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Chapter 2 is concerned with research questions. We discuss the different processes through which research questions can be identified and developed in corpus-based research on health communication. Three case studies are considered. The first study involved the analysis of press representations of obesity. In this study, the researchers developed their own research questions in a variety of ways, including by drawing from the non-linguistic literature on obesity. The second study focused on the McGill Pain Questionnaire – a well-known language-based diagnostic tool for pain. A pain consultant asked the researchers if they could help understand why some patients find it difficult to respond to some sections of the questionnaire. In response, the researchers formulated a series of questions that could be answered using corpus linguistic tools, and identified some issues with the questionnaire that address the pain consultant’s concerns. The third study involved the analysis of patient feedback on the UK’s National Health Service. The researchers were approached by the NHS Feedback Team and given 12 questions that they were commissioned to answer by means of corpus linguistic methods.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 42 covers the topic of rapid eye movement sleep (REM) sleep behaviour disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the management of patients with the above disorder from first presentation to subsequent complications of the condition and its treatment. Topics covered include diagnosis, differential diagnoses, restless leg syndrome, stages of sleep.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 40 covers the topic of breathing-related sleep disorders. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis of a patient with breathing-related sleep disorders. Topics covered include diagnosis, differential diagnoses, obstructive sleep apnoea, central sleep apnoea.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 17 covers the topic of pica and rumination disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis and treatment of a patient with pica and rumination disorder. topics covered inlcude diagnosis and co-morbidities of pica and the diagnosis of rumination disorder.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 12 covers the topic of body dysmorphic disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis and treatment of a patient with body dysmorphic disorder. topics covered inlcude diagnosis, differential diagnoses, co-morbidities, risk assesment and management.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 39 covers the topic of narcolepsy disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through from first presentation to treatment of narcolepsy disorder. Topics covered include diagnosis, assessment of severity and management.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 41 covers the topic of non-rapid eye movement sleep (NREM) behaviour disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis of a patient with a NREM sleep behaviour disorder (sleep terrors). Topics covered include diagnosis, sleepwalking and sexsomnia.
Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 38 covers the topic of insomnia disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through from first presentation to treatment of insomnia disorder. Topics covered include diagnosis, differential diagnoses, sleep hygiene advice, non-pharmacological treatment and pharmacological treatment.
Asylum seekers face significant mental health challenges but underutilise mental health services and are at increased risk of misdiagnosis. The Cultural Formulation Interview (CFI) could be helpful by introducing individuals’ culture and context to psychiatric evaluation. However, its impact on the diagnostic process for asylum seekers remains underexplored.
Aims
This study aims to evaluate the added value of the CFI in the psychiatric diagnostic assessment of asylum seekers.
Method
A mixed-methods design was applied. Diagnostic shifts from the CFI were quantitatively described in 63 participating asylum seekers. The CFI’s value was explored using qualitative content analysis.
Results
In about a third of cases, diagnoses were either confirmed (34.9%), changed (25.4%) or narrowed (33.3%), with notable shifts from depressive and psychotic disorders to either trauma- and stressor-related disorders or no psychopathology. Qualitative analysis revealed that the CFI enhanced understanding of participants’ experiences, including the impact of trauma, migration and social context. It provided insights into their strengths and therapeutic needs. The shift towards stress-related diagnoses and away from other common DSM categories reflects the CFI’s ability to provide a more nuanced, contextual understanding of asylum seekers’ mental health.
Conclusion
This study underscored the CFI as a valuable tool in asylum seekers’ diagnostic assessment. The CFI facilitated a shift towards a more holistic, recovery-oriented approach. It prompted conceptual reflections on psychopathology in asylum seekers. The CFI presents a promising yet underutilised tool for addressing diagnostic challenges in cross-cultural settings. The findings highlight its potential for broader clinical implementation.
Human babesiosis is a disease transmitted by the bite of an infected tick or via blood transfusions involving contaminated blood products; in humans, it can lead to severe complications and even death, depending on the clinical history, age and health status of the affected patient. Babesiosis is caused by members of the Babesia spp., protozoan parasites whose life cycle includes sexual reproduction in the arthropod vector and asexual reproduction in the mainly mammalian host. Cases of human babesiosis have been rare, but there are increasing reports of human babesiosis associated with climatic changes affecting the geographical distribution of the parasite and tick vector, enhanced vector–human interactions and improved awareness of the disease in humans. Diagnostics and treatment options for humans are based around discoveries in veterinary research, such as point-of-care testing in cases of bovine babesiosis, and include direct diagnosis by blood smears, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) technologies, and indirect diagnosis by ELISA, immunofluorescence tests (IFAT) and fluorescent in situ hybridisation. Treatment involves a combination of drugs such as azithromycin and atovaquone, or clindamycin and quinine, but more effective options are being investigated, including, but not limited to, trans-chalcones and tafenoquine. Improved surveillance, awareness and diagnosis, as well as advanced technologies to interrupt vector–host interactions, are crucial in managing the increased threat posed by this once-neglected disease in humans.
Objectives: Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop- Mediated Isothermal Amplification (LAMP) method is faster and easier to perform compared to polymerase chain reaction (PCR)-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance. Methods: We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method limit of detection (LOD) and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The LOD of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI. Results: The LOD of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the LOD of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation. Conclusions: This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.
Dengue is an arboviral infection that poses a substantial public health concern, with early diagnosis being a critical factor in effective management. However, limited diagnostic expertise in developing countries contributes to the under-reporting of dengue cases. This review compares the accuracy of rapid diagnostic tests (RDTs) and the tourniquet test (TT) in diagnosing dengue fever (DF) in non-laboratory-based settings. Relevant original articles on the use of RDTs and TT for dengue diagnosis were retrieved from PubMed, Scopus, and ScienceDirect. The STARD and QUADAS-2 tools were employed to evaluate the methodological quality of the included studies. Search terms included combinations of ‘fever’, ‘dengue’, and ‘“diagnosis’. In total, 23 articles were eligible for inclusion. The RDTs demonstrated mean sensitivities and specificities of 76.2% (SD = 13.8) and 91.5% (SD = 10.3), respectively, while the TT showed mean sensitivity and specificity values of 48.6% (SD = 24.9) and 79.5% (SD = 14.9), respectively. Overall, RDTs exhibited superior diagnostic performance compared to the TT. Our findings suggest that the TT is an inadequate stand-alone diagnostic tool for dengue. RDTs should be prioritized for dengue diagnosis in resource-limited settings. However, in situations where RDTs are unavailable, the TT may serve as a supplementary option.
The objective was to identify the predictive markers and develop a diagnostic model with predictive markers for Parkinson’s disease (PD) and investigate the roles of immune cells in the disease pathology. Microarray datasets of PD and control samples were obtained from the Gene Expression Omnibus (GEO) database. We then performed a comprehensive analysis of differentially expressed genes (DEGs), functional enrichment, and protein-protein interactions to pinpoint a set of promising candidate genes. To establish a diagnosis model for PD, we utilized machine learning algorithms and evaluated the corresponding diagnostic performance using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Additionally, the differential abundance of immune cell subsets between PD and control samples was evaluated using the single-sample Gene Set Enrichment Analysis (ssGSEA) method. A total of 264 DEGs were identified in GSE72267. The PPI network ultimately identified 30 hub genes for model construction. Seven genes, namely CD79B, CD40, CCR9, ADRA2A, SIGLEC1, FLT3LG, and THBD, were identified as diagnostic markers for PD, with an AUC of 0.870. This seven-gene signature model was subsequently validated in an independent cohort (GSE22491), demonstrating an AUC of 0.825. Ultimately, the infiltration of 28 immune cells showed that activated B cells, natural killer T cells, and regulatory T cells may contribute to the occurrence and progression of PD. We also found complex associations between these genes and immune cells. CD79B, CD40, CCR9, ADRA2A, SIGLEC1, FLT3LG, and THBD were identified as diagnostic markers for PD, and the infiltration of immune cells may contribute to the pathogenesis of the disease.
