A previous study developed a clinical prediction rule to distinguish between septic arthritis (SA) and transient synovitis (TS) in children presenting with acute hip pain. This study prospectively validated the rule in a new patient population. The study found that the same four predictors from the original study - history of fever, inability to bear weight, elevated ESR, and elevated WBC - were independently associated with SA. The diagnostic performance of the rule was similar between studies, accurately predicting SA 72.8-93% of the time depending on the number of predictors present. This validation confirms the clinical prediction rule is useful for differentiating between SA and TS in children with acute hip pain.
Common disorder with an annual incidence of 0.1% to 0.5%.
The peak age at onset is 20 to 30 years
Men > Women ( until 50s )
Wide geographic variations exist, due to differences in diet and water composition, as well as ambient and sunlight exposure. 5-9% in Europe 20% in Saudi Arabia
Common disorder with an annual incidence of 0.1% to 0.5%.
The peak age at onset is 20 to 30 years
Men > Women ( until 50s )
Wide geographic variations exist, due to differences in diet and water composition, as well as ambient and sunlight exposure. 5-9% in Europe 20% in Saudi Arabia
Inflammatory arthritis; a quick run through.Ronan Kavanagh
A short presentation aimed at primary care docs walking them through the mechanism and pitfalls in diagnosing inflammatory arthritis. Part of the Rheumatology Toolbox workshop. Stats for an irish population.
Inflammatory arthritis; a quick run through.Ronan Kavanagh
A short presentation aimed at primary care docs walking them through the mechanism and pitfalls in diagnosing inflammatory arthritis. Part of the Rheumatology Toolbox workshop. Stats for an irish population.
Common forms of plague
Bubonic plague is the most common form of plague. It usually occurs after the bite of an infected flea. The key feature of bubonic plague is a swollen, painful lymph node, usually in the groin, armpit or neck. Other symptoms include fever, chills, headache, and extreme exhaustion. A person usually becomes ill with bubonic plague 1 to 6 days after being infected. If not treated early, the bacteria can spread to other parts of the body and cause septicemic or pneumonic plague.
Challenging clinical trials: Why doesn't early goal-directed therapy work? De...scanFOAM
A talk by Derek Angus at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Pathology Optimisation in Chronic Blood Disease MonitoringAndrew O'Hara
Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study
Urology Journal Club
The lecture explains the steps of thinking while applying the principles of evidence based medicine on radiology.An example from real life is given and how to apply this type of thinking in order to achieve the best results.
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
in this slide you will learn about
what is screening
types and uses of screening
difference between screening and diagnostic tests
criteria of screening
and
evaluation of screening tests
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.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Case Presentation
• A previously healthy 4 year old male
presents to the ED with a limp. He has been
reluctant to bear weight on his left leg during
the last 24h and has a temperature of 38.0°C.
• Hip exam: shows decreased ROM due to pain.
• ROS: 2 day hx of rhinorrhea and cough,
resolved 10 days ago.
3. Review of Septic Arthritis
• Septic arthritis (SA)
• The synovium is extremely vascular and contains
no basement membrane, allowing easy access for
bacteria to the synovial space.
• Either by hematogenous spread or direct invasion by
local soft tissue infection, and or penetrating trauma.
4. Review of Septic Arthritis
• Within 24-48 hrs of bacterial invasion:
• Infiltration by neutrophils
• Vascular congestion
• Synovial proliferation
• Within 1 week following bacterial invasion:
• Continual purulent effusion
• Continual synovial proliferation
• Infiltration by mononuclear cells
• Granulation tissue
• Abscess development
• Within 10 days after abscess formation:
• Cytokine induced protelytic enzymes are released
• End result is joint destruction and or systemic sepsis
5. Review of Transient Synovitis
• Transient Synovitis (TS)
• Arthritis secondary to a transient inflammation and
hypertrophy of the synovial membrane.
• Leads to slight effusion that causes bulging of the
anterior joint capsule.
• No definitive cause of TS is known
• Posttraumatic or allergic mechanisms
• Infectious etiology
• Antibody titers
6. Clinical Question
• In children presenting with acute hip pain, is
there a clinical tool or diagnostic test that will
distinguish between septic arthritis and
transient synovitis?
7. PICO
• Patient Population:
• Children with acute hip pain.
• Intervention:
• Clinical feature(s) and or diagnostic test(s) that can
confirm the diagnosis of SA vs TS.
• Comparison:
• The gold standard of joint aspiration.
• Outcome:
• Preventing an invasive procedure with a percentage of
certainty without missing an emergent diagnosis.
10. Validation Study
• The original study published by Kocher, et al. 1999,
described a clinical prediction rule based on four
independent multivariate predictors of SA of the hip:
• A hx of fever
• Non weight bearing
• ESR of 40mm/hr
• WBC >12,000
• The CPR was derived from the data of 82 pts with SA and
86 pts with TS evaluated between 1979-1996. Results
showed statistical significance with a p value of <0.0001 with
an ROC curve of 0.96.
11. Validation Study
• Objective: To evaluate the diagnostic
performance of the previously described
CPR for the differentiation between SA and
TS of the hip in children in a new pt
population.
12. Material and Methods
• Prospective study
• Patient Population
• All patients who presented to a major tertiary care children’s
hospital between 1997-2002 with an acutely irritable hip and a
differential diagnosis of TS or SA.
• 213 eligible consecutive patients
• 24: SA
• 27: Presumed SA
• 103: TS
• 59: Excluded- such as those with immunocompromise, renal
failure, neonatal sepsis, postoperative infection of the hip, later
development of rheumatologic disease, Calve-Perthes disease and
or due to osteomyelitis.
