This document provides guidance on critically appraising articles about diagnostic tests using the four steps of evidence-based medicine: ask, acquire, appraise, and apply. It discusses assessing whether diagnostic test results are valid by evaluating the study design, spectrum of patients, and blinding of test interpretation. Key results include likelihood ratios which indicate how much a test result changes the probability of disease. Application involves considering test reproducibility, applicability to practice, and whether test results will change management and improve patient outcomes with acceptable risks and available treatment.
Pulse Wave Velocity: Theory, Applications, Methods, and Future DirectionsInsideScientific
Lee Stoner, PhD and Gabriel Zieff, MA present a complete, in-depth overview of their research involving Pulse Wave Velocity (PWV) in a variety of different applications and a deep dive into the methods they use to record high-quality, repeatable data.
Arguably, the “gold-standard” method for noninvasive assessment of cardiovascular disease risk is pulse wave velocity. The PWV is widely used in both epidemiological and physiological studies to assess arterial stiffness, a construct dependent on the functional and structural characteristics of a vessel. PWV is calculated by measuring the transit time of the arterial waveform between two points of a measured distance. The most widely studied path is between the carotid and femoral arteries, which represents the aorto-illiac pathway. Traditionally, these measurements are made using tonometers, which are highly sensitive pressure transducers. However, alternative approaches to tonometry are available, and pathways other than the aorta can be measured. These alternative approaches may be better suited for use with certain populations or study designs. The focus of the presentation is to assist the audience in identifying the correct research tool for their particular research paradigm. Specifically, these experts outline the theoretical principles underlying PWV, as well as the importance of this measure to both epidemiological and physiological studies. Subsequently, they highlight some of the different approaches for measuring PWV, including technical considerations. This is followed by discussion pertaining to the identification of the appropriate PWV measure for the specific study design and populations of interest. This includes consideration of internal and external validity. They end the session by providing some tips to facilitate high-quality PWV assessments.
Key Topics Include:
- Meaning and clinical importance of pulse wave velocity
- How to measure and interpret pulse wave velocity
- Considerations for internal- and external-validity
- Considerations for the measurement of pulse wave velocity of various study designs and populations
Pulse Wave Velocity: Theory, Applications, Methods, and Future DirectionsInsideScientific
Lee Stoner, PhD and Gabriel Zieff, MA present a complete, in-depth overview of their research involving Pulse Wave Velocity (PWV) in a variety of different applications and a deep dive into the methods they use to record high-quality, repeatable data.
Arguably, the “gold-standard” method for noninvasive assessment of cardiovascular disease risk is pulse wave velocity. The PWV is widely used in both epidemiological and physiological studies to assess arterial stiffness, a construct dependent on the functional and structural characteristics of a vessel. PWV is calculated by measuring the transit time of the arterial waveform between two points of a measured distance. The most widely studied path is between the carotid and femoral arteries, which represents the aorto-illiac pathway. Traditionally, these measurements are made using tonometers, which are highly sensitive pressure transducers. However, alternative approaches to tonometry are available, and pathways other than the aorta can be measured. These alternative approaches may be better suited for use with certain populations or study designs. The focus of the presentation is to assist the audience in identifying the correct research tool for their particular research paradigm. Specifically, these experts outline the theoretical principles underlying PWV, as well as the importance of this measure to both epidemiological and physiological studies. Subsequently, they highlight some of the different approaches for measuring PWV, including technical considerations. This is followed by discussion pertaining to the identification of the appropriate PWV measure for the specific study design and populations of interest. This includes consideration of internal and external validity. They end the session by providing some tips to facilitate high-quality PWV assessments.
Key Topics Include:
- Meaning and clinical importance of pulse wave velocity
- How to measure and interpret pulse wave velocity
- Considerations for internal- and external-validity
- Considerations for the measurement of pulse wave velocity of various study designs and populations
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
differentiating between supraventicular tachycardia and ventricular tachycardia in wide complex rhythm is always confusing and management is totally different. correct diagnosis will make dramatic difference in patient management.
