vorliegenden spezifischen Thrombozytenfunktionsdefekt zu klassifizieren, da dies für eine adäquate Behandlung und eine gezielte genetische Beratung notwendig ist
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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49

Winter, Zuzana. "Impact of the diagnosis of borderline personality disorder and its diagnostic process." Thesis, Canterbury Christ Church University, 2015. http://create.canterbury.ac.uk/14396/.

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Contrary to the long-held assumptions, borderline personality disorder (BPD) is now considered a treatable disorder. Timely assessment has been recognised as one of the key treatment enablers and basic assessment standards have been stipulated by the UK’s National Institute for Health and Clinical Excellence (NICE). The current study was the first to have specifically investigated the quality of the diagnostic process in light of the government recommendations. Interpretative phenomenological analysis was used to analyse semi-structured interviews with eight adult female service users about their lived experiences with the original diagnostic disclosure of BPD. Five master themes and several subthemes featured in the majority of the participants’ experience: a) answer with a question mark; b) if only…; c) BPD like a star sign; d) star signs are not enough; it’s what happens afterwards!; e) being at the mercy of the system. Most participants’ experiences suggested that the original diagnostic process was largely negative and did not follow the national guidelines. Nevertheless, a minority of positive views also emerged. The findings are discussed with reference to the existing literature, whilst also detailing the study’s limitations, clinical and research implications.

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50

Gatten, Shauna L. "Clinical differentiation of mental disorders in the eldery : validation of the CAMDEX." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/862267.

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The present series of investigations examined the diagnostic accuracy of the Cognitive Examination (CAMCOG) from the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) in the differential diagnosis of various dementing conditions. Specifically, this study examined: (a) the degree to which the CAMCOG would differentiate normal individuals from patients with Alzheimer's Disease (AD) and from those suffering from non-AD dementing conditions, (b) the extent to which the CAMCOG would distinguish between patients suffering from organic dementing conditions, those having functional psychiatric disorders, and normal persons, and (c) whether the CAMCOG would offer an improvement in diagnostic accuracy over a widely used screening instrument (i.e., the Mini-Mental Status Examination, MMSE) when attempting to differentially diagnose dementing patients and normal cohorts.A review of the literature was presented with an emphasis on the difficulties in establishing differential diagnosis, inaccuracies in diagnosis, the importance of improved diagnostic accuracy, and the use of neuropsychological measures in the assessment and diagnosis of patients suffering from dementing illnesses. Further, research relevant to ancillary diagnostic techniques, the various neuropsychologicalapproaches used in evaluating and diagnosing mental disorders in the elderly, and studies investigating the utility of specific cognitive/neuropsychological measures in the differential diagnosis of dementing diseases was presented.The results of these investigations revealed that the CAMCOG provides excellent diagnostic sensitivity and specificity when differentiating normal persons from clinically diagnosed AD patients and when distinguishing between individuals with an organic-dementing condition and normal adults. The CAMCOG was found to be less effective in differentiating AD and non-AD dementia patients and in distinguishing between patients suffering from organic dementia versus specified psychiatric disorders. Finally, the CAMCOG demonstrated a slight improvement in diagnostic accuracy over the Mini-Mental Status Examination. These results were discussed in terms of their support for the utility of the CAMCOG as an excellent screening measure when used to differentiate patients suffering from various dementia-producing disease states and normal persons.
Department of Educational Psychology

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