13. Materials and Methods
• True septic arthritis defined:
• Positive culture of joint fluid or
• WBC ≥50,000 in the joint fluid with a positive blood culture.
• Presumed septic arthritis defined:
• WBC ≥50,000 in the joint fluid with negative cultures of the joint
aspirate and blood.
• Transient synovitis defined:
• WBC <50,000 in the joint fluid.
• Negative culture and resolution of symptoms without antimicrobial
therapy and no further development of a disease process as
documented in the medical record.
14. Material and Methods
• Data obtained from all patients:
• Age, gender, date of presentation, duration of sx, hx of fever, hx
of recent infx, hx of recent abx, temp, ESR, WBC, evidence of
hip joint effusion on X-ray, results of gram stain, cell count,
differential, and cx of joint fluid.
• Fever:
• PO temp 38.5°C during wk before presentation.
• Weight bearing status:
• Based on clinical hx and was considered the inability or refusal to
bear weight even with support.
• Effusion:
• As side to side distance of > 2mm from the medial part of the
femoral head to the medial part of acetabulum on anteroposterior
pelvic radiograph.
15. Material and Methods
• Analysis of data
• Univariate analysis by Student T- test.
• Predictors with p<0.20 in univariate analysis were
entered into multivariate logistic regression using
backward selection to identify independent clinical
predictors of SA and TS groups.
• Receiver operating characteristic curve was than
constructed to assess the diagnostic performance of the
group of multivariate predictors in identifying SA.
16. Results of Multivariate Analysis
• Showed the same four independent multivariate
predictors of SA in the current population as they
had in the original population.
17. Results of Algorithm for
Probability of SA
PREDICTORS ORIGINAL
STUDY
NEW STUDY
Zero < 0.2% 2.0%
One 3.0% 9.5%
Two 40.0% 35.0%
Three 93.1% 72.8%
Four 99.6% 93.0%
20. Study Limitations
• CRP not included in new study.
• Authors admitted CRP shows greater benefit than ESR
for detecting SA in children. However, at the beginning
of the study CRP testing was limited at the hospital as the
study progressed it became routine testing. Therefore,
to avoid biases associated with incomplete data analysis
CRP was not incorporated into the CPR.
• Not an external validation.
21. Study Limitations
• Diagnostic cut off <50,000 WBC in joint fluid was
considered TS and >50,000 considered SA or
presumed SA. Other sources state 60,000 or
greater.
• When comparing SA to TS in multivariate analysis,
the study does not specify if its true SA and
presumed SA or just true SA.
• Variables might be different in a community based
population vs this tertiary care hospital’s
population.
22. Are the results of this diagnostic study
valid?
1. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?
• yes
1. Was the diagnostic test evaluated in an appropriate
spectrum of patients (like those in whom it would be used
in practice)?
• yes
1. Was the reference standard applied regardless of the
diagnostic test result?
• maybe
1. Was the test (or cluster of tests) validated in a second,
independent group of patients?
• yes
23. Are the valid results of this
diagnostic study important?
• Yes
24. Can we apply this valid, important evidence
about a diagnostic test in caring for our
patient?
1. Is the diagnostic test available, affordable, accurate, and
precise in our setting?
• yes
1. Can we generate a clinically sensible estimate of our
patients pre-test probability (from personal experience,
prevalence statistics, practice databases or primary
studies?
• yes
A. Are the study patients similar to our own?
• yes
A. Is it unlikely that the disease possibilities or
probabilities have changed since this evidence was
gathered?
• yes
25. Caring for our patient cont.
3. Will the resulting post test probabilities affect our
management and help our patient?
• yes
A.Could it move us across a test-treatment
threshold?
• yes
A.Would our patient be a willing partner in
carrying it out?
• yes
26. Conclusions
• In my patient’s case:
• My patient had 3 of the predictors (fever, elevated WBC
count, and inability to bear weight, CRP was not
elevated. I chose not to aspirate and dx him with TS.
• How would I make a better study?
• CRP
• External validation
• Strictly SA versus TS
27. Resources
Kocher MS., Zurakowski D., Differentiating between septic arthritis and
transient synovitis of the hip in children: an evidence based clinical
prediction algorithm. J Bone Joint Surg Am. 1999; 81: 1662-70.
Raheem B., Shojani, et al. Case-based review : Septic arthritis in patients
with pre-existing inflammatory arthritis. Canadian Medical Association
Journal. May 22, 2007; 176 (11).
Electronic based medical databases. E-medicine and UpToDate.
And…. Harriet :)
Leads to damage to the joint cartilage and increase in pressure within the joint, impairing bloody supply and leading to avascular necrosis of the femoral head, dislocation or osteomyelitis.
32-50% of pts have had a recent URI
About 50% have had elevated titers to M. pneumoniae or a range of viruses (sometimes more than one), including parvovirus B19
UTD and emedicine
Narrowed down to 5 that specifically discussed the clinical prediction rule developed by Kocher. Two of the studies were prospective studies while the other two had small patient populations. The one chosen was a prospective study that was a validation study by Kocher, the original author of the CPR.
ROC= receiver operating characteristic curve.
Mean duration of follow up was 11.8 months (5.9 to 23.7 months).
The predicted probability of septic arthritis of the hip from the prediction rule was similar to the actual distributions in the new patient population. The area under the ROC curve for the new population was 0.86 compared with 0.96 in the original population. Both close to 1 and indicating still very good diagnostic performance.
These are the data values for the original population and the new population to form the ROC curve.