Tag: Examenes complementarios

Colonoscopy: Principles and Practice


Colonoscopy: Principles and Practice

Colonoscopy: Principles and Practice
By Jerome D. Waye, Douglas K. Rex, Christopher B. Williams
Publisher: Wiley-Blackwell
Number Of Pages: 672
Publication Date: 1991-01-15
ISBN-10 / ASIN: 1405114495
ISBN-13 / EAN: 9781405114493
Binding: Hardcover
Endoscopy is a medical specialism that is actively recruiting new entrants. There is considerable demand for colonoscopists in the USA and the UK to meet the respective guidelines for colorectal cancer screening in the general population. In the USA, it is recommended that men and women aged 50 years and older get screened for colorectal cancer as many studies have shown that screening reduces mortality from cancer. Colorectal cancer is the second leading cause of death in the US: the American Cancer Society estimates that 148,300 new cases will be diagnosed in 2002.

Colonoscopy is now a mainstream procedure and is widely used as a screening and treatment tool for colorectal cancer and inflammatory bowel disease. As a result, the focus is now changing from developing new techniques to enhancing the efficiency and quality of fundamental techniques. There are three elements to this agenda: initial training, continuous quality improvement and patient empowerment.

The table of contents has been created with these three elements at the fore. It is an extremely comprehensive textbook aimed primarily at the experienced colonoscopist but the book will be an extremely useful manual of procedures – clinical, administrative and managerial – for everyone working in the Endoscopy Unit.

these three elements at the fore. It is an extremely comprehensive textbook aimed primarily at the experienced colonoscopist but the book will be an extremely useful manual of procedures – clinical, administrative and managerial – for everyone working in the Endoscopy Unit.

Biomarkers of Disease: An Evidence-Based Approach


Biomarkers of Disease: An Evidence-Based Approach

Biomarkers of Disease: An Evidence-Based Approach
By Andrew K. Trull, Lawrence M. Demers, David W. Holt, Atholl Johnston, J. Michael Tredger, Christopher P. Price

Publisher: Cambridge University Press
Number Of Pages: 516
Publication Date: 2002-06-15
ISBN-10 / ASIN: 0521811023
ISBN-13 / EAN: 9780521811026
Binding: Hardcover

This new publication takes a critical, evidence-based look at the efficacy of new diagnostic tests which are increasingly being used to evaluate organ damage and dysfunction. The use of biomarkers is growing, with a steady stream of new products being brought out by the pharmaceutical industry. However, in many cases the evidence which supports the use of these new methods as opposed to traditional biochemical tests has not yet been demonstrated, and it is intended that this volume will help clarify the strengths and weaknesses of using these biomarkers across a wide range of applications and in the various organs of the body. This approach will provide an invaluable overview of the diverse applications of biomarkers in medicine.

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UK experts call for national system to evaluate diagnostic tests


UK experts call for national system to evaluate diagnostic tests

Susan Mayor

1 London

the first 150 words of the full text of this article appear below.

A national system should be introduced to evaluate diagnostic tests for use by the NHS, a report published this week recommends. It warns that currently no process is available for deciding which of the rapidly growing number of new tests should be used.

Such an evaluation system should extend to tests and scans aimed at people who are well, making information available to the public to warn them that many of these tests are not useful and can be harmful, according to a second report.

The first report, The Evaluation of Diagnostic Laboratory Tests and Complex Biomarkers, notes that about one billion laboratory tests are performed each year in the United Kingdom. “NHS laboratories have sophisticated systems to ensure the analytical accuracy of the tests, yet no system is in place to ensure the clinical effectiveness and utility of individual tests,” warned Peter Furness, consultant histopathologist at the University . . . [Full text of this article]

Rapid Responses:

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Plain Films
Stephen LITTLEFAIR
bmj.com, 14 Mar 2008 [Full text]

Paracentesis


Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results? Camilla L. Wong, MD, FRCPC; Jayna Holroyd-Leduc, MD, FRCPC; Kevin E. Thorpe, MMath; Sharon E. Straus, MD, MSc, FRCPC
JAMA. 2008;299(10):1166-1178.

Context Abdominal paracenteses are performed in patients with ascites, most commonly to assess for infection or portal hypertension and to manage refractory ascites.

Objectives To systematically review evidence for paracentesis methods that may decrease risk of adverse events or improve diagnostic yield and to determine the accuracy of ascitic fluid analysis for spontaneous bacterial peritonitis or portal hypertension.

Data Sources Relevant English-language studies from MEDLINE (1966-April 2007) and EMBASE (1980-April 2007).