About Shearwave Elastography of Liver. The presentation was done at IRIA Kerala Midterm 2018 at Kochi. Divided into 4 parts : Physics , Pathology ,How to do , Cases
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
differentiating between supraventicular tachycardia and ventricular tachycardia in wide complex rhythm is always confusing and management is totally different. correct diagnosis will make dramatic difference in patient management.
About Shearwave Elastography of Liver. The presentation was done at IRIA Kerala Midterm 2018 at Kochi. Divided into 4 parts : Physics , Pathology ,How to do , Cases
MRCPsych08 - How To Analyse Diagnostic Test Studies (June08)Alex J Mitchell
This is an educational talk/presentation on the science of diagnostic tests using examples from psychiatry. It was first presented for MRCPsych (Royal College of Psychiatrists UK) June 2008. Now updated in 2009...see newer version
Carriers have historically been backwards-focused and have tended to maintain established processes without question. They also have the propensity to be risk-averse. These characteristics need to change. Carriers must be willing to try new things without betting the ranch or subjecting the company to undue risk.
MedicalResearch.com: Exclusive Interviews with Medical Research and Health Care Researchers from Major and Specialty Medical Research Journals and Meetings
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
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The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Critical appraisal of diagnostic article
1. CRITICAL APPRAISAL OF ARTICLES
ABOUT DIAGNOSTIC TEST
Dr. Faisal Al Haddad
Consultant of Family Medicine & Occupational Health
Incharge of Occupational Health Unit
PSMMC
5. Was there an independent, blind. 1
?comparison with a reference standard
Is
reference standard used acceptable?
Were
the investigators interpreting a test
blinded to the results of the other test?
6. Did the patient sample include an appropriate. 2
spectrum of patients to whom the diagnostic
?test will be applied in clinical practice
Representative
of the patients in whom the test is to
be used.
Varying
Varying
Varying
presentations of the target disorder
severity of the target disorder
stage of the target disorder
7. 3. Did the results of the test being evaluated
influence the decision to perform the
reference standard?
Was
the gold standard applied to subjects in
whom the study investigation was negative?
Were
both reference standard and test under
investigation applied to all patients?
8. Were the methods for performing .4
the test described in sufficient detail
?to permit replication
Preparation
of patient?
Performance
Analysis
of test?
and interpretation of results?
10. What is Likelihood Ratio
NLR: Ratio of the probability of a false negative result if the disease is present
to a true negative result if the disease is absent. FN/TN
The extent to which a negative test decreases the likelihood that a patient has disease
The less the NLR, the less the likelihood that a patient with negative test has disease
e.g. CT scan with NLR of 0.05
-ve CT scan indicates that the pat is free from PE
PLR: Ratio of the probability of a true positive result if the disease is present to
a false positive result if the disease is absent. TP/FP
The extent to which a positive test increases the likelihood that a patient has disease.
The more the PLR, the more the likelihood that a patient with positive test has disease
e.g. CT scan with PLR of 20
+ve CT scan indicates that the pat has PE
11.
12. III Will the results help me in
?caring for my patients
13. 1. Will the reproducibility of the test result
and its interpretation be satisfactory in my
clinical setting?
14. Are the results applicable to the. 2
?patient in my practice
Similar
distribution of disease severity?
Similar
distribution of competing diseases?
Does
the patient meet the study inclusion criteria?
Does
the patient violate any of exclusion criteria?
15. Will the results change my management. 3
?strategy
Are the test LRs high or low enough to shift post-test
probability across a test or treatment threshold?
16. Pulmonary embolism management:
Treatment threshold 80%
Test threshold 10%
VQ scan properties:
PLR 20
NLR 0.36
78-year-old woman chest pain and shortness of breath 10
days after surgery
Pretest probability of pulmonary embolism 70%.
Posttest probability with abnormal VQ scan result 97%
Posttest probability with normal VQ scan result 19%
28-year-old man chest pain and shortness of breath
experiencing a high level of anxiety.
Pretest probability of pulmonary embolism 20%
Posttest probability with abnormal scan result is 85%
Posttest probability with normal VQ scan result is 2%
17.
18. Will patients be better off as a. 4
?result of the test
Is
target disorder dangerous if left undiagnosed?
Is
test risk acceptable?
Does
effective treatment exist?