Dementia has certain features relevant to values-based medicine. It is a progressive condition, so that a person’s choices and preferences may change over time, and they may require increasing input from others over time. Furthermore, our perceptions of diseases like Alzheimer’s, which cause dementia, are changing over time, along with the philosophy of care. Although memory impairment is the commonest presenting feature of dementia, it is by no means the only issue that arises during the course of the condition. This chapter examines four broad themes in the dementia pathway: early dementia; changes in behaviour; legal and ethical issues; and advanced dementia and care. Vignettes are used to discuss some of the typical issues that arise in clinical situations and how these can be addressed through the application of both evidence- and values-based practice.
Biomarkers alone cannot resolve psychiatry’s diagnostic challenges, particularly the boundary between normal variation and pathology. Diagnosis should prioritise the subjective, phenomenological experiences of patients rather than solely relying on biological evidence, emphasising a framework centred on suffering, debilitation and societal impact.
The ‘overview effect’ was described by astronauts who saw the earth from space and found this gave them a very different perspective. This effect is a shift in worldview, and it has been suggested that politicians be sent to space to change their narrow perspectives. In a similar vein, it is crucial that psychiatrists have an overview of their patients so that their perspectives on patient care enable them to deal with the patient from different angles. In this editorial, the overview effect is described in the context of clinical care.
Female genital schistosomiasis (FGS) is a chronic disease manifestation of the waterborne parasitic infection Schistosoma haematobium that affects up to 56 million women and girls, predominantly in sub-Saharan Africa. Starting from early childhood, this stigmatizing gynaecological condition is caused by the presence of Schistosoma eggs and associated toxins within the genital tract. Schistosoma haematobium typically causes debilitating urogenital symptoms, mostly as a consequence of inflammation, which includes bleeding, discharge and lower abdominal pelvic pain. Chronic complications of FGS include adverse sexual and reproductive health and rights outcomes such as infertility, ectopic pregnancy and miscarriage. FGS is associated with prevalent human immunodeficiency virus and may increase the susceptibility of women to high-risk human papillomavirus infection. Across SSA, and even in clinics outside endemic areas, the lack of awareness and available resources among both healthcare professionals and the public means FGS is underreported, misdiagnosed and inadequately treated. Several studies have highlighted research needs and priorities in FGS, including better training, accessible and accurate diagnostic tools, and treatment guidelines. On 6 September, 2024, LifeArc, the Global Schistosomiasis Alliance and partners from the BILGENSA Research Network (Genital Bilharzia in Southern Africa) convened a consultative, collaborative and translational workshop: ‘Female Genital Schistosomiasis: Translational Challenges and Opportunities’. Its ambition was to identify practical solutions that could address these research needs and drive appropriate actions towards progress in tackling FGS. Here, we present the outcomes of that workshop – a series of discrete translational actions to better galvanize the community and research funders.
Non-coding RNAs (ncRNAs) are transcribed RNA molecules that do not encode proteins but regulate diverse biological processes. Dysregulation of ncRNAs is implicated in cancer, where chemical modifications such as N6-methyladenosine (m6A), N4-acetylcytidine (ac4C), and glycosylation critically influence their function. However, these modifications, as precise regulators of ncRNA activity, have been less well-documented and understood in tumorigenesis and cancer progression.
Methods
This article systematically analyzes the roles of chemically modified ncRNAs – ribosomal RNA (rRNA), circular RNA (circRNA) and others – in cancer biology, synthesizingevidence from published studies on their mechanistic involvement in malignancy.
Results
We reveal how specific chemical modifications drive oncogenesis, impact cancer diagnosis, and affect therapeutic responses, while also exploring their prognostic potential. Furthermore, we highlight emerging connections between ncRNA epitranscriptomics and cancer.
Conclusions
This review provides novel insights into ncRNA epitranscriptomics as emerging biomarkers and intervention targets for precision oncology.