Study Selection Paracentesis studies evaluating interventions (use of preprocedure coagulation parameters, needle type, insertion location, ultrasound guidance, bedside inoculation into blood culture bottles, and use of plasma expanders in therapeutic taps) for reducing adverse events or improving the diagnostic yield, and studies assessing the accuracy of ascitic fluid biochemical analyses for spontaneous bacterial peritonitis or portal hypertension.

Data Extraction For technique studies, data on intervention and outcome; and for diagnostic studies, data on parameters for diagnosing spontaneous bacterial peritonitis and portal hypertension (ie, ascitic fluid white blood cell and polymorphonuclear leukocyte [PMN] count, ascitic fluid pH, blood–ascitic fluid pH gradient, and serum-ascites albumin gradient).

Data Synthesis Thirty-seven studies met inclusion criteria: 2 showed that obtaining preprocedure coagulation was likely unnecessary prior to paracentesis; 1 showed the 15-gauge, 3.25-inch needle-cannula results in less multiple peritoneal punctures [P = .05] and termination due to poor fluid return [P = .02] vs a 14-gauge needle in therapeutic paracentesis; 1 showed immediate inoculation of culture bottles improves diagnostic yield vs delayed (from 77% to 100% [95% CI for the difference, 5.3%-40.0%]); 9 evaluated therapeutic paracentesis, performed with or without albumin or nonalbumin plasma expanders, and found no consistent effect on morbidity or mortality; 16 showed the accuracy of biochemical analysis of ascitic fluid in patients suspected of having spontaneous bacterial peritonitis to increase the likelihood of spontaneous bacterial peritonitis (PMN count >250 cells/µL [summary likelihood ratio {LR}, 6.4] 95% CI, 4.6-8.8; ascitic fluid leukocyte count >1000 cells/µL [summary LR, 9.1] 95% CI, 5.5-15.1; pH < 7.35 [summary LR, 9.0] 95% CI, 2.0-40.6; or a blood–ascitic fluid pH gradient ≥ 0.10 [LR, 11.3] 95% CI, 4.3-29.9) and other levels lowered the likelihood (PMN count ≤ 250 cells/µL [summary LR, 0.2] 95% CI, 0.11-0.37; or a blood–ascitic fluid pH gradient < 0.10 [summary LR, 0.12] 95% CI, 0.02-0.77); and 4 showed the diagnostic accuracy of the serum-ascites albumin gradient lowers the likelihood of portal hypertension (< 1.1 g/dL [summary LR, 0.06] 95% CI, 0.02-0.20).

Conclusions Ascitic fluid should be inoculated into blood culture bottles at the bedside. Spontaneous bacterial peritonitis is more likely at predescribed parameters of ascitic PMN count or blood–ascitic fluid pH, and portal hypertension is less likely below a predescribed serum-ascites albumin gradient.

Author Affiliations: Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada (Dr Wong); Knowledge Translation Program, Faculty of Medicine, University of Toronto and St Michael’s Hospital, Toronto, Ontario, Canada (Dr Holroyd-Leduc, Mr Thorpe, and Dr Straus); Department of Public Health Sciences, University of Toronto (Mr Thorpe); and Divisions of General Internal Medicine and Geriatrics, University of Calgary, Calgary, Alberta, Canada (Drs Holroyd-Leduc and Straus).

RELATED ARTICLES

This Week in JAMA
JAMA. 2008;299(10):1105.
FULL TEXT

Abdominal Paracentesis
John L. Zeller, Alison E. Burke, and Richard M. Glass
JAMA. 2008;299(10):1216.
EXTRACT | FULL TEXT

McGraw-Hill Manual of Laboratory


Product Details
»Book Publisher: McGraw-Hill Professional (08 October, 2007)
»ISBN: 0071481524
»Book author: Denise D. Wilson
»Amazon Rating: 5.0

Book Description:

Critical testing information and key clinical protocols in the palm of your hand

McGraw-Hill’s Manual of Laboratory & Diagnostic Tests focuses specifically on what you need to know to understand the test, educate the patient, and provide safe, effective care before, during, and after the test. In addition, this easy-to-use clinical companion is the only text to actively incorporate evidence-based practice features throughout, both in test monographs and appendices-a major advantage that enhances your ability to apply the book’s content to your daily practice.

Features:

A cohesive 5-part organization covering the full range of laboratory tests, diagnostic tests, laboratory/diagnostic assessments of body function, education, and screening
Time-saving alphabetical organization of tests with handy thumb tabs
Full-color icons that highlight the organization of each test, and clearly identify important features throughout
Skill-sharpening references to national guidelines, including JCAHO
Full coverage of clinical interventions/implications
Essential insights into the possible meanings of abnormal values and contraindications
Key references that pertain to evidence-based practice
Timely appendix on the increasing use of evidence-based practice
Critical patient teaching information

Gracias Rochy 